Ionotherapy

IONOTHERAPY, iontophoresis (ionogalvanization), a method of introducing medicinal substances into the body through intact skin or mucous membranes by means of direct current. When salts, acids, or bases are dissolved in water, according to the ionic theory of Arrhenius, a portion of the dissolved molecules dissociate into two parts called ions, one charged with positive electricity, the other with negative; such a solution is a conductor of electricity and is called an electrolyte. When a galvanic current passes through an electrolytic solution, ions with a positive charge begin to move toward the negative pole; ions with a negative charge begin to move toward the positive pole. This movement of ions under the influence of a direct current forms the basis of the method called ionotherapy, iono-electrotherapy by French authors, iontophoresis by German authors, and ionogalvanization, galvanoionotherapy by Russian authors. In its development, the method passed through several stages and was called 'cataphoresis,' 'anaphoresis'; however, these names characterized only the physical phenomenon of the movement of some ions to the cathode and others to the anode; whereas the names 'electrophoresis,' 'iontophoresis' generally indicated their ability to move under the influence of current. The scientific development of the method was mainly carried out by Leduc, and his experiment with rabbit poisoning serves as the best demonstration of the method. To the shaved sides of two rabbits I and II (see figure), electrodes with sponge pads soaked in solutions were applied: pads A and D with a solution of nitrate of strychnine, pads B and C with a solution of common salt; the electrodes with pads on the sides of the rabbits facing each other were connected by a wire; thus both animals with electrodes form a continuous circuit. If a current is passed through this circuit in the direction from A to D, i.e., making A the positive and D the negative pole, the result of the current's action will be poisoning of rabbit I. This phenomenon is explained by the entry into its body of strychnine ions, which are positively charged and therefore move toward the negative pole along the pad to rabbit I and then into its body, where the poisonous properties of the ions were discovered.

Shatsky, through his experiments, proved that ions, encountering a moving fluid on their path, can be captured by it and carried away from their original direction by the current of this fluid. Thus, the strychnine ions that entered Leduc's rabbit's body in the experiment were captured by the blood current and with it quickly reached the nervous system. The experiment cited fully proves the possibility of introducing medicinal ions into a living organism with the help of direct current through intact skin.

