COLUMBIA LIBRARIES OFFSITE 
 
 HEALTH SCIENCES SrANOAHD 
 
 f 
 
 HX64056732 
 RD131 M192 Reclaiming the maime 
 
 ;laiming 
 the maimed 
 
 MC- KENZIE 
 
Colttmbia Wlni\3tvsiitp 
 in tje Citp of iSetn gcrfe 
 
 CoUege of l^fi^^itim^ anb ^urgeonjf 
 
 l^eference JLihvavv 
 
Digitized by the Internet Archive 
 
 in 2010 with funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/reclaimingmaimedOOmcke 
 
RECLAIMING THE .MAIMED 
 
•The 
 
 THE MACMILLAN COMPANY 
 
 NEW YORK • BOSTON • CHICAGO - DALLAS 
 ATLANTA • SAN FRANCISCO 
 
 MACMILLAN & CO., Limited 
 
 LONDON • BOMBAY • CALCUTTA 
 MELBOURNE 
 
 THE MACMILLAN CO. OF CANADA, Ltd. 
 
 TORONTO 
 
Reclaiming the Maimed 
 
 A HANDBOOK 
 OF PHYSICAL THERAPY 
 
 BY 
 
 R. TAIT McKENZIE, M.D. 
 
 MAJOR R. A. M. C, PROFESSOR OF PHYSICAL THERAPY 
 UNIVERSITY OF PENNSYLVANIA 
 
 ILLUSTRATED 
 
 THE MACMILLAN COMPANY 
 1918 
 
 All rights reserved 
 
(^ 
 
 Copyright, 1918, 
 By the MACMILLAN COMPANY. 
 
 Set up and electrotyped. Published May, 1918. 
 
 '^1 \-J'/:_ 
 
 WortDooU prE00 
 
 J. S. Cushing Co. — Berwick & Smith Co. 
 
 Norwood, Mass., U.S.A. 
 
CONTENTS 
 
 PAGE 
 
 Chapter I i 
 
 Conditions brought about by the present war. Cla[:s of 
 cases capable of improvement by physical means. Plan- 
 ning and equipping of department of physical therapy in 
 hospitals. Recording of cases. 
 
 Chapter II lo 
 
 Medical electricity. The use of galvanism and ionization 
 in wounds and scar tissue. 
 
 Chapter III 23 
 
 The faradic current and high frequency. Muscle testing 
 and exercising. 
 
 Chapter IV 37 
 
 Radiant heat and light; their uses in a military' hospital. 
 
 Chapter V 45 
 
 Hydro-therapy, The Whirlpool Bath and other forms of 
 treatment. 
 
 Chapter VI 54 
 
 Massage. Its technique and place in treatment. Passive 
 movement. Its place and limitations in contracted joints. 
 
 Chapter VII 65 
 
 Reeducation. A description of twenty appliances for 
 the reeducation of the weakened muscles and stiff joints, as 
 designed for, and adopted by, the Military Hospitals Com- 
 mission of Canada. (This is the first description published.) 
 
 Chapter VIII 92 
 
 Gymnastics and athletic games. Their place in, and 
 progressive course of, reeducating the disabled man, 
 
 V 
 
vi CONTENTS 
 
 PAGE 
 
 Chapter IX 105 
 
 Treatment by occupation. Importance of occupation 
 to prevent the "hospital habit." Forms of occupation 
 taught. The placing of men in civil life, after recovery. 
 
 Chapter X 117 
 
 Masking of facial deformity. The construction of metal 
 masks to enable disfigured men to occupy positions, without 
 attracting attention to their disfigurement. 
 
INTRODUCTION 
 
 In the following pages I have endeavored to put in small 
 compass a description of the means that have been potent 
 in putting back into active military service nearly half of 
 those men wounded or otherwise disabled in action, who 
 had climbed with decreasing speed the uphill road to re- 
 covery that too often halts at permanent invalidism. 
 
 This work is founded on an experience of over a year as 
 Medical Officer, in charge of the "Command Depot" at 
 Heaton Park, Manchester, and as Inspector of similar in- 
 stitutions for the treatment of convalescents, founded by 
 the War Office throughout the British Isles. This experience 
 was added to by a tour of inspection of the Canadian Con- 
 valescent Hospitals, established by the Military Hospitals 
 Commission, for the purpose of standardizing the teaching 
 and practice of physical therapy. 
 
 My thanks are due, and gladly given, to Sir Alfred Keogh, 
 G.C.B., Director General of Medical Services, whose fore- 
 sight and energy made this work possible in Britain and 
 whose sympathetic support helped it over the difficult stages 
 of organization, to proved efficiency. To the practical 
 common sense and unbounded activity of Sir Robert Jones, 
 K.C.B., Inspector of Military Orthopedics, who founded 
 the chain of orthopedic centers, to which curative work- 
 shops are attached, I owe much, received during our associa- 
 tion in the inspection of hospitals and camps. To Doctor 
 R. Fortesque Fox I am indebted for assistance in establish- 
 ing the Hydro at Heaton Park. I wish to thank Captain 
 A. E. Barclay, R.A.M.C., for invaluable help on the first 
 appliances used for reeducation at Heaton Park, of which 
 
 vii 
 
viii INTRODUC TION 
 
 more than thirty sets have already been distributed through- 
 out Great Britain and India, and also my assistants, Doctor 
 H. S. Seeuwen, and Doctor Frank Radcliffe, for loyal and 
 efficient service at all times. 
 
 To Sir James Lougheed, K.C.M.G., President of the 
 Military Hospitals Commission, now the Invahded Soldiers' 
 Commission, who showed his appreciation of the importance 
 of physical therapy by ordering an inspection and report on 
 the subject, I owe the opportunity of studying the con- 
 ditions in the Canadian Military Hospitals, and also to the 
 Superintendent, Colonel Alfred Thompson, M.P., C.A.M.C, 
 and to the Director, Mr. S. A. Armstrong, I am a willing 
 debtor for many services cheerfully rendered. 
 
 I cannot close without reference to the experimental work 
 of E. A. Bott, Ph.D., and his staff at the reeducation center. 
 Hart House, University of Toronto. Many of the standard 
 appliances adopted by the Military Hospitals Commission 
 for the reeducation of disabled muscles owe much to their 
 study and suggestions. 
 
RECLAIMING THE MAIMED 
 
RECLAIMING THE MAIMED 
 
 CHAPTER I 
 
 The calamity of war has been necessary to startle the pro- 
 fession into a realization of the wide field that should be 
 occupied by physical methods in the treatment of disease. 
 The sporadic wounds that peaceful life produced have been 
 multiplied in our military hospitals into groups, the excep- 
 tion has become the ordinary; torn and mangled bodies 
 have had to be patched and remade, and functions lost or 
 weakened gradually coaxed back toward the normal, by 
 means hitherto despised, or ignored by too many physicians 
 and surgeons. 
 
 Until the outbreak of the war these means were in the 
 hands of a few enthusiasts in the profession, or were exploited 
 by that motley army of camp followers who had entered the 
 highway of medical practice, not by the gate, but through 
 holes in the wall, puffed up by the importance of partial 
 knowledge, or making fact bow to some preposterous theory. 
 
 Old conditions have come up with new names, and new 
 conditions have had to be met by a rearrangement and 
 application of old means. We must reconsider at this 
 time the whole field of physical therapy as applied to and 
 affected by the great war. 
 
 This Cinderella of the therapeutic family may be said to 
 include the application of Electricity in its many forms, 
 Radiant Heat, Water, Hot and Cold, Massage, Passive Move- 
 ment, Muscular Reeducation, and Gymnastic Exercises. 
 
2 RECLAIMING THE MAIMED 
 
 Application of Physical Therapy. — i. Injury to pe- 
 ripheral nerves, all the way from bruising of a nerve trunk 
 to its destruction and restoration by surgical means. 
 
 These cases are accompanied by weakness, or paralysis, 
 muscular wasting, and contractures. They are treated by wet 
 or dr}' heat to exalt the local circulation, support in proper 
 position by splints to prevent the overstretching of weakened 
 
 Fig. I. — Bullet wound of the arm followed by ulnar paralysis 
 with wasting. 
 
 muscles, and the resultant permanent contraction of those that 
 are unimpaired, galvanic, and afterward faradic, stimulation 
 to the affected muscles, massage to keep up or improve their 
 nutrition, passive movement to prevent contraction and limi- 
 tation of the normal range of the joint, progressive active 
 movement, joint by joint, to bring back and strengthen volun- 
 tary power ; ending with gymnastic and vocational training 
 for skill to fit the patient to take his place in civil life again. 
 
RECLAIMING THE MAIMED 
 
 2. Scar tissue, either in preparation for, or after operation. 
 A bullet may leave a small entrance scar, but its course 
 through the tissues 
 may leave great 
 areas in which mus- 
 cle, fascia, tendon, 
 nerve, periosteum, 
 and skin are matted 
 together in one 
 confused, distorted 
 mass, leaving the 
 limb blue, clammy, 
 moist with con- 
 tinual perspiration, 
 and so painful that 
 the patient winces at 
 the slightest touch 
 — even after ampu- 
 tations the sensi- 
 tive nerve endings 
 caught in the scar of the operation are among the most 
 
 troublesome conditions of 
 war surgery. 
 
 Such wounds are 
 treated by the warmth 
 of the whirlpool bath, 
 which in twenty minutes 
 changes the cold purple 
 of the painful hand into 
 a warm crimson, and 
 enables the masseur to 
 stroke, knead, and move 
 a joint in a way that no 
 amount of persuasion would have made tolerable with- 
 out it. 
 
 Fig. 2. — Bullet wound of the back. Entrance at 
 first dorsal level ; exit at seventh dorsal. 
 
 Fig. 3. 
 
 - Painful stump following explo- 
 sion of hand grenade. 
 
4 RECLAIMING THE MAIMED 
 
 The hastening of repair in these scars by diathermy and 
 ionization and the stretching of beginning contractures by 
 careful manipulation, taking care to avoid the breaking down 
 of scar tissue in course of organization, are among the triumphs 
 of these methods. 
 
 Fig. 4. — One hundred and thirteen wounds from the 
 explosion of one shell. 
 
RECLAIMING THE MAIMED 5 
 
 3. Old septic wounds, long since healed, are frequently 
 persistently painful, and a focus of infection may be dis- 
 covered. It is a frequent experience to find part of a long 
 scar become painful, then red, and finally to see a sequestrum 
 of bone extruded that would have lain for months a source of 
 trouble without the stimulation of heat and massage to 
 hasten its removal. Naturally such cases need most careful 
 supervision, and a rough and unskilled operator may easily 
 do more harm than good. Electricity, heat, and massage 
 have a most important place in softening extensive scar 
 tissue and making the work of the surgeon easier. 
 
 4. In all post-operative conditions, the cure must be 
 completed by physical means. 
 
 It is not enough to break down an adhesion, or restore a 
 joint to potential usefulness. Its nutrition must be improved, 
 and the patient must be taught to use it. Even if it is pos- 
 sible to move it passively throughout its whole range, the 
 cure is not complete till the patient can do this himself with 
 power and skill. He must be taken through a course of re- 
 education beginning with simple single movements, and 
 advancing to those harder and more complex. Devices for 
 this purpose must be designed and employed until he can go 
 through the more complicated actions of the craft he may 
 elect to practice. 
 
 5. Functional neuroses, which take the form of palsies, 
 contractures, loss of sight, speech, or hearing, areas of 
 anaesthesia or hypersesthesia, show many dramatic cures 
 by physical means. Contractures slowly stretched and kept 
 in place by splints, systematically massaged, and exercised 
 by the faradic battery, where voluntary movement cannot 
 be obtained, can be brought back to usefulness by a com- 
 bination of hypnotism, suggestion, encouragement, and the 
 gradual replacing of them by voluntary movement. The 
 operator here must be both priest and physician, for the 
 mental is even more important than the physical treatment, 
 
RECLAIMING THE MAIMED 
 
 and these very real conditions, beyond the patient's cont 
 in most cases, require persistent and intelHgent treatme. 
 sometimes over long periods of time. 
 
