Page Four P H Y S I O T H E R A P Y April, 1956. APPLICATIO N S AND ADVANTAGES OF STABLE GALVANISM By DR. HAROLD THOM. TO -D A Y it seem s to b e fo r several re a so n s p a rtic u la rly a p p ro p ria te to d ra w a tte n tio n to a p h y sic o th e rap e u tic al m e d iu m o f p rim e im p o rta n c e , n a m e ly to th e sim ple d irec t c u rre n t. P a rtic u la rly so since e le c tro th e ra p y — we re fe r h e re o n ly to th e d ire c t a p p lic a tio n o f th e e lectric c u rre n t— like p e rh a p s n o o th e r m e th o d is in th e u n fo rtu n a te p re d ic a ­ m e n t o f losing its rig h tfu l p o sitio n in p h y sic o th e ra p y as a re su lt o f in c o rre c t use a n d insufficient kno w le d g e o f m eth o d s a n d in d ic a tio n s. H o w ev e r, d u e to th e in tro d u c tio n o f m o d e rn lo w -freq u e n c y th e ra p y , its g re a t success a n d a d ­ v a n ce m e n t a b o v e a ll in th e tre a tm e n t o f p aralyses, th e d a n g e r o f le ttin g fall in to o b liv io n a m e th o d k n o w n a n d a p p ro v e d fo r a lm o s t tw o h u n d re d years h a s by n o m eans b ecom e sm aller. M o re o v e r, kno w le d g e o f th e bio lo g ic al effects o f th e d ire c t c u rre n t c o n stitu te s th e basis fo r th e u n d e rsta n d in g o f th e e n tire lo w -freq u en cy th e ra p y since th e m odified a n d in te rru p te d (n o m a tte r in w hich way) d ire c t c u rre n t b e ing th e s ta rtin g -fo rm fo r a ll stim u la tin g c u rre n ts used to d a y c a n even tu ally alw ays be tra c e d b a c k to th e c o n s ta n t d irec t c u rre n t. K n o w le d g e o f its effects is a c c o rd in g ly a n a b so lu te n ecessity f o r a ll fu rth e r u n d e rsta n d in g . F in a lly th e c o n sta n t ( o r a lso sim ple surging) c u rre n t h a s a w ide, th e ra p e u tic ra n g e in io n o - a n d io n to p h o re sis w hich w e shall la te r tre a t in d etail. C o m b in e d w ith h istam in e, be e-p o iso n , etc. th is m e th o d h a s a n excellent influence o n th e v a rio u s fo rm s o f rh e u m a tis m , o n n e u ralg ia e , a rth ro s e s , c irc u la to ry d is­ tu rb a n c e s , etc. T h e use o f th e g alvanic c u rre n t fo r electrolysis h a s b een in th e m a in re p la ce d by c o ld c a u te riz a tio n (h igh-frequency surgery). I t is h o w e v er still used freq u e n tly fo r th e re m o v a l o f h a irs , w a rts, etc. as well a s fo r e le c tro p u n c tu re (surgical g a lv a n iza tio n ). A s a g a in st th e c o n tin u o u s g a lv a n iz a tio n c u rre n t th e in te rru p te d d irec t c u rre n t h a s a d d itio n a l, com p le te ly differe n t effects u p o n th e h u m a n b o d y , especially o n all c o n tra c tile tissues. H e re it is u se d chiefly f o r ele ctro g y m ­ n a stic s a n d d iag n o stic s by m ea n s o f its stim u la tin g effect re su ltin g fro m th e m a k e a n d b re a k o f th e c u rre n t. H o w ev e r w e shall discuss o n ly th e effects o f a n evenly flow ing, n o n ­ in te rru p te d d irec t c u rre n t w ith fixed e lectrodes, in sh o rt th e effects o f sta b le g a lv a n iza tio n . G e n e ra lly th e te rm “ sta b le g a lv a n iz a tio n ” d e n o te s m erely th e u se o f fixed e lectrodes. I t d oes n o t a p p ly to a “ sta b ility ” o f th e c u rre n t. I n o u r case, how ever, sta b le g a lv a n iz a tio n shall m ea n a lso th e use o f a c o n tin u o u s d irec t c u rre n t.