Mechanism of ion movement during ionization: advancing under the influence of current through the electrode moist pad, medicinal ions after a certain period of time (different for each type of ion) reach the skin of the animal or human; here they encounter enormous resistance from the surface horny layer of the epidermis and mainly use openings in the skin-ostia of the excretory ducts of the skin glands-through which they penetrate into the glands and through their walls into the surrounding tissue. Spreading through the latter, they reach the capillaries of the vascular and lymphatic networks and are carried into the general blood flow by the movement of fluid, and therefore relatively shortly after the beginning of the ionization session it is possible to detect the introduced ions in saliva, urine (e.g. iodine ions, salicyl radical). Part of the ions remains in the area of their introduction and saturates the skin tissues, and in some cases also the tissue of deeper organs. The above applies to ions that do not have cauterizing properties, i.e. to ions J, Cl, salicyl radical, quinine, etc. Ions of heavy metals that form insoluble compounds with tissue proteins remain for the most part in the tissue layers near the site of introduction and penetrate into the general blood flow only after very prolonged and intensive sessions or even a series of sessions. Research by Ench, Anikin, Kharkovich and others has shown that ions circulating in the body during the application of galvanic current can be removed from the bloodstream into the surrounding tissue by the force of the current and even from the body itself-consequently galvanic current can be used for detoxification purposes. Ionization now denotes not only the introduction of ions but also the introduction with the help of galvanic current of more complex particles-colloids, antibodies, vitamins. Ionization is a combined method of treatment: its action consists of the action of galvanic current and the action of medicinal ions introduced into the tissues through its mediation. One should assume an exchange of own ions between tissue cells under the influence of galvanic current in the interpolar space, the movement of these ions and changes in their arrangement at cellular partitions; possibly, movements of colloidal particles also occur, and the tissues thus experience a specific irritation; as a result of the passage of current through tissues, local blood circulation changes-active hyperemia, acceleration of blood flow, improvement of tissue nutrition. Experimentally it has been noted that foreign particles (ions) circulating in the bloodstream accumulate more in areas of tissues experiencing some irritation-heat, electric current, etc., and thus one should assume that the amount of medicinal ions will be greater in the layers of tissues subjected to irritation from the passage of electricity. These considerations cannot be ignored when explaining the special effective action of the method in a number of diseases when ordinary galvanization did not give success. Technique. The rules for applying electrodes existing for producing galvanization must be fully observed here. Solutions for moistening electrode pads should be prepared on distilled water; contamination of them even with a negligible amount of foreign substances can lead to the appearance of 'parasitic' ions undesirable for introduction into the body. Before the session it is recommended to wash the pads thoroughly also in distilled water. Proper arrangement of solutions on the electrodes connected to the corresponding poles of the current source has primary importance, since from the solution of the same salt one can introduce either the positive or negative ion (completely different in their action), depending on which of the poles the pad moistened with the solution is placed on. It should be placed on the pole with the same name as the charge of the ion being introduced, following the following scheme. Hence the following rule: from the anode are introduced acid ions, metals, organic cations, alkaloids; from the cathode-alkalis, inorganic acid radicals, organic anions (salicyl, ichthyol, chrysarobin).-The concentration of solutions used for ionization varies according to different authors. Caustic substances are usually used in a concentration of 4-5‰. The most commonly used solutions are the following: 1%-KJ, Natr. salicyl., CaCl₂; LiCl₂, NaCl; 0.001 - 0.005% - Aconitin. nitric.-Current dose. The greater the amount of current per unit time passes through the solution, the more ions are released from it at the poles and probably the greater their quantity can be introduced into the body; on the other hand, one must take into account the maximum sensitivity or tolerance of the skin of the subject being electrified. Usually the current density rarely exceeds 0.5 mA per 1 cm².-Current sources for ionization are the same as for galvanization-preferably a galvanic or even better an accumulator battery. Electrodes are preferably made of thin rolled tin-0.1-0.3 mm; lead or copper electrodes should not be used, as lead and copper ions may detach from them and enter the body. In some cases for ionization, baths (porcelain, glass) filled with medicinal solution with carbon electrodes immersed in them can be used. Baths are used for the effect of current on large areas of skin of the limbs or for general saturation of the body with medicinal ions.-The arrangement of electrodes in local ionization in relation to the pathological focus has a certain significance: one should strive for the focus to be as much as possible on the path of transverse passage of current from one electrode to another.-Ionization sessions are done either daily or in the first week daily, later every other day; after 20-30 sessions a break of 10-15 days is necessary. In some cases during the break the therapeutic effect increases. The mass experience of using ionization speaks in favor of such a treatment method. Indications for ionization: the more superficially the pathological process is located, the more easily and energetically galvanic current and the medicinal ion introduced by current act on it. The method gives the best effect in a number of skin diseases, diseases of mucous membranes, surgical cases with open defects, in neuralgias of deeply lying nerves, in diseases of joints, tendons and bones not protected by thick layers of tissue, and in lesions of accessible organ cavities-vagina, uterus, bladder, rectum, auditory canal, nasopharynx. Indications for the use of certain ions do not differ from the general pharmacological indications for each of them: iodine ions as having a resorptive effect; zinc ions-disinfectant, astringent; lithium ions-antigout; salicyl-antirheumatic, analgesic, etc.-General ionization is indicated in gout (lithium ions), diseases of the cardiovascular system (calcium ions), arteriosclerosis (iodine ions); it is performed either through baths for the limbs filled with a solution of the medicinal substance, or by applying wide electrodes to the limbs and trunk. The maximum tolerable current dose by the patient, the largest electrode area and a prolonged session up to 30-40 minutes-guarantee the greatest saturation of the body with medicinal ions.-Local ionization: the use of iodine ions [NaJ, KJ (1% solution)] is indicated in the pathological development of connective tissue: scars, postoperative, post-inflammatory connective tissue strands, keloids, scars after burns. In lesions of joints, bursae, tendons of a rheumatic nature, ionization with salicyl ions has an analgesic effect; in the development of fibrous tissue in the joint area (as a consequence of the inflammatory process), iodine ionization often provides great benefit. Wounds, ulcers, furuncles, abscesses, fistulas, cracks heal more successfully under the influence of zinc ions (1% solution ZnCl₂, ZnSO₄), sterilizing the deeper tissue layers. It should be remembered that when introducing large amounts of heavy metal ions, toxic albuminuria may appear. A number of diseases of the central nervous system are indications for the use of ionization: arteriosclerosis of the central nervous system-for general and local iodine ionization; cortical epilepsy of scar etiology-for local iodine ionization; cerebral diseases-for transcerebral iodine ionization or ionization with calcium according to Bourguignon through the orbits; lesions of syphilitic etiology-for iodine ionization, etc.

Diseases of the peripheral nervous system: facial neuritis for iodine-ionogalvanization of the entire half of the face and simultaneously the auditory canal, filled with a tampon soaked in a solution of iodide salt; neuralgia of the trigeminal nerve—depending on etiological factors—ions of quinine, salicylic, aconitine (the electrode is moistened with solutions—Bergonie's half-mask); intercostal neuralgia (if spinal disease or tumor is excluded)—ions of iodine, quinine, lithium, salicylic, depending on etiology; sciatic neuralgia—the same. Women's diseases: in various chronic processes in the pelvic region, accompanied by the development of connective tissue strands, iodine ions are indicated through intravaginal application of ionogalvanization; in gonococcal endometritis, cervicitis, Friel recommends zinc ions with a special zinc electrode. Skin diseases: lupus erythematodes is susceptible to the action of Chinini bimuriatici ions 1-5%; sycosis non parasitaria—zinc ions; multiple warts—zinc ions, copper ions, magnesium sulfate; the latter—as a 3-percent solution from the anode, 2 sessions with a weekly interval, 5-8 mA—15 min. Ionogalvanization with zinc is successfully used in furunculosis, acne. Various forms of toxic pruritus can be treated with ionization of sodium salicylate or aconitine nitrate (0.001:100.0 water).—Finally, ionogalvanization has been proposed for diagnostic purposes for all kinds of skin tests, but its value in this area has not yet been sufficiently clarified.