 6. The conditions variously grouped under the nam 
 ''Shell Shock," which vary all the way from minute hemor- 
 rhages into the brain substance, caused by concussion, to 
 
 fear and intolerable weariness, 
 must be treated by this 
 means. A soldier begins to 
 move his head rhythmically, 
 twitch his arm, or clutch at 
 the sound of a shell, and the 
 regimental surgeon, if he is 
 wise, sends him back to the 
 rest camp for a week or two. 
 If he is kept until the inevi- 
 table smash comes, his re- 
 covery will be a matter of 
 months at best, and he is 
 usually out of commission 
 permanently. Tremors coarse 
 and fine, up to the point of 
 a general convulsive seizure, 
 rhythmical movements when 
 the man is spoken to and 
 calming down when he is left 
 alone, are characteristic. 
 Many of them are martial misfits, never built for the noise 
 and stress of modern warfare, and rapidly going to pieces 
 under it, with a history of nervousness and frequently with 
 enlarged thyroids, rapid pulse, and prominent eyes. All 
 these conditions call for rest and sedative treatment, at 
 first the continuous bath at skin temperature, an hour's 
 rest in bed daily, and the substitution of gentle massage 
 and electricity for active movement, with later a gradual 
 
 Fig. 5. — Functional paralysis of ab- 
 dominal muscles following crush- 
 ing injury in a trench. 
 
RECLAIMING THE MAIMED 7 
 
 crease of exercise beginning with a slow walk, and ending 
 ith gymnastics, games, and vocational training. 
 
 7. The "soldier's heart" is but a manifestation of over- 
 ;5train. The rapid pulse and breathlessness, the enlarged 
 
 ■thyroid, all show the nervous origin of the condition so 
 familiar to medical officers as D. A. H. In these cases the 
 faradic or high frequency current through the thyroid, the 
 sedative bath, gentle massage, and rest quickly reduce the 
 rapid pulse rate and allow him to bear, without damage, 
 an increasing load of work in the form of light gymnastic 
 exercise and walking. 
 
 8. The debilitated, whether from typhoid or dysentery, 
 are built up again, hardened, and made ready for service by 
 graduated exercises of effort like gymnastics, and of endur- 
 ance like walking, until they can bear the load of work to 
 which they were formerly accustomed. 
 
 9. The place of physical remedies in the treatment of 
 sprains and fractures, in rheumatism and gout, in fiat foot 
 and other postural defects, need not be discussed here. 
 Enough has been said to show that most of the men that 
 fill our war hospitals, command depots, and convalescent 
 homes must depend in great measure for their present treat- 
 ment and future prospects on the masseuse, the practitioner 
 of electro- and hydro-therapy, the physical instructor, and 
 the teacher of vocational training. 
 
 The progress of treatment usually begins with prepara- 
 tion by heat, either wet, dry, or produced by electricity, on 
 through stimulation of nutrition, by massage, and passive 
 movement, then to simple exercise taken voluntarily, and 
 finally to skilled movements by gymnastics, games, and 
 handcrafts. 
 
 Cases naturally divide themselves into two classes, those 
 requiring general treatment and those requiring local treat- 
 ment ; and in planning a Department of Physical Therapy 
 this should be kept in mind. 
 
RECLAIMING THE MAIMED 
 
 Fig. 6. — Plan for department of physical 
 therapy in a military hospital for con- 
 valescents. 
 
 1. By general treatment 
 we include the douche, the 
 full bath, the cabinet for 
 light and heat and general 
 massage. For all these 
 the patient must undress 
 and after them he should 
 rest. Make ample pro- 
 vision for a waiting and 
 dressing room with linen 
 closet and blanket warmer. 
 A patient with irregular, 
 irritable heart, or suffer- 
 ing from shell shock, re- 
 quires sedative treatment 
 and quietness. His bath 
 should not be in the same 
 room with the douche, 
 where there is continual 
 traffic, talking and 
 splashing. 
 
 The rest room should 
 be conveniently placed to 
 both douche and bath 
 rooms. It should be 
 darkened and patients 
 should be left quiet and 
 undisturbed for an hour 
 or more after treatment, 
 well wrapped up on com- 
 fortable couches. 
 
 2. For local treatments 
 the patient usually bares 
 an arm or leg only, and 
 provision for dressing 
 
RECLAIMING THE MAIMED 9 
 
 need not be so elaborate. They pass in a continuous stream 
 through the treatment rooms from bath to table or couch 
 and on to apparatus and the gymnasium. 
 
 The floor plan should be arranged to keep these two 
 streams of patients apart. For massage, electricity, and 
 corrective exercise, one large room is to be greatly preferred 
 to several small ones. There is no great objection to having 
 arm and leg baths at one end of it. The head masseuse can 
 supervise her work much better, it is more cheerful for the 
 patients, and any required privacy can be secured by screens. 
 Plugs should be inserted at short intervals around the wall 
 to connect with the lamps, photophores, and electrical 
 appliances. This gives flexibility to the equipment, and 
 allows the setting up and application of radiant heat, gal- 
 vanic, or sinusoidal current wherever it may be most needed. 
 Each masseuse should have her own couch or table, and the 
 plinth and appliances for corrective gymnastics and re- 
 education should be placed in a zone down the center of the 
 room. 
 
 In addition to the case history which follows the man 
 wherever he goes, a card should be issued for him when he 
 starts treatment. This card should contain a brief case 
 history, diagnosis, and proposed treatment. The masseuse 
 in charge of the case should enter on it the measurements of 
 movement, strength, and other notes of progress. It should 
 be kept by her, ready for inspection by the medical officer, 
 and when the case is finished, it should be used as a store- 
 house of accurate information from which to make notes 
 for the case sheets. The card should then be filed in the 
 records of the Department. 
 
 When some such plan is not used, important facts are sure 
 to be lost or to remain unrecorded. The card serves as a 
 constant reminder, both to the medical officer and the 
 masseuse, and in dealing with large numbers of patients, 
 it is a great time saver as well. 
 
CHAPTER II 
 MEDICAL ELECTRICITY 
 
 Galvanism, Ionic Medication 
 
 The subject of electricity is approached by many medical 
 men in an attitude of apparent contempt but of very real 
 apprehension. To this succeeds an increasing confusion of 
 ideas ending in a final collapse, as the intricacies of the various 
 currents or ''modalities" are exposed to his astonished gaze, 
 and their conflicting claims set forth. It is in the hope of 
 saving the reader from some of the quagmires through which 
 I have floundered that I will endeavor to bridge some of the 
 most obvious of the pitfalls which beset the unwary trav- 
 eler and prevent him from appreciating the real value of 
 this therapeutic agent. 
 
 Electricity is produced by chemical action, by induction, 
 and by friction, all these forms being used in medical treat- 
 ment. 
 
 Object. — The object of electrical treatment is (i) to 
 produce heat either on the surface or in the tissues and so 
 to induce hyperaemia and absorption of inflammatory prod- 
 ucts, (2) to cause absorption of drugs, (3) to stimulate 
 nerves and so produce muscular contraction, (4) to cause 
 muscular, contraction by chemical action on the muscle 
 tissue itself, and (5) to soothe and alleviate pain. 
 
 Continuous Current. — The continuous current is 
 produced by chemical action. If we take an earthen vessel 
 
 10 
 
RECLAIMING THE MAIMED 
 
 11 
 
 Copper or Carbon — ' 
 Containing vessel 
 
 Electrol^ftlc fluid 
 
 \-Z\r\c rod 
 
 Fig. 7. — A galvanic cell. 
 
 containing dilute sulphuric acid and place in it a rod of 
 zinc and a rod of copper, there is a transfer of electricity 
 from the zinc to the copper. If a connecting wire is- placed 
 between the copper and the zinc, electricity will flow along 
 it back to the zinc in order 
 to reestablish the equilib- 
 rium, and this flow of elec- 
 tricity will cause bubbles 
 of hydrogen to form at the 
 copper rod, as may be 
 readily observed. It keeps 
 paying back its debt to the 
 zinc. The part of the plate 
 to which the wire is attached 
 is called the pole. It is 
 quite logical then that the 
 copper should be called the 
 plus pole (anode) and the zinc the negative (cathode), the 
 part which is immersed being called the plate and the fluid 
 the electrolyte. 
 
 There are many influences which vary the strength of 
 the current induced by the action of this simple cell just 
 described. 
 
 If the hydrogen bubbles are allowed to accumulate on the 
 copper plate, the layer becomes thick and acts as a barrier 
 so that the current is weakened ; and finally when the layer 
 of gas becomes thick enough, the current is completely 
 blocked. This is called polarization, and the cell may be 
 depolarized by wiping the bubbles away. 
 
 The cell just described has been, in many cases, replaced 
 by the dry cell in which the electrolyte is a solid instead of 
 a fluid, but the chemical action is in every case substantially 
 the same. 
 
 The Variations in Current. — To understand the 
 relationship between voltage, resistance, and volume, we 
 
12 RECLAIMING THE MAIMED 
 
 may take a simple illustration. Imagine a cistern full of 
 water placed at a high level. If it has no outlet, the water 
 remains at rest, but with high potentiality for power. If 
 a pipe be arranged leading from it to a low level tank, the 
 water will flow through it to the lower tank with a certain 
 force. This may be compared to the current flowing from 
 the positive to the negative pole. The strength or force 
 of the stream is directly dependent upon the amount of 
 difference in the two water levels. The pressure of this 
 stream is comparable to the voltage of the electric current. 
 As soon as the high level cistern is emptied, the flow of water 
 will cease, and it is only possible to have a continuous 
 flow by pumping the upper cistern full. Such a pump may 
 be compared to an electrolyte which keeps continually charg- 
 ing the positive pole and taking from the negative pole. 
 The resistance, measured in ohms, in the wire or conductor 
 and in the tendency to polarization as already described, 
 resembles the slowing of water by the friction of the walls 
 of the pipe. The volume of current (measured in am- 
 peres) will vary, according to the resistance and the caliber 
 of the carrier. The greater the resistance, the smaller will 
 be the resultant current, just as a narrow and tortuous pipe 
 will allow less water to pass through it than a large, straight 
 one. To get a greater amount of water, you would have to 
 reduce the resistance by using a bigger pipe or straightening 
 it, or else raise the level of the upper cistern to increase the 
 pressure, and the resistance is reduced as much as possible 
 in every circuit by the use of good conductors. The follow- 
 ing electrical units have been adopted. 
 
 A volt is the amount of electromotive force generated by 
 a Daniell's cell, which is standardized. While this is only 
 approximately correct, other cells are always measured with 
 this for comparison. 
 
 Currents for lighting purposes usually consist of either 
 no volts or 220 volts. For medical purposes, the voltage 
 
RECLAIMING THE MAIMED 13 
 
 is usually very small in comparison, except in static and high 
 frequency machines, where it rises to looo or more with 
 very small volume. 
 
 The unit of resistance (the ohm) is that offered by a 
 copper wire looo feet long, and ^ inch in cross section. 
 With this, other resistances can be measured. The resist- 
 ance of the human body with a wet skin has been quoted 
 as between looo and 300 units, or ohms. 
 
 A unit of current is called an ampere. It is the quantity 
 of electricity which an electromotive force of one volt will 
 cause to flow through a resistance of one ohm in one second. 
 
 The ampere is too large a unit for medical purposes and 
 a thousandth part is employed as the most convenient unit. 
 It is called a milliampere. 
 
 It will thus be evident that with resistance remaining 
 constant, doubling the voltage doubles the current, or "The 
 current varies directly as the voltage." If the voltage re- 
 mains constant, then doubling the resistance halves the cur- 
 rent; or halving the resistance doubles the current, or "The 
 current varies inversely as the resistance." 
 
 The current can be varied in any of these respects by 
 combining cells in series or in parallels. The joining of two 
 
 Fig. 8. — Cells arranged in series. 
 
 cells negative to positive forms a battery. If they are joined 
 in a series by means of connecting wires, it is as if you 
 added a number of pumps to a pipe containing water. The 
 result will be an enormous increase in the force in which the 
 water is driven along, or, in electricity, an increased voltage. 
 
14 
 
 RECLAIMING THE MAIMED 
 
 but the volume will not be correspondingly increased be- 
 cause much of the effort will be spent in overcoming the in- 
 creased resistance. Currents with high voltage and small 
 volume are used in medical practice for diathermy, where 
 the resistance of the tissues is shown by the production of 
 heat. If, however, cells are joined in parallel, it is as if we 
 had a common reservoir which we wished to fill with water 
 and a number of pumps, not joined one after the other, but 
 each acting independently and pouring its own stream into 
 the reservoir. The force of the flow will be small (that of 
 one pump), but the volume will be great in a given time. 
 
 Fig. 9. — Cells arranged in parallel. 
 
 In other words, the parallel grouping gives a voltage equal 
 to one cell only, but the internal resistance being reduced, 
 the current or ampereage is increased, and we have a large 
 current flowing at a low voltage. This is the current used 
 for the cautery and diagnostic lamps. 
 
