From

the collection of the

zj

nTTr"^

o

Prelinger av

JLJibrary

San Francisco, California 2006

By

the

same author

A MANUAL OF PHYSICAL THERAPY12mo, 309 pages, with 118 engravings

LEA

&

FEBIGER

PHILADELPHIA

a

O

E o

ELECTROTHERAPYAND

LIGHT THERAPYWITH THE ESSENTIALS OF HYDROTHERAPY AND MECHANOTHERAPY

BY

RICHARD KOVACS,

M.D.

PROFESSOR OF PHYSICAL THERAPY, NEW YORK POLYCLINIC MEDICAL SCHOOL AND HOSPITAL ATTENDING PHYSICAL THERAPIST, MANHATTAN STATE, HARLEM VALLEY STATE, COLUMBUS, AND WEST SIDE HOSPITALS; VISITING PHYSICAL THERAPIST, NEW YORK CITY DEPARTMENT OF CORRECTION HOSPITALS; CONSULTING PHYSICAL THERAPIST, NEW YORK INFIRMARY FOR WOMEN AND CHILDREN, MARY IMMACULATE HOSPITAL, JAMAICA, N. Y., HACKEN8ACK HOSPITAL, HACKEN8ACK, N. J., ST. CHARLES HOSPITAL, PORT JEFFERSON, L. I. ALEXIAN BROTHERS HOSPITAL,ELIZABETH, N.J.

Fifth Edition, Thoroughly RevisedIllustrated with

352 Engravings and a Color Plate

LEA & FEBIGERPHILADELPHIA

COPYRIGHT

LEA & FEBIGER1945

Reprinted

OCTOBER, 1946

PRINTED IN

U. S. A.

PREFACE TO THE FIFTH EDITIONTHEfive successive editions of this

work

reflect

the steady expansion

of the use of physical energies for treatment during the past fifteen years. Its contents are based on the subject matter of the author's instruction

courses, given first under the auspices of theof

Columbia University School Medicine at the Reconstruction Hospital in New York and since 1927 at the New York Polyclinic Medical School and Hospital. Electrotherapyandlight

of physical

therapy have been always the main forms for office employment treatment agents by physicians because of their fairly simpleefficiency.

control

and

ELECTROTHERAPY AND LIGHT THERAPY was writtenon the theory and practice of these The intervening years have brought

primarily to offer reliable information

two important therapeutic agents. about the development not only of new phases of the original subject but also a steady increase in the use of treatment procedures by water, exercise

and manipulation. Some of these methods require very simple equipment or none at all except the knowledge of how to use them, which makes itpossible to give patients their benefit at the bedside as well as in the

In order to furnish information about these methods, with the fourth edition of this work, the essentials of hydrobeginning therapy and mechanotherapy were included in the presentation.physician's office.

The

story of the progress of ''physical medicine" as part of the practice

of medicine, in the period of the past twenty-five years during

which the

author has been actively engaged in it, is an impressive one. In the United States up to the time of the World War I, the few medical men practicingas "electro therapists'5

were looked upon by

many of then* medical

brethren

with suspicion, mingled with pity. Hydrotherapy, manipulation and were mostly exploited by poorly educated technicians. Generally massagespeaking, there were no physical therapy departments in hospitals where the different physical methods could be correlated as part of a general

be carried on.after

therapeutic scheme and where clinical and laboratory research could This situation first changed for the better during and

World War I, by the creation of broadly conceived physical treatment departments in order to benefit those injured and disabled in that war. In these departments all the time-honored and many of the newmethodsof physical therapy

were practiced under the watchful eyes of

competent medical men.

After the

War

there

became available a

large

bodytheir

of

competent technicians and ain civilian practice

number

of physicians

who

continued

work

and under

this impetus,

development of

many new and efficient physical therapy methods took place. Groups of medical men and technicians organized for mutual cooperation and study(5)

6

PREFACE TO THE FIFTH EDITION

and the medical profession at large showed much interest in physical therapy. The American Medical Association created in 1927 a Council of Physical Therapy which became a potent factor in disseminating proper information, in advocating basic training in physical therapy, and incurbing unwarranted claims and commercialization. As a result of all these factors, in the years up to World War II there was constant progress ineducation, research, and in the development of

expansion of clinical application of physical therapy.

new methods and the The lines of demarcaby general

tion between physical therapy that can be effectively carried onpractitioners,

by

specialists in various

departments of medicine and by

medicine" became gradually established. World War II thus found physical therapy ready for further expansion and for its fullest utilization for the benefit of war casualties. No wonder that the number of physical therapy departments and training centers in Army and Navy hospitals and other service and rehabilitation centersspecialists in "physical

time high. The need for caring for the injured, convalescent and those to be rehabilitated has made physical therapy methods the cornerstone of this work and also by practical necessityhas reached anall

brought occupational therapy in close correlation to it. All this is likely to continue for many years to come. At the same time, the term Physical Medicine became officially adopted in connection with the greatly increased

Medical Association, in renaming in 1944

scope of physical methods for treatment and diagnosis. The American its Council on Physical Therapy

the Council on Physical Medicine, stated: "Physical medicine includes the employment of the physical and other effective properties of light,heat, cold, water, electricity, massage, manipulation, exerciseical devices for physical

treatment of disease."

and mechanand occupational therapy in the diagnosis and In the same year a great American citizen and

humanitarian appointed the Baruch Committee on Physical Medicine, and after its extensive survey of the needs of this branch of medicine

he donated a fund of over a million dollars to carry out the most Simultaneously, the urgent educational and research requirements.National Research Council and the National Foundation for InfantileParalysis alsoof all these

made grants for research in physical medicine. As a result new developments, prospects for large scale increase in instrucandclinical application of physical

tion, research

medicine in the near

future are indeed bright. In the fifth edition of this

work a concise presentationis

of all present

day

phases of physical medicine

offered, while special

emphasis on electro-

therapy and light therapy is being retained. In this volume the newer uses and methods of electronics, of electrodiagnosis, of ion transfer, and of ultraviolet radiation have been incorporated; the chapter on exercise has been considerably enlarged; a

new

PREFACE TO THE FIFTH EDITION

7

chapter on hypothermy has been added, and a revised glossary inserted,pertaining to definitions of electrotherapy and light therapy as well as to muscle and nerve action, and mechanotherapy. All chapters in the general as well as in the special part

seven

new illustrations The author is deeply

have been brought up to date. were added and 49 obsolete ones omitted.grateful to

Eighty-

many

laboration. Drs. R. V.

Gorsch (now serving as Colonel

medical friends for their colin the U. S. Army),

serving as Commander in the U. S. Navy), and have revised their special chapters. Dr. F. W. EwerDr. Hans Behrend hardt contributed to the Glossary, Dr. Arthur L. Watkins to the chapter on

W. W. Morrison (now

Electrodiagnosis, Dr.

Jerome Weiss reviewed the chapters on physics and Dr. Robert Schlesinger again skillfully furnished a number of schematic drawings. A number of authors permitted reproductions of their illustrations and the educational and technical departments of the electromedicalindustry again assisted in furnishing technical data and illustrations. credit for all these contributions appears in the text.

Due

most liberal and cooperative in producing a volume profusely illustrated and typographically excellent. R. K. NEW YORK CITY

The

publishers were again

CONTENTSCHAPTERPhysical Therapy in the Practice of Medicine Basis of Physical Therapy Scope of Physical Therapy Place of Physical Therapy Classification of Physical Therapy Methods Apparatus for Physical Therapy Electrotherapy and Light TherapyI

INTRODUCTION23 23 26 27 27 28 29

PART

I

ELECTROPHYSICSCHAPTERThe TheStructure of Matter and the Atomic Theory Electron Theory of Matter

II

FUNDAMENTAL ELECTROPHYSICS

'.....

3031

Charge The Elementary Law of Electrophysics Conductors and Insulators Transfer of Electrical Charges Charging by Contact and by Induction CondensersStatic Electricity Current Electricity Electric Current Effects of Current Electricity Thermal Effects Electromagnetic Effects Chemical Effects Electrical Units Unit of Current. The Ampere Unit of Resistance. The Unit of Electromotive Force. The Volt

Electric

.

Ohm

Difference Between Amperes and Volts Ohm's Law Unit of Power. The Watt Unit of Capacity. The Farad Measuring and Regulating Devices Ampere Meters and Voltmeters Measuring Power in Alternating Current.

.

:

t

Circuits

Rheostats'

.

32 32 33 34 34 34 36 38 38 39 39 40 42 44 44 44 45 45 45 46 46 47 47 49 49

CHAPTERChemical Generation of ElectricityCells

III

GENERATION, CONVERSION AND DISTRIBUTION OF ELECTRICITY

and Batteries

51 51

Mechanical Generation and Conversion of Electricity

The Dynamo The Electric Motor The Faradic Coil The Transformer The Rotary Converter (8)

53 53 53 54 55 55

CONTENTSElectric Oscillations

956 57 57 5961,

and Waves

.