— O n th e o th e r h a n d , a “ n o n -sta b le g a lv a n is a tio n ” designates th e u se o f m o b ile ele ctro d e s, e.g. ro lle rs o r b ru sh e s. H e re u su a lly “ fa ra d ic ” c u rre n ts a re a p p lie d , since w ith this te c h n iq u e m o stly a nonspecific excitatin g effect is inte n d e d . T h e re a so n s fo r th e diverse effects o f th e electric c u rre n t a r e to be fo u n d in its c ap a c ity o f cau sin g changes in th e e le ctro c h em ica l c o n c e n tra tio n o f th e tissues. F o r e x p la n a ­ tio n o f th e processes ta k in g p lac e h e reb y th e th e o ry first e x p ressed by N e r n s t a t th e b eg in n in g o f th is c e n tu ry c a n e sse n tia lly still b e a p p lie d . I t c o n stitu te s even to d a y th e b asis fo r u n d e rs ta n d in g th e p h y siological a n d th e ra p e u tic a l effects o f th e e lectric c u rre n t. S ince th e h u m a n (a n d a n im a l) tissu e fro m th e view point o f physics re p re se n ts a se m i-c o n d u cto r, tra n s p o rt o f th e electric c u rre n t th ro u g h th e tissues is ta k e n o v e r by ions (m ig ra tin g io n s ) ; as a g a in st th e m etals, first-class c o n d u cto rs w here a c c o rd in g ly th e tr a n s p o r t is ta k in g place by electron flow. T h ese e le ctrically c h a rg e d a to m s re sp . g ro u p s of a to m s (ions) a re c re a te d by e lectro ly tes sp littin g into negatively a n d positively c h a rg e d p a rticle s w h en th e c urrent is led th ro u g h . T h e re b y th e m o m e n t th e c irc u it is closed a ll positively c h a rg e d ele ctro ly te c o m p o n e n ts (cations) s ta rt m o v in g to w a rd s th e c a th o d e a n d a ll negatively charged c o m p o n e n ts (a n io n s) to w a rd s th e a n o d e . T h u s th ere is n o t o n ly a flow fro m th e so -called plus to th e m in u s pole — as is a ssu m e d f o r th e sake o f easier c o m p re h e n s io n __ b u t a lso in th e o p p o s ite d irec tio n . I n a d d itio n to th e tra n s­ p o r t o f c h arg e d pa rticle s a c e rta in p a r t is p layed also by th e t r a n s p o r t o f u n c h a rg e d p articles. H o w ev e r w e shall n ot e n te r h e re in to th e p a rtic u la rs o f these p a rtly very com pli­ c a te d processes p a ra p h ra s e d by term s like electroosm osis cata p h o re sis, ele ctro p h o re sis, etc. T h e m ig ra tio n o f ions, ta k in g p lace h e reb y , effects in the m a in a c h an g e in th e chem ical c o n c e n tra tio n , a n d th a t in th e cell su b sta n c e (p ro to p la sm ) as well as in th e tissue fluid. O n a c c o u n t o f v a ria b le c o n d itio n s o f perm eability th ese c h an g e s o f c o n c e n tra tio n o c c u r chiefly o n th e cellular lim itin g su rfaces re sp . w herever tw o m ed ia o f a different k in d b o rd e r o n e ach o th e r. Since f o r in stan c e th e hydrogen io n s d u e to th e ir sm aller m o le c u la r size p ossess a c on­ sid e rab ly h ig h e r m ig ra tio n velocity th a n th e o rg a n ic anions, th e ra p e u tic a lly useful effects result, fo r ow ing to e v acuation o f s o u r in fla m m a to ry p ro d u c ts a fa v o u ra b le influence on th e fo c i o f in fla m m a tio n is achieved. F u rth e rm o re , by the extensive m ig ra tio n o f io n s as well a s by th e c h a n g e in the chem ical c o n c e n tra tio n re su ltin g th e re b y a ll m etabolism a n d b io logical processes a re intensively stim u la te d . Thus c o u n tle ss h a lo g e n a n d m in e ral ions a re a c tiv a te d a