Page' Eight P H Y S I O T H E R A P Y March, 1949 Physiotherapy in the Treatment of Infantile Paralysis E x tra c ts from a paper read by M iss E . E e ? , a m em ber o f the staff o f the N ational Foundation for Infantile P aralysis, D enm ark , to students o f the School o f P hysiotherapy, U niversity o f W itw a te rsra n d , Johannesburg, in O ctob er, 1948. I N T R O D U C T I O N B e f o r e I s t a r t to tell y o u li o w t h e p o s t - t r e a t m e n t o f p o li o m y e l it is p a t i e n t s is c a r r i e d o u t in m y c o u n t r y — D e n m a r k — I w o u l d li k e to e x p l a i n b r i e f l y h o w w e h a p p e n to be in th e p o s iti o n w e a r e t o - d a y , a m o n g the f e w c o u n t r i e s w h i c h h a v e a N a t i o n a l F o u n d a t i o n f o r I n f a n t i l e P a r a l y s i s . I w o u ld a l s o lik e to tell yo u a b o u t th e I n s t i t u t e f o r R e s e a r c h a n d T h e r a p y , w h ic h b e l o n g s to th e F o u n d a t i o n . B y so d o in g, m y e x p l a n a ­ tion o f th e t r e a t m e n t s w h i c h a r e g i v e n t h e r e will h a v e a b e t t e r b a c k g r o u n d . S o m e y e a r s a go , D a n i s h s u f f e r e r s w i t h p o li o m y e l it is r e a li s e d th at , in A m e r i c a , h o p e an d e n c o u r a g e m e n t w a s o f f e r e d to t h e i r f e l l o w s u f f e r e r s . I n t h a t c o u n t r y , p h y s i c a l t r a i n i n g w a s c a r r i e d o ut f o r m a n y y e a r s in the b e l i e f t h a t a f f e c t e d m u s c l e s c oul d o f t e n r e c o v e r — if n o t c o m p l e t e l y — t h e n to an a p p r e c i a b l e ex te nt . T h e D a n e s t h e m s e l v e s f o r m e d a s m a ll a s s o c i a t i o n w h i c h g r a d u a l l y e x p a n d e d until in M a y , 1945, a N a t i o n a l F o u n d a t i o n f o r I n f a n t i l e P a r a l y s i s w a s f o r m e d u n d e r the p a t r o n a g e o f Q u e e n I n g r i d . T h e N a t i o n a l C o m m i t t e e in c lu d ed m a n y o f th e le a d i n g d o c t o r s in O r t h o p a e d i c s , P h y s i c a l M e d i c i n e a n d R e ­ s e a r c h . T h e G o v e r n m e n t a c c o r d e d t h e ' m o v e m e n t its s u p p o r t a n d t r e m e n d o u s e n t h u s i a s m w a s s h o w n b y t h e public. A s a r e s u l t o f th e g e n e r o u s fin a n c ia l s u p p o r t r ec e i v e d , th e F o u n d a t i o n w a s e n a b l e d to s e n d D r . C l e m m e s o n , w h o is in c h a r g e o f th e M a s s a g e D e p t, o f th e M u n i c i p a l H o s p i t a l , C o p e n h a g e n a n d tw o O r t h o p a e d i c s u r g e o n s to A m e r i c a to u n d e r g o a s t u d y c o u r s e . T h e s e w e r e l a t e r f o l l o w e d b y th e p h y s i o ­ t h e r a p i s t in c h a r g e . T h e F o u n d a t i o n e s t a b l i s h e d its h e a d q u a r t e r s in a l a r g e h o u s e in C o p e n h a g e n w h i c h w a s o p e n e d in O c t o b e r , 1945, as the I n s t i t u t e f o r R e s e a r c h and T h e r a p y . O r i g i n a l l y , f o u r g i rl s, i n c l u d i n g m y s e l f , w e r e t r a n s f e r r e d f r o m th e M u n i c i p a l H o s p i t a l . On his r e t u r n f r o m A m e r i c a , D r . C l e m m e s o n w a s p l a c e d in c h a r g e o f th e I n s t i t u t e a n d at o n c e s t a r t e d a c o u r s e o f i n s t r u c t io n . T o - d a y , th e M a s s a g e D e p t , h a s a s t a f f o