.

....'...

Electronics.

-

.

/

Thermionic Emission Vacuum-electronic Devices Gas-filled Electronic Devices . , The Electron Microscope Electrical Current Supply in Homes and Office Measuring and Protecting the House Supply The Role of Fuses Locating Trouble Current Outlets.

....../...PARTII

...-.-.

'.

62 62 63 63 64 65

GENERAL ELECTROTHERAPY AND ELECTRODIAGNOS1SCHAPTERGeneral Considerations Classification of Currents Direction and Frequency of Flow Voltage or Tension.

IV

ELECTROMEDICAL CURRENTS, APPARATUS AND ACCESSORIES.

....

.

Amperage or Volume Electromedical Apparatus Typical Features of Apparatus Conducting Cords and Cables Electrodes Miscellaneous AccessoriesTreatment TimersPatient's Release

Foot Switches ;...''.' Treatment Tables and Couches

...:..... ............. ...CHAPTER V

.... .... .... .... .... ....

66 67 67 68 68 68 69 6971

76 76 76 77 77

EFFECTS OF ELECTROMEDICAL CURRENTS. PASSAGE THROUGH THE BODY. GENERAL RULES OF TREATMENTPrimary Physical EffectsIonic Effect Thermal Effect Specific Electrical Effects Secondary Physiological Effects Psychological Effects.

78 78 79.

.

.

.

..

82 82 82

Electric

Conduction Through the Body Resistance of the Skin Skin Resistance to Different Currents Practical Importance of Skin Resistance Changes in Skin Resistance Resistance of Other Tissues. .

......,.

....,

Dielectric Conductivity Passage of Currents Through the

87

Body.

Current DensityInfluence of the Size and Position of Electrodes . General Rules of Electrical Treatment Method of Procedure Position of Patient Inspection of Parts Placing of Electrodes and Cords Starting the Treatment Regulation of Current Strength Termination of Treatment.

......

.

.

.....

.

95

10

CONTENTS CHAPTERVI97 97 97 98 100101 101 101 101

ELECTROPHYSIOLOGYBioelectric

Phenomena

Action Currents Action Currents of Skeletal Muscles Action Currents in Nerves Injury Current Action Currents of the Heart and the Brainof Bioelectric Phenomena Electrical Stimulation of Nerves and Muscles Nature of Nerve Impulses

....

.

.

.

.

.

Theory

.

.

Stimulation by Direct Current Electrotonus

.102.

Nerve Block

.

.

Electrical Excitability

Strength-Duration Curves Chronaxie Progressive Currents Intensity-Frequency Relation

....

103 104 104 104 104 105 105

CHAPTERGeneral Considerations Motor Points

VII107 108 109 110 Ill 112 113 114

ELECTRODIAGNOSISApparatus and Accessories General TechniqueDifficulties in Testing Testing Charts Faradic and Galvanic Test Reaction of Degeneration Course of the Reaction of Degeneration Diagnostic Significance of the Prognostic Significance of the Testing for the Reaction of Degeneration The Polar Formula Diagnostic Limitations Other Changes in Electrical Reactions Increased Excitability

RD RD

.116 .116119 120 120 121 121 121 121 123 123 125 126 127 128

Diminished Excitability

Newer Methods of Electrodiagnosis Testing by Strength-Duration Measurements Testing by Chronaxie MeasurementTechniqueTesting by Progressive Currents Electromyographic Diagnosis

CHAPTERHistorical

VIII134 134 138 139 139 141 143 143 143 144 146 149 149 149 150 150 150

THE GALVANIC CURRENT AND ION TRANSFERPhysics and ApparatusPolarity Effects of the Galvanic Current Physical Effect Physiological Effect

Upon

the

Body

Therapeutic Forms Medical Galvanism General Technique.

'

Dosage and Length of Application The Galvanic Bath Electrolysis or Surgical Galvanism

Removal of Superfluous Hair Skin BlemishesHemorrhoidsStrictures.

Galvanic Acupuncture

CONTENTSIon Transfer or Iontophoresis Physicochemical Considerations Leduc's Experiments Penetration of Ions Clinical Uses of Ion Transfer General Technique A. Applications From the Positive Pole Heavy Metals

11151 151 151

.......

r

.

.

Vasodilating Drugs

Histamine Mecholyl Cocain EpinephrineAconitine

CalciumB. Applications Chlorine Iodine.

...... From. .

152 153 153 154 154 155 155 156 159 159 159 159 159 160 160 160161

tHe Negative Pole

.159

Salicylic Acid Dangers in Galvanism fety Rules in Galvanism

CHAPTER IXCURRENTS OF Low FREQUENCYHistorical

General Considerations Physics and Physiological Effects The Interrupted Galvanic Current The Faradic Current The Surging Faradic Current The Slow (Galvanic) Sinusoidal Current The Modulated Alternating or Interrupted Sinusoidal Current Low-frequency Apparatus Motor Generators Generators of Thermionic Tube Types Single Types of Low-frequency Apparatus Therapeutic Aspects of Electric Muscle Exercise Clinical Application of Low-frequency Currents Simple Muscle Weakness Paralysis Following Nerve Injuries or Anterior Poliomyelitis Miscellaneous Indications Choice of Current for Muscle Stimulation Special Forms of Low-frequency Currents The Leduc Current Galvano-faradization Condenser Discharges by Progressive Currents General Technique of Low-frequency Stimulation Individual Motor Point Stimulation Group Stimulation of Muscles Dangers of Application.

...

.

163 163 164

,164

.

.....

165 167 168 169 169 170171

.

176.

177 177 179

.179179 180

...

.

Static Electricity

History Physics Physicophysiological Effects

.

...

183 184 184 184 185

CHAPTER XHIGH-FREQUENCY CURRENTS AND APPARATUSGeneral ConsiderationsHistorical

187.

High-frequency Oscillations and Radiowaves Physics of High-frequency Apparatus.

Basic Principles

Vacuum-tube Apparatus Power Supply Circuit

.

The The

Oscillator Circuit Patient's Circuit

Two-tube Short-wave Circuits Controls of Vacuum Tube Apparatus

19o

12

CONTENTS197.

Spark-gap Apparatus Operating the Spark-gap Apparatus

The Oudin

Coil. .

Combination Apparatus Requirements for Acceptance of Diathermy Apparatus Protection Against Radio Interference by Electrical Apparatus High Frequency Treatment Methods

199 200 203 200201

232

CHAPTER XIMEDICAL DIATHERMYGeneral Considerations Experimental Demonstrations.

Thermal Effect of Diathermy Heating by Direct ContactHeating in the Electric Field Heating in the Electromagnetic Field Heating in Relation to Wave LengthPhysiological Effects of Diathermy Effects on Circulation Effects on the Nervous System Effect on Bacteria

....

205 205 206 207 208 208211

^

.....210 213.

.

.

Diathermy vs. Long- wave Diathermy Contraindications and Dangers of Diathermy General Technique of DiathermyShort-waveGeneral Considerations Regulation of Dosage Duration and Frequency of Treatment Technique of Short-wave DiathermyElectrodes Electric or Condenser Field Heating Electromagnetic or Coil Field Heating Direct Contact Heating

Clinical Uses of

....

....

....

.....

....

Technique of Long-wave DiathermyTheir Position and Size The Reading of the Milliampere Meter Regional Technique of Diathermy BrainElectrodes

.....

Eyes

Head Neck

Sinuses

Dorsal and

Lumbar Spine

Coccyx Organs of the Chest and Abdomen Abdominal Organs Male and Female Organs Rectal Diathermy Shoulder and Upper Extremity. .

.

.

^

..

Elbow , Wrist and Hand . Hip and Thigh Knee Ankle and Foot Sciatic Nerve \ Safety Rules in All Diathermy Treatments Special Precautions With Short-wave Diathermy Special Technique With Long-wave Diathermy General Diathermy.

.... . .

.

.

,

.

.

.

.

..

.

v..

.

.

.

..

.

.

.

.

.

.

.

'

.

.

.

.

..

.......'

.

.

.

.

.

Autocondensation Monoterminal High-frequency (Oudin) Treatment Combination of Low-frequency Currents With Diathermy

.

.

.

.

.

.

213 214 215 216 217 218 218 218 219 220 220 220 222 223 225 225 226 227 227 228 229 230 231 231 231 232 233 233 233 235 235 236 236 238 238 239 240 240 240 240 242 243

CHAPTERGeneral Considerations Methods of Inducing Hyperthermy Hydriatic MethodsElectrical

XII HYPERTHERMY.

Methods

Requirements for Fever Apparatus

245 246 247 247 250

CONTENTSPhysiological Effects Bactericidal Effects Clinical Use of Hyperthermy

13251 253 253 253 254 255 255 255 255 255 255 255 256 256 257 257

Gonorrhea andSyphilis.

Its

Complications

.