n d m obi­ lized w ith o u t a d m in is tra tio n o f a lien su b sta n c es, w hereby th is physiological pro cess is a d d itio n a lly a id e d by a likewise effected lo n g la stin g h y p e rem ia . T h e v a s o m o to r a n d tro p h ic effects o f th e galv a n ic current^ a re n o less significant; th e y c a n be re ad ily o b se rv ed by ex am in in g a fte r g a lv a n iza tio n , especially u n d e r the ele ctro d e s, th e flushed a n d w a rm skin. I t c o u ld be d e m o n ­ stra te d by th e rm o e le c tric a l m ea su re m e n ts t h a t h e reb y the sk in te m p e ra tu re is in cre ased by m o re th a n 2 to 3° C. The c irc u la to ry increase c aused by th e g a lvanic c u rre n t is far h ig h e r th a n th e o n e a tta in a b le by m assage o r even by sh o rt w ave th e ra p y . H o w ev e r, th e h y p e rem ia is n o t lim ited to th e sk in , b u t e x te n d s also to th e m o re de ep -se a te d tissue layers. A f u rth e r a d v a n ta g e o f th e h y p e re m ia p ro d u c e d by gal­ v a n iz a tio n is its very lo n g d u ra tio n . E v en a fte r d ays an in cre ased ten d e n cy to w a rd s v a so d ila tio n c a n o fte n be show n. I f o n e o r tw o d ays a fte r a g a lv a iz a tio n a p a tie n t is tre a te d fo r in sta n c e w ith h o t-a ir, th e skin a re a which w as c overed by th e e lectrodes u sed fo r th e g a lv a n iza tio n sta n d s o u t d istin c tly a g a in st its su rro u n d in g s b y its deeper re d n ess. T h is lo n g la stin g increased c irc u la tio n h a s in m any re sp ec ts a fa v o u ra b le effect o n th e p a th o lo g ic a l process, n o t a t last a lso o n th e im p ro v e m en t o f th e tro p h ic ity o f th e tissues w hich is n e a rly alw ays affected a s a re su lt o f p a raly se s, especially p o liom yelitis, a n d o f c irc u la to ry d istu rb an c es. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) April, 1956. P H Y S I O T H E R A P Y Page Five a d d itio n to th e fa v o u ra b le influence o n c irc u la tio n ^ " trn n h ic ity as well as th e stim u la tio n o f all processes o f * holism th e se d a tiv e a n d analg esic effect o f th e galvanic m t ta k in g p lac e p re d o m in a n tly u n d e r th e a n o d e , is C V r r ? n e a n im p o rta n t p a r t th e ra p e u tic a lly . T h is so o th in g is n o t lim ited t o a ll p e rip h e ra l (sensory) nerves, b u t c a n also be d e m o n s tra te d o n th e c e n tra l n e rv o u s system . T h u s if c e rta in low a n im a ls , e.g. fishes, a re e x p o se d to o w t r i c c u rre n t in such a m a n n e r t h a t th e a n o d e is a t fhoir h e ad a n d th e c a th o d e a t th e ir ta il, th e y fall a fte r a h n rt tim e in to a k in d o f n a rc o sis. W h e n th e d ire c tio n o f thp c u rre n t is su d d e n ly reversed h o w e v er, th e a n im a ls w ake nn imm ediately a n d in v io le n t a g ita tio n c h an g e th e ir p o sitio n o long u n til—w ith th e ir h e a d tu rn e d a g a in to w a rd s th e nositive pole th ey re la p se in to n a rco sis. T h is process, observed fo r th e first tim e in low a n im a ls a n d te rm e d plectrotropism , a pplies in a c e rta in w ay a lso t o th e c e n tra l nervous system o f h ig h e r a n im a ls a n d o f h u m a n beings. I f we ap p ly fo r th e ra p e u tic a l p u rp o se s th e plus p o le to the h ead a n d th e m in u s p o le in th e re g io n o f th e o s sa c ru m (“ descending g a lv a n iz a tio n ” ), a re d u c tio n o f th e reflex