 A galvanic battery consists of a suitable box containing 
 cells and a switchboard to which they are connected by 
 conducting cords of copper wire. On this switchboard are 
 found the terminals to which the connecting cords are 
 attached, leading to the electrode by which the current is 
 applied to the patient, a switch to turn the current off and 
 on, a milliamperemeter to measure it, a metronome or 
 rheotome to interrupt it, and a rheostat or cell collector to 
 increase or decrease the amount and strength of the current. 
 
RECLAIMING THE MAIMED 
 
 15 
 
 The binding screws or terminals are marked plus for the 
 positive pole or anode and minus for the negative pole or 
 cathode. 
 
 6 
 
 O 
 
 O. 
 
 o 
 
 O- 
 
 o. 
 
 v8 
 
 O 
 
 O 
 
 O- 
 
 40) )ii 
 
 Pa t lent 
 
 0+ 
 
 Fig. io. — Cell collector. 
 
 Effect of Galvanic Current upon the Muscles. — 
 A constant current produces no contraction when flowing 
 with uniform strength through the body; but if it is sud- 
 denly cut off or broken, a muscular contraction is produced. 
 If it is suddenly switched on (or made), a muscular contrac- 
 tion is also produced. These contractions are not equal 
 either at the break or make of the current or at both poles, 
 for the contraction at the cathode when a current is turned on 
 is much the most active. Various devices are used to in- 
 terrupt the galvanic current and produce these contractions. 
 
16 
 
 RECLAIMING THE MAIMED 
 
 The chief devices are the reversing switch and the metro- 
 nome. The simplest form of metronome is a wire rhyth- 
 mically introduced and 
 withdrawn in a cup of 
 water ; the strength 
 of the current varies 
 with the depth of im- 
 mersion as it rises and 
 sinks, so that the 
 patient will receive a 
 current of constantly 
 varying intensity, ris- 
 ing and falling in 
 waves. It is also 
 possible to reverse it 
 by the use of the pole 
 changer and so to have 
 the direction of the 
 current change at each insertion. "Sinusoidal" is the term 
 applied to a current which starts at zero, comes up to its 
 
 . mnnnnmmmmnmmn 
 
 Fig. 12. — Current varied by the metronome. 
 
 full strength on the positive side, of the line, and goes back 
 to zero, forming what is called a true sine curve. It then 
 
 Fig. II. — Reversing switch. 
 
 Fig. 13. — Sinusoidal current from the metronome and pole changer. 
 
 repeats this on the negative side, so that there is an alternat- 
 ing current positive and negative, rhythmical in character. 
 
RECLAIMING THE MAIMED 
 
 17 
 
 This is found to be very much less irritating and painful 
 than if the current were opened and closed abruptly, and 
 in consequence this current is the most popular for general 
 use in muscular stimulation. 
 
 Galvanometer. — This is an instrument for measuring 
 the amount of a constant current. It is graduated in milli- 
 amperes for medical instruments, 
 and the deflection of the needle 
 records the strength of the current, 
 the amount being recorded on the 
 scale. 
 
 Very different effects are pro- 
 duced on the tissues by the electric 
 current at the anode and the 
 cathode. The direction of the 
 current may be determined easily 
 by litmus paper. A strip is laid 
 upon a wet surface and the current 
 is led through it. Blue litmus 
 
 paper turns red at the anode, where acids are produced, and 
 red litmus paper turns blue around the cathode, where 
 alkalis are produced. There are other tests, but this is 
 perhaps the simplest. 
 
 Physiological Effects ; Electrotonus. — The irritabil- 
 ity of the nerve and muscle through which a constant current 
 is passing is altered as follows : In the region of the anode, 
 irritability is decreased and muscular contraction is less 
 readily obtained, the circulation is lowered, sensation is 
 decreased, and pain is deadened. In the region of the 
 cathode, muscular contraction is more readily obtained, 
 sensation is increased and there is hyperaemia and redden- 
 ing of the part. 
 
 Chemical. — The human body contains a large amount 
 of sodium chloride in solution. The constant current splits 
 salts into their constituents, the metallic portion being at- 
 c 
 
 Fig. 14. — Milliamperemeter. 
 
18 RECLAIMING THE MAIMED 
 
 tracted to the cathode, and the acid portion to the anode. 
 This change in the tissues can be made use of medically, for 
 fatigue products in the muscles, such as carbonic acid and 
 sarcolactic acid, which result from excessive muscular ac- 
 tivity, are dispersed by the cathode. This constitutes what 
 is known as the "refreshing" action of the current, but 
 since the anode attracts acids and repels metals, we can also 
 drive solutions of certain metals into the tissues by this 
 action of the anode. 
 
 This introduction of the salts of such metals as lithium 
 and copper by the anode and of iodine and sodium by the 
 cathode is known as ionic medication. 
 
 Application of the Galvanic Battery. — Certain 
 precautions must be observed before using the galvanic 
 battery. 
 
 The skin of the patient should be carefully examined for 
 abrasions. Wherever the skin is broken, the resistance is 
 lowered, and the current will concentrate at such areas, 
 causing a more or less serious burn. If possible, the area 
 chosen for the application should be where the skin is normal. 
 If this is impossible, the abrasions must be protected by cover- 
 ing them with collodion or adhesive plaster. The part 
 should be thoroughly moistened to improve conduction. 
 A dry or greasy skin increases the resistance. Electrodes 
 to which the connecting wires from the battery are attached 
 will vary with the region to be treated. They come in many 
 sizes and shapes, but can 'be improvised out of copper wire 
 mesh to which are soldered the binding screws. They are 
 covered with felt, cotton wool, or lint, the essentials being 
 that they should be clean, soft, smooth, and absorbent, and 
 at least one fourth of an inch thick. Great care should be 
 taken to have them applied to the body uniformly flat and 
 free from creases. Burns occur at a crease because here the 
 pressure is greater than elsewhere. The pad should also ex- 
 tend well beyond the metal edge of the electrode on every 
 
RECLAIMING THE MAIMED 
 
 19 
 
 side. Electrodes and pads may be kept in firm position 
 for treatment by the pressure of a well-applied bandage, 
 by sandbags, or other weights. 
 
 The two electrodes should not be placed close enough to 
 touch each other, as the current would then become short- 
 circuited instead of penetrating the tissues. 
 
 When both electrodes have been correctly applied, the 
 current is turned on very slowly and gradually, cell after 
 
 Fig. 15. — Continuous current applied to the sciatic nerve by elec- 
 trodes of copper mesh covered by felt, and held in place by sand- 
 bags across the thigh. 
 
 cell being brought into the circuit. The patient soon becomes 
 conscious of a sharp pricking sensation and a feeling of heat. 
 As the unpleasantness of this diminishes, the current can be 
 increased. If the patient complains of much discomfort 
 or burning, the current should be slowly decreased and the 
 electrodes remoistened and adjusted. 
 
20 RECLAIMING THE MAIMED 
 
 The region of the cathode is the danger point. Watch 
 it. Here burns are most hkely to occur. Where anaesthetic 
 areas are treated, keep a double lookout for possible burns, 
 because the patient cannot help you ; however severely he 
 may be burnt, he will not have any complaints at the time. 
 Burning may be caused by too small a pad, and a good rule 
 is to allow one square inch of electrode for every milliampere 
 of current used. 
 
 At the termination of treatment, the current should be 
 turned off slowly and carefully. If you turn it off suddenly 
 you will hear from the patient, and what you hear will not 
 be complimentary. The electrodes should not be removed 
 until the current is completely turned off. The skin must 
 at once be carefully dried and examined for undue redness, 
 blisters, or burns. 
 
 After using a battery, all switches should be turned off, 
 the cords and electrodes dried, and metal parts polished and 
 freed from all verdigris, and the pads rinsed out and kept 
 in an antiseptic solution or dried. 
 
 Methods. — When both anode and cathode are placed 
 upon the affected part, and are of use in the treatment, 
 the method is called bipolar galvanism. If only one is wanted 
 and the other would be detrimental, the pole placed upon the 
 affected part is called the active electrode, while the other 
 pole or indifferent electrode is placed upon some remote 
 part of the body and used merely to complete the circuit. 
 This is called unipolar galvanism. 
 
 The method of application already described is stabile 
 or stationary because both electrodes are fixed upon the 
 patient and kept at rest throughout the treatment. 
 
 When the active electrode, usually in the form of a roller 
 disk or sponge, is moved up and down or on and off the part 
 treated, it is called labile or movable ; and the action becomes 
 stronger or weaker with its approach to, or recession from, 
 the part under treatment. 
 
RECLAIMING THE MAIMED 21 
 
 Effect of Constant Current. — The constant current 
 applied to the whole body by means of a general bath has a 
 profound effect upon metabolism. For painful local condi- 
 tions, the anode is used for neuritis in its various forms, neu- 
 ralgia, and inflammation. The cathode is used to stimulate 
 the circulation in such conditions as frost-bite or trench foot, 
 old scars, Volkman's ischaemic contraction, and other con- 
 ditions requiring active hyperaemia. This may be applied 
 in a local bath ; or where this is unavailable, the labile method 
 may be substituted, the body being treated area by area. 
 
 Ionic Medication. — The salicylates of soda are recog- 
 nized as being of use for rheumatic affections, lithium for 
 gout, and copper and zinc as antiseptics, while chlorine 
 seems to possess the additional virtue of softening recently 
 formed inflammatory tissue. Instead of taking these drugs 
 by the mouth they can be driven into the body by means 
 of the galvanic current. 
 
 These salts when dissolved in water will split up into 
 atoms called "ions" or "wanderers" or travelers, and the 
 process is called ionization. In this way salts of iodine, 
 sodium, chlorine, and potassium are driven in by the cathode, 
 which repels alkalis, while the salts of lithium, zinc, copper, 
 and magnesium are driven in by the anode, which repels 
 metals. A one per cent or two per cent solution of the 
 required drug is made, and the padding which covers the 
 active electrode is dipped into it. The amount that will be 
 driven in depends on the strength of current and the length 
 of time it runs, the usual treatment lasting about twenty 
 minutes. Heat your solution. It gives comfort to the patient, 
 and it forms a better conductor for the current. These 
 drugs are put up in the form of soloids especially prepared 
 for this purpose, but it is quite as convenient to have them 
 in stock solutions of about twenty per cent, which you can 
 dilute to the required one per cent, as required. The drugs 
 you will need are : salicylate of sodium for chronic arthritis, 
 
22 
 
 RECLAIMING THE MAIMED 
 
 fibrositis, myositis, and for certain forms of bursitis, rheu- 
 matism, neuritis in its various forms, especially lumbago 
 and sciatica, and for the chronic pain so often left after in- 
 juries to joints and limbs; iodine in the form of potassium 
 iodide, as an antiseptic ; chlorine in the form of sodium 
 
 Fig. i6. — Application of sodium chloride solution by the cathode 
 in an arm bath — for painful scars. 
 
 chloride or common salt for the treatment of irritable con- 
 tracting scars — all these introduced by the cathode. Zinc, 
 in the form of sulphate or chloride, and copper sulphate 
 are valuable antiseptics, for suppurating sinuses, chronic 
 ulcers, and other slow infective conditions. They are in- 
 troduced by the anode through electrodes of zinc and copper 
 respectively. 
 
CHAPTER III 
 MEDICAL ELECTRICITY 
 
 Faradism 
 
 Induction. — The second form of electricity used in 
 medicine is produced by induction. 
 
 If you introduce a magnet into a coil of wire forming a 
 closed circuit, an electric current is produced running in one 
 direction. Withdraw it, and its direction is reversed. Keep 
 it still, and no current will flow. If the coil is made to move 
 in relation to a stationary magnet, alternating currents are 
 also produced. This briefly is the principle upon which the 
 dynamo works. Wind a coil of wire around a bar of soft 
 iron and pass a current along the wire ; the iron bar becomes 
 magnetized. So long as the current runs, it is an electro- 
 magnet. If a closed coil of wire carrying a current be brought 
 into the neighborhood of another coil, electric currents are 
 produced in this second coil whenever the current is made 
 or broken. This induced current in the secondary coil passes 
 in the same direction as the inducing current when the cir- 
 cuit is broken, and in the opposite direction when the current 
 is made. Thus we obtain the alternating current. Its voltage 
 can be made high by having a larger number of turns 
 of wire in the secondary coil, so that a low-voltage inducing 
 current can produce an alternating current of high voltage in 
 the secondary coil. Keep these facts in mind and the mech- 
 anism of the faradic battery will be easily understood. Its 
 essential parts are : (i) a source from which a continuous 
 
 23 
 
24 
 
 RECLAIMING THE MAIMED 
 
 current can be obtained ; (2) a stationary coil of wire wound 
 on a wooden bobbin, "the primary coil" ; (3) a device in the 
 circuit of the primary coil for making and breaking this 
 current, "vibrating armature" ; (4) a second coil of wire un- 
 connected with the first, also mounted on a hollow wooden 
 bobbin, "the secondary coil," in which induced alternating 
 
 Fig. 17. — Diagram of faradic coil. 
 