Neurosyphilis and Wassermann-fast Syphilis Chorea

Bronchial Asthma Chronic Arthritis Multiple Sclerosis Other Conditions Contraindications to Hyperthermy General Technique of Hyperthermy Preparation Initial Steps The Induction Period Period of Maintenance.

.

.

Treatment Height, Duration and Frequency Complications of Hyperthermyof.

End

............

.

....

.

of

Fever Sessions

.

Restlessness Heat Prostration

Burns / Herpes Labialis Heat Cramps and Tetany Abdominal Cramps, Nausea and Vomiting.

259 259 259 260 260 260 260261 261 261 261

.

.

.

.

.

.

.

........

,

.

.

Circulatory Collapse Pathogenesis of Fatal Cases

...CHAPTER.i

I

.

.

.

.

*. .. .,

262

XIII*

ELECTROSURGERYGeneral Considerations HistoryElectrosurgical Methods Electrodesiccation

and Their Effects

N. .

.

Electrocoagulation Electrosection

Healing of Electrosurgical

Wounds.

Specific Effects on Blood-vessels Advantages of Electrosurgery Apparatus for Electrosurgery Technique of Electrodesiccation.

....

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

Experimental Practice Operative Technique Technique of Electrocoagulation.

.

.

.

.

.

.

'.

.

..

Electrodes

Experimental Practice The Role of the Milliammeter Operative Technique The Use of Biterminal Electrodes Technique of Electrosurgical CuttingElectrodes

Experimental Practice Operative Technique Hemostasis Underwater Cutting Cpnization Bipolar Cutting.

........ ......' ............*.

264 264 265 265 265 268 268 268 269 269 272 273 273 275 275 276 277 279 279 279 280 280

.277

.

.

.

.

.

.

.

*

,

.

.

.

.....

281

Anesthesia in Electrosurgery Clinical Uses of Electrosurgery

.

.

Uses of Electrodesiccation Uses of Electrocoagulation and ElectrosectionCritique

.

283 283 285

CHAPTER XIVELECTRICAL INJURIESAccidents During Electrotherapy The Equation of the Operator Equation of the Patient Equation of the Apparatus

287

289

14

CONTENTS290 290 290 290 291 291 292 292 292 292 293 293 294 295 295 297 297

Burns Pathology Burns From Heat Lamps Burns From Diathermy Burns From Galvanism Burns From Ultraviolet Electric Shock Low-frequency Current Passing Through Cardiac Area Accidental Contact With a Grounded Object Transformer Breakdown Mechanical InjuriesMedicolegal AspectsElectrical Accidents in

Homes and

in Industry

External InjuriesElectrical Shock Injuries to Eyes

Injuries

from Lightning

PART

III

LIGHT THERAPY

CHAPTER XVPHYSICS OF RADIANT ENERGYGeneral Considerations Theory of Radiant Energy Classification of Radiant Energy'

299 300...

.301302 303 304 305 306 306 308 309

Measuring

Wave Length

Spectroscopic Comparison

Physical Phenomena The Inverse Square Law The Angulation of Rays (Cosine Law)

Common

Measuring Radiant Energy.

Penetration

Comparative Physical Effects Comparative Physiological Effects

CHAPTER XVIINFRARED AND LUMINOUS RADIATIONPhysical Considerations Long-wave Infrared Short-wave Infrared Sources of Infrared Radiation Sunlight

311 311

312 312

Heat LampsInfrared RadiatorsElectric Light Baths Physiological Effects of Infrared and Luminous Radiation Physiological Effects of Infrared Radiation Effect on Circulation Effect on Nerve Endings of the Skin General Effects Physiological Effects of Visible Radiation Clinical Use of Local Heat Radiation.

313 315316 317

.317

Choice Between Luminous and Non-luminous Radiators Technique of Local Radiant Heat ApplicationClinical

....

320321

Precautions Use of General Heat Radiation Indications.

.321321 322

Technique

CONTENTSCHAPTER XVIIULTRAVIOLET RADIATIONGenerationClassification

15

PHYSICS AND EFFECTS325 325 325 326 326 327 327 327 328 328 329 329 330 330 332 332 333 333 333 334 334 335

Physical Properties Physiological Effects of Ultraviolet Radiation.

Erythema Production Degrees of ErythemaHistological Changes Difference in Erythema Effect of Certain Wave-lengths Biological Explanation of Erythema Erythema Reaction as a Measure of Effectiveness of Ultraviolet Radiation

PigmentationAntirachitic Effect Bactericidal Effect Effects on Blood Effects on Metabolism Clinical Uses of Ultraviolet Radiation

;

Metabolic Disorders Tuberculosis Skin Conditions Miscellaneous Conditions Contraindications to Ultraviolet Radiation Photosensitization

CHAPTERHistorical Physics of Solar Radiation Clinical Considerations of Heliotherapy Technique of Heliotherapy

XVIII

HELIOTHERAPY337 337.

Well People and Children Ultraviolet Transmitting Window Glass

Sun Bathing

in

....

340 343

CHAPTER XIXARTIFICIAL ULTRAVIOLET THERAPYGeneral ConsiderationsHistorical

Carbon Arc LampsConstruction Radiation Characteristics Relative Advantages and Disadvantages Quartz Mercury Vapor Arcs Hot Quartz Lamps Cold Quartz Lamps Low-pressure Mercury Arcs Electrpdeless High-frequency Induction Lamps Combination of Hot Quartz and Infrared Units Choice of Ultraviolet Generators and Standards of Emission Standards of Emission.

346 346 347

350 350 350354 356 358 358 35936(36. 36(

Technique

of Ultraviolet Irradiation

Administration

DosageSpecial Techniques of Ultraviolet Irradiation Local Irradiation

The Finsen TreatmentUltraviolet Blood Irradiation Air Sterilization

357'

Physics of GermicidalPractical Uses

Lamps

372

16

CONTENTS

PART

IV

ESSENTIALS OF HYDROTHERAPY

AND MECHANOTHERAPY

CHAPTER XXHYDROTHERAPYGeneral Considerations Physical PrinciplesPhysiological Principles Cold Applications Hot Applications Applications of Slowly Increasing Temperature;.

....*...

.

Hydrothermal Measures Wet Compresses Wet PacksAblutionsSpecial

.

*

Hot and Cold Baths Forms of Baths

374 374 375 375 376 376 377 377 377 379 379 384 384 384 385 387

Hydrokinetic Measures

..... .

Douches and Showers The Whirlpool Bath Therapeutic Pools and TanksColonic Irrigation

... ... ....,

....

.

.

CHAPTER XXIHYPOTHERMYGeneral Considerations*

Methods

of

Hypothermy

Physical and Physiological Effects

Therapeutic Considerations Cold Injuries .. .

... ... ..... .... .

388 389 393 394

.

.

...

.

.

CHAPTER XXIIGeneral Considerations. .

....

MASSAGE

Massage Movements

........... . .

.

Physiological Effects of Massage Effects of Massage on Pathological Conditions

..

.

.

.

.

.

.

.

.

General Technique of Massage . Uses of Massage Traumatic Conditions .'' Arthritis and Rheumatic Conditions Disorders of the Digestive Tract Disorders of the Nervous System Cardiovascular Conditions .' Other Systemic Conditions..

.....

.

.

.

.'.';

.

..

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.......

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.

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..'....... .

.....

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.......

.

.

.

.

.

.

.

. .

..

..

; ,

.

.

.

.........

.

.

.

...

400 405 407 407 408 409 410 410 410 410411.

.

.

.

Contraindications to Massage

.

.

.

.

.

.

....

.

.

.411

CHAPTER XXIIIEXERCISEGeneral ConsiderationsPhysiological Effects.

.

.

..

.

.

General Technique of Exercises Exercise in Various Conditions Circulatory System.

.

.... .... .............. ....... .

.

.

.

.

.

.

.

.

,

.

.

.

.

..

,.

.

.

.

.

.

Respiratory SystemGastro-intestinal.

.

.

....

~

.

.

.

.

.

_....

...

.

.

.

. .

.

.

.

.

.

System.

.... ...

.

..

.

.

.

.

.

.

.

Nervous System : Injuries of Bones and Joints.

..

Peripheral Vascular Disease Arthritis and Rheumatic Conditions Contraindications Posture Underwater Exercises.

.

.

..,...*..

.

.

.

.

412 412 414 418 418 418 420 420 420 420 420 425 425 429

CONTENTS

17

PART VAPPLIED PHYSICAL THERAPYCHAPTER XXIVCARDIOVASCULAR CONDITIONSReviewGeneral Considerations of Physical Measures in Cardiac Conditions Rest and RelaxationExercise.

Massage and Passive Exercise HydrotherapyElectrotherapy.

Angina Pectoris HypertensionExercise in Cardiac Patients.

.

....

.

;

.

,

\..

.

.

.

.

.

.

Hypotension Cardiac Neuroses

.

.

. r.

.

Peripheral Vascular Disease Diagnostic Considerations Review of Physical Measures in Peripheral Vascular Disease

.

.

.

.

.