excitability c a n b e d e m o n s tra te d . T h is m eth o d o lo g y used for th e first tim e b y S chem inzky is fa v o u re d even to d a y in the tre a tm e n t o f a ll sp a stic paraly tic s, hem iplegics a n d o th ers, and th ere is h a rd ly a n o th e r ty p e o f p h y sic o th e ra p y w hich in these cases w o u ld b e s u p e rio r to th e sim ple galvanic current. U n fo rtu n a te ly it h a p p e n s a g a in a n d a g a in th a t such spastics a re tre a te d w ith fa ra d ic surg in g c u rre n ts a n d possibly even w ith th e fa ra d ic ro lle r. S uch th o u g h tle ss therapy is a lre a d y b o rd e rin g o n w h a t is c u sto m a rily called m alpractice. A n a d d itio n a l field o f a p p lic a tio n o f th e c o n s ta n t d irec t current to w hich m u c h t o o little a tte n tio n h a s b een given is th e th era p y o f pa raly se s. H e re it is a b le to a chieve ex­ cellent results as a su p p o rtin g a n d p re p a ra to ry m ea su re fo r subsequently a p p lie d ele ctro g y m n astic s w ith selectively acting stim u la tin g c u rre n ts. Since a c o n sta n tly flow ing direct c u rre n t— a t th e ra p e u tic a l a m p e ra g e s— does n o t c au se any m uscle c o n tra c tio n s, it w as fo rm e rly ta k e n fo r g ra n te d th a t no usefulness c o u ld be a ttrib u te d t o it in th e tre a tm e n t o f paralyses. H o w ev e r, a m p le e x p erim e n tal stu d ies a re available by a larg e n u m b e r o f a u th o r s w h e re th e beneficial effect o f th e c o n s ta n t g a lvanic c u rre n t o n p a raly ze d a n d a trophic m u sc u la tu re w as p ro v e n u n e q u iv o c ally . T h e first tests o f th is k in d w ere c a rrie d o u t a s e arly a s 1848, w hen Reid w as e x p erim e n tin g w ith fro g s w h ich h e p a raly se d o n their h in d legsi by c u ttin g th ro u g h th e re sp ec tv e ro o ts o f the spinal nerves a n d w hich h e th e n g a lvanized o n ly o n o n e side. A fte r tw o m o n th s th e m uscles o f th e tre a te d side could still be well excited electrically a n d shew n o d ecrease in volum e, w h ereas th e m u sc u la tu re o f th e o th e r u n tre a te d side was a tro p h ic a n d h a d sh ru n k . I n 1875 D e je rin e re p e a te d these experim ents o n g u inea-pigs w hereby h e o b ta in e d th e sam e fa v o u ra b le re su lt. L a te r G o tz e a n d P io n tk o w sk i c arried o u t sim ilar tests o n d ogs a n d ra b b its w ith e q ually good result. T h ey w ere, m o re o v e r, a b le to p ro v e h is to ­ logically th a t re g e n e ra tio n in th e tre a te d m uscles w as m o re rapid. K o s a k a a n d Iz w a as well a s L en o c h o b ta in e d th e sam e re su lt. A s c a n be in ferre d a lre a d y fro m th ese few citations, n o t a ll th e ra p e u tic m e th o d s in u se a re b a se d o n such a n a b u n d a n c e o f e x p erim e n tal stu d ies a s well as clinical experiences a s precisely g a lv a n iz a tio n . T h e beneficial influence o f th e ga lv a n ic c u rre n t o n p a r a ­ lyses is n o t lea st d u e to its effect o n v a so m o tric ity a n d tro phicity, m an ifested b y a h y p e re m ia o f lo n g d u ra tio n . T his is especially tr u e fo r a ll p a raly se s c a u se d by p o lio ­ myelitis w hich as a ru le re p re se n t th e larg e st c o n tin g e n t o f th e cases c o m in g u p f o r tre a tm e n t, since th e c o m b a tin g o f v a so m o to r a n d tro p h ic d istu rb a n c e s m an ifestin g them selves above all in c y