f t h r e e d o c t o r s a n d m o r e t h a n t w e n t y p h y s i o ­ th e r a p is t s . I n th e b e g i n n i n g , t r e a t m e n t w a s b a s e d on A m e r i c a n m e t h o d s , i n f o r m a t i o n d i g e s t e d f r o m th e n e w e s t b o o k s on p o l i o m y e l i t i s an d f r o m o u r p r e v i o u s k n o w l e d g e o f the d i s e a s e . A s t h i n g s d e v e lo p e d , o u r m e t h o d s g r a d u a l l y i m p r o v e d , an d w e r e c e i v e d i n s p i r a t i o n and n e w i d e a s f r o m v i s i t i n g d o c t o r s a n d p h y s i o t h e r a p i s t s f r o m o t h e r c o u n t r i e s . E v e n t u a l l y , th e c lin ic d e v e lo p e d m o r e o f a n i n t e r n a t i o n a l t h a n a D a n i s h n a tu re .. E a r l y in 1946 p a t i e n t s w e r e r e c e i v e d f r o m N o r w a y , S w e d e n a n d F i n l a n d . L a t e r t h e y a r r i v e d f r o m c o u n t r i e s ev en f u r t h e r afield. F o u n d a t i o n d o c t o r s a n d p h y s i o t h e r a p i s t s w h o le c t u r e d to D a n i s h an d f o r e i g n s t u d e n t s w e r e i n v it e d to l e c t u r e in F r a n c e , H o l l a n d , S w e d e n a n d F i n l a n d . In 1948 t h r e e E n g l i s h p h y s i o t h e r a p i s t s v i s i t e d the c lin ic fo r t h r e e m o n t h s in e x c h a n g e f o r t h r e e F o u n d a ­ tion p h y s i o t h e r a p i s t s . S i s t e r K e n n y le c t u r e d to us an d p r e s e n t e d an i n s t r u c t i o n a l film on h e r m e t h o d s o f t r e a t m e n t . T R E A T M E N T I th in k it is n o w ti m e to tell y o u ab o u t th e de t a i ls o f o u r w o r k . T h e r e a r e m a n y d i f f e r e n t o p i n i o n s on h o w to t r e a t p o li o m y e l it is . F r o m o u r a c c u m u l a t e d k n o w l e d g e w e r e a l i s e d t h a t the t r e a t m e n t w a s b a s i c ­ a l l y the s a m e in m o s t c o u n t r i e s a l t h o u g h th e de ta il s v ar ie d . O u r t r e a t m e n t w a s t h e r e f o r e b a s e d on e x e r ­ c ise s, m a s s a g e , e l e c t r o t h e r a p y a n d h y d r o t h e r a p y . W h e t h e r w e c o m b in e d t h e s e t r e a t m e n t s o r c o n c e n ­ tr a t e d on o n e o r tw o t y p e s d e p e n d e d o n th e n a t u r e an d l e n g t h o f ti m e f o r w h i c h th e p a t i e n t h a d b e e n a f f e c t e d . S o m e p a t i e n t s r e c e i v e t r e a t m e n t s o o n a f t e r th e o n s e t w h i l s t o t h e r s a t t e n d f o r th e fi r st ti m e ten to t w e n t y y e a r s a f t e r t h e y h a v e c o n t r a c t e d th e d i s e a s e . T h a t w e t r e a t s u c h l o n g s t a n d i n g c a s e s m a y s e e m s u r p r i s i n g bu t w e b e l i e v e t h a t m u s c l e s t r e n g t h c a n in m a n y c a s e s be r e g a i n e d a n d d e v e l o p e d m a n y y e a r s a f t e r th e o n s e t o f th e d i s e a s e . E v e n i f th is is n o t a c c o m p li s h e d , it is fe l t th a t s o m e t h i n g c a n a l w a y s b e d o n e to m a k e li f e e a s i e r f o r th e c h r o n i c c a s e . A n d n o w to t h e a c t u a l t r e a t m e n t , so w e wil l s t a r t w i t h e x e r c is e s . E xercises.