Thermal Measures Electrochemical Measures Mechanical Measures. .

.

.

.

.

.

.

.-.-...'.

"V

.

.

.... .

.

Neurovascular Disorders Raynaud's Disease Organic Vascular DisordersArteriosclerosis Obliterans

.

.

.

;

Thrombo-angiitis Obliterans (Buerger's Disease) Thrombophlebitis Acute Thrombosis and Embolism Care of Feet in Peripheral Vascular Disease. .

..

.

.

-. '--....

.

432 432 432 433 433 433 433 433 434 436 437 437 438 438 439 439 441 441 444 444 444 444 445

.

.445.

.

.

.

.

,

446 446

CHAPTER XXVRESPIRATORY, GASTRO-INTESTINAL AND METABOLIC CONDITIONSGeneral ConsiderationsBronchitis.

.

.

,': .,

.

.

.

.

.

.........'

PneumoniaErripyemaPleurisy>

.

.

.

.

V%;

".

-

.

.

.

"*. .

Pulmonary Tuberculosis.

.

.....

;

.

.

.

.

.

.

.

:'.

.

".

.

Gastro-intestinal Conditions Gastric Neuroses.

......

.

.,

.

.

.

.

.

.

.

.

ConstipationVisceroptosis

...".,....,

.

448 448 449 450 450 450 452 452 452455

Postoperative.

and

Postpartum. \Yeakness.. ..

of

Abdominal.

Muscles Abdominal Adhesions

.*

...:

:

45.6

Intestinal Tuberculosis

.

.

.

.

.

.

.

.

.

.

.../..

.

Peritoneal Tuberculosis Diseases of the LiverCholecystitis

.

Metabolic Conditions RicketsInfantile

456 456 456 457 457

.457458 458

Tetany

Obesity

CHAPTER XXVICHRONIC ARTHRITIS AND FIBROSITISGeneral Considerations Role of Physical Therapy 2461

462

18Classification of

CONTENTSRheumatic Diseases Rheumatic Fever Chronic Joint Changes. ...

....

.

.

.,.

.

..". . .

.

.

.

.

"..,

.

Non-articular Manifestations Grading of Cases Physical Treatment Measures in Arthritis.

' ."

._.

.

.

.

.

.. .

...'

.

.

.

.

.

Thermal Measures Mechanical Measures Thermal and Mechanical Measures Counterirritant Measures Thermal and Counterirritant Measures Spa Treatment Scheme of Physical Treatment..

....

.

.

.

.

.

.

.

.

.

.

.

. ...-.:.

.

.

....

.

.

,

.

..... .....

.

.

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.

.....

,

.

.....'.

.

.

..

.,

....

.

Osteo-arthritis Rheumatoid Arthritis Gonorrheal Arthritis.

.

.....

.

.

.

.

.

,

,

..

.....

^

Spondylitis Deformans (Marie-Striimpell Disease)

Gouty

Arthritis.

Acute Arthritides Tuberculous Arthritis Traumatic ArthritisFibrositis.

.

.

.

.

.

.

.

.

.

.

.

.

.

...

.

'.

.

.

.

.

.

.

.

.

*

.

..'.:.

PathologyDiagnosis and TreatmentPanniculitisClassification..

.

Treatment

........ .....

.

.

.

.

.

.

,

.

.

.

>.. .

462 462 462 463 463 464 465 467 469 469 470 470 471 472 472 472 473 474 474 474 474 474 474 476 476 477 478

CHAPTER XXVIIAFFECTIONS OF THE CENTRAL NERVOUS SYSTEMGeneral Considerations Hemiplegia General Paresis Locomotor Ataxia Multiple Sclerosis. . .

.

.

.

.

.

.

.

.

.

.-*

.>...... . .

.

.

.

.

.

.

.

.

.

.

:

Myelitis

.

.

.

Chorea MinorCerebral Palsy (Spastic Paralysis) Obstetrical Paralysis Infantile Paralysis

The NeurosesVegetative Neurosis

Traumatic Neurosis Mental Conditions Electric Shock Therapy

.

.

.

.

.

.

'.....-.:..CHAPTER XXVIII

480 482 484 484 485 486 486 486 487 487 493 494 494 495 496

AFFECTIONS OF PERIPHERAL NERVESGeneral ConsiderationsPeripheral Nerve Injuries Pathology and Diagnosis.. .

....'

.

..

.

',

.

.

.

,

.

.

TreatmentNeuritis

Pathology

.

...'

.

.

.

.

...'...........508.

501 501 501 503 508

.

.

.

Classification Relief of Pain in.

Acute Neuritis

"

Chronic Neuritis Special Forms of Neuritis Facial Paralysis (Bell's Palsy) Brachial Neuritis Sciatic Neuritis Meralgia Paresthetica. Trifacial Neuralgia Intercostal Neuralgia.

v

.

.: -

'.

................. ....

.

.

^

.

.

.

.

.

.

.

.

.j*.

.

.

...'....

,

.

.

.

.

.

.

-.;

.

:

.

.j

508 509 510 510 510 514 515 516 516 517

CONTENTSCHAPTER XXIXAFFECTIONS OF BONES, JOINTS, MUSCLES AND TENDONSTraumatic ConditionsGeneral Considerations General Pathology of Injuries Objects and Methods of Physical Treatment Injuries of Joints and Muscles Contusions.

19

"...

.

,

.

'.'.'.',

519 519 519 520521 521 522 522 524 524 525 525 525 528 528 529 529 529 530 531 531 531 532 532 532 533 533 534 534 540

Strains

Sprains Dislocations

Traumatic ArthritisStiff Joints Injuries of Bones..

....

.'

.

.

.

.....

.

.

.

.

.

,

...*,.

.

.

..

Fractures

Amputations

.

.

.

.....

"..'

Back

Injuries

.

.

.

.

...

.

,

.

.

.

Coccygodynia Affections of Bones and JointsOsteomyelitis Tuberculosis of Bones and Joints Affections of Muscles Acute Myositis Chronic Myositis Volkmann's Ischemic Contracture Affections of Tendons and Bursae Tenosynovitis.

Bursitis Superficial Bursae

.:.....

Deep Bursse Shoulder Affections Miscellaneous Surgical Conditions Adenitis.

.

Burns

.... ...................

Scars Foot Conditions (By Jerome Weiss, M.D.)

'.

.

.

.

.

.

.

.

.

540 540 541 541

CHAPTER XXXGYNECOLOGICAL CONDITIONSGeneral Considerations General Rules of TechniqueElectrodes Pelvic Heating by Diathermy Pelvic Heating by Non-electrical Methods Pelvic Iontophoresis Inflammatory Conditions;..

...

.

.

.

.

Gonorrheal Cervicitis and Urethritis Pelvic Inflammations Chronic Endocervicitis . Cervical Erosion

.'

...".........

Miscellaneous Conditions Non-inflammatory Conditions Infantile Uterus With Stenosis of Cervix

..........."...... .

.

AmenorrheaSterility

Dysmenorrhea Menopausal Syndromes Minor Surface Growths

545 545 546 547 549 551 551 551 552 553 556 556 557 557 557 558 558 558 558

CHAPTER XXXIGENITO-URINARY CONDITIONSGeneral ConsiderationsElectrodes and Technique Nephritis Tuberculosis of the Kidney.

....

.

..

.

.

.

...

560 560 561 562

20Renal ColicCystitis. Incontinence of Urine.

CONTENTS.562..

.

.

.

.

.-

.

.

.;

,

.

.

.

Prostatitis

and Seminal

Vesiculitis.

.

.

.

.....

Prostratism.

..

.....

.

f

-

.

Gonorrheal Epididymitis * .... .... Gonorrheal Urethritis ...'. Tuberculous Epididymitis Calcified Deposits in Corpora Cavernosa Stricture of the Urethra Electrosurgery in Urology (By Daniel A. Sinclair, M.D.).

.........

.

.

.

.

.

,

.....

.

.

563 563 563 564 564 564 565 565 566 566

CHAPTER XXXIIPROCTOLOGICAL CONDITIONS

BYHemorrhoids Medical DiathermyElectrosurgery Surgical Galvanism

R. V. GORSCH, M.D."'-

,

.

..... ..

.

.

t

.

.

.

..

.'.

.

.....'...

-.

.

.

.

.

>

..

.

.

Fistula in Ano Fissure in Ano Stricture of the Rectum and Anal Canal Polypi of the Rectum and Colon Proctitis Pruritus Ani

,

.

-

.

.

*\..

.

.

CoccygodyniaNeuralgia, Hysteria of the Rectum, etc Tuberculous Peritonitis, Enteritis and Anorectal Tuberculosis Cancer of the Rectum

569 570 570 572 573 573 573 574 575 576 576 576 577 577

CHAPTER XXXIIIDERMATOLOGICAL CONDITIONSGeneral Considerations

Acne VulgarisAlopeciaCallositas

.

.

Benign NeoplasmsCorns Dermatophytosis Eczema Seborrhoicum'.

