"I was fascinated by this," says Kraus. "It almost fell into the area of folk medicine, yet it made a lot of sense, and I resolved to try it as soon as I could." A short time later, two skiers were admitted to the hospital, each with a badly sprained ankle. Kraus told them about the Kowalski treatment, and they insisted he experiment with it on them. The result was amazing: "In only three days they had full range of their ankles and they were back skiing soon."
But the application of alcohol compresses-cum-clouds of steam was cumbersome, and Kraus began to experiment with other, more efficient, chemicals—mixtures of ether and acetone with alcohol, for example—to produce numbness. At last he hit upon ethyl chloride, which had long been used by physicians as a local skin anesthetic to reduce pain when lancing boils and making small incisions. The numbness is produced by freezing the skin: indeed, the use of too much ethyl chloride results in frostbite.
The first patient Kraus treated was a veterinarian with two canes who came limping in on an excruciatingly painful sprained ankle. Kraus sprayed ethyl chloride on the ankle, then had the vet move it. The pain ebbed. Kraus sprayed the ankle again, then had his patient exercise further until he said he felt reasonably comfortable. The veterinarian returned three times in the next week for treatment, and declared that his ankle felt fine. Kraus released him. telling him to come back in a month for a checkup. When the vet returned, the ankle was in perfect shape and the man was beaming. "You've got a good thing," he told Kraus. "You know, I've started using it on horses and dogs. I shave the sprained leg and spray it with ethyl chloride. It works exceptionally well: almost all the animals run off after the treatment."
Kraus immediately began treating other patients with ethyl chloride. "I tried it on everything from appendicitis to concussion," he says with a chuckle. In 1932, he gave a paper on the use of ethyl chloride spray before the Academy of Physicians in Vienna. "I was just a young kid," he recalls. "They could have laughed me out of town, but they were very understanding." A correspondent for the American Medical Association heard the presentation, and an abstract of Kraus' paper was later printed in the AMA's Journal. And Kraus was assigned to teach on the use of ethyl chloride and early exercise in injury treatment at the Vienna Medical School.
Eventually, Kraus coined the acronym MECE to describe his treatment, in contrast to the more commonly used technique he calls RICE. "I can't name a dozen doctors using my treatment," he says. "Most people will use the RICE treatment, which stands for 'rest, ice, compression and elevation.' MECE stands for 'movement, ethyl chloride and elevation.' "
There are, of course, limitations to MECE therapy. "Obviously you can't treat a major ligament tear or a fracture requiring immobilization with ethyl chloride spray," Kraus says. "On the other hand, you don't have to worry about using it, because it's self-limiting and will cause no trouble; it will remove pain from strains and sprains so you can move them, but not from major ligament tears or major fractures. Thus, there is no danger from excessive movement that would worsen the injury, such as might occur if novocaine is used as the pain-numbing agent." However, Kraus warns that people must not try the treatment on themselves without first consulting a doctor.
When Kraus describes the way his MECE treatment works, it sounds little short of miraculous: "Let's say you're a jogger who has a sprained knee and you have come to me for treatment. I first find out where your pain is most severe. If it is in the medial collateral ligament of the knee, I spray the area with ethyl chloride, and then have you bend and extend the knee two or three times. If you still have pain, I'll ask you to show me where. The pain usually shifts from the more acutely damaged area to a less damaged area, because limitation of motion has concealed it until now. The idea is to follow the pain with the spray. I then spray this area, and have you bend and extend the knee several times, rest briefly, then move the knee again. If there is no pain, you walk out. Of course, we must find the true cause of the injury, but a minor sprain will respond to ethyl chloride spray and gentle exercise of the affected part with immediate recovery."
No one knows precisely why ethyl chloride, a surface anesthetic, produces such a deep beneficial effect. One theory is that pain originating in one area of the sensory motor chain leads through a series of links to reflex muscle spasms and the involuntary locking of joints, and that the elimination of pain at any point in the chain breaks the entire linkage of pain, relaxing the affected muscles and joints. How ethyl chloride spray breaks the pain chain when combined with motion isn't precisely known, either, but, as Kraus says, "the important thing is, it does."
Once MECE became known, Kraus was overrun with patients, many of them athletes. From 1931 to 1938, he served as official surgeon to the Austrian Sports Teachers Association and to several Austrian Olympic teams. He became an espouser of therapeutic exercise and of physical fitness as a cultural boon whose benefits could extend far beyond elite athletes. "As an intern, I had gotten a diploma as an exercise teacher," Kraus says. "I helped train the Austrian Olympic hockey team and many skaters; Vienna was the capital of ice skating then. We discovered that you had to be in very good shape to compete in athletics. We also learned that systematic exercise was necessary to good health in general. Vienna was the center of this fitness movement many, many years ago. It has only recently dawned in the United States."
Nonetheless, Kraus revised and widened his concepts of orthopedics because of American influences, most notably that of a U.S. runner and coach named Harold Anson Bruce, who had been hired as a track and field coach by the Austrian Olympic Committee. "Harold Bruce introduced me to the world of track and to many forms of treatment for sports injuries," says Kraus. "When I came to America, he was the man who put me in touch with sports people whom I treated and made friends with."