Physical Therapists

U. S. doctors are educated to treat disease chiefly by means of drugs and surgery. Nonetheless, they habitually use such homely adjuncts as hot and cold applications, baths and massage. In recent years some doctors analyzed the therapeutic effect of such physical agents, tried their hands at others. As a result a new specialty of physical medicine gradually developed. Called physical therapists, such doctors treat disease by heat, massage, baths, exercise, rest, work, radiation and electricity. The specialty is still not sharply defined. On one hand physical therapists must combat the tendency of other doctors to treat them as if they were simply operators of medical machines. On the other hand physical therapists must combat the bumptiousness of their technicians who actually operate the machines and call themselves physiotherapists. This confusion is gradually resolving itself. Technicians distinguish themselves as members of the American Physiotherapy Association which met in Los Angeles ten weeks ago (TIME, July 13), and the American Registry of Physical Therapy Technicians. Doctors belong to the American Congress of Physical Therapy which met in Manhattan last week. There they described the following procedures and results of their art:

Operation Gauge. To tell whether a patient is apt to die of shock as result of an operation, take his pulse and blood pressure while he lies down and again while he stands up, advised Dr. Charles Ward Crampton of Manhattan. The figures indicate the patient's vasotone efficiency according to a chart which Dr. Crampton showed the physical therapists, declaring:

"If the vasotone is poor to a certain point, the patient certainly will die during or after the operation, no matter how good the surgeon or the surgery.

"To cope with this, where there are low readings, the operation is postponed until by rest and the use of digitalis the patient's vasotone is raised beyond the danger point. When the readings are low, but immediate surgery is imperative the surgeon must expect trouble, employ speed, spare trauma and select the less severe operative procedure, such as draining an organ rather than removing it."

Perilous Showers. Dr. Hans Jacob Behrend of Manhattan considers cold showers perilous. Said he: "Those in robust health and with good circulation can overcome the strain engendered by the cold shower. But those less fortunate, particularly weak, anemic and older people, may suffer serious damages as a result of it. Colds, feebleness and fatigue are some of the harmful effects of the cold shower habit. . . . I would not advise any one to take a cold shower."

Best time to bathe, according to Dr. Behrend, is just before going to bed.

Shrinking Drinks. To demonstrate how rapidly capillaries react to heat and cold. Dr. Fred Bennett Moor of Los Angeles had a fellow doctor take a drink of ice water while holding his arm immersed in a tank of water. Soon as the cold drink made itself felt in the demonstrator's stomach, water level in the tank fell measurably, thus indicating that the cooled stomach drew blood from the capillaries of the arm. Consequently the capillaries shrank, and the bulk of the arm with them. These changes must have some effect on heart and lungs, argued Dr. Moor, urging doctors to search for such changes.

Bubble Massage. The main curative agent in natural springs is the carbon dioxide which bubbles through the waters, said Dr. Franz Maximilian Groedel, one-time director of the Kerckhoff Institute, Bad Nauheim, Germany, now adviser to the vast bathing establishment at Saratoga Springs, N. Y. (TIME, Aug. 5, 1935). The gas bubbles, he explained, burst against the skin, massaging certain nerves. The stimulated nerves dilate blood vessels. Some of the gas is absorbed into the tissues and acts on the superficial capillaries causing them to fill. The skin reddens and the increased flow of blood benefits because it relieves the internal organs of congestion. The baths aid a patient within eight minutes but the effect continues for two hours. The respiratory centre is stimulated and increased breathing enables the lungs to ventilate faster, which is of prime importance in heart failure.

Facial Neuralgia ranks close to angina pectoris as a racking pain. Cause of such neuralgia has never been ascertained. Usually some obscure infection is suspected. The pain may last for years, or it may return from time to time. Drugs only allay the pain, never cure it. Some surgeons stop the neuralgia by cutting the offending nerve, thus preventing it from carrying its message of pain to the brain. This operation occasionally paralyzes the painful side of the face, causes the features to droop lopsidedly. Other surgeons treat facial neuralgia by injecting alcohol into the nerve, thus stultifying it for a period. This procedure is difficult. The operator must push his hypodermic needle through the cheek and into a small notch in the skull midway between cheek bone and ear. Then he must blindly puncture a nerve slimmer than the lead of a pencil. If he misses the nerve, the alcohol causes dreadful pain. Many victims prefer the neuralgia.

Last week Dr. Benjamin Ulanski of Philadelphia told the American Congress of Physical Therapy that a certain kind of high-frequency current gave "instant relief" to most of his neuralgia patients. Said he: ". . . We have been so impressed with the almost instant relief and the uniformity of results obtained that we feel this method of treatment warrants a preliminary report to stimulate further investigation. However, we are unable, at the present time, to state on what scientific basis this treatment rests. Several physiological processes have come to mind, and it is our purpose to pursue this subject further with the hope that we may be able to demonstrate its modus operandi."

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