579 581 581 581 581581 581

Erysipelas

/

Furuncles Impetigo Keloids and Hypertrophied Scars Keratoses

Neurodermatitis

Malignant Neoplasms Molluscum Cpntagiosum

.... .

Nevi Pigmented Nevi Pityriasis RoseaPsoriasis

.

.

...;

.

RhinophymaSycosis Vulgaris Telangiectases. .. .

-

.

.

Tuberculodermas Verruca Vulgaris Ulcers and WoundsHypertrichosis Epilation by Electrolysis. .

.

"

583 583 584 585 585 585 586 586 586 586 587 588 588 588 589 589 589

.589.

.

...

Equipment

.

.

.

.

.

.

.

Preparation of Electrolysis Setting of Current Flow The Operation

,

.

.

590 591 592 592 593 594 594

CONTENTSHypertrichosis Epilation bv Electrolysis Technique With Insulated Needles Test Treatment Complications and Dangers Postoperative Treatment.

21

.

.

.'.....;Treatments

:

'.

.

.

.

.

.

.

Number and FrequencyEpilation

of

by High-frequency Current

.

.

.

.

The Operation

596 597 597 597 597 598 598

CHAPTER XXXIVDISEASES OF THE EAR, NOSE AND THROAT BY WALLACE MORRISON, M.D.p General Considerations . . ; Diseases of the Ear The Pinna and External Auditory Canal Acute Dermatitis of the Pinna and External Canal Subacute and Chronic Dermatitis of the Pinna and External Canal Furunculosis of the External Canal.

;

*.

.

.'

.

.

.

.

600 600 600 600 600601 601 601

The Middle Ear and Mastoid

Process

Acute Non-suppurative Otitis Acute Suppurative Otitis Media and Mastoiditis Chronic Suppurative Otitis Media Chronic Catarrhal Otitis Media, Otosclerosis and Auditory Nerve Deafness Diseases of the Nose and Nasal Accessory Sinuses The External Nose and Nasal Vestibule Acute and Chronic Dermatitis Furunculosis..

....', Media

602 602 603 604 604 604 604 604 604 605 605 605 607 607 607 607 607 607 608 608608 609 609

.................ChronicAtrophicRhinitis

The Nasal Chambers

Acute Rhinitis Chronic Generalized HypertrophicRhinitis Chronic Localized Hypertrophies Vasomotor Rhinitis and Hay Fever

..-.- and..

Nasal SynechiaeEpistaxis..

....

Lupus and True Tuberculosis of the Nose Benign and Malignant Growths of the Nose and Sinuses

The Nasal AccessoryAcute Sinusitis Nasal Polyps

Sinuses.

Granulation Tissue Diseases of the Pharynx

Acute Pharyngitis Chronic Pharyngitis Hypertrophied and Infected Lymphoid Tissue Hypertrophy of the Adenoid Hypertrophied Remnants of the Adenoid Acute Tonsillitis Chronic Tonsillitis and Hypertrophy of the Tonsils.

'

.

.

.

.

........

609 609610 612 612

Electrosurgical

Peritonsillar Elongation of the Uvula Hypertrophy of the Lingual Tonsil.

Removal of the Tonsils and Retropharyngeal Abscesses. .

.....

.

.

Varicose Lingual Veins Diseases of the Larynx

.

.

.

...

.

.

.

Acute Laryngitis Chronic Laryngitis

"

.

.

.

....

.

.

.

....

.

.

Laryngeal Tuberculosis Benign and Malignant New Growths of the Mouth, Pharynx and Larynx

614

CHAPTER XXXVDISEASES OF THE EYEGeneral Considerations . Eyelids and Conjunctiva Cornea, Uveal Tract and Retina..

.

.............. . .

615

'.

Electrosurgery of the

Eye

619

22

CONTENTSCHAPTER XXXVIPHYSICAL THERAPY IN OFFICE PRACTICE

General Considerations Planning Physical Treatment.

.

...

.

.....-.'.

.

Frequency of Treatment Judging Results The Treatment Habit Selection of Apparatus Office SpaceOffice Assistants

621 622 622 623 623

624 624 626

CHAPTER XXXVIIPHYSICAL THERAPY IN INSTITUTIONAL PRACTICEGeneral Considerations Relation to Other Departments The Director of Physical Therapy Location and Floor Space

.... . ..

EquipmentRecordsPhysical Therapy Library....

.

.

.

.

;

.

.

1

.

Appendix.Glossary

Electrodiagnostic Charts.>.

and Tables..

....

....

627 627 628 633 634 635 637

640654669

Author's IndexSubject Index

.

.

.

.

.

672

ELECTROTHERAPY AND LIGHT THERAPYCHAPTERI

INTRODUCTIONPHYSICAL THERAPY IN THE PRACTICE OF MEDICINEall life on earth. The warming of the sun, the flow of water, the electrical charge in some of the rays bodies around us, all form parts of Nature's inexhaustible and all-powerful

PHYSICAL forces furnish the basis of

properly mastered are of help to increase circulation, enhance local and general body metabolism, relieve nerve irritation or stimulate nerve function, inhibit growth of germs or destroy them altogether. As a result of all these effects, physical agents may speed up repair of injured or diseased tissues, restore disturbed function, relieve pain and improve the condition of the entire body. Basis of Physical Therapy. The human body is a complex transformer of energy. Chemical energy stored up in food or in drugs is split into component molecules and serves to keep up or modify physiological functions in the body. Some of these chemical processes create physical energy such as heat, electrical action currents either as a by-product or as an essential object. Physical energy can also be conveyed to the body from the outside by various methods and thus serves to stimulate physiological processes. Any form of physical energy applied to the human tissues exerts a primary physical or physico-chemical action and this in turn affects cellular activity. These "secondary" physiological effects serve to influence a pathological condition either locally or system ically and thusif

array of forces. The same physical forces inestimable value in the art of healing. They

may

create therapeutic effects.

Most of the procedures and effects of physical measures are applied through the skin. The skin is not merely a protective covering of the body but also a complex structure of perception, absorption and excretion. It is capable of a variety of reactions to stimuli from the outside and from within. Most of the reactions brought about by physical forces are nonspecific in character. It has been shown that stimuli of different nature, such as heat, manipulation, chemical or electrical agents may cause similarvascular response in the skin, consisting of dilatation of blood-vessels, increased permeability of the vessel walls and increased circulation. The nervous reflex effect of "counter-irritation" through the skin upon deeper parts may be alike and this explains the seeming paradox of similar

therapeutic effects on painful conditions by physical agents of apparently There are definite reflex reactions between certain cutaneous areas and the gastro-intestinal tract. In general, internal organs are reflexly related to the skin directly overlying them, and the effectdifferent nature.

(23)

24

INTRODUCTION

produced by reflex is the same as that seen in the cutaneous area treated. Cold applications to the cutaneous area produce a related effect on the organ beneath, i. e., a tonic or stimulating procedure. Applications of heat cause relaxation, increased blood supply and increased activity. (Fig. 1.)

Manycanal,

may

visceral disorders, particularly disorders of the gastro-intestinal be beneficially influenced by appropriate stimulation of the

corresponding cutaneous areas. There are, on jthe other hand, specific reactions in the skin, such as those caused by ultraviolet radiation, which cannot be produced by any other agency. With physical agents capable of penetrating the protective covering of the skin and other tissues, specific effects on inner organs can be expected. This part of physical medicine offers at present a large field for clinical research.TABLE1.

PRINCIPAL PHYSICAL AGENTS AND SOME OF THEIR EFFECTSPrimary physicalSecondary physiologicaleffectseffect

Physical agent

Hot water Hot airRadiant heaters Incandescent lampsC

HyperemiaSedation of sensory or motor irritation Attenuation of germs

Thermal

j

Diathermy Sun Sun Heated metals Carbon arc Mercury vaporRoentgen-ray

[

(

ErythemaPigmentationActivation of ergosterol Effects on blood

Photochemicalarc

I

j

[

RadiumGalvanic current

PhysicochemicalT-, Electrochemical,

Contraction of tissues Molecular disintegrationPolar; vasomotor stimulation

,

i

metabolic

Low frequency, interruptedand alternating currentsVibration

Electrokinetic

Massage

Kinetic

Muscle stimulation Increase of venous and lymph flow, stretching of tissue, reflex stimulation

The strength, duration and extent of application determine the local or general sedative, stimulative or destructive effects of any physical agent.It is evident that a definite diagnosis arrived at by all known methods, or at least an acceptable working diagnosis, is essential before any form

of therapeutics is instituted. If physical treatment is being considered, either as a primary line of attack, or as an adjunct to other appropriate treatment, the question should not be "What kind of apparatus shall be

The query should be rather: "What type of physical agent, or combination of agents, will be best suited to overcome the anatomical or functional disorders in this individual patient?" must strenuously resist the conception fostered by commercial interests that, for treating a given condition, a certain make of apparatus is necessary. The object of physical therapy is the bringing about of certain physiological responses and the student of this branch of therapeutics must learnapplied?"