an o sis, p aleness a n d c o ldness o f th e skin, is playing a n im p o rta n t p a r t h e re. H o w ev e r, th e h y p e rem ia produced by g a lv a n iz a tio n is n o t lim ited to th e sk in b u t e x tends a lso to th e m o re deep -se a te d tissues, a s c o u ld be pro v e n b y S tra u c h b y m ea n s o f p le th y sm o g ra p h ic e x a m in a ­ tio n s . A n effect o f n o lesser im p o rta n c e fo r th e th e ra p y o f a tro p h ic p aralyses is th e re d u c tio n o f th e rh e o b a se , a p p e a r­ ing— p a rtic u la rly u n d e r th e negative ele ctro d e — a s a re su lt o f g a lv a n iz a tio n . I t is ex p ressed by a m o re e asy excitab ility o f th e affected n erve-m uscle system s c o n c e rn in g n o t o nly electrical im pulses (re d u c tio n o f th e c h ro n a x y , e tc .), b u t also fo r in sta n c e p u re ly m ech an ic al im pulses (e x a m in a tio n o f te n d o n reflexes). H o w ev e r, n o t o n ly will m u sc u la tu re p re tre a te d w ith c o n s ta n t g a lv a n iz a tio n show a n in creased re sp o n se to su b seq u e n tly a p p lie d p u lsin g o r su rg in g c u rre n t th e ra p y , b u t a b o v e a ll th e p a tie n t will re sp o n d b e tte r to v o lu n ta ry im pulses o rig in a tin g in h im self. T h e re fo re a fte r each tre a tm e n t th e p a tie n t is m a d e to c a rry o u t a c tiv e exercises, w hich u n d o u b te d ly re p re se n t th e a im o f a ll o u r th e ra p e u tic efforts in th e tre a tm e n t o f paralyses. Forms of application of galvanization. B est su ite d fo r c a rry in g o u t a sta b le g a lv a n iz a tio n a re p la in m e ta l p late s o f z inc o r lead w hich a re a v a ila b le in v a rio u s sizes o r w h ich c a n b e c u t fro m a big sh e e t in th e d esired shape. B etw een th e skin a n d th e e le c tro d e p late s a n in te rm e d ia te lay e r o f fa b ric , as th ic k as possible, is placed— K ow arschiic re co m m e n d s te rry c lo th fo ld e d e ight tim es— w h ic h sh o u ld so m e w h a t su rp a ss th e rim o f th e m e ta l plates. I n n o c ase sh o u ld th e e le c tro d e itself o r a n o t in ­ su la te d c o n n e c tin g te rm in a l (c ro c o d ile term in al) be in d irec t c o n ta c t w ith th e sk in , since oth erw ise c a u te riz a tio n s will b e th e in ev itab le re su lt. T h e in te rm e d ia te fa b ric lay er h a s to b e well so a k e d w ith w a te r (w a rm if possible) in o rd e r t o re n d e r it electrically sufficiently c o n d u ctiv e. (A d d in g sa lt to th e w a te r increases th e c o n d u ctiv ity , b u t is sup e rflu o u s, e specially in m o d e m u n its w hich k eep th e c u r re n t in te n sity c o n s ta n t in d ep e n d e n tly f r o m th e resistance). W a te r is fo r m an y p u rp o se s o f g a lv a n iz a tio n th e id ea l e le ctro d e . T h is c a n be a p p lie d e ith e r in fo rm o f a tw o o r a fo u r-ce ll b a th o r in f o r m o f a h y d ro e le c tric full b a th , e.g. th e S ta n g e r b a t h . T h e fo u r-ce ll b a th a c c o rd in g to S chnee c o n sists o f tw o n o n c o n d u c tiv e tu b s fo r th e a rm s a n d th e fe et c o n ta in in g m eta l o r c a rb o n e le ctro d e s p ro te c te d a g a in st d ire c t c o n ta c t. B y m ea n s o f a special a rra n g e m e n t it is p o ssib le t o a d ju s t v a rio u s c u rre n t d ire c tio n s a n d c o m b in a tio n s o f th e in d iv id u a l tu b s. T h e g re a t a d v a n ta g e o f th is b a th a s a g a in s t th e