— F i r s t l y , w e m a k e it a g e n e r a l r u le not^ to w a s t e ti m e b y g i v i n g e x e r c i s e s w h i c h a r e e i t h e r too e a s y o r too difficult. E x e r c i s e s a r e g i v e n to i m p r o v e c o - o r d i n a t i o n an d to help p a t i e n t s o v e r c o m e di ffi­ c u l ti e s in th e ir w o r k o r d a i l y life. T h e m a i n g r o u p is g i v e n to d e v e l o p s t r e n g t h in th e a f f e c t e d m u s c l e s , so w e wil l t a lk a b o u t t h e m first. E xercises for M u scle Stren gth .— W h e n all the m u s c l e s in a c e r t a i n g r o u p a r e a f f e c t e d to th e s a m e d e g r e e , it is a f a i r l y s im p le m a t t e r to find s pe c if ic e x e r c i s e s d i r e c t e d to i m p r o v i n g m u s c l e s t r e n g t h . A s an e x a m p l e , let us c o n s i d e r a c a s e in w h i c h th e l e f t hip e x t e n s o r s a r e af fe c te d . I f t h e s e m u s c l e s c a n c o m p l e t e a full r a n g e o f m o v e ­ m e n t a g a i n s t r e s i s t a n c e , th e p a t i e n t s h o u l d b e p l ac e d in th e p r o n e po s it io n w i t h th e le g s s t r a i g h t . F u l l a c t i v e e x t e n s i o n o f th e hip s h o u l d b e p e r f o r m e d a g a i n s t r e s i s t a n c e a p p li e d a b o v e a n d b e h i n d th e k n e e . T h e p e l v i s s h o u l d b e s t a b i l i s e d to e n s u r e t h a t he does n o t h o ll o w his b a c k . I f th e m u s c l e s a r e too w e a k to p e r f o r m this a c t i o n , a g a i n s t r e s i s t a n c e , th e s a m e e x e r c i s e is g i v e n a s a f r e e m o v e m e n t . I f th e m u s c l e s 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. ) March, 1949 P H Y S I O T H E R A P Y Page Nine s o w e a k t h a t t h e y c a n n o t o v e r c o m e g r a v i t y , 3ue p a tie nt s h o u l d be p l a c e d on hi s n o r m a l side. H i p ^ t e n s i o n c a n n o w t a k e p l a c e w i t h g r a v i t y e lim in a te d . j^et us n o w d e a l w i t h th e c a s e w h o s e hip e x t e n s o r s e a f f e c t e d ' n d i f f e r e n t d e g r e e s . F o r e x a m p l e , let us !*qsunie th at g l u t e u s m a x i m u s is a f f e c t e d w h i l s t the f m s tr in g m u s c l e s a r e n o r m a l . I n this c a s e , hip e x ­ t e n s i o n is g i v e n w i t h th e k n e e f l e x e d t h u s d e c r e a s i n g tlie acti on o f t h e h a m s t r i n g s . T h e c o n d i t i o n o f the nuscle w o u ld d e t e r m i n e w h e t h e r r e s i s t a n c e s h o u l d be u s e d o r g r a v i t y e li m i n a te d . T h i s e x e r c i s e is c a l l e d an 's o l a t e d g lu t e u s m a x i m u s e x e r c i s e a n d b r i n g s us t o pIie of o ur g r e a t e s t p r o b le m s , i.e., t h a t o f d e v i s i n g and iriving is o la t ed m u s c l e .e x e r c i s e s . I s o l a t e d M u sc le E xercises.— T h e c h i e f p u r p o s e served b y th e s e e x e r c i s e s is to d e c r e a s e th e a c ti o n 0 [ n o r m a l s y n e r g i s t s in a n e f f o r t to g e t th e a f f e c t e d m u s c l e to w o r k . H o w to a c c o m p l i s h th is w h e n th e s y n e r g i s t s a r e s t r o n g e r — o r n o t a f f e c t e d at all — has been e x p l a i n e d in th e p r e v io u s e x a m p l e . I n th at case, gl u t eu s m a x i m u s w a s i s o l a t e d b y f l e x i n g the knee. H a d th e e x e r c i s e b e e n g i v e n w i t h the k n e e - e x t e n d e d , the n o r m a l h a m s t r i n g m u s c l e s w o u l d h a v e p e r f o r m e d all, o r at le a s t m o s t o f the m u s c l e w o r k i n v o l v e d in e x t e n d i n g t h e hip a n d g l u t e u s m a