We

to choose from the available methods, according to the circumstances. He should have no difficulty to make his choice once he had sufficienttheoretical grounding

and acquired

clinical experience

under competent

guidance. For the efficient and safe application of any physical measure, the following basic knowledge is essential 1. What is the physical nature of the form of energy employed?:

PHYSICAL THERAPY IN THE PRACTICE OF MEDICINE2.

25

What

are

effects3.

its primary on the body?

physical,

and

its

secondary physiological,it

In what pathological or functional changes doesuseful?

prove

clinically

4.5.

What What

is

are

the correct technique of its employment? its possible dangers and contraindications?

Schematic diagram to illustrate the interrelation of vasomotor, secretory and caused by sensory stimulation through the reflex arc. Afferent pathIt can thus be seen how radiant heat on left, efferent pathways on the right. the skin surface can cause reflex vasodilatation of deeper structures and change in muscle tone. Also it is apparent how visceral stimuli can elicit muscle spasm and referred pain.1.

FIG.

myo tonic phenomenaways on the

(After Wiggers.)

It is evident that any physical measure capable of doing good is also capable of doing harm if it is incorrectly applied. Likewise there is a threshold of intensity and duration where therapeutic efficiency begins; and there is a danger zone when that threshold is exceeded. The quantita-

26tive or

INTRODUCTION

measured conception of physico-physiological effects is established clinical and laboratory research work and is the main factor in gradually elevating physical therapy procedures from an empirical

by painstaking

stage to that of a well-defined scientific procedure.

Scope of Physical Therapy. A frequent Abjection voiced by the uninformed is that physical therapists concern themselves with all too many pathological conditions, instead of remaining within a well-circumscribed domain. No such objection is voiced against the similar wide use of drug1 therapy in all departments of medicine. Sollrnan states, "Although drug therapy and drugless therapy may seem direct antipodes to the superficial thinker, they involve the same principles, evoke the same phenomena, accomplish the same results. They differ only in the means which they employ, of which sometimes the one, sometimes the other is better adapted to secure the desired end. Indeed, the differences between physical therapy and pharmaco-chemical therapy are no greater than those between radiant

and

direct heat, or

Physical therapyof conditions.

local and general anesthetics." neither a causal nor a specific therapy in the majority It serves in acute disease conditions to relieve symptoms

betweenis

and speed up recovery. Simple thermal and hydriatic measures have been part of standard nursing procedures for a long time. In local and general infections, ultraviolet radiation and heat measures are of considerable importance. In certain acute systemic infections such as gonorrhea and its complications and a few others, artificial fever therapy has an almostspecific effect.

In acute traumatism, the

efficient application of physical

measures

Theand

essential for early recovery. most important field for physical therapy lies in the treatment ofis

chronic disease conditions.safe for relieving pain

In these, physical agents are quite dependable and offer often a definite chance for recovery

by bringing about gradual

resolution of chronic inflammatory processes. General thermal or hydriatic agents acting through the skin as an organ will stimulate general circulation and elimination. Local thermal agents can stimulate the function of any organ or body region and speed up absorption of products of inflammation or trauma. Mechanical, electrical and photochemical stimuli can promote local chemical interchange which in turn affects the whole system; they also may act by active exercise or nerve reflex upon deeper situated parts or organs. Ultraviolet irradiation is a specific treatment for rickets. High-frequency electricity and surgical

galvanism are valuable methods for the destruction of minor new-growths tissue; major electrosurgery has made possible important advances in surgical technique. Among the many conditions in which physical measures prove of definite value are traumatism, both acute and chronic; the various forms of arthritis and the rheumatic states, many kinds of paralysis and other organic and functional affections of the nervous

and diseased

system, chronic digestive disturbances, chronic diseases of the heart and blood-vessels, acute and chronic inflammatory conditions of the genital organs, nose and throat and many skin lesions. There are some obvious advantages in employing physical remedies. Usually they can be directly applied to the affected parts and in acute conditions, as a rule, they give immediate relief. In chronic conditions, patient and systematic application is essential, but there is no danger of habit-forming as is the case in

PHYSICAL THERAPY IN THE PRACTICE OF MEDICINE

27

the use of certain drugs. In some instances physical measures will enable the clearing up of lesions apparently requiring an operation. Place of Physical Therapy. Physical therapy is not a new system forrecognizing and treating disease.of medicineIt rightfully

forms part of the practice

and will be of most value in the treatment of disease and injury when employed by or under the immediate supervision of the

physician

who has

learned

why

there

is

a

scientific basis for the

use of

some physical energy or its combination with others and who knows when and how to apply it. Physical therapy cannot be practiced apart from general medicine and surgery, for it must be applied with a broad knowledge of clinical diagnosis. As a matter of fact its methods serve as a diagnostic aid in a number of conditions; hence its newer designation as physical medicine. Conversely medicine and surgery should not be practiced without physical therapy, a valuable adjunct, when coordinated with other indicated therapeutic measures, and, at times, a primary method of treatment. There is ample need and opportunity for the systematic use of physical measures by all medical men. However, the best interests of patients will be most satisfactorily secured if the possibilities and limitations of each group of physicians employing physical therapy are clearly understood. The general practitioner should be able to utilize simple thermal and hydriatic measures both at his office and at the bedside, and should be able to prescribe and demonstrate exercise for traumatic, arthritic, and other every-day conditions. He should employ elaborate pieces of equipment only after he has had competent clinical instruction in their use. Specialists in various fields of medicine, such as surgery, orthopedics, gynecology, and nose and throat diseases will all derive great satisfaction from such physical measures as are applicable to their respective fields, once they have had proper theoretical grounding, and at least the rudiments of clinical training in their employment. There is need in every large center of population, and certainly in all large hospitals, for medical men with special training in general physical therapy to be able to render service with all modern resources, such as fever therapy, under-water exercise, and the various electric and light treatments. It requires training

and aptitude, as well as

official

support, to carry on clinical and experi-

mental research work, and to check on the claims for the ever-increasing number of new devices. Properly trained technicians are indispensable for administering physical therapy in institutions, and in most physicians' offices. But it is not fair to expect technical aides who have been trained to employ physical measures only according to instruction, to be responsible for the ordering of treatments, and the judging of their efficiency. This will be the case if a department is only nominally in charge of a physician or a group of physicians who have neither special interest nor training in the subject. No fountain can rise above its source and no physical therapy department can render the best possible service unless it is headed by a physician thoroughly familiar with the methods and scope of modernphysical treatment.Classification of Physical

Therapy Methods.

The

classification of the

for no matter various physical measures is on what basis it is done, there will be overlapping, For didactic purposes and for institutional classification, heading under each physical agent

a somewhat involved problem

28

INTRODUCTION

such as electrotherapy, hydrotherapy, etc., as shown in Table 2 has proven practical. In such a classification the same agent, according to its form of application, may exert a variety of physical and physiologicaleffects. For an intelligent conception of basic effects and prescribing, a grouping of physical measures according to the primary thermal, mechanical or chemical effect is more desirable, as has been shown in Table 1. This brings together physical agents of a different nature electricity, water, but shows that their physiological effect is based on a similar primary light

physical effect.

TABLE1.

2.

METHODS OF PHYSICAL MEDICINEElectrophoresis

Electrotherapy Galvanic or direct current

Low-frequency currents Electrodiagnosis High-frequency currents ElectrosurgeryStatic electricity2.

Light therapy Photo thermal radiations Visible and infrared rays Photochemical radiations Ultraviolet rays

Heliotherapy3.

4.5.

Hydrotherapy Hydrothermal measures Hydrokinetic measures Hyperthermy and Hypothermy Mechanotherapy Massage and manipulation Medical gymnasticsOccupational therapy

Roentgen-ray or roentgen therapy although employing an agent ofphysical nature does not appear in the above classification because by well-established custom it forms part of another large special field of medicine. Apparatus for Physical Therapy. It is by no means necessary to possess

a large array of machinery to produce the few basic physical and physiological effects Simple hot and cold applications, active and passive exercise can do a world of good by themselves. There is danger in too much and too complicated apparatus for therapy, just as there is danger of too much:

apparatus for diagnostic purposes when one's five senses and clinical experience, unaided should be adequate to solve many problems. On the other hand, modern mechanical and electrical progress offers many types of efficient apparatus, with the saving of expenditure of one's own energy, of time in accomplishing results, and with the possibility of accurate dosage and location of the physical energy to be applied. The advantages of modern electrical apparatus over some of the older crude methods are just as evident as those of the modern methods of transportation over the time-honored mode of walking and pushcarts. Those who grudgingly admit that they believe in massage and exercise, but do not care three figs for all this apparatus, the glittering machinery of practice, simply handicap themselves very sadly. They limit their speed and confine their radius of action to a narrow segment of what it might be.

