LETTERMAN GENERAL HOSPITAL 1919

HISTORY OF LETTERMAN GENERAL HOSPITAL

Physio-Therapy

Pages 22, 23a, 52b

Just as a twig is bent the tree’s inclined,” is a line that well illustrates the slow, patient training of an injured part from its deformed condition back to its originally normal shape. Often it is necessary that the surgeon first operate and remove the mechanical obstruction, thus clearing the way for action. And sometimes it is the other way about---the aid in the Physio-Therapy Department must do her part in preparation of the injured part by improving the condition of the muscles before an operation be possible.

No attempt to explain the therapeutic effects of Physio-Therapy treatments can be made here. The majority of cases treated in the department have been gunshot injuries. Some of these have resulted in a state of serious collapse from excessive bleeding, long exposure to wet, cold, hunger, etc. There have been many extensive shell wounds, associated with fractures of the long bones, especially of the leg; a large majority of the gunshot wounds have not inflicted very lasting serious injury. There have been many amputation cases.

Most treatments, unless they consist of massage alone, require from forty-five minutes to an hour. However, each case has certain laws unto itself in regards the duration of treatment and the frequency of the necessary applications. In treating a new case it is necessary for the aide, not only to know the normal structure of the human body but in every separate case to observe and make a mental note of all the conditions as they are.

All “drop feet and hands” may be typical, but with each individual there is a difference. The aide who treats Jones’ “drop hand” does not do the same good to the patient as the aide who treats the individual Jones, who incidently (sic) has a “drop hand.” It is necessary to observe the attitude of the patient, his whole general condition, whether or not his shoulder is stiff from disuse, etc. It is nearly impossible to produce complete reaction in a patient who does not take kindly to his treatment. The mind exercises inhibitory influences over the body functions; that is of the greatest importance. Also it is very necessary to treat the whole of an injured limb, and not only the injured part. A patient will generally keep his eyes fixed to the injured part, and wonderful results can be obtained by affecting little distraction. Movement can not be satisfactory given while the patient offers a nervous resistance long before the movement is even attempted. Muscles move and fix a joint. Muscle re-education should commence before any joint can be moved, and while, if necessary the limb is still in a cast or splint.

After injury of any sort there is a tendency for muscular atrophy to follow, sometimes from lack of use, sometimes as a result of direct injury to the muscle, its nerve supply or the reflex action caused by the injury to the joint. And in treatments for joint injury we try to re-educate the muscles controlling the joint action. There is no more misinterpreted word than massage, and I know of no higher or more dignified profession than the therapeutical (sic) action of scientific massage, and exercises.

In the electrical ward are many different kinds of machines—all therapeutic agents to assist nature in her efforts of restoration. In the Hydro-Therapy ward are the electric and super-heated air baths, the showers, sprays, etc. Revulsive showers have a mild tonic and stimulant effect. Alternative hot and cold showers are more vigorous. The super-heated air baths are very helpful. Certain cases require tonic treatments—salt glow, hot and cold applications to the spine followed by needle spray and douche. Cold is a depressant, while heat is a stimulant to vital activities. The kinds of treatment are many—one knee may require a baking, while another needs cold packs. Applications of warm water to a nerve trunk produce dilation of the vessels, yet warm water applied to the general skin surfaces by immersion will produce a narrowing of the pial vessels.

Some men must need receive treatment in one, some in all these various branches of the Physio-Therapy Department. Many a man has come first to Ward 15 for massage and dressing of a particular part, later he has had electricity and Hydro-Therapy added. Gradually he has advanced from wheel chair to crutches, hence to the gymnasium and finally gone back to duty.

But, granted that these curative measures are not only satisfactory and sometimes almost miraculous, let us remember that at best the restorative power in a body can only be rejuvenated. The power itself is given every living body by the Creator. In the gymnasium, the Hydro-Therapy ward, the electrical ward and the massage ward, all these branches of the Physio-Therapy Department, ours has been the privilege to serve.

Patients Gymnasium

But when doctors and surgeons have done their best, and wounds are healed and bones repaired, health and spirits restored, the work of completing physical reconstruction begins.

The government has placed Professor Jules Wieniawski in charge of this work, to give the soldiers the best service of this kind that is obtainable on the Coast. The results of the work are attested by the statements of the patients and the records on the improvement charts. Awkward disabilities which seemed permanent are entirely or very materially removed or reduced.

And the soldiers regaining the use of arms, legs, hands, ankles, knee-joints, become happier and more satisfied with life. They are inclined to make light of their past hardships and suffering, and to face life with confidence. They cheerfully and freely testify to the value of the gymnastic reconstruction work.

The methods used embody the ideas of the best known European and American scientists. The exercises are divided into several general classes under the headings of active and passive. There are exercises of strength which correct irregularities of posture and carriage affecting the general health. Of special value are exercises developing muscles and parts atrophied or put into disuse by surgical operations, frequently inseparable from severe wounds.

This class of work is used also for the general development of abdominal, back, chest and leg muscles where weakness exists. Strength is built up and force acquired.

The lighter endurance exercises, manipulation of the patient’s body by the professor or his assistants, are resorted to in weak heart cases and certain chest cases, graduated and moderated to fit each individual case. Simple and easy as these movements seem, not only to the onlooker but to the patient as well, results soon are apparent when the resistive movements are used. The general tonic action is due to the action upon respiration, circulation and secretion.

Under the head of passive movements come the methods used to stimulate local circulation for the improvement of any bodily ill or condition requiring such treatment. Also there are exercises of skill, coordination, judgment of speed, or distance and of weight.

Probably the greater part of the gymnasium work consists however, in the treatment of disabled joints, sometimes the result of injuries or rheumatism, but much more often the result of wounds, as the scarred limbs mutely testify. The gentle art of stretching and breaking down adhesions is constantly being practiced.

Patients are taken into the gymnasium only upon orders of ward surgeons who prescribe the class of treatment or nature of work desired. The desire of patients to do more than the work allotted is controlled, and their activities are guided within bounds. Sounds of piano music may be heard emanating from the gymnasium at all hours of the working day. But the music, which makes the physical exercises seem lighter to scores of patients, also serves another purpose in the manner of its production. Soldier patients limber up ankylosed ankles by pedaling the pianola. One finishes his work and the music stops. Another takes his place and the music resumes.

Reconstruction Aides

Reconstruction Aides of the Physio-Therapy Department were first recruited from the ranks of Physical Directors throughout the U. S. This did not suffice to fill the need and under the direction of the Surgeon General certain colleges and universities were designated to prepare women for this emergency.

The entrance standard to this course was high; most schools asking that the women be University or College graduates, with successful experience in some allied field as a background. Physical training majors were especially sought.

These women when accepted for training were put through a fourteen weeks course which was on a par with the fourteen weeks course put in by men who entered the R. O. T. C.

Prescribed courses in Anatomy, Muscle Activity, Psychology, Remedial Exercise, Physiology, Pathology, Massage, Emergency Treatment, Hydro-Therapy, Electro Therapy-Development Exercise, Surgical Clinic and Reconstruction Clinic experience, were among those stressed, maintained from the very first until those who finished and whose recommendations were forwarded to Surgeon General were a representative body of trained workers.

Captain C. L. Lowman, Director of Physio-Therapy, is acting also as laison officer between Orthopedic Department and Education Service, consultant to both services. Uncle Sam is training his disabled soldiers so that they may be self-supporting. Help him make use of his training by offering him a job.

Transcribed by Sharon Walford Yost.

Source: ”The History of Letterman General Hospital, Pages 5, 6 & 50. Published by the Listening Post, Presidio, San Francisco, Cal. 1919.