x i m u s w o u l d h a v e b e e n g i v e n li tt le if a n y e x e r c i s e . I t wil.l h e seen t h e r e f o r e th a t i s o l a t e d m u s c l e e x e r c i s e s a r e o f the g r e a t e s t i m p o r t a n c e a n d i f p o s s i b le s h ou ld always be in c lu d e d in th e s c h e m e o f t r e a t m e n t . [M i s s E e g t h e n d e m o n s t r a t e d th e m e t h o d s u se d to isola te v a r i o u s m u s c l e s a n d w e n t on to s t a t e th at the i so la ti on o f m u s c l e s p r o b a b l y r e q u i r e d m o r e specialised k n o w l e d g e an d skil l on th e p a r t o f the o per ato r t h a n a n y o t h e r s i n g l e f a c t o r in th e p h y s i o ­ therapeutic t r e a t m e n t o f th e d i s e a s e . ] • Conducted E xe rcises.— I w i ll n o w de al w i t h a n o t h e r group o f e x e r c i s e s — th e C o n d u c t e d e x e r c i s e s . T h e s e are used o n l y to d e v e lo p v e r y w e a k m u s c l e s o r t h o s e in which a c o n t r a c t i o n c a n n e i t h e r b e s e e n n o r felt. As an e x a m p l e l e t - u s t a k e a c a s e w h e r e t h e r e is no contrac.tability in the h a m s t r i n g s . T h e m ai n point is to tea ch th e p a t i e n t to f e e l t h e s e m u s c l e s a s t h e y are p a ss i v e l y m o v e d r i g h t f r o m th e s t a r t o f t r e a t m e n t . To assist h im to do this, he s h o u l d b e s h o w n a d i a ­ gram o f the k n e e f l e x o r s , a n d t h e ’ m e c h a n i s m t h r o u g h which t h e y f l e x th e k n e e u n d e r n o r m a l c o n d i ti o n s should be e x p l a i n e d to h i m f o r th e fi r st f e w s e a n c e s . The pa tient s h o u l d t h e n b e p l a c e d in th e p r o n e p o s i ­ tion wh ilst th e o p e r a t o r b e n d s th e k n e e up an d u o w n in a s lo w a n d r h y t h m i c a l m a n n e r , th e s p e e d b e i n g dictated b y the pa ti e n t . H e is i n s t r u c t e d to c o n c e n ­ trate on the b e n d i n g m o v e m e n t , to p i c t u r e in his mind the m e c h a n i s m a n d to t r y a n d a c t u a l l y “ f e e l ” the m o v em en t . F o r th e fi rst f e w s e a n c e s , c o n d u c t e d exercises can o n l y be g i v e n f o r a v e r y s h o r t t i m e as the pa tient ti r e s, v e r y e a s i ly . L a t e r , t h e y c a n be carried on f o r i n c r e a s i n g l y l o n g e r p e r i o d s — s a y three to five m i n u t e s — a f t e r w h i c h m a s s a g e is g i v e n and the e x e r c i s e s m a y b e c o n ti n u e d . I n m a n y c a se s, this type o f e x e r c i s e is u s e d in c o m b i n a t i o n w i t h electrical s ti m u la t io n . T h r e e s ti m u li a r e g i v e n w h i l s t the o pe ra to r c o u n t s 1 - 2 - 3 ; th e p a ti e n t t h e n a t t e m p t s the m o v em e n t ' w h i l s t the o p e r a t o r c o n t i n u e s to b en d ‘ he knee to th e s a m e r h y t h m o f 4-5-6. Exercises for C o-ordination.