Seven years ago I made the statement that the average general practitioner had left the use of electricity in the practice of medicine to the specialist or the quack. I said that quite a few, if not the majority of, physicians had batteries of some sort, but they were usually of antiquated pattern, and were more likely to be found on the top shelf of a closet than in active use in the doctor’s office.
Such a statement could not be made at the present date with any regard to the truth. The past six or seven years have seen the essay of many physicians into the field of electro-therapeutics. But even this increased interest has developed upon somewhat narrow lines. Eight years ago Roentgen made his famous discovery of the X-rays, and within a few months medical literature contained reports of the treatment and apparent cure of intractable and ordinarily fatal diseases by means of this new agency. It was this fact, unquestionably, that awakened a wider interest in electro-therapeutics, and skillfully and sedulously worked up by commercial interests, was followed by a boom in the manufacture of static machines. With the assurance that a single case of cancer cured by the X-ray, or perhaps treated only, would more than pay for the apparatus, which would thenceforth become a perpetual source of income, and that all that was necessary for the operator to know would be taught him by the manufacturer’s agent or solicitor, is it any wonder that hundreds of physicians swallowed the bait, purchased the static machine, treated the patient and – well, the majority of them have lost a good deal of the enthusiasm of their youthful days, and many machines are gathering the dust of which the galvanic and faradic battery formerly enjoyed the monopoly.
Not all the cases of cancer in the country have yet been cured; we still have the old rheumatic with us; and the practitioner who was taught that the millenium had come with the static spark is a sadder and a wiser man.
Such a phenomenal and violent growth of interest in a scientific subject can hardly take place without damage to the subject. Science is knowledge; and knowledge is not a thing of mushroom growth. The use of static electricity and the X-rays by operators who have made little if any study of the physics of the subjects has discredited these agents with not a few of the laity.
Within the past few weeks I heard of a physician who purchased a static machine and X-ray outfit from a practitioner about to retire from the practice of medicine. Instruction in electro-physics and the principles of the static machine was not included in the bargain and it was not many hours before the purchaser came to the conclusion that it was difficult to make a direct current motor operate on an alternating circuit.
But the static machine has come to stay, and with the usual happy optimism of Americans we are content to believe that the situation will right itself in time. From static electricity to the high-frequency current is but a step; and the manufacturer has seized the opportunity, and is selling vacuum electrodes to the doctors whom he supplied with static machines.
What, then, we need is education, and it is gratifying to see that attention is being paid to this department of medical learning in our colleges. And the demand for literature on the subject shows that the man in active practice is anxious to learn about these new therapeutic agencies. In France, Germany, England and this country there are one or more peridical journels devoted to physical therapeutics, and a really good book on the subject is eagerly bought.
In the endeavor to keep abreast with modern advances we should be careful not to neglect or despise old and tried friends. Galvanism and faradism we had with us many years before the modern development in favor of the higher potential currents. And these currents have been thoroughly investigated and made the subjects of laboratory and clinical research; so that we know just what they will do. Is it not possible that some of us would be better employed in using these agents according to established indications, than in experimenting with the newer modalities whose effects we must still speculate about.
How many of those now using electricity every day could make a technical electro-diagnosis? How many could accurately define what is meant by the reaction of degeneration?
But electricity is not all there is in physical therapeutics; heat, light, water, and vibration are included in its domain. In these departments the use of special apparatus has not kept pace with the progress made in electrotherapy. Such apparatus is technical and costly, and the majority is hanging back, waiting to learn from the experience of the few. It would be of much assistance if new types of apparatus could be thoroughly and clinically tested at some institution as soon as they are evolved.
With regard to vibratory apparatus there is considerable lack of accurate knowledge. A more or less complicated machine for this purpose ranges from $25 to upwards of $200. The range is quite large, to say the least. If the smaller machines will do all that is necessary, even though they be less perfect in construction or attended with some drawbacks, and not make such a psychical appeal to the patient as the more costly apparatus, the younger practitioners to whom expense of equipment means a good deal, would be keenly interested in the fact.
It seems to me that one of the greatest needs at the present time is the clinical testing of different types of apparatus by independent authorities.
The scientific use of hydrotherapy and the employment of electric baths is much more general in Europe than in this country; and it is suggested that here are fields capable of wide development. At present their use is practically confined to a few sanitaria.
The rise and popularity of ostheopathy is forcing us to see that the medical man has been taking too narrow a view of his professional duties. The laity has outstripped him in its demands. The fact is being brought home to some of us very closely by the loss of dollars which we might have earned if we had kept abreast of the times. To any student of current literature the enormous strides made by the exponents of different systems of physical culture must be apparent.
There is undoubtedly a wide-spread revolt against the taking of drugs; and even the purveyors of such inoffensive members of the pharmaceutical family as the tissue-remedies have found sales can be increased by calling them foods.
Systems of physical exercises and methods of correct breathing are extensively advertised; the puny can be made strong, the feeble, herculean, the misshapen, comely in proportions. The Bible speaks of the difficulty of adding a cubit to one’s stature; but an enterprising American claims to have solved the question.
So we are surrounded by what may be called a multitude of irregular practitioners. Shall we seek the aid of law in suppressing them? The attempt would be foolish and doomed to failure. Their patrons have left us to avail themselves of a service that we could not render. It is true the limitations of the knowledge of anatomy, physiology and pathology must handicap these outsiders and in some respects make them false and dangerous guides. In this they are on a par with the “refracting optician” examining eyes and prescribing lenses; but just so long as it can be shown that the average general practitioner does not add to his knowledge of medicine the ability to make the simple eye-tests now possessed by the optician, it will be impossible to repress the latter. Similarly, until the rank and file of the medical profession are capable of prescribing and directing physical exercises, special baths, etc., etc., the man or woman on the outside will reap the shekels.
And when the day comes that we are all prepared to handle these cases, forcible repression of the intruder will not be necessary. So long as we are prepared to do the work our patients will not leave us; and the ill-success of operators whose work must be hampered by insufficient knowledge of the working of the human economy in health and disease, will point the way back again to the medically trained manipulator.
The acquirement of the necessary knowledge should be fairly easy to any medical man. What we want is a thorough grasp of the principles of the situation. We want to be able to determine what is lacking and what must be supplied; we need not tie ourselves down to hard and fast methods of obtaining the result. It is the end we must keep ever in view, and exercise a ready intelligence to adapt our means to that end. Prof. Blank’s system of exercises may have some excellent ideas embodied in them; but I think too highly of the average intelligence of the modern medical practitioner to believe him able to evolve as good a system of his own.
Physical therapeutics has a large place in the practice of medicine; and while we must not expect that the use of drugs will ever be entirely dispensed with, the time seems to be coming when the medical man who lacks a thorough grasp of the principles of this department of practice will be left behind in the race.
One feature of the work that soon impresses itself upon the mind of the physician who takes up this department of therapeutics is that, not only is the apparatus costly, but satisfactory treatments are time-consuming to a marked degree. In a good many cases, too, they involve the attendance of a nurse or assistant. It, therefore, seems that this class of work is difficult of accomplishment in the busy general practitioner’s life, and it looks as if the cases must be eventually transferred to the physician confining his practice to office treatments exclusively if they are to receive the proper attention and derive the full benefit that physical therapeutics can afford. It will be found just as difficult to use complicated and technical apparatus with an office full of people waiting for prescriptions, or some sick patients or an obstetric case demanding immediate attention as it has proved to be impossible to carry on a general practice and at the same time do satisfactory work as a surgeon.