For the ever-increasing scope of physical therapy, apparatus is quite indispensable, and will tend to become more so in the future. The finer and more varied the control, the larger the range of power, the more

PHYSICAL THERAPY IN THE PRACTICE OF MEDICINE

29

accurate the measurement of energy input, the more varied and the more dependable will be the subsequent physiological and clinical results. Electrotherapy and Light Therapy. From the standpoint of the generalpractitioner, electrotherapy and light therapy open up many new vistas in medicine and surgery and although not entirely replacing some of the simple methods of application of heat, massage and exercise, enable a

and more extended application of physical energies. With simple and inexpensive equipment, the general practitioner comparatively can produce results in many conditions in which treatment by medication and surgery alone is not quite satisfactory. The rational use of such measures should be part of the office work of most progressive physicians because it increases the efficiency of the medical service rendered. A striking illustration of the changed conception of the place and future of electrotherapy is contained in an editorial of the New York Times, 2 written apropos the First International Conference of Fever Therapy: "Twenty-five years ago the physician who clamped a pair of electrodes on a patient and passed an electrical current through the body either to heat tissues according to the principles of diathermy or twitch muscles or stimulate the flagging system was regarded either as a self-deluded enthusiast or as a quack who could not be restrained because he had a Now the First International Conference on Fever Therapy is license. held under the high patronage of such medical eminences as Nobel being Prize winner Wagner-Jauregg, Volhard and Bessemans. No longer is there any doubt about the cures of the electrotherapist. Venereal diseases, general paralysis of the insane, arthritis and a score of other diseases are now treated electrically and successfully without causing the professors in the medical colleges to lift their eyebrows. "In French a physicist is still called a physicien. The justification for doing so is more apparent than ever in these days of waves and highfrequency currents applied in medicine. Many of the men who practice the new electrotherapeutics are so well grounded in physics and electrical engineering that they have made striking technical improvements. This new science needs their combination of electrical and medical knowledge. It still lacks measurements, still lacks standards. But empirical as it still is it supplies evidence that the old pill box is obsolescent. Medicine today belongs to the chemist, the electrotherapist, the bacteriologist, the radiation expert. Gradually it is acquiring the precision that we associate with real science. And the electro therapists who were once regarded as little better than charlatans helped to bring about the change."well-controlled

REFERENCES1.

SOLLMAN,

2.

Address of Welcome to the 19th Annual Convention of the American Congress of Physical Therapy, Arch. Phys. Ther., 21, 561, 1940. New York Times, March 31, 1937.J.:

PART

I

Electrophysics

CHAPTER

II

FUNDAMENTAL ELECTROPHYSICSThe StructureMatter and the Atomic Theory. The Electron Theory of Matter. The Elementary Law of Electrophysics. Conductors and InsuTransfer of Electrical Charges. Charging by Induction. Condensers. lators. Electric Potential. Static Electricity. Electric Current. Thermal, Electro-magElectrical Units: the Ampere, the Ohm, the Volt. netic, and Chemical Effects. Difference Between Amperes and Volts. Ohm's Law. The Watt and the Farad. Measuring and Regulating Devices.of

Electric Charge.

No

fairly well

one can apply electrotherapy efficiently and safely unless he is grounded in the physics of electricity and has acquired practical

experience in the therapeutic employment of the various electromedical currents. The physician must be familiar with the e very-day use of electricity and the construction and control of every piece of apparatus he employs. It would seem a poor exhibit of efficiency should a busy physician's officework come to a stop while someone scurries around to get an electrician to remedy such common troubles as a blown fuse, or a broken

connection in a conducting cord or socket plug. The Structure of Matter and the Atomic Theory. The modern theory of the structure of the atom holds that electricity forms an integral part in the structure of all matter. Anything which has weight and occupies space is called matter. Matter is composed of some ninety-two primary substances, known as elements, which cannot be split up into bodies of a different kind without changing their characteristics. Some of these are solids, like zinc, iron, sulphur, others are liquids, like bromine, mercury;

some are gases, like hydrogen, oxygen and nitrogen. All complex forms of matter, all minerals, all tissues in animal or vegetable life are formed by the combination of these elementary substances. It is obvious that, while masses can be split up into smaller and smaller particles, there must be an ultimate particle of any element that cannot be divided, and which forms the basis of the element as a stable unit. According to Dalton's classical theory, proposed in 1802, such a particle is called an atom (from the Greek a-tomos: indivisible). The atom, the most minute unit of matter, takes part in chemical changes by uniting either with the other atoms of the same kind to form appreciable quantities (molecules) of the same element or with atoms of other elements to formfinally,

compounds. A molecule may consist of two or more atoms, the atoms being for instance, all hydrogen or all oxygen, or the all of the same elementmolecule may consist of different elements for instance, a molecule of water is composed of 2 atoms of hydrogen and 1 of oxygen (H^O). The unit of atomic weight is the lightest of atoms, the hydrogen atom.(30)

THE ELECTRON THEORY OF MATTER

31

The Electron Theory of Matter. Experimenting with electrical discharges from glass tubes having a high degree of exhaustion, J. J. Thomson, later Lord Kelvin, of Cambridge, England, discovered, in 1897, a stream of extremely minute particles projected from the negative electrode or cathode. He proved that the particles forming these "cathode rays" have each a mass amounting to about 1/1800 that of a hydrogen atom and that each carries a negative charge. He named these particles electrons (from the Greek elektron: amber, the substance which can be electrified by friction) and Millikan, the American physicist, succeeded in measuringandisolating

them.

electron theory supposes that every atom of matter in the neutral state is made up of a certain number of elementary positive units and an equal number of electrons. The charge on the electron is negative but thisis

The

only an accident; the choice of what was to be positive electricity and

originally quite arbitrary and it happens to have made the electron negative. Electrons have become universally accepted as the smallest known particles of matter and have now almost become an article of commerce. In radio tubes electrons are given off as readily as hot water gives off steam. The electron is the unit of electricity and represents a universal element of structure of all matter, whether flowing along slowly in an electric current or hastening through space at an extremely high rate as a cathode ray, whether it is emitted in radioactive disruption or in a photoelectric process, whether it is "jumping" in our lamps, etc. It is always the same physical unit, proving its identity by exhibiting the same charge and the same mass, in particular by keeping the ratio of charge to mass constant. Rutherford's experiments with radioactive elements established the second universal constituent of the atom called the proton. The proton has an electrical charge of the same value as the electron, though of opposite charge but its mass is quite different, being 1800 times as heavy as that of the electron. Every atom is believed to consist of an extremely small nucleus in which is packed all the positive electricity and around which the negative electrons are arranged in some definite order but with wide spaces

what negative was

between them. The atoms of all elements are thus believed to contain as constituents both positive and negative electricity. In the hydrogen atom there is only one proton and one electron present, but in all other atoms there are more protons than electrons in the nucleus, which thus possesses a positive charge. This is balanced by the addition of electrons surrounding the nucleus. The atom of oxygen contains sixteen protons and sixteen electrons.(Fig. 2.)

Modern physical research has made numerous new discoveries about the structure of matter. Anderson in 1932 found the positron a positively charged, rather unstable elementary particle of the same weight as the electron. Chadwick in the same year discovered the neutron, an electrically neutral particle of the same weight as the proton. Research in radiation energy has added another primary constituent of matter, that of thephoton or light quantum, about which more will be said in Part III. Recent work with atoms through the use of the cyclotron and similar atom smashing devices causes atoms to give up other than electron particles; in fact, actually transforming or transmuting the atom to one of a different ele-

32

FUNDAMENTAL ELECTROPHYSICSetc.,

are

mental character. Electrons, protons, neutrons, positrons, dueterons, all fragments of atomic destruction.

H1

16+

1

16 +8

26Schematic illustration of electron theory. Each atom contains an equal number of protons and electrons. Protons are represented by + sign and electrons by dots. In the hydrogen atom there is only one proton and one electron present, while the oxygen atomFIG.2.

contains 16 protons and 16 electrons.

(After Gibson.)

Electric Charge.electrical

The

electron theory

is

the basis of explanation of

all

phenomena. The binding together of electrons and protons into atoms represents large amounts of energy. An object containing a normal balance of electrons and protons shows no electrical properties. If the atomic structure is disturbed by an external force of sufficient strength, such as friction, heat or chemical action some of the electrons of the atomsbe driven away. Charging a body consists of taking away or adding A negatively charged body is one which contains more electrons than its normal number; a positively charged body is one which contains less electrons than its normal number. The Elementary Law of Electrophysics. The basic law which underlies all considerations in electrophysics is: bodies charged with the same kind of electricity repel each other while those charged with a different kind of electricity attract each other. In other words, like charges repel and

may

electrons.

body one may use an electhread from a glass support or the wellknown gold leaf electroscope, two strips of thin gold leaf attached to an insulated brass rod and hung in a glass jar. (Fig. 3.)troscope, a pith ball

unlike charges attract. For detecting the condition of an electrified

hung by a

silk

CONDUCTORS AND INSULATORSConductors and Insulators.

33

currents) any enough atomic change to permit a flow of electrons, and hence under sufficient electrical stress there is no sharp demarcation between conductors and non-conductors.insulator

Substances which lead off the electric charge quickly are called conductors; those which prevent the escape of an electric charge are called non-conductors or insulators. Most substances conduct a little and under powerful influence (high voltage

may

suffer

it

Detecting an electric charge. A goldleaf electroscope is charged by approaching with an electrified vulcanite rod. The negative charges are driven toward the two leaves which show an electric charge by repelling each other.FIG. 3.

Metals are the best conductors. In all metallic substances there are always a number of electrons free from their atoms and as soon as these free electrons are pushed along in the conductor, a flow of electricity willlarger the number of free electrons in any substance, the greater conductivity. The substances which are good conductors of electricity are also good conductors of heat. Watery solutions of acids, bases and salts are known as electrolytes (from elektron and lutos: soluble)

begin.will

Theits

be

and

also conduct well.is

The

difference

between metallic and

electrolytic

conductors

that in the latter a flow of electricity brings about chemical

changes. A substance in which there are no free electrons and the resistance of which to the flow of electricity is high is called an insulator. There are solid insulators such as hard rubber, mica, glass, amber, porcelain and silk and fluid insulators, such as oils, paraffme and pure distilled water. Lubricating oil placed over parts of electrical apparatus through which the current has to flow will prevent its passage instead of facilitating it. To prevent leakage of electricity electric light wires and terminals of electromedical apparatus are mounted on glass, porcelain or hard rubber,3

34

FUNDAMENTAL ELECTROPHYSICSPartial conductors are substances which ordinarily resist the flow of but under certain conditions will become conductors.

electricity

TABLEInsulators

3.

INSULATORS AND CONDUCTORSGood conductorsMetals

Partial conductors

AmberGlass

Dry woodPaperAlcohol Tap water

CarbonGraphite

Hard rubberParaffine

Watery

solution of salts

and acids

Dry

air

PorcelainDistilled water

Moist air Kerosene

Wet wood

Important examples of partial conductors are: (1) Distilled water is an insulator, if sufficiently pure, containing no dissociated molecules; as soon as it contains a slight trace of salts, however, electrolytic dissociation takes place and the water becomes a good conductor. Ordinary tap water, always holding an admixture of salts, is therefore considered a partial conductor. (2) The tissues of the human body; they are good conductors on account of their saline ingredients, but the horny substance in the superficial layers of the skin serves as a fairly good insulator. By moistening the surface of the skin w e overcome its insulating property. In applying some forms of electricity to the body, part of our technique is directed toward overcoming skin resistance, so as to secure a free passage of current to the well-conducting tissues beneath. In conduction of so-called hightension or high-voltage forms of electricity skin resistance plays only a minor role. (3) Dry air is an insulator, while moist or ionized air is a partial conductor. The high-tension charge of static machines leaks off when the atmosphere is humid, while on dry days the charge is easily retained. Perfect vacuum is an insulator; in the so-called glass vacuum electrodesr

used in treatment the air is only rarefied, so that they are fairly good conductors of high-tension current. Transfer of Electrical Charges. For transferring electrical charges conductors such as wires or metal plates are used; at the same time, these must be insulated from other conductors by non-conducting material, hence the covering of copper conducting wires by an insulating layer of silk or rubber, and the mounting of electrodes on insulating handles. Electricity of high tension, such as the static current or the monoterminal discharge of a high-frequency machine, is difficult to insulate, and its tendency to leak off to a neutral body or the ground in the form of sparks must be guarded against by long insulating handles and by holding it at a safe distance from all grounded objects. Charging by Contact and by Induction. This is easily explained by the When a positively charged body is brought near an electron theory. insulated conductor, the free electrons in the conductor are attracted from all parts of the conductor to the end nearest the positively charged body and this end thus becomes negatively charged. As these electrons were drawn away from the far end of the conductor, it has less than its normal

number

of electrons

and

is

therefore positively charged.

condenser consists of two opposing surfaces of metal by some insulating substance (glass, mica or air) on which separated electric charges can be collected (or condensed) because the reciprocal attraction across the separating insulation annuls the repulsion. Capacity is the relative power of holding the ratio of the electricity held captive to

Condensers.

A

CONDENSERS

35

the tension that arises; it depends on the size of the plates, their distance and the kind of insulating substance between them. A dielectric (unelectric) substance is one which offers great resistance to the passage of electricity

by conduction, but through which

electrical force

may

act

by induction.

Charging by contact. A Leyden jar is held by the hand, and thus grounded; brought in contact with a source of frictional charge, such as the positive terminal of the static machine; the positive charge on the outer layer will be repelled to the ground and the earth will supply the outer layer with an amount of charge sufficient to counterbalance the charge on the inner layer.FIG. 4.its

knob

is

Condensers may be likened to water tanks and are necessary for the holding of a definite amount of electrical energy ready for immediate flow in certain types of apparatus, such as high-frequency machines and electronic devices. If the plates of the condensers are connected, the positive and negative charges are united and the condenser is "discharged." Such

FIG. 5. Charging by influence or induction. Bringing a charged body near but not in actual contact with an insulated conductor will cause a separation of the electrical charges; the opposite charges are repelled to the far end of the conductors, and if they are led off by another conductor a definite charge is left on the first conductor.is usually "oscillatory" in the form of electric waves and is accompanied by a sound. (See next chapter.) The Leyden jar is the earliest and best known form of a condenser and consists of a wide-mouth glass jar coated by a metal, such as tinfoil, to about two-thirds of its height, both on the inside and the outside. A brass

discharge

36

FUNDAMENTAL ELECTROPHYSICS

rod extends through an insulated stopper; the lower end of the rod is connected with the inside coating by means of a brass chain and terminates in a knob on its upper end. Modern electrical apparatus is usually equipped

Copper orfoil

tin.

/

mica or paper/Copper orfoiltin,

/

/mica or paper/

JarFIG. 6 FIG. 7of

FIG. FIG.

6.

Diagram

Leyden

jar, its

discharge through a "spark gap."

7.

Plate condenser.

with plate condensers, consisting of a number of flat metal (copper) sheets separated by insulating material (mica). The alternate layers of the conducting material are connected to the terminals of an electrical source. A large capacity can be built up in these plate condensers.

FIG.

8.

Electric repulsion.

A

from a static machine; the charge spreading and as a result each hair repels its neighbor.

person seated on an insulated platform receives a charge all over the body electrifies each hair similarly

Static or frictional electricity is the first known form Static Electricity. the Greek name of which of electricity. The Greeks observed that amber

STATIC ELECTRICITYis

37

attract light objects, such as feathers, Gilbert, physician to Queen Elizabeth, discovered that glass, sulphur, resin and some other substances possessed the same property as amber and he coined the name electricity (electricitas) from the Greek

elektron

when rubbed, would

or bits of paper.

word.dissimilar substances, preferably non-conductors of electricity, some substances take on an excess of electrons, while others are left with a deficit of electrons. Those with an excess of electrons are

When

are rubbed

considered to possess a negative charge, while the ones deprived of their electrons are considered to be charged positively.Electricity produced by friction is held on an insulated conductor in a state of tension, ready to flow away, and is called "static" electricity, in contrast to "current" electricity which flows all the time.

N

FIG. 9. Primitive static machine (Tcepler-Holtz type). R-R', contact brushes; N, diagonal bar for neutralizing charges; J-J', small Leyden jars to increase capacity of apparatus.

Lightning may be explained by the separation of electric charges on the heavy raindrops from the thunderclouds by the violent air currents. The negative charges remain on the finest particles blown high into the air while the heavy positively charged raindrops are left behind. Thus an electric field of enormous tension is created and, due to the overpowering pull of the lines of force, the charges rush forward, ionize the air (making it a conductor) and there is a lightning flash. The static machine is a miniature generator of lightning. In its primitive form it consists of two circular glass discs mounted on a spindle, with only a small space between them. When rotated by a handle, or by motor power, at high speed, a separation of electric charges takes place and metallic brushes draw off the positive and negative charges from the revolving disc, leading them to two metallic "prime" conductors or ter-

38

FUNDAMENTAL ELECTROPHYSICS

minals. When the difference of potential between these two terminal conductors becomes sufficiently high an electric discharge occurs in the form of a spark.

CURRENT ELECTRICITYElectric Current.is

A stream of loose electrons passing along aToestablish or maintain

conductor

called a current of electricity.itis

an

electric

current

necessary that there be a source of energy generating an

FIG. 10 FIG. 10. Electric circuit. FIG. 11. Short circuit. low-resistance by-pass.

FIG. 11

An

accidental overflow of current due to an establishment of a

electric charge and there be a- complete electrical circuit maintained between the higher and lower level of electrons. The path of the current from the generating source through the various conductors back to the generating source is called an electric circuit. As the electric current flows, the circuit is said to be "closed;" if an interruption or a break occurs the circuit is said to be "open' and the current ceases to flow. This terminology'

O