 A. Core and primary coil. B. Condenser. D. Secondary coil and terminals -\ . 
 
 c, b, d. Armature. 
 
 currents are produced ; (5) an iron core in the center of the 
 wooden bobbin which becomes magnetized by the currents 
 passing in the coils, (6) binding screws to which electrodes 
 can be attached to convey the current from the primary or 
 the secondary coil to the patient. 
 
 When a current source is connected with the binding 
 screws, from an outside, a circuit is completed as in the fol- 
 lowing diagram : 
 
RECLAIMING THE MAIMED 
 
 25 
 
 (i) Through binding screw, A. 
 
 (2) Up the metal support, B. 
 
 (3) Along the limb of the hammer to the contact screw, C. 
 
 (4) From the contact screw to the primary coil, D. 
 
 (5) From primary coil 
 to electromagnet, E. 
 
 (6) From electromag- 
 net to binding screw, F. 
 
 (7) Thence back to 
 cell. 
 
 At the moment that 
 the current passes from 
 the cell through the cir- 
 cuit, the iron rod E is 
 converted into an elec- 
 
 FiG. 19. — Current closed. 
 
 Current open. 
 
 tromagnet strong enough 
 to attract the head of the 
 hammer, thus drawing 
 down the limb of the 
 hammer out of touch 
 with the contact screw. 
 When the hammer leaves 
 the contact screw, the 
 following sequence of 
 events takes place: 
 
26 RECLAIMING THE MAIMED 
 
 (i) The circuit is broken at the contact screw. 
 
 (2) The current ceases to flow. 
 
 (3) The iron rod ceases to be a magnet. 
 
 (4) The hammer is released, and is caused to fly back to 
 the contact screw by the tension of its wire spring. 
 
 (5) The circuit is remade at the contact screw. 
 
 (6) The current again flows through the circuit. 
 
 (7) The iron rod is remagnetized, attracting the hammer to 
 it and again breaking the circuit. 
 
 (8) This sequence of events occurs again and again with 
 great rapidity : thus the constant current from the cell is 
 automatically converted into the rapidly interrupted current 
 of the primary winding. 
 
 The rate at which these interruptions can be produced can 
 be varied by adjustments of the interrupter. The arrange- 
 ment of the two coils and of the central core varies with dif- 
 ferent instruments, but the principle is the same. The pri- 
 mary coil gives an interrupted current flow in one direction 
 which resembles the interrupted galvanic current except 
 that it is jerky and uneven, the make and break being of dif- 
 ferent strengths, and it is painful to the patient. The current 
 in the secondary coil alternates rapidly but the alternatives 
 are uneven. It is always to be remembered that the currents 
 in the secondary coil are induced and have no direct continuity 
 with those of the primary. 
 
 One of the most useful forms of faradic battery has the 
 same number of layers of wire in the secondary, which is the 
 current used, as those in the primary, the secondary current 
 being no stronger than the primary in consequence, with an 
 interrupter arranged to give perfect regularity of rhythm, 
 and a condenser to steady the current. In it a thick core of 
 soft iron is made to slide easily in the primary bobbin. The 
 sliding of the iron core in and out regulates the current by 
 decreasing the amount of the current which is in use as the 
 core is withdrawn and increasing it as it is shoved in. This 
 
RECLAIMING THE MAIMED 
 
 27 
 
 produces a painless muscular contraction which is capable of 
 perfect control, the operator being enabled to produce any- 
 thing from a faint tremor to full contraction of the muscle. 
 
 Effects. — The effect of the faradic current upon mus- 
 cular tissue is very much like that of the normal nerve im- 
 pulse to the healthy muscle. The current is readily conducted 
 along the nerve and enters the muscle through it. It is 
 rapidly distributed to every part of the muscle and throws 
 it into a series of contractions synchronous with the make 
 
 Fig. 20. — Curves of primary (£), and secondary (5) faradic current. 
 
 and break of the current. If the interruptions are rapid 
 enough and the current strong enough, the muscle fibers are 
 thrown into tetanus, which causes rapid exhaustion. At 
 each normal contraction of a muscle the blood is squeezed out 
 and new blood flows in during relaxation, but in tetanus the 
 muscle strangles itself. The value of faradism from a med- 
 ical standpoint lies in its power to act as a substitute to 
 normal nerve impulses when they are not fully conveyed to 
 the muscle. 
 
 When nerves, through disease and degeneration, have lost 
 all power of conducting their normal impulses, the muscles 
 remain passive under this form of electric stimulation ; but if 
 we turn on the galvanic current to the same muscle, it will 
 sluggishly respond to the chemical stimulation of its sub- 
 stance. This difference in the action of the two currents on 
 
28 RECLAIMING THE MAIMED 
 
 the same muscle enables us to secure the "reaction of de- 
 generation." 
 
 Use of the Faradic Battery. — Place the indifferent 
 electrode, a metal plate four or five inches square covered 
 with lint, over the nerve trunk or plexus and the active 
 electrode over the motor point, after wetting them both in 
 soapy water to remove grease. The active electrode should 
 be a metal disk about two inches in diameter covered with 
 lint. The electrode is grasped, together with the muscle, 
 between the thumb and forefinger of the left hand, and with 
 the other hand gradually insert the core into the coil. The 
 amount of contraction is estimated by the feel of the muscle 
 under the left hand. The core is inserted and withdrawn 
 rhythmically at about one-second intervals, or the mechanical 
 metronome is used. Fatigue, felt by weak, irregular con- 
 tractions, is a signal to stop. The motor points of all the 
 muscles can be found by consulting any good chart. Great 
 care must be taken not to produce exhaustion, as muscles 
 recover slowly, and may be badly damaged by overstimu- 
 lation.^ 
 
 This surging faradism is also used in applying strong cur- 
 rents over large areas, the current being slowly and rhyth- 
 mically increased and decreased by the metronome or 
 rheostat. In this way a good substitute for exercise can be 
 obtained. Bergonie has used it for exercising the abdominal 
 muscles in obesity, and Kellogg for cases where the heart 
 will not permit more active exercise. 
 
 The general effect of faradism is to stimulate muscle ac- 
 tivity, and to improve the local circulation by which the 
 general nutrition of the patient is benefited. This stimu- 
 lation is employed in many conditions from which wounded 
 soldiers suffer. In functional neuroses, the thyroid glands, 
 which are so frequently enlarged, may be reached by its 
 application to the sides of the neck. Many cases of aphonia 
 
 ^ Treatment of Joint and Muscle Injuries, by W.Rowley Bristow. 
 
RECLAIMING THE MAIMED 29 
 
 are cured by its careful use over the laryngeal muscles, throw- 
 ing them into spasm violent enough to make the patient cry 
 out. In the treatment of weakened muscles the current 
 should be strong enough to produce a brisk contraction, but 
 not strong enough to cause pain, and the dangers of over- 
 fatigue must always be kept in mind. 
 
 Combinations of Electric Currents. — The galvanic 
 and faradic may be combined. If a part of a muscle or 
 
 Fig. 21. — The Mcintosh polysine generator. 
 
 group v/ere responsive to galvanic stimulation only, it would 
 be neglected if the faradic stimulation only were used. 
 
 They are combined on most switchboards and on all of the 
 combination machines known as pantostats, multostats, com- 
 postats, or universal machines. These machines in every 
 case consist of a small motor which is used to operate a 
 dynamo which generates a current. This current has no 
 direct connection with the source of supply to the dynamo. 
 It is of low voltage and can be used for treatments with per- 
 
30 
 
 RECLAIMING THE MAIMED 
 
 Fig. 22. — Medical switchboard. 
 
RECLAIMING THE MAIMED 
 
 31 
 
 feet safety. If the current from the main were used, it 
 would be too high in voltage and would also be danger- 
 ous if suddenly interrupted while the galvanic current was 
 in operation, as it will be remembered that a twitch is pro- 
 duced every time the current is made or broken. This 
 low-voltage current is led off to various terminals labeled 
 galvanic, faradic, and sinusoidal, with their combinations. 
 
 Switchboard. — The medical switchboard is supplied 
 from a main current or accumulator, and is then distributed 
 
 Fig. 23. — Diagram of rheostat. 
 
 to the terminals through certain safety devices which pre- 
 vent sudden variations in strength. These consist of the 
 fuse, or blow-out, to prevent the current from becoming too 
 strong, and the rheostat for regulating its strength. There 
 are also the reversing switch for changing direction and the 
 galvanometer for measurement. 
 
 Both forms of electricity are in constant use for injuries in 
 which the nerves are completely or partly destroyed, and the 
 stiff, contracted, or weak hand may make its first movement 
 towards recovery through their use. For paralyses, tremors, 
 
32 RECLAIMING THE MAIMED 
 
 areas of anaesthesia, and disturbances of the special senses, the 
 more stimulating forms would be effective. The disorderly 
 heart can be helped back to reason by f aradism and the sinus- 
 oidal current, and ionic medication has proved its value for 
 rheumatism in its many forms and in the after-effects of 
 wounds resulting in sinuses or in the formation of scar tissue 
 and contractures, as has already been insisted upon. 
 
 Condenser Impulses. — The condenser may be considered 
 as a means of storing a definite quantity of electricity. 
 It consists of two insulated conductors each presenting a 
 
 large surface to the 
 other with a small dis- 
 tance between them. 
 When one conductor is 
 connected to earth, a 
 small electromotive force 
 is able to charge the 
 other with a much larger 
 quantity of electricity 
 than if it stood alone. 
 
 Fig. 24. — OscilLtory discharge of Leyden jar. The Leyden jar is an 
 
 example. (See also Fig. 
 17, B.) The discharge of a condenser through a coil takes 
 place by a series of oscillations like that of a flexible bent 
 rod when released. 
 
 High Frequency. — An induced current having a frequency 
 of millions to the second, at a high voltage and low amperage, 
 can thus be obtained by introducing into the circuit a Leyden 
 jar, a spark gap, and a solenoid (wire spiral). This form 
 of current is applied direct to the patient through vacuum 
 electrodes, or metal plates grasped by him or placed against 
 his skin. The rapidity of the oscillations is such that a large 
 volume of the current (800 milliamperes) produces but slight 
 physiological or chemical effect, and muscular twitches or 
 stinging sensations are not perceived from this current, how- 
 
RECLAIMING THE MAIMED 
 
 33 
 
 ever strong, which changes its direction at a rate of a million 
 to the second. Its strength is controlled by a rheostat. It is 
 even possible to light a high-powered incandescent lamp 
 through the body, without any 
 shock or other feeling, except one 
 of heat. 
 
 Diathermy. — The quality for 
 v/hich it is most used in medical 
 treatment is the production of 
 heat, caused by the resistance the 
 tissues offer to its passage. The 
 patient grasping the electrode 
 
 STE.PUP 
 
 T(<AN5. 
 
 Coll 
 
 Cond- 
 
 Fig. 25. — High frequency apparatus. 
 
 Fig. 26. — Composite high fre- 
 quency apparatus. 
 
 feels an immediate sensation of warmth, and it can be demon- 
 strated that its penetration is great, and affects the most 
 deep-lying tissues. It is of value for the production of 
 
34 
 
 RECLAIMING THE MAIMED 
 
 hyperaemia, and makes an excellent preparation for massage, 
 by flushing a joint or area of scar tissue with blood just as 
 is done by a hot bath. 
 
 Fig. 27. — High frequency (i) and diathermy (2) oscillatory discharges 
 compared. Lewis Jones. 
 
 Static Electricity. — The third and oldest method of 
 producing the electric current is by friction, and in the earlier 
 machines this was done by revolving a glass plate between 
 stationary brushes. The brushes were charged positively 
 and negatively so long as the plate revolved, producing a 
 continuous current of high voltage and small volume. The 
 next step was to start the machine by friction and continue 
 its action by ''influence" or induction. In the Holtz ma- 
 chine, one plate of glass revolves in close proximity to another 
 slightly larger one. The machine first is charged from an 
 outside source before starting, but the current continues, 
 once it is started. The Wimshurst machine is self-starting. 
 
RECLAIMING THE MAIMED 
 
 35 
 
 It consists of from two to twelve circular glass disks mounted 
 in pairs and made to rotate in opposite directions at a dis- 
 tance apart of not more than a fraction of an inch. It is 
 really a friction machine as well as one using induction or 
 ''influence." Owing to the high tension of the current, in- 
 sulation is important, and the patient is usually placed upon 
 a platform with glass legs. The electrodes used are a 
 point, a ball, a roller, and a brush. As it gives a con- 
 tinuous current, it has polarity, and this must be deter- 
 mined by the character of the spark. The treatments 
 
 /I J 
 
 
 
 Nz 
 
 
 ^ 
 
 n 1- -1 \-'-\ 
 
 -^\ 
 
 !-;-! 1- -1 r^ 
 
 ^ 1+ +1 K +1 r^ 
 
 
 •6- 7 i 
 
 i ^ ^ :: J 
 
 ' J 6< 
 
 
 B ?• 
 
 
 
 
 — »■ < 
 
 Vv 
 
 i r| 
 
 p 
 
 
 
 J 
 
 
 
 
 +- 
 
 
 
 
 
 
 
 
 ^ 
 
 
 J' 
 
 
 :0 e= 
 
 7 r 
 
 Fig. 28. — Diagram of static machine. 
 J , J , Leyden jars. C, C, Collecting brushes. A, B, Glass plates. T, T, Terminals. 
 
 are simple charging, which increases blood pressure and 
 pulse rate, but acts as a sedative in sleeplessness, when 
 the anode is used ; the Morton wave current, a static wave, 
 in which the patient is alternately charged and discharged, 
 producing contractions, a tonic treatment ; the brush dis- 
 charge, or breeze, which gives a cool and agreeable sensa- 
 tion like a douche of hot sand, leaving a warm glow 
 after-effect — it is useful in soothing the pain of neu- 
 ralgia, neuritis, and nervous irritability of "shell shock"; 
 single sparks, given by the ball — the effect is like a blow, 
 and is followed by a reflex muscular contraction, stimulat- 
 
36 
 
 RECLAIMING THE MAIMED 
 
 ing in its effect, and producing relaxation of spasm. Electric 
 friction by the roller gives a shower of stinging sparks and so 
 resembles the spark. It gives intense cutaneous stimulation, 
 but no penetration. It is followed by redness of the skin. 
 
 m. 
 
 © 
 
 Fig. 29. — Electrodes for static machine. 
 
 The care of the machine and the technique of the various 
 forms of treatment are too complicated for a handbook of this 
 length. The reader is referred to standard works for further 
 particulars. They are not taken up here, because the ma- 
 chines are not in general use, except in special hospitals, and 
 by specialists. They do not form part of a standard equip- 
 ment for convalescent hospitals. 
 
CHAPTER IV 
 RADIANT LIGHT AND HEAT 
 
 The sun's rays have always been used as a curative agent. 
 If they be passed through a prism to divide them into the 
 colors of the spectrum, they will be found to extend above 
 and below the range of visibility. The infra-red rays, with 
 a low frequency of vibration, give out heat and penetrate 
 the tissues of the body deeply. The ultra-violet, with a 
 high frequency of vibration, are mainly instrumental in 
 producing the cutaneous irritation known as sunburn. All 
 artificial sources of light contain these heat, light, and ultra- 
 violet or actinic rays in varying proportions. The arc 
 light is rich in actinic rays ; the incandescent is rich in heat 
 rays. By passing through a screen of red glass the actinic 
 rays can be cut out and by using a violet screen the effect of 
 the heat rays can be diminished, a result that can be ob- 
 tained equally well by a douche of cold air on the part. 
 
 The electric arc light most nearly approaches sunlight 
 and can produce an erythema just like sunburn, and when 
 repeated daily a definite pigmentation of the skin like tan- 
 ning. It has a marked bactericidal action which makes it 
 especially useful for many skin diseases. The light is ap- 
 plied by the solar therapeutic lamp, mounted upon a portable 
 stand (see figure), and adjustable for position, distance, and 
 strength of current. To apply it, the patient is seated and 
 the lamp adjusted to the part to be treated. The current 
 is thrown on and regulated by a rheostat starting at the 
 
 37 
 
38 
 
 RECLAIMING THE MAIMED 
 
 minimum intensity. The treatment should not last more 
 than one or two minutes at first and will be followed by 
 
 \4 
 
 
 
 < 
 
 
 reddening of the skin. The length of time for the treatment 
 can be increased with tolerance just like exposure to the sun, 
 
RECLAIMING THE MAIMED 39 
 
 the effect is counterirritant, and is useful for referred pains, 
 neuralgia, rheumatic pains, and skin infections. The treat- 
 ment of joints requires deep penetration and for this purpose 
 a light with more heat and fewer actinic rays is to be preferred ; 
 but it must always be borne in mind that all three are present 
 in most of the lights that are in general use. 
 
 Radiant heat causes a dilation of the surface capillaries 
 drawing the blood out from the deeper parts. This is 
 succeeded by a contraction of the superficial and dilation 
 of the deeper vessels, so that the flow of blood to the 
 part is stimulated just as in diathermy. 
 
 The masseuse who first heats the limb is thus able to work 
 on a part already flushed with blood instead of pumping 
 it in by massage, and the beneficial effect is increased directly 
 with the increased volume with which she starts, for the 
 exchange in the circulation will be correspondingly hastened. 
 The athletic trainer who would send a runner or jumper 
 out for a contest without first warming up the muscles would 
 run the risk of having him pull a tendon or rupture a muscle, 
 and preliminary massage to heighten the circulation in the 
 muscular tissue is the best preventive of such an accident, 
 especially if it is continued by putting on a warm woolen 
 covering to retain the heat. 
 
 The heating of a part in all cases where the circulation 
 is lowered is essential before other treatment is undertaken. 
 Scar tissue has poor circulation at best, and frequently the 
 toothache-like pain in it is relieved by raising the tempera- 
 ture and improving the local circulation alone. In all cases, 
 weakened and impaired muscles should first be flushed by 
 blood before having the massage and active movements 
 that complete their treatment. Certain superficial scars 
 become sodden and tender if wet heat is applied, so that dry 
 radiant heat is especially indicated for them. 
 
 The most convenient form for giving a local treatment 
 consists of a lamp of about 60 c.p., contained in a metal cone 
 
40 
 
 RECLAIMING THE MAIMED 
 
 lined with a metallic reflecting surface. This is moved 
 back and forth or in circles a few inches from the surface, 
 
 t^ 
 
 S 
 
 O 
 
 until the temperature of the part is sufficiently raised as 
 shown by reddening of the surface. Care must be taken to 
 
RECLAIMING THE MAIMED 
 
 41 
 
 avoid scorching the skin, where the part is anaesthetic. The 
 patient will see to that if the sensation is normal, and the 
 treatment should never be carried to the point of extreme dis- 
 comfort, nor should it be continued more than three or or four 
 minutes. Toleration is increased by moving the lamp about. 
 The first dilation of the surface capillaries is what is wanted. 
 The second form is called the local electric light bath. 
 This is composed of six or twelve i6 c.p. lights contained 
 in a reflector, so 
 placed in relation to 
 the part that a con- 
 stant temperature 
 can be maintained. 
 It is important that 
 there shall be an 
 even distribution of 
 light and heat over 
 the entire area, that 
 a wide range of con- 
 trol be allowed from 
 a low graduated heat 
 continued for fifteen 
 to twenty minutes 
 to the most intense 
 that can be borne. 
 It should be light 
 
 and portable and, in every case, the operator should be able 
 to observe and regulate the temperature by means of a ther- 
 mometer. The limit of temperature in these baths is about 
 1 80°, although, if ventilation is allowed and the air kept 
 dry, the temperature can go up as high as 300°. This form 
 is used when we want to get more than a surface effect in 
 myalgia and rheumatic joints. In all cases, the heat should 
 be put on gradually and reduced gradually, and the treat- 
 ment should not last more than twenty minutes. 
 
 Fig. 32. — Local bath adjustable and with 
 thermometer. — Burdick. 
 
42 RECLAIMING THE MAIMED 
 
 The third form is a full electric light bath. Apparatus 
 is constructed so that this bath may be given with the 
 patient in bed (see illustration). By combining two of these 
 appliances, we can make a cabinet in which the patient may 
 be seated. This cabinet contains forty to fifty i6 c.p. 
 incandescent lights. A thermometer enables the operator 
 
 Fig. 2>2>- — Full electric light bath for a bed case. — Burdick. 
 
 to regulate the temperature, and the whole body is placed 
 within the cabinet except the head. The temperature is 
 raised to about ioo° before the patient enters and the current 
 gradually increased until i6o° or i8o° is reached, cold water 
 compresses are applied to the head, and the patient should 
 drink water during the treatment to promote sweating. If 
 fainting threatens, the treatment must be stopped ; and if, 
 at any time, the patient feels faint, the pulse should be 
 
RECLAIMING THE MAIMED 
 
 43 
 
 counted and the treatment stopped if it rises above 120. 
 This bath should last from thirty to forty minutes. The 
 patient then leaves the cabinet, takes a warm sponge bath, 
 and rests between blankets for at least half an hour. They 
 should not be given more than twice or three times a week. 
 The effects of these 
 baths are, first, red- 
 ness of the skin ; 
 second, a profuse 
 perspiration ; third, 
 acceleration of the 
 pulse, which should 
 remain strong and 
 regular throughout 
 the treatment ; 
 fourth, rise of tem- 
 perature during the 
 treatment, which 
 falls to normal after ; 
 fifth, increase of 
 elimination, both by 
 the lungs and kid- 
 neys. They should 
 not be followed by 
 a feeling of lassi- 
 tude. They are of 
 great value in all 
 forms of intoxica- 
 tions, alcoholic, 
 
 rheumatic, gouty, and nephritic, and relieve congestion of 
 abdominal organs, like the liver, spleen, and kidneys. 
 
 Steam Compresses. — Dry heat without light can be 
 applied locally by Kellogg's apparatus, the electrothermo- 
 phore, hot water bags, or hot salt or sand ; and the elec- 
 tric light can be applied to give moist heat as well, through 
 
 ^B 
 
 n 
 
 ■ 
 
 
 
 ^^1 
 ^^^^1 
 
 WKm T 
 r \ 
 
 '1 
 
 i 'H 
 
 Fig. 34. — Cabinet bath made by combining two 
 appliances as shown in Figure 33. • — Burdick. 
 
44 RECLAIMING THE MAIMED 
 
 the steam compress, which consists of a container with air- 
 tight covering, in which is placed a Hnen pad wrung out of 
 cold water. This is placed on the part to be treated, and the 
 local heat bath is placed over it until the compress is brought 
 
 Fig. 35. — Kellogg's thermophore. 
 
 to the desired temperature, where it can be kept indefinitely 
 without changing. The advantage of this over the old 
 method of wringing cloths out of hot water will be at once 
 apparent. 
 
CHAPTER V 
 HYDROTHERAPY 
 
 Hydrotherapy has the additional resource of cold as 
 well as heat, and like radiant heat it can be applied to the 
 whole body or to a single part. Most wounded men are 
 quite sound except for the injury to a leg or arm and require 
 treatment for that only. 
 
 In these cases its great field is in preparing the part for 
 treatment by massage, stretching, and reeducation. The 
 cases that derive most benefit are healed wounds with great 
 areas of contracted scar tissue — painful stumps and weak 
 and stiffened joints in which the circulation is far below 
 normal. After treatment for twenty minutes by whirling 
 water at no to 115°, the cold, blue, painful limb becomes 
 red and warm, and the apprehension of the patient to any 
 form of manipulation disappears under the feeling of well- 
 being and comfort that results. Spasm disappears, and the 
 part becomes soft and relaxed. Masseurs unite in declaring 
 that muscles and joints are then more easily manipulated, 
 a judgment in which the patients themselves heartily con- 
 cur. Slight adhesions can frequently be broken down with- 
 out pain and function quickly restored. Irritable bruised 
 nerves, however, may be made more irritable by this method, 
 and the temperature should then be not more than 100, nor 
 should it be followed by any manipulation. The warmth 
 of the water should here act as a poultice to soothe the pain. 
 
 4.^ 
 
46 
 
 RECLAIMING THE MAIMED 
 
 A sort of gymnastics for the circulation can be given by 
 dipping a limb alternately in hot water which dilates, and 
 cold which contracts, the capillaries. The vessel walls are 
 thus exercised and their tone trained to respond to the normal 
 stimuli of heat and cold. 
 
 For general treatment, water is also used, hot or cold. 
 The man who is tired out finds himself restored to vigor by 
 getting into a hot bath. The blood is drawn out to the sur- 
 face from the brain and abdomen and the whole circulation 
 redistributed, but here again it must not be continued past 
 the first flush, otherwise there is a rapidly increasing debility. 
 
 PULS£ 
 KATE. 
 
 IZO 
 
 110 
 
 too 
 
 90 
 
 80 
 
 70 
 
 -^^=^=====F= 
 
 /i' 
 
 sT 
 
 pna. 
 
 J 'If 
 
 rd. 
 
 4-_ 
 
 ih 
 
 ^th. 
 
 6^J' Week. 
 
 Fig. 36. — Average pulse rates of ten cases of disordered action of the heart 
 during six weeks' treatment by the pool bath at Heaton Park. — Dr. Frank 
 Radcliffe. 
 
RECLAIMING THE MAIMED 47 
 
 One evening after a long drive I plunged into a thermal 
 mountain spring at about ioo° and swam in it for 
 ten minutes, sometimes with my head under water. No 
 cold shower was taken to follow, and the result was a head- 
 ache, suffused eyes, a sleepless night, and an assiduous use 
 of the pocket handkerchief for the next twenty-four hours. 
 This illustrated the results of neglecting to secure the 
 necessary reaction. 
 
 As soon as the flushing of the surface is obtained the pa- 
 tient should be removed and a cold shower taken to get a 
 good reaction, or the patient put to bed with the room at 
 an even temperature till the vessels regain their equilibrium. 
 
 For conditions following shell shock, irritable heart, 
 hallucinations, fearful dreams, and neurasthenia, the general 
 poultice of a bath at 94°, kept up for an hour or more is 
 hard to beat. This has long been recognized in the treat- 
 ment of mania in the insane, and the conditions are suffi- 
 ciently close to form an analogy. 
 
 Water is a good conductor of electricity, so that this agent 
 may be applied through a local or general bath, as already 
 described in Chapter II. 
 
 The hydro therapeutic equipment, necessary for the treat- 
 ment of disabled men, consists of a douche and shower, 
 immersion tubs, or a pool for water, kept at a constant tem- 
 perature, local baths for the treatment of arms and legs, and 
 electric baths for both local and general application. 
 
 The Douche. — The douche should have a powerful jet, 
 the stimulant effect of the water being increased by its 
 force which may go up to thirty pounds. 
 
 A treatment should always begin by warm water (90°), 
 rising to hot (115°) and ending with cold (60)°. It 
 should not last more than one or two minutes, and, 
 where the stimulant effect must be great, the Scottish 
 douche should be applied. In this two jets, one at 
 100 degrees and the other at 60 degrees, are applied alter- 
 
48 
 
 RECLAIMING THE MAIMED 
 
 
 nately by a lateral sweep of the nozzle up and down the spine. 
 This plan is also used in the local contrast baths of Robert 
 Jones for exercising the circulation of an arm or leg. The 
 shower is a gentler form of this treatment in which the 
 
RECLAIMING THE MAIMED 
 
 49 
 
 massage of the water jet is absent, but the same rules apply 
 to it as to the douche. 
 
 Immersion Baths. — Immersion baths are given at three 
 temperatures, below, at, and above the skin temperature. 
 The bath at 94 degrees, skin temperature, is soothing in 
 character, a good sedative. Its greatest use is in decreasing 
 
 Fig. 38. — The pool bath at Heaton Park. Capacity twelve 
 men. Temperature of the water 94°. 
 
 nervous irritability, in whatever form it may be, and in sooth- 
 ing a disordered heart. After one hour's immersion the 
 patient should be wrapped up and allowed to rest for another 
 hour. The relief from the constant and insidious irritation 
 of clothing and movement, and the support of a medium of 
 about the same specific gravity as the body, doubtless ac- 
 counts for much of the benefit. 
 
 The hot bath (98 to no degrees) dilates the peripheral 
 vessels and increases the frequency of the pulse. Its merit 
 
50 
 
 RECLAIMING THE MAIMED 
 
 is founded on its stimulant effect on the circulation. The 
 blood is drawn out to the surface, which becomes red and 
 warm. The effect is somewhat the same as the cabinet bath, 
 without the perspiration, and it is of special use in the treat- 
 ment of fatigue and also in chronic conditions in which the 
 general circulation is sluggish. The immersion should be 
 very brief, not more than five or ten minutes, and should be 
 followed by a cold shower to restore the tone of the dilated 
 vessels, and the patient should be wrapped up and put to 
 bed for an hour. 
 
 Local Baths. — The whirlpool baths have proved their 
 value in the after treatment of wounds, during the present 
 
 % 
 
 f 
 
 Fig. 39. — Two arm and one leg whirlpool baths. Heaton Park. 
 
 war, and are widely used. The arm or leg is thrust into a 
 vessel containing water at a temperature varying from 105 
 up to 115 degrees. This water is circulated by means of 
 jets set at an angle or by a propeller. Air is also introduced, 
 so that the limb is immersed in a swirling, bubbling current. 
 In this way the part is flushed with blood, and the full effect 
 
RECLAIMING THE MAIMED 51 
 
 of heat is obtained in a way that is impossible if the water 
 is still. The air bubbles- increase the stimulant effect on 
 the skin. They are peculiarly adapted to the treatment 
 of painful stumps, painful scar tissue, partial paralysis, 
 injuries to nerves, and, in fact, to any condition which lowers 
 the circulation and nutrition of the part. The period of 
 immersion is about twenty minutes, and with increased 
 toleration, it may be possible to raise the temperature as 
 high as 1 20 degrees. Great caution must be used to prevent 
 scalding, especially if any area of anaesthesia is present. 
 It makes the best preparation for massage and manipulation 
 in cases where the limb is cold, blue, and painful. Movements 
 and manipulations can then be performed which would not 
 be tolerated by the patient without this preparation. 
 
 Contrast Baths. — - The contrast bath is a form of 
 gymnastics for the circulation, which is like the Scottish 
 douche in its effect. It consists of two oblong baths, placed 
 side by side, one supplied with water at a temperature of 
 no degrees, the other supplied with water at 60 degrees. 
 The patient dips the hand or foot alternately in these baths, 
 leaving it in for about two minutes. They are applied to 
 all conditions in which the local circulation requires stimula- 
 tion. 
 
 Electric Baths. — The use of a glass or porcelain vessel 
 made to contain an arm or a leg permits the use of electricity 
 and ionic medication through the medium of water. The 
 vessel must not be metallic or a conductor. Water at, or 
 slightly above, the skin temperature is used, and an electrode 
 of copper or carbon is placed in the water at one end and the 
 indifferent electrode applied to some part of the body by a 
 large pad. The polarity is determined unless the sinus- 
 oidal current is used, and the current turned on till a tin- 
 ghng sensation is felt. It is afterwards increased with added 
 toleration. Twitching of the muscles can be obtained by 
 rhythmical interruptions of the current, and the laws govern- 
 
52 
 
 RECLAIMING THE MAIMED 
 
 + 
 
 
 1 
 
 i 
 
 i^i 
 
 V 
 
 V 
 
 '-»^ 
 
 f 
 
 9oX 
 
 ^ 
 
 u 
 
 TSV 
 
 f^\ 
 
 ro 
 
 o L 
 
 
 j= 
 
 1% 
 
 
 r 
 
 + 
 
 
 1 
 
 
 k'^'/ 
 
 [ 
 
 
 l-»^ 
 
 p 
 
 (dJ 
 
 ?! 
 
 Q) 
 
 ^> 
 
 /-if 
 
 Po 
 
 1 
 
 
 X 
 
 c J 
 
 
 S 
 
 + I 
 
 U2 
 
 (=1 
 
 03 
 
 H 
 
 
RECLAIMING THE MAIMED 53 
 
 ing ionization already described would apply (Chapter II). 
 The entire current passes through the limb from or to the 
 indifferent pole, and in this the unipolar local bath differs 
 from the general electric bath. Various combinations are 
 made of arm and leg, right and left, by the Schnee baths, 
 which come complete with switchboard and commutator. 
 
 In the immersion bath, which must be carefully insulated, 
 two large copper electrodes are inserted, one at either end. 
 They are protected so that they cannot be touched by the 
 patient. The bath is filled with water at loo degrees, the pa- 
 tient immersed, and the current turned on slowly. The pa- 
 tient should be conscious of a pleasant tingling sensation. The 
 period of immersion should begin at 1 5 minutes and go up to 
 30. The current is slowly turned off before the patient leaves 
 the water to take a half hour's rest, well wrapped up. It 
 is probable that not more than one tenth of the current passes 
 through the patient ; the rest goes through the water. 
 
 The bath should not be of metal. If the current is from 
 the main, it must be carefully insulated from the waste pipe. 
 Taps and switches must be out of the patient's reach, and 
 additional water added from a jug. In fact, owing to the 
 necessary precautions, this bath is not recommended except 
 under most skilled supervision in special hospitals. 
 
 It is used for neurasthenia and debility, and the current 
 employed is the sinusoidal or galvanic. 
 
 Medicated Baths. — In most of the spas, medicated 
 baths can be obtained. These are taken up in the full de- 
 scription of each spa. They are saline, sulphur, or iron, and 
 can be prepared artificially. 
 
 A shower or douche is frequently given combined with 
 massage and manipulation carried along under water, the 
 patient reclining in a hollow table bath. Its value is not 
 great enough to make it worth while to install the expensive 
 and complicated apparatus necessary. 
 
CHAPTER VI 
 
 MASSAGE AND PASSIVE MOVEMENT 
 
 Massage in its many forms is used to dissipate effusions 
 after sprains, to soften and stretch contracted scars or ad- 
 hesions, to prevent atrophy and contractures following nerve 
 injuries and fractures, to stimulate the circulation after 
 frostbite, and to improve general nutrition in local and 
 general rheumatism. It is of great value as a preliminary to 
 operation to loosen scars and make operation easier, and to 
 excite inflammatory action about a sequestrum and help to 
 expel it, or to diagnose any lurking infection in an old wound. 
 
 Aimless rubbing is as useless as waving a palm-leaf fan, if 
 the operator be weak and timid, but it has the additional 
 possibilities of doing much harm if the operator, besides being 
 ignorant, is rough and strong. Sometimes massage is of 
 value when passive movement is contraindicated, and of the 
 manipulations of massage themselves, tapotement may be 
 effective when effleurage would be useless, as will appear. 
 
 Efffeurage is essentially a surface manipulation. It forms 
 the beginning of treatment in all painful conditions like 
 sprains, fractures, or after breaking down adhesions. It is 
 a preparation for more active manipulations. The hand is 
 passed lightly over the skin, like stroking a cat, usually from 
 the periphery to the center. It is performed by the palm of 
 the hand, the thumb, or the finger tips. Both hands are 
 used for large fleshy parts like the buttock, thigh, chest, 
 back, or neck ; the thumb or finger tips are employed around 
 
 54 
 
RECLAIMING THE MAIMED 55 
 
 bony parts like the hand, ankles, wrist, forehead, and scalp, 
 and about adherent scars ; the fingers adapting themselves 
 to the part worked upon. If properly done, it should act as a 
 sedative to pain ; and when the fears of the patient have been 
 stilled, friction may be made vigorous enough to act upon 
 
 Fig. 41. — EiSeurage of the arm. 
 
 the deeper structures and wake up the sluggish circulation in 
 and about the seat of trouble. 
 
 In petrissage or kneading, the skin moves with the hand 
 like a glove. It is done with the thumb opposed to the hand, 
 the fingers opposed to the palm, or the two hands opposed to 
 one another. The muscles are rolled under the hand and 
 skin, and intermittently pressed against the underlying bone. 
 It is slow and deep, usually following the course of the venous 
 circulation. This manipulation should be firm, but not too 
 
56 
 
 RECLAIMING THE MAIMED 
 
 painful, — persistent pain following treatment means either 
 a clumsy operator or a condition that should not be massaged. 
 It is most useful for stretching adherent scars, for removing 
 the products of fatigue or effusions, and for improving the 
 blood supply. It is the main manipulation used in general 
 
 Fig. 42. — Kneading the calf muscles. 
 
 treatment for rheumatism, fibrositis, or lowered circulation 
 from any cause. 
 
 Tapotement or striking is a surface and also a deep manipu- 
 lation. It consists of slapping with the open hand, hacking 
 with the ulnar border of the hand, using the tips of the fingers 
 like a flail, or beating with the fiat of the clenched knuckles. 
 The blows should be sharp and quick, short and snappy, done 
 from a loose wrist, but not heavy enough to bruise. The 
 main action is stimulation of the superficial nerves. The 
 vessels dilate and the part becomes reddened. If repeated 
 long enough and strongly enough, sensation is dulled. 
 
RECLAIMING THE MAIMED 57 
 
 Vibration is a rapid form of tapotement, in which the rate 
 of the strokes runs from 500 to 5000 to the minute, and is 
 best performed by a machine for the purpose, with the 
 various forms of applicators for the different regions. Vi- 
 bration is followed by a feeling of numbness, then tingling, 
 and then warmth, so that its general effect is stimulation. 
 
 Fig. 43. — Hacking with ths ulnar border of the hands. 
 
 Always plan beforehand the choice and sequence of these 
 procedures in a treatment, and do not continue one manipula- 
 tion more than four or five minutes over one region. It 
 should then be interrupted and replaced by another pro- 
 cedure, but a definite sequence thought out and maintained. 
 Limit your conversation with the patient to the giving of 
 directions and don't let the treatment degenerate into a 
 social visit accompanied by the aimless rubbing, pulling, and 
 twisting of a limb, which too often goes by the name of 
 massage. 
 
58 
 
 RECLAIMING THE MAIMED 
 
 The surface to be treated should be scrupulously clean, and 
 should not be greased or oiled, except occasionally about a 
 tough and irritable scar. The part may be dusted with 
 
 Fig. 44. — The vibrator in use. 
 
 talcum powder, and a very hairy surface may even be pro- 
 tected from irritation by manipulation through a silk or 
 cotton undergarment. 
 
 A stiffened joint or painful scar should be prepared for 
 massage by heat in the form of baths of running water at 
 about no degrees for thirty minutes, or by exposure to 
 radiant heat until it is thoroughly reddened. Where these 
 are not available, it may be packed in hot sand or salt, — 
 anything that will flush the part with blood greatly assists 
 
RECLAIMING THE MAIMED 59 
 
 in making possible massage and manipulation that would 
 otherwise be too painful. 
 
 In sprains, or after breaking down adhesions, which is the 
 same thing, massage should be given at once, beginning with 
 efifleurage and continued by kneading, alternating these two 
 procedures until the whole region has been covered, and sup- 
 porting the ankle or elbow between treatments by a bandage 
 over cotton wool to exert elastic pressure. In certain frac- 
 tures the splint may be removed for treatment as early as the 
 third day and effleurage given above and below the seat of 
 fracture. The technique is too complicated to go into here, 
 but is fully described in Mennell's book on massage.^ Stumps 
 of limbs remaining after amputation should be prepared by 
 heat, given effleurage kneading and vibration to improve 
 nutrition and promote absorption of scar tissue ; and where 
 necessary, contractures should be stretched, followed by 
 movement and exercise for reeducation. 
 
 Red in a painful scar is the color signal of danger for the 
 masseur who intends to stretch it. It means that there is a 
 network of vascular loops whose thin walls are easily torn, 
 that will bleed and form new scar tissue if roughly handled, 
 leaving that man's last condition worse than his first. Treat- 
 ment must begin, in such cases, with effleurage, light circular 
 friction, and kneading of the neighboring tissue. 
 
 Scars may not show their true character on the surface. 
 An innocent looking surface scar will often show a slight 
 dimple which is deepened by any voluntary movement of 
 the muscles, and dissection would show that it has spread out 
 its tentacles deep into the surrounding tissue, strangling in 
 its grasp nerves and vessels, and adhering tenaciously to bone 
 and muscle far from its apparent place. Persistent pain 
 following treatment always means too much force. Some 
 patients wince on the slightest touch, but this false pain must 
 be distinguished from real and persistent variety. Slowly 
 
 ^ Massage, its Principles and Practice. J. B. Mennell. 
 
60 RECLAIMING THE MAIMED 
 
 and gradually increase the pressure or tension, and at the 
 same time distract the patient's attention. This will fre- 
 quently serve to make the diagnosis clear. 
 
 Massage may be used to assist in removing a sequestrum 
 or foreign body. A red spot appears over the site of per- 
 sistent pain, the skin opens, and the dead bone is extruded 
 more rapidly than if left to unaided Nature. After wounds 
 by high explosives or shrapnel, it is a frequent experience to 
 thus bring to the surface and extrude bits of belt buckle, 
 shreds of cloth, or fragments of shell. Here the pain follow- 
 ing treatment will be continual until the disturbing cause is 
 discharged, but the masseur is here assisting Nature in her 
 work of elimination. Such cases require the most careful 
 supervision, and if inflammation becomes intense or wide- 
 spread, stop until it has quieted down. 
 
 General massage is best given at an hour midway between 
 meals, and never immediately after a meal. The seance 
 should last from thirty to forty minutes and be followed by 
 a rest. The limbs should be taken in sections, and the 
 general direction of the manipulations be directed from 
 extremity to center. 
 
 Passive Movement. — Passive movement is used to 
 stretch contracted scars, to increase the range of movement 
 in stiffened joints, to rehearse the movements of joints whose 
 muscles are paralyzed or weakened and thus detect or pre- 
 vent contractures. It does not always accompany massage, 
 and may be contraindicated as in some fractures or im- 
 perfectly healed wounds. It may be necessary to early 
 them out with the limb on a splint to keep weak muscles 
 relaxed and free from strain, — the dropped wrist or foot 
 may have to be kept dorsi-flexed, and the arm with deltoid 
 paralysis abducted. 
 
 All movements should be don€ by slow. Insistent pressure ; 
 never use quick or jerky motions ; they frighten the patient, 
 and he locks the joints to resist the attack. Distract the 
 
RECLAIMING THE MAIMED 61 
 
 patient's attention from the movement that is being given, 
 especially in functional cases. It greatly assists in getting a 
 fuller range of movement, and suggestion, deception, en- 
 couragement, scolding, or even bullying, all have their uses 
 in such cases. Slight adhesions can be broken down with 
 great relief by this means, especially if the part has been well 
 prepared by heat, but serious or firm old adhesions should 
 be left alone or broken down by the surgeon under an anaes- 
 thetic. After such an operation, for the breaking down of 
 adhesions, passive movement should be started the following 
 day, and the joint moved once only through its range. This 
 should be repeated every day, and the limb kept at rest be- 
 tween treatments. Don't make a pump handle of such an 
 arm. It is like a fresh sprain, and must be given a chance 
 to become quiet, which is impossible if it is worried inces- 
 santly. In all cases of scars and contractures in which pain 
 persists for twelve hours after treatment, rest the joint and 
 fix it in the best possible position, if necessary by a splint, 
 until the pain has disappeared, then start with massage only, 
 without movement, given after adequate preparation by 
 heat. An old white scar can be stretched only by continu- 
 ous tension, best given by the use of splints, which should 
 be worn for weeks or even months and even then the added 
 movement is got mostly by stretching the sound tissue that 
 surrounds it. 
 
 Passive movement of single fingers is done best by the 
 operator's hand, the joint being slowly extended and flexed 
 as far as possible, and the improvement maintained by a 
 splint worn between treatments if necessary. This is es- 
 pecially true of functional contractures where fixation in the 
 correct position is essential until the patient can be taught 
 to maintain the correct position himself. 
 
 The wrist is flexed, extended, adducted, and abducted, by 
 the operator's hand passively as follows : The patient's fist 
 should be clenched and grasped by one hand, the other being 
 
62 RECLAIMING THE MAIMED 
 
 used to steady his forearm. The movement should be strong, 
 firm, and slow. 
 
 Pronation and supination may be done passively by the 
 hand of the operator, seated facing him and grasping the 
 patient's hand, palm to palm, the patient's arm and forearm 
 being kept at right angles, and so fixed as to prevent rotation 
 of the shoulder. It is the old game of twisting wrists. 
 
 Flexion and extension are performed by the same grasp 
 of the hand, and from the same position. 
 
 Rotation of the shoulder is performed by the operator as 
 follows : 
 
 The patient sits with the arm down, the forearm flexed at a 
 right angle. The operator, standing behind him, grasps the 
 wrist and forearm with one hand and the shoulder with the 
 other. The elbow is the fixed point, and the wrist is used as 
 a lever, being brought out and in slowly without changing the 
 angle of flexion at the elbow. 
 
 Circumduction is performed by seating the patient on a 
 stool, the arm stretched straight out to the side, the operator 
 standing behind with one foot on the bench, and the knee 
 under the axilla to steady the shoulder, which is also held by 
 one hand, whilst, with the other, he circumducts the shoulder 
 by grasping the arm just below the elbow. Slight adhesions 
 may be broken down by these means, not only without in- 
 jury, but with great relief to the joint, but any persistent 
 pain after treatment warns the operator of the necessity for 
 caution. 
 
 Circumduction of the ankle is done by the hand, but full 
 flexion is difficult or impossible when the powerful tendon 
 Achilles is contracted, and a preliminary tenotomy is often 
 indicated. The hold for this purpose is shown in Fig. 45. 
 
 Flat foot and claw foot (pes cavus) are often treated for 
 long periods by massage and passive movement without re- 
 sults. These procedures can have but a minor place in the 
 treatment of such conditions, and they should be referred 
 
RECLAIMING THE MAIMED 
 
 63 
 
 for surgical or orthopedic treatment by operation, support, 
 and reeducation. 
 
 Flexion and extension at the knee may be done by the 
 hand, the patient being seated with the leg over the end of a 
 plint for flexion, or lying prone on a plint for either extreme 
 flexion or full extension. The hand is much better than any 
 
 Fig. 45. — The hold for flexion of the ankle and stretching the 
 tendo Achillis. 
 
 machine, because it can give the important rotation move- 
 ment of the leg upon the thigh in flexion so wefl insisted upon 
 by Sir Robert Jones. At the end of each complete flexion of 
 the knee, twist it in and out. 
 
 The hip can be extended, flexed, rotated, adducted, and 
 abducted, with the patient supine on a plint, the ankle of 
 the side to be moved being grasped by the operator by one 
 hand, his other hand placed on the knee of the same leg, and 
 the other knee drawn up to a right angle. The hips should 
 be strapped in place. The movement of the thigh can then 
 be made in the required direction. 
 
64 RECLAIMING THE MAIMED 
 
 Passive movement of the back can best be done with the 
 patient strapped at the level of the trochanters prone to a plint, 
 with the body projecting over the end, and supported by an 
 assistant (leg lying) ; the trunk can then be flexed, extended, 
 or rotated, on the fixed pelvis. Rotation can also be given 
 from the position of sitting astride the plint by pressure on 
 one shoulder and tension on another. 
 
 Passive movement of the neck in all directions should be 
 done by the hands only, and with the greatest caution, the 
 patient lying supine on the plint, with the head projecting 
 over the end. 
 
CHAPTER VII 
 ACTIVE MOVEMENT AND REEDUCATION 
 
 Active Movements. — Active movements are done free 
 or with apparatus, and are for correction, reeducation, and 
 the cultivation of strength and endurance. 
 
 Free movements of the joints need not be described in 
 detail ; they are simply a rehearsal of all the movements 
 normal to each joint ; but even where the limb is still in a 
 splint, the patient may learn muscle dancing or twitching 
 the muscles without moving the joint until they become 
 strong enough to raise the dropped wrist from its dorsi- 
 flexed splint, or bend the stiffened knee and so reduce the 
 time of splintage. 
 
 Principles. — Apparatus is necessary to bridge the gap 
 between free movement and the more complicated and skill- 
 ful coordination of gymnastics and occupation, and it can 
 be constructed so as to give a graduated and measurable 
 load, to be increased as strength returns. Muscles work 
 better against resistance than free, and the necessary resist- 
 ance may be given by the hand, by friction, forming a 
 brake on the turning of a wheel or handle, by stretching 
 elastic cords, or by stretching or compressing springs. In 
 these devices, it is difficult, or impossible, to measure ac- 
 curately the work done. They vary at different stages of 
 the movement, are uneven, and the patient quickly tires 
 and becomes discouraged, because he cannot see a definite 
 and measurable improvement. The best principle to use is 
 r 65 
 
66 
 
 RECLAIMING THE MAIMED 
 
 the raising of graduated weights, either by a lever or by a 
 rope and pulley. In the former, the weight is clamped on 
 a lever at points indicated on a scale, the lengthening of the 
 lever increasing the force necessary to raise it. This is the 
 principle employed by Zander in 
 most of his machines, which, 
 however, are expensive, com- 
 plicated, cumbrous, require much 
 space, and need an engine to 
 supply motive power for some of 
 them. Appliances can be con- 
 structed to produce accurately 
 the same effects at one tenth the 
 cost, by making use of the weight 
 and pulley. 
 
 Figure 46 shows diagrammati- 
 cally an arrangement by which 
 the direction of the resistance 
 may be upward, downward, or 
 from the side. Machines com- 
 bining these three movements 
 are called triplex, or triplicate 
 machines, but, in addition to 
 these, special devices are neces- 
 sary for exercising certain joints. 
 The following set of appliances 
 are designed to combine sim- 
 plicity, cheapness, and efficiency. 
 They can be easily multiplied to 
 any extent by a good carpenter 
 and blacksmith who has the 
 pattern before him. 
 
 Sequence. — Their use should 
 have a place in a definite se- 
 quence; treatment begins with 
 
 
 \ 
 
 
 n 
 
 <t 
 
 C-<©4-. 
 
 
 
 Fig. 46. — The triplicate pulley 
 weight. 
 
RECLAIMING THE MAIMED 67 
 
 the preparation of the Umb or joint by electricity, radiant 
 heat, or hot baths, then massage and passive movements, 
 as already described, followed by active movement. 
 
 Fig. 47. — Protractors for measuring angles of movement in the 
 shoulder, elbows, wrist, knee, and ankle. Hart House. 
 
68 RECLAIMING THE MAIMED 
 
 A mirror is of great value to teach accuracy and associate 
 the feeling of the movement with its appearance. 
 
 Measurement. — Before beginning the reeducation of a 
 joint, the range of movement should be carefully measured. 
 
 Fig. 49. — Small protractor for measuring the angle of flexion 
 in fingers. Hart House. Toronto. 
 
 This is done by means of protractors of cardboard, or gal- 
 vanized sheet iron, with the scale marked in degrees. The 
 illustration shows the method of measuring movements of 
 the shoulder forward and backward, the protractor being 
 
RECLAIMING THE MAIMED 
 
 69 
 
 set with zero perpendicular to the joint as checked by a 
 plumb line. The movement in either direction is marked 
 in degrees. The elbow, wrist, knee, and ankle are measured 
 
 Fig. 50. — Measuring strength of grip by the tycos sphygmo- 
 manometer. — F. W. Harvey. 
 
70 RECLAIMING THE MAIMED 
 
 by the second protractor made of galvanized iron strips, 
 hinged, and with a scale pasted on to a side plate. Figure 
 49 shows a small one for the fingers. 
 
 Most of the appliances about to be described have protrac- 
 tors attached, so that the range of movement can be watched 
 by the patient himself, during the exercise, and this additional 
 incentive given him to use his best efforts. The measure- 
 ment of abilitv to repeat movement will be in terms of weight 
 raised and number of repetitions. The maximum strength 
 of the grip can be taken conveniently by partly inflating the 
 cuff of a tvcos sphvgmomanometer and noting the height 
 to which the mercurv is raised when the cuff is squeezed. 
 This is quite as reliable as Amar's Bulb, and is better than the 
 ordinarv hand dvnamometer. 
 
 The appliances are for two purposes, stretching and im- 
 proving the strength. All the stretching movements are 
 kept within the voluntary control of the patient, who can 
 be trusted to desist before'danger of lacerating firm adhesions 
 is imminent. The appliances for improving the strength 
 can be loaded with increasing weights as the power to lift 
 them returns and the patient can be interested in watching 
 the extent of each movement, as shown on the scale, in watch- 
 ing the rising weight as it is lifted, in calculating the total 
 amount of work done in foot pounds, or in listening to and 
 counting the clicks of the ratchet as the movement is made. 
 
 The operator should be seated opposite the patient in 
 all hand and arm exercises on the table, Fig. 48, and should 
 regulate the machines and amount of work done. 
 
 Upper Extremity. — i. Finger board. — (a) For stretch- 
 ing contraction of the fingers, in flexion, and (6) for stretch- 
 ing abduction at the metacarpophalangeal joints. 
 
 (a) Extension of single fingers: The fingers are placed on 
 the board in moderate flexion, and the finger under treat- 
 ment goes up the stair, step by step. Note the last step 
 at which the finger under treatment can be raised from the 
 
,1 
 
 i'f 
 
 ^1 
 
 r} 
 
 :f 
 
 4itJ 
 
 7,0 .Ififob^^U laam"? ,a .aonJdOiianssail ,K 
 
Fig. . 
 
 4, Finger machines. B, Finger treadmill. C, Wrist circvmiductor. Z), Wi 
 
 G, Creeping 
 
he arm table, 
 
 ad adductor. E. Wrist mill for flexiou and extension. F. Pronator and supinator 
 shoulder abduction. 
 

RECLAIMING THE MAIMED 
 
 71 
 
 Fig. 51. — Finger board for stretching contractions and linger flexions. 
 Hart House. Toronto. 
 
 step without assistance. Depress the hand to stretch still 
 farther. 
 
 ih) Place the index finger against the peg at i and spread 
 the second finger out, noting the farthest point at which 
 
 Fig. 52. — Finger board for stretching abduction of fingers. Hart House. 
 
72 
 
 RECLAIMING THE MAIMED 
 
 it can touch the peg. Repeat with the second, third, and 
 fourth. 
 
 Repeat each movement not more than five times. 
 
 Fig. 53. — Pulley weights for exercising fingers in flexion and extension, right 
 hand doing exercise i, left hand with thumb attachment doing abduction. 
 
 The patient then moves to the next five apphances, the 
 operator sitting opposite. 
 
 2. Finger pulleys. — For flexion and extension of the 
 
 fingers. Strap the wrist and arm at the elbow, insert the 
 
RECLAIMING THE MAIMED 73 
 
 fingers into the glove stools and add weight until it can barely 
 be lifted by the voluntary power of each finger. The weights 
 are increased as improvement goes on, and the movements 
 repeated up to the point of exhaustion. 
 
 ist exercise : High attachment. Flex 
 metacarpophalangeal joints, keeping in- 
 terphalangeal rigidly extended. 
 
 2d exercise: Horizontal attachment. ^ ' ^^' 
 Flex interphalangeal joints, keeping ip^hm^i^— ^ 
 metacarpophalangeal joints extended. '*^ 
 
 3d exercise : Low attachment. Ex- ^^^- 5S- 
 
 tend metacarpophalangeal joints, keep- ^ 
 
 ing inter-phalangeal extended. ^\ 
 
 4th exercise : Low attachment. Ex- *\^ 
 
 tend metacarpophalangeal and flex \ 
 
 interphalangeal joints. : 
 
 The operator seated opposite the 
 patient should count the repetitions and ^^' ^^' 
 
 encourage his efforts. Each exercise to U* •■ | 
 
 be continued till movement shows flag- f** 
 
 ging, and then stopped. The most con- ; 
 
 venient weights are shot bags, loaded to }. 
 
 two ounces each, and attached by hooks. \ 
 
 They can easily be made and repaired fig. 57. 
 
 by the masseuse. 
 
 3. Thumb ad- and abduction. — Hsind in pronation. 
 Attach the stool on the radial side to the thumb for 
 adduction. 
 
 ist exercise : Draw the thumb across the hand. Repeat 
 the movement to exhaustion. 
 
 2d exercise : Attach the stool on the ulnar side to the 
 thumb; draw the thumb out in abduction, Fig. 53. Repeat 
 to exhaustion. 
 
 4. Finger treadmill. — For voluntary flexion of fingers. 
 Strap the wrist and turn the wheel by flexing the fingers 
 
74 
 
 RECLAIMING THE MAIMED 
 
 in turn till exhaustion of each finger. The amount of work 
 done by a single finger can be calculated by using that 
 finger only, and noting the weight, and the distance it is 
 raised. 
 
 5. Circumduction of wrist for stretching. — Strap the wrist 
 and forearm, grasp the handle, and turn the wheel about 
 twenty revolutions each way. Move out the attachment 
 to the farthest possible point compatible with the movement. 
 
 Fig. 58. — Circumduction of wrist. 
 
 The operator may assist at the most difficult part of the turn, 
 by turning the crank. 
 
 6. Ad- and abduction of wrist. — Place the fingers under 
 the straps on the hand board, strap down the wrist and fore- 
 arm, ad- and abduct the hand, noting the range of movement 
 on the protractor. The weights will vary for these two move- 
 ments, which should be done separately. 
 
 7. Flexion and extension of wrist. — (i) Grasp the roller 
 overhand and wind up the weight, without releasing the 
 grasp and exerting the full range of movement. The scale 
 will measure the range of the joint, and the weight and 
 distance multiplied gives the total work done in foot 
 pounds. 
 
RECLAIMING THE MAIMED 75 
 
 Precaution: see that the movement is done at the wrist 
 only and not at the elbow or shoulder. 
 
 (2) Reverse the grasp and repeat for flexion. 
 
 Fig. 59- — Adduction and abduction of wrist. Note the scale to measure the 
 
 angle of movement. 
 
 8. Pronation and supination. — Patient stands facing the 
 machine and grasps the handle with the left hand, his left 
 elbow joint flexed, his right forearm across his back, and his 
 hand grasping his left arm above the elbow to prevent 
 sideways movement. Set weight and ratchet for supination 
 
76 
 
 RECLAIMING THE MAIMED 
 
RECLAIMING THE MAIMED 77 
 
 and turn, counting the clicks for each movement and noting 
 the weight and the distance raised. The measurement of each 
 movement will appear on the protractor. See that patient 
 does not move his elbow out or in, or twist body. Reverse 
 the ratchet and repeat for pronation. 
 
 9. Flexion and extension at elbow. — (i) The patient faces 
 the triplicate machine, grasping the floor handle, the arm 
 and cord in line. Flex 
 
 and relax the forearm. * ^ f\ 
 
 (2) Patient faces away •*' />^ ^/ 
 
 from the machine, grasp- . •*' /J . 'v 
 
 ing the shoulder handle, / // * ^ 
 
 the arm full flexed, the •* ^( 3« •'C .'C 
 
 upper arm in line with Fig. 61 Fig. 62. 
 
 the cord. Extend and 
 
 relax the forearm. In both these exercises, the position of 
 the upper arm must remain unchanged. If this is not done, 
 the direction of the pull is changed. 
 
 10. Shoulder rotation. — Grasp the floor handle, the elbow 
 on a bracket, shoulder high, the forearm flexed to a right 
 
 \ 
 
 n> <r/\ <'/\ 
 
 Fig. 63 Fig. 64. ' Fig. 65. 
 
 angle. Pull up with the hand, throughout whole range of 
 shoulder movement without changing the height of the elbow 
 or its angle of flexion. 
 
 11. Flexion and extension 0} shoulder joint. — (i) The 
 patient stands with his back to the floor handle, the arm 
 down and straight. Arm forward, raise, and lower. (2) Face 
 to the floor handle, draw the arm back, and lower to position. 
 
78 
 
 RECLAIMING THE MAIMED 
 
 12. Ad- and abduction of the shoulder. —The patient 
 stands with the side to the tripHcate machine, shoulder at- 
 tachment, arm and cord in hne. (i) Bring the arm forward 
 across the chest. (2) Patient stands as in exercise i, but 
 
 J 
 
 Fig. 66 
 
 
 Fig. 67. 
 
 > — .0 
 
 Fig. 68. 
 
 o 
 
 V; 
 
 Fig. 69. 
 
 using the floor attachment. Bring the straight arm upward, 
 and lower to position. (3) Patient stands with his side to 
 the machine, overhead attachment, arm in Une with the cord. 
 Bring the arm downward and forward, then downward and 
 backward, alternately. (4) The patient stands with the 
 
 side from the machine, 
 the arm across chest, 
 grasping the shoulder 
 attachment. Extend 
 the forearm and arm, 
 keeping them at the 
 shoulder level. 
 
 13. Passive abduction 
 of shoulder. — Patient 
 standing with the side 
 to the creeping board, 
 and the forearm rigidly extended. Climb up the board by 
 the fingers with a straight arm, and note : ist, the highest 
 point at which the Angers can be lifted from the board 
 by the patient ; 2d, the level to which he can bring up his 
 arm, without bending his elbow. Fig 72. Keep the body 
 rigid throughout, not bent or twisted. 
 
 
 
 Fig. 70. 
 
 Fig. 71. 
 
 I 
 
 0/: 
 
 Fig. 72. 
 
RECLAIMING THE MAIMED 
 
 79 
 
 Fig. 7,3. — Crumpling up a newspaper as an exercise for the hand. 
 
80 
 
 RECLAIMING THE MAIMED 
 
RECLAIMING THE MAIMED 
 
 81 
 
 General movements that are of value in treating the 
 muscles of the upper extremity are rolling up a ball of paper, 
 throwing and catching balls of all sizes and weights, quoits, 
 bowling, pingpong, crokinole, billiards, weaving, knitting, 
 rope splicing, knots, the use of tools, like scissors, boring. 
 
 Fig. 75. — The inversion and eversion treads in use. Hart House. 
 
 hammering, modeling, painting, bookbinding, saddlery, and 
 shoemaking. 
 
 Lower Extremity. — 14. Circumduction 0} the