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Page 19 text:
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it necessary to supplement defects in the education of its medical officers by the introduction of specialized post-graduate training in physical medicine. The number of patients referred for physical therapy in Army hospitals ranges from 20 to 30 per cent of all admissions. Indeed, it now appears that the physical rehabilitation of psychiatric casualties and the high incidence in the present war of fractures, amputations and peripheral nerve injuries, will be the most serious medical and social problem of its kind the world has ever known. The lives of many men injured in military service are now being saved by the prompt use of whole blood and its substitutes, the sulfonamide drugs and penicillin, and by new methods of rapidly transporting the wounded to med ical centers remote from the field of military operations. Many men with comparable injuries were lost in the last war. Among those saved, then, will be a larger percentage of the seriously disabled in need of prolonged treatment by the procedures utilized in the practice of physical medicine. Thus, this formerly obscure and poorly developed branch of medical practice assumes such critical importance as to make it worthy of serious consideration by all medical students laying plans for their professional future. The trend of the times appears to place more and more directly under medical control all aspects of the process of returning the physically injured and psychically disturbed to a useful civilian life. The term rehabilitation has become one of the medico-sociologic catch phrases of the war epoch. Its potentialities for good have fired the imagination of large numbers of lay and professional people. It now appears that the rehabilitation procedures growing out of current military hospital experience will in all probability become an integral part of postwar civilian health service, with greater emphasis than before on the general restoration of psychosomatic function. Every medical student knows that the successful setting of a fracture does not insure the prompt and spontaneous return of the part to full function. Many lesions which heal in weeks may seriously incapacitate a man for many months because of secondary, often preventable, (Please turn to page 12) These patients are engaged in a checker game as a requirement in the achievement program For arm prosthetic patients. The checkers are graded in size and weight to give practice in grasping various sized objects. Photo courtesy U.S. Army Signal Corps. hirlpool at St. Philip Hospital being used to hasten the recovery of an injured worker
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Page 18 text:
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Captain Paul Todera of New York City learns to walk by means of an artificial limb with the help of Apprentice Physiotherapy Aide Catherine Putman of Urbana, III., at Army and Navy General Hospital, Hot Springs, Ark. Photo courtesy U. S. Army Signal Corps Pvt. John Thorburn, Jr., of Jamaica Plain, Mass., wounded twice at Mateur, Tunisia, strengthening his back and shoulder muscles by sanding a table top at Lovell General Hospital, Fort Devens, Mass. Miss Peggy Lind, right, occupational therapy student, from the Boston School of Occupational Therapy, serves as instructor with Miss Marie P. Murphy, Occupational Therapy Aide, supervising the work. Photo courtesy U. S. Army Signal Corps cr r- J Vew fye ' c wective in fUkuHcai yl leJLuiue The two world conflicts of the twentieth century have demonstrated the effectiveness of physical forms of therapy in the immediate care of the injured and have revealed unsuspected vistas of their application to the ultimate prob- lems of rehabilitation. Although the use of physical agents in the treatment of disease dates back to antiquity, it was their help in the salvage of those disabled in the World War of 1914-18 which first aroused widespread in- terest on the part of the medical profession. Unfortunately, skepticism, prejudice, lack of a sustained program of scientific research, coupled with the failure to introduce physical therapy into the medical school curriculum on a high academic plane, inhibited the impetus to growth stimulated by the war. Now a quarter century later, American medicine finds itself inade- quately prepared to meet the urgent physical reconstruction problems suddenly presented by another world conflict. Organized physical medicine is making heroic efforts to meet the current situation and to plan more intelligently for the future. While it has been estimated that (in the normal civilian practice of medicine) from 5 to 10 per cent of all patients hospitalized require some form of physical treatment, the needs of war medicine in this respect are infinitely greater. No sooner had large numbers of selectees been subjected to military training, than it became evident that there was an acute shortage of the type of medical and technical personnel necessary to care adequately for their needs. It was apparent early that a vigorous educational program would hav to be introduced in order to meet the vastly increased demand for physical therapy which would accompany actual participation in hostili- ties. Thus, both the Army and the Navy found (14)
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Page 20 text:
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Electrical stimulation in the treatment of peri pheral nerve injuries 4 St. Dr. Fischer and Miss Ramse studying the effect of electrical stimulation on various properties of denervated mammalian muscle J-ke z ntY)ottance oj: (J- e eatck ui llskuucal 1 LeJLicine No remedial agent merits the confidence of the physician unless it fulfills the following conditions: (a) ready accessibility, (b) a rationale ascertained by experiments on a physiological basis, (c) facility of dosage, (d) reliable clinical observations. Thus wrote Dr. Simon Baruch in his Epitome of Hydrotherapy published in 1920 shortly before his death. The larger portion of his professional career was devoted to untiring efforts to demonstrate that hydro- therapy fulfills these four conditions. From his earliest writings on, he emphasized the importance of establishing the rationale for this branch of physical therapy. The first quarter of his first book, The Use of Water in Modern Medicine published in 1892, deals exclusively with the physiological changes brought about by the various applications of water, while the clinical :hapters contain a wealth of sound observations accompanied by attempts at a statistical evalua- tion of the results obtained. Simon Baruch ' s well known Text Book of Hydrotherapy, first published in 1898 and translated into French and German, also stressed the importance of an understanding of the basic physiological reaction produced by water and the need for critical evaluation of all clinical observations. Baruch was well aware that if the medical profession failed to grasp the value of hydrotherapy and to study its biological foundation, The quack and semi-quack, who haunts the flanks of the medical army, as the guerilla does that of a nation would pick up these methods and drive the physician from the field. Unfortunately, Simon Baruch ' s advice was too often disregarded. The regrettable result was that the average physician did not realize that sound physical therapy requires, as does sound drug therapy, a thorough knowledge of the basic effects of the various remedial agents used and of the relation between dosage and effect. Because of these omissions, physical therapy became one of the least respected specialties of medicine. As so often happens a vicious cycle developed. Relatively few good physicians were attracted to physical medicine in the last decades. In consequence, our knowledge of the basic process involved in the curative effect of physical agents advanced much less than our physiological and therapeutic knowledge in general. Students often get the mistaken impression that physical therapy is based solely on
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