— A g r e a t v a r i e t y o f is type o f e x e r c i s e is g i v e n to help th e p a t i e n t s in ()le i r . da il y life, e.g., to a s c e n d - s t e p s , to u s e c r u t c h e s (|r .sticks a n d to g e t up f r o m a w h e e l - c h a i r , etc. F o r [atter a c t i o n a w h o l e s e r i e s o f e x e r c i s e s is suable, the c h i e f p u r p o s e o f w h i c h is to s t r e n g t h e n the s h o u l d e r a n d a r m m u s c l e s p a r t i c u l a r l y tr i c e p s . I n a d d i t i o n to th es e, all p a t i e n t s , w h a t e v e r t h e i r d e g r e e o f d i s a b le m e n t , r e c e i v e a g e n e r a l t r a i n i n g fo r t h e i r n o r m a l m u s cl es . A l a r g e n u m b e r o f c o r r e c t i v e w a l k i n g e x e r c i s e s a r e t a u g h t, e s p e c i a l l y to th o s e l o n g s t a n d i n g c a s e s w h o h a v e n o w r e c o v e r e d , bu t t h r o u g h f o r c e o f ha bi t, c o n t i n u e to w a l k in a n u n g a i n l y fa s h i o n . E L E C T R I C A L T R E A T M E N T E l e c t r i c a l t r e a t m e n t is u s e d e x t e n s i v e l y in D e n ­ m a r k in th e t r e a t m e n t o f p o li o m y e l it is . T h e a p p a r a t u s u s e d is k n o w n as a M y o t e n s o r a n d w a s d e s i g n e d b y D r . C l e m m e s o n in c o l l a b o r a t i o n w i t h t w o D a n i s h e n g i n e e r s . T h i s a p p a r a t u s ha s c e r t a i n te c h n ic a l a d v a n ­ t a g e s o v e r b o th g a l v a n i c a n d f a r a d i c a p p a r a t u s e s . [ M i s s E e g t h e n g a v e a f e w c o m p a r a t i v e d e t a i ls in s u p p o r t o f this c o n t e n t i o n . ] In man}- c a s e s w h i c h h ad p r e v i o u s l y s h o w n no r e s p o n s e to g a l v a n i c s t i m u la t io n , a s t r o n g a n d p a in le s s c o n t r a c t i o n w a s p r o d u c e d w i t h th e M y o t e n s o r . T h i s is o f g r e a t v a l u e in th e t r e a t m e n t o f c h il d r e n . I n c a s e s w i t h o n l y s l i g h t p a r e s i s , a l a r g e n u m b e r o f th e m o t o r u n i ts p o s s e s s an u n i m p a i r e d i n n e r v a t i o n a n d r e q u i r e 110 e l e c t r i c a l s t i m u l a t i o n e x c e p t p o s s i b l y f o r th e c i r ­ c u l a t o r y e ff e c t pr o du ce d . I n s e v e r e c a s e s , e le c t r i c a l s t i m u l a t i o n o f f e r s the a d v a n t a g e t h a t it p e r m i t s the i s o l a t e d t r a i n i n g o f a f f e c t e d m u s c l e s d u r i n g th e p e r i o d w h e n t h e i r a c t i v e ' i n n e r v a t i o n is still s l u g g i s h . W h e n s u c h s t i m u la t io n is g i v e n r e g u l a r l y , th e p a t i e n t wi ll — to s o m e e x t e n t — r e t a i n th e s e n s a t i o n o f c o n t r a c t i o n a n d it is e a s i e r f o r hi m to “ find the i n n e r v a t i o n ” w h e n m u s c l e p o w e r r e t u r n s . A c e r t a i n a m o u n t o f t r a i n i n g o f p a r t i a l l y p a r e t i c o r w e a k m u s c l e s is e f f e c t e d in c h i l d r e n a n d in p a t i e n t s w h o a r e n o t s u f f i c i e n t l y e n e r g e t i c o r l a c k c o - o r d i n a t i o n . H Y D R O T H E R A P Y I n u s i n g h y d r o t h e r a p y , th e w a t e r s h o u l d b e s l i g h t l y b e l o w b o d y t e m p e r a t u r e th u s a v o i d i n g e x h a u s t i v e s y m p t o m s . H y d r o t h e r a p y is u s e d f o r t w o p u r p o s e s :— ( 1 ) T o d e v e lo p m u s c l e s t r e n g t h b y e x e r c i s i n g — in th e H u b b a r d ta n k . (2) T o i n c r e a s e the c i r c u l a t i o n b e f o r e t r e a t m e n t — w i t h th e aid o f h o t s h o w e r s a n d lo c a l b at hs . C a r e is t a k e n no t to w a s t e t i m e o r o c c u p y th e b a t h s u n n e c e s s a r i l y b y e x e r c i s i n g m u s c l e s w h i c h a r e s t r o n g en o u g h to w o r k w i t h o u t th e s u p p o r t o f w a t e r . S e r i o u s l y a f f e