electric full b a th is o n o n e h a n d th e fa c t t h a t th e p a tie n t d oes n o t n e ed to u n d re ss, a n d o n th e o th e r h a n d t h a t th e c u rre n ts in d ic a te d o n th e m illia m m e ter a re re ally tra v e rsin g th e b o d y a t full in te n sity w hereby th e c u rre n t d e n sity is in deed g re a te s t o n th e e xtrem ities. T h e fo u r-ce ll b a th c a n n a tu ra lly b e u se d a lso a s th re e , tw o o r one-cell b a th . I n th e la tte r case a c o n v e n tio n a l e le c tro d e w ith u n d e rla id fa b ric c o n stitu te s th e se c o n d pole. A s a ru le th e o n e o r tw o-cell b a th is used f o r th e tre a tm e n t o f single e x trem ities, w hile th e four-cell b a th is a p p lie d fo r h a v in g th e c u rre n t flow th ro u g h th e e n tire b o d y . T h e h y d ro e le c tric full b a th is su ited p a rtic u la rly f o r g eneral tre a tm e n t. D u e to th e g o o d c o n d u c tiv ity o f t h e w a te r a larg e p a r t o f th e c u r re n t by-passes th e b o d y o f th e p a tie n t u nless m em b ran e s o f a su ita b le in su latin g su b s ta n c e sto p p in g th e c u rre n t a re u se d . C o n c e rn in g th e d o sa g e o n e is fo r th e m o st p a r t d e p e n d e n t o n th e se n sa tio n subjectively e x p eri­ e nced by th e p a tie n t. T h e S ta n g e r b a th is a special fo rm o f th e h y d ro e le ctric b a th w h e reb y c e rta in su b sta n c es a re a d d e d to th e w a ter (tan n in ). O w ing to a n in g en io u s a rra n g e m e n t o f n u m e ro u s p r o ­ tec ted ele ctro d e s selective tre a tm e n t c a n b e given to v a rio u s p a rts o f th e b o d y . T h e effect o f th e e lectric full b a th s is s u p p o rte d a d d itio n a lly b y th e so o th in g a n d re la x in g in ­ fluence o f th e w a rm w a te r (34 to 37 °C.) F o r rh e u m a tic diseases a h o t b a th o f a b o u t 4 0 °C is re co m m e n d e d . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) O th e rw ise th e size o f th e e le ctro d e s is selected a cc o rd in g to th e p u rp o se . Since in sta b le g a lv a n iz a tio n it is in te n d e d to h a v e th e c u rre n t flow evenly th ro u g h th e b o d y o r in d i­ v id u al p a rts o f t h e b o d y w ith o u t giving p reference t o e ither o n e o f th e poles, a s a ru le tw o e lectrodes o f e q u a l size a re c hosen. I f p a rtic u la rly intensive tre a tm e n t is d esired as fo r in stan c e in th e th e ra p y o f ischialgiae, th e so-called tra n sv e rsa l g a lv a n iz a tio n re c o m m e n d e d by K o w a rsc h ik — as a g ain st th e u su a l lo n g itu d in a l g a lv a n iz a tio n — c a n be a d v an tag e o u sly a p p lie d . H e re b y a b o u t 25 inches lo n g a n d 3 inches wide ele ctro d e s a re u sed w hich a re a p p lie d to th e flexor a n d e x te n so r side o f th e leg (c a th o d e below ). C a re h a s to be ta k e n in e ac h ty p e o f tra n s v e rsa l g a lv a n iz a tio n t h a t the e le c tro d e w id th sh o u ld n o t be m o re th a n a q u a rte r o f th e c irc u m fe re n ce o f th e e xtrem ities, since o th erw ise a t th e p o in ts o f c o n ta c t o f th e tw o ele ctro d e s a n u n d e sirab le in cre ase o f c u rre n t density c a n result, th e so-called fringe effect. T h e d u ra tio n o f a galv a n ic tre a tm e n t is a s a ru le 10 to 15 m inutes. I n excitab le a n d sensitive p a tie n ts o n e begins w ith s h o rte r tre a tm e n ts a n d increases th e p e rio d s g ra d u ally in th e c o u rse o f th e th e ra p y . F o r th e tre a tm e n t o f severe n e u ra lg ia e in p a rtic u la r, like sc iatica o r facial ne u ralg ia e , it is re c o m m e n d e d to e x te n d th e tre a tm e n t to o n e h a lf o r th re e -q u a rte rs o f a n h o u r. F in a lly it h a s to be m en tio n e d t h a t a d ju s tin g th e desired a m p e ra g e m a y n e v e r be d o n e suddenly. T h e c u rre n t h a s to be increased g ra d u a lly , it h a s to “ creep in ” a s we u sually say. I n th is m a n n e r c o n sid e ra b ly h ig h er a m p e rag e s c a n be a p p lie d th a n if th e in te n sity is in cre ased ra p id ly . A c co rd in g ly b re a k in g th e c irc u it a lso h a s to be d o n e slowly. T h is applies especially to excitab le p a tie n ts as well as to tre a tm e n ts o f th e h e ad , since o th e rw ise dizziness a n d o th e r disa g ree ab le se n sa tio n s m ay easily o c cu r. J u s t as th e c u rre n t m ay n o t be su d d e n ly in te rru p te d d u rin g tre a tm e n t it m ay n o t be rev ersed e ith e r. I f a c h an g e o f th e c u rre n t d ire c tio n is in te n d e d , o n e first h a s t o creep o u t slowly a n d o n ly a fte r h a v in g c h an g e d th e d ire c tio n o f th e c u rre n t creep in a g ain slowly. A m o n g th e c h ie f in d ic a tio n s o f sta b le g a lv a n iz a tio n a re n e u ra lg ia e a n d every ty p e o f n e u ritis in clu d in g trig e m in u s n e u ra lg ia a s well as o c c u p a tio n a l ne u ralg ia e . F u r th e r m y algiae (lu m b a g o , w ry-neck, m uscle c ram p s a n d spasm s, a tro p h ic a n d sp a stic pa raly se s, tre m o r, p a raly sis a g ita n s, p o ste n c e p h a litic c o n d itio n s a n d m igraine. H y d ro e le c tric full b a th s as well as four-cell b a th s a re a p p lie d a b o v e a ll in ge n era l stages o f e x c ita tio n , spastic d iseases o f v a rio u s k in d s, p a raly se s o f se ctions o f th e spinal c o rd , m u ltip le sclerosis, in so m n ia as well as a n g io sp astic diseases (R a y n a u d in te rm itte n t c la u d ic a tio n ) a n d c irc u la to ry d istu rb a n c e s o f differe n t genesis. T h e re is n o d o u b t t h a t th e field o f in d ic a tio n o f h y d ro ­ e le ctric b a th s a n d th a t o f u ltra so n ic s a re to a g re a t e x te n t o v e rla p p in g . W h e th e r to u se h y d ro e le ctric b a th s , u ltr a ­ sonics o r m u d -b a th will h a v e to be decided individually fro m c ase to c ase a c c o rd in g to th e given c irc u m stan c es a n d w ith d o c to r a n d p a tie n t in a g ree m e n t. I n c e rta in cases also a c o m b in a tio n o r a n a lte rn a tin g u se o f v a rio u s m eth o d s will b e o f a d v a n ta g e . I n c h ro n ic rh e u m a tic diseases, c h ro n ic d e fo rm in g a r tic u la r diseases a s well as in c h ro n ic in fla m ­ m a to ry diseases o f th e a d n e x a generally a m u d -b a th tr e a t­ m e n t is p re fe rre d . Generation o f direct current. A review o f th e v a lu e o f th e galv a n ic c u rre n t w o uld n o t be c o m p le te w ith o u t briefly m e n tio n in g so m e th in g a b o u t its g e n e ra tio n . B esides, h a n d lin g a lte rn a te ly th e m o s t different ty p es o f a p p a r a tu s m ak e s a n u n d e rs ta n d in g o f th e basic prin cip les d e sirab le in o rd e r t o fa c ilita te effortless m a n ip u ­ la tio n o f different m odels. I n p rin cip le, th e d irec t c u rre n t necessary fo r g a lv a n iz a tio n c a n b e o b ta in e d e ith e r by m ean s o f th e u su a l g a lv a n ic cells resp. b a tte rie s o r by connectino th e u n its to th e m ain s. In th e la tte r case th is is d o n e by in te rp o sin g m o to r c o n v e rto rs (in d ire c t c u rre n t su p p ly )_ l a s in th e M u lto s ta t o r th e o ld M o to r - P a n to s ta t— o r tra n s­ fo rm e rs a n d rectifiers (in a lte rn a tin g c u rre n t supply). The b a tte ry o p e ra te d u n its w hich, since th e y do n o t require a n y m a in te n a n c e , a re u se d a lm o st exclusively w ith d ry cells have— a s a g a in st m ain s o p e ra te d u n its— u n d o u b te d ly the a d v a n ta g e o f su p p ly in g in d ep e n d en tly fro m th e flu ctu atio n s in th e m ain s a n a b so lu te ly c o n s ta n t c u rre n t, while the c u rre n t su pplied by w ay o f a m o to r c o n v e rto r is alw ays su b je cted to sm all flu c tu a tio n s. S u ch a p p a ra tu s w ere th ere­ fo re fa v o u re d fo r c a rry in g o u t m o st p recise d iagnostic e x am in a tio n s . I n th e c o u rse o f tim e th e b a tte ry operated u n its w ere a lm o st a ll re p la ce d by u n its w hich c an be c o n ­ n ected to th e m ain s. T o d a y th e re is n o difficulty a n y m ore in c o n v e rtin g , by m e a n s o f so-called filters c o n n e c te d in series, th e rip p le c u rre n t o b ta in e d fro m ha lf-w a v e o r full- w ave rectifiers in to a n e n tirely s m o o th , i.e. e n tire ly c o n sta n t d ire c t c u rre n t. Since th e m a jo rity o f o u r m a in s supply a lte rn a tin g c u rre n t a n d as a ru le th e m e c h an ic al w ork re su ltin g fro m u sin g a m o to r c o n v e rte r—a s in th e form er M o to r-P a n to s ta t— c a n be d ispensed w ith, fo r so m e time a lre a d y a p p a ra tu s h a v e b een p ro d u c e d w here, a fte r in te r­ p o sin g a tra n s fo rm e r fo r iso la tio n fro m th e m a in s a nd fo r re d u c tio n o f th e m ain s v oltage, th e a lte rn a tin g c u rre n t is rectified by m eans o f a valve rectifier o r a b a rrie r-la y er. A ll a p p a ra tu s fo r g a lv a n iz a tio n h a v e in a d d itio n to a m a k e a n d b re ak sw itch term in als fo r p ick in g u p th e c u rre n t (plus a n d m in u s p o le) a s well as a c u rre n t reverser which m ak es it p o ssible to reverse th e flow d ire c tio n o f th e c u rre n t a s o fte n a s d esired w ith o u t h a ving to c h an g e th e electrodes. A ll a p p a ra tu s h a v e a n in te n sity c o n tro l fo r a d ju s tin g the am p e rag e . Since m an y a p p a ra tu s a re used fo r b o th , gal­ v a n iz a tio n a n d fa ra d iz a tio n , th ey a re a lso e q u ip p e d with a se lec to r sw itch fo r a d ju s tin g th e d esired k in d o f c u rre n t, if n eed be a lso f o r c o n s ta n t o r surging g a lvanic o r faradic c u rre n t as well a s fo r th e c o m b in a tio n o f b o th k in d s o f c u rre n ts. D e l i v e r a n c e • • . from pain . . . . the hum anitarian function of o f the p ra c titio n e r . . . . now accomplished w ith g re a te r speed, more economy and w ith a{ higher degree o f safety than e v er before. Full details and clinical notes on the use of R E N O T I N in the treatment of Migraine, Neuritis, Lumbago, Sprains and M yalgia may be obtained from E xclusive D istributors fo r Southern A fr ic a P H A R M A C E U T I C A L S L T D . P .O . B O X 7 7 9 3 J O H A N N E S B U R G R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )