The Value of Physical Treatment

The following Letter to the Editor, published in The Lancet in 1918 provides an extraordinary review of the growth of physiotherapy from the First World War.

SIR,—The Prime Minister in his speech on Nov. 16th, in placing the case for the Coalition at the Central Hall, Westminster, said: ” The health of the people must especially be the concern of the State. This is one of the war’s revelations.” Might I be allowed to express in your columns my views regarding the adoption of physical treatment in a State scheme of medical service?

During the past four years physical treatment in all its branches has made great progress ; it has been universally adopted, and the War Office in 1915 recognised the important role it plays in the treatment of men who are suffering from the many after-effects of disabilities contracted in the war. Dr. Fortescue Fox and others have, through the Royal Society of Medicine and other channels, left no stone unturned in their endeavour to inform the profession what could be done in this country and what was being done in other countries. Its adoption has been to a very large extent in conjunction with orthopaedic treatment, and most of the institutions where these cases are treated possess complete physical treatment installations. Cases pass from the surgical or medical sides of a hospital to the after treatment or physical treatment department, and remain there until no further improvement can be attained.

I should like to enumerate a few of the conditions which can be successfully dealt with by these methods – viz., hydrology, electricity, massage, exercise (active and passive).

1. Debility from any cause, e.g., pneumonia, typhoid, dysentery, all post-operative conditions, e.g., appendicitis, hernia, &c.
2. Rheumatism, including myositis, myalgia, fibrositis, rheumatoid arthritis, osteo-arthritis, both in the earlier stages.
3. Neuritis, including neuralgias or all kinds, particularly headaches, which are often of rheumatic origin due to fibrositis of the cervical muscles.
4. Nervous conditions, including neurasthenia, loss of nerve tone, general tremors and insomnia associated at the present time with the overstrain of war and shell shock.
5. Heart conditions, particularly arrhythmia, tachycardia, bradycardia, loss of myocardial tone ; dilatation whether associated with valvular disease or not.
6. Post-operative conditions, such as adhesions following abdominal operations, contracted scars producing deformity by the trapping of nerves or tendons.
7. Fractures with only fibrous union; in other words, deficiency of callus.
8. Paralysis and paresis of any nerve, more particularly facial, ulnar, median, musculo-spiral, sciatic and branches.
9. Synovitis and fibrous ankylosis of large or small joints where breaking down of tissue and re-education of movement are necessary.
10. Circulatory conditions, such as trench feet, post frostbite, and erythromelalgia.

There are many other conditions which might be mentioned where physical treatment is indicated. It is the accurate and direct therapeutic application of exercise in its many forms which is absolutely necessary to ensure a scientific and well-balanced method of procedure. Most of the men in our Army have been brought under discipline for the first time in their lives, and training in speed, alertness, agility, the strengthening of flabby and weak muscles, all combine to give them a feeling of well-being, confidence, and fitness to which they have been strangers.

Professor Tait McKenzie, of Pennsylvania University, who has served as a Major in our Royal Army Medical Corps, in taking part, on his return to America, in a discussion on a paper concerning the Reconstruction and Rehabilitation of the Disabled Soldiers, says :-

“In the inspection of training camps (in the early days of the war), which ran from 30,000 to 80,000 men, it was my duty to travel from one to the other, and we repeatedly found a number of men who were unable to take full training. Now these were paraded, and in the course of examination we found that many of them were suffering from conditions that could be cured by proper treatment, sometimes by operation, but more frequently by some form of physical therapy that would bring them back to military usefulness. The number of these was very considerable.”

During the past two and a half years 10,000 officers and men have been treated by physical therapy in the department of which the writer has charge. Of this number 45 per cent. have finally been passed fit. These statistics show what physical treatment can accomplish in restoring the unfit to a state of fitness or, failing that, to the maximum point of utility. I trust that the authorities who formulate the scheme of State medical service will bear in mind the important role played by this form of treatment. It will certainly replace many bottles of medicine and benefit the patient by Nature’s remedies. But I would emphasise that the application of physical therapeutics to pathological conditions must depend for its success upon careful selection and accuracy of the dose employed, and also on persistence in following a course of treatment. It is the neglect of these considerations which is responsible for most of the failures in their application. The physician often fails to appreciate the range and effectiveness of the most powerful and versatile system of therapeutics which is always at his command.

I should like to say that there is a very grave danger of this form of treatment falling into unqualified hands, and I beg to suggest that the Government should take steps to prevent quacks and charlatans from gulling the public by unprofessional advice and unskilled treatment. At present there is no law to prevent these individuals from opening elaborate treatment rooms and advertising, and thereby gaining distinct and unfair advantage over the qualified practitioner.

I am, Sir, yours faithfully,
FRANK RADCLIFFE,
M.O. I/c Treatment
Western Command Depot, Heaton Park, Manchester

References

Radcliffe, F. (1918). The value of physical Treatment. The Lancet, 192(4973), 860.

Posted by Glenn Ruscoe

Glenn is a Specialist Musculoskeletal Physiotherapist working in private practice in Perth, Australia. A strong advocate for the profession, Glenn has been heavily involved in leadership of professional associations and regulatory boards. Currently he is Managing Director of the Registry Operator of the .physio domain top level extension.

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