c t e d m u s c l e s a r e i n v a r i a b l y t e s t e d f o r v o l u n t a r y r e s p o n s e in the t a n k a s t h e y o f t e n r e v e a l a r e s p o n s e in w a t e r w h i c h h a s n o t p r e v i o u s l y b e e n a p p a r e n t . M a s s a g e is g i v e n o n l y to th e w e a k e s t m u s c l e s f o r its s t i m u l a t i n g e f f e c t a n d to i m p r o v e th e c ir c u l a ti o n . O n l y a g e n t l e p e t r i s s a g e is used, c a r e b e i n g t a k e n not to s t r e t c h o r i n j u r e th e w e a k ti s su es . M A N I P U L A T I O N T h i s f o r m ’ o f t r e a t m e n t w a s in c lu d e d in o u r s c h e m e in 1947. B e n e f i c i a l r e s u l t s w e r e o b t a i n e d in th e m a n i ­ p u la ti o n o f a n k l e a n d fo o t jo i n t s . T h e s e w e r e th e o n l y j o i n t s in w h i c h m a n i p u l a t i o n w a s a t t e m p t e d . S P A S M A N D C O N T R A C T U R E S t I n D e n m a r k , s p a s m is s e ld o m a s a p p a r e n t a s it is in th is c o u n t r y o r in A m e r i c a . W h e n a p a t i e n t is r e p o r t e d a s e x h i b i t i n g this s y m p t o m , th e h o s p it a l c o n ­ c e r n e d , w h e r e v e r in D e n m a r k it m a y be, c al ls f o r a 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. ) Page Ten P H Y S I O T H E R A P Y March, 1949 p h y s i o t h e r a p i s t f r o m the F o u n d a t i o n . S h e h a s b e e n t r a i n e d in th e K e n n y m e t h o d o f a p p l y i n g h o t p a c k s to p a t i e n t s in th e a c u t e s t a g e , a n d h e r j o b is to i n s t r u c t the n u r s e s in this m e t h o d . A s w e h a v e so little e x p e r i e n c e w i t h th is t y p e o f c a s e , I a m u n a b l e to g i v e y o u a n y f u r t h e r i n f o r m a t i o n o n this su b je ct . W i t h c o n t r a c t u r e s , h o w e v e r , th e p o s it io n is qu ite d i f f e r e n t . W i t h th e e x c e p t i o n o f the m o r e r e c e n t c as e s w h o h a v e h a d th e a d v a n t a g e o f c o r r e c t n u r s i n g and t r e a t m e n t , n e a r l y all th e c a s e s w e h a v e r e c e i v e d h a v e h a d a t l e a s t o n e 'c o n t r a c t u r e . T h e s e c a s e s a r e g i v e n r e p e a t e d c o n t r a c t u r e s t r e t c h i n g s d u r i n g the c o u r s e o f t h e i r t r e a t m e n t , r e g a r d l e s s o f the s t r e n g t h o f the c o n t r a c t e d m u s c l e s , b e c a u s e w e h a v e l e a r n t fr o m e x p e r i e n c e t h a t a g r e a t e r d e g r e e o f m u s c l e s t r e n g t h c a n be a t t a i n e d in w e a k c o n t r a c t e d m u s c l e s w h ic h h a v e b e e n s t r e t c h e d t h a n w o u l d o t h e r w i s e b e the case . I w o u ld li k e to fi ni s h th is t a lk b y e x p r e s s i n g the ho pe t h a t a f o u n d a t i o n w i ll b e f o r m e d in S o u t h A f r i c a , no t f o r r e s e a r c h o n ly , bu t f o r t r e a t m e n t . I n D e n m a r k , all c a s e s r e c e i v e f r e e t h e s p e c i a l i s e d t r e a t m e n t w h ic h t h e i r c o n d i ti o n m e r i t s . N e w c a s e s a r e t a k e n in han d i m m e d i a t e l y a n d c o n t a c t is m a i n t a i n e d w i t h c h r o n ic c a s e s . L o c a l d o c t o r s a n d p h y s i o t h e r a p i s t s a s s i s t b y s e n d i n g t h e s e l a t t e r t w i c e y e a r l y to th e I n s t i t u t e for c o n s u lt a t i o n . I n c a s e o f i n d ig e n c e , th e b e n e f i t s o c i e t y — to w h i c h it is c o m p u l s o r y f o r a l l D a n e s to b e lo n g — c o - o p e r a t e s w i t h th e F o u n d a t i o n to p a y e x p e n s e s . T h e F o u n d a t i o n h a s e s t a b l i s h e d t h r e e s p e c i a l l y t r a i n e d d o c t o r s in w i d e l y s e p a r a t e c e n t r e s . T h e s e act as a d v i s e r s in all m a t t e r s p e r t a i n i n g to po li o m y e l it is . A t r e g u l a r i n t e r v a l s , c o u r s e s o f i n s t r u c t i o n a r e held f o r d o c to rs , n u r s e s an d p h y s i o t h e r a p i s t s . O n e final p o in t w h i c h I w o u l d li k e to m a k e c o n c e r n s o u r I n s t i t u t e f o r R e s e a r c h a n d T h e r a p y . A s w e dea l w i t h o n e c o n d i ti o n o n ly , a v a s t a m o u n t o f r e s e a r c h is do n e on the p a t h o l o g y an d t r e a t m e n t o f polio my el it is. | T h e t h e r a p y s t a f f a c q u i r e s a c o n f i d e n c e in t h e i r k n o w ­ le d g e an d t r e a t m e n t o f th is c o n d i ti o n w h i c h is r e ­ fl e c t e d in th e e x c e l l e n t r e s u l t s w h i c h a r e o b ta i n e d . M P j T h i s is th e n e w m o d e l f o r u l t r a ­ v i o l e t r a y t h e r a p y ( g e n e r a l b o d y i r r a d i a t i o n ) . I t i n c o r p o r a t e s so m a n y po i n t s o f te c h n i c a l an d m e c h a n i c a l e x c e l l e n c e t h a t it al m o s t c a ll s to be d e p ic t e d in th e t r a n s ­ a t l a n t i c o r S t . S e b a s t i a n m a n n e r — w i t h a r r o w s d i r e c t e d to all the v it a l sp o ts . A s a p r a c t i t i o n e r , h o w e v e r , y o u w i l l be m o r e i n t e r e s t e d in w h a t y o u c ou ld a c c o m p l i s h w i t h th e la m p . f o r y o u r p a ti e n t s . W i t h th is A l p i n e S u n y o u w o u l d be e q u i p p e d to h a v e “ the m o s t v i t a l i z i n g o f all m e a s u r e s ” a d m i n i s t e r e d u n d e r y o u r S w n d i r e c t io n a n d s u p e r v i s i o n . Y o u w o u l d b e ab le to build r e s i s t i v i t y a n d d e v e lo p r e a c t i v e c a p a c i t y , a s s i s t i n g o t h e r f o r m s o f t r e a t m e n t . A n d y o u w o u l d b e a p p l y i n g this p r o t e a n t h e r a p y in th e m o s t e f f e c ­ ti v e a n d e c o n o m i c a l m a n n e r po ssi b le, fo r w h i l s t th e c o s t o f th is unit is m o d e r a t e , no b e t t e r lam p c an be b o u g h t at a n y price. J u s t w r i t e fo r o u r le a fl et M i 59 ( o r po s t this c o u p o n ) . HAW O VM A L T D . SLOUGH, ENGLAND The Specialists in A ctinotherapy Equ ip m en t Represented throughout Southern Africa by T H E BRITISH G E N E R A L ELECTRIC C O ., LTD. “ M A G N E T H O U S E ” C/o Loveday & Anderson S ts., J O H A N N E S B U R G B ra nc hes : C A P E T O W N , D U R B A N , P O R T E L I Z A B E T H , S A L I S B U R Y , B U L A W A Y O T o : T h e B ritish G en eral E le c tric C o . Ltd ., P .O . Box 2406, Johannesburg Please send me Leaflet describing No. 159 “ T H E A L P I N E SUN LAMP ” Name.................................................................................. "....................................................... Address...........................................................................................................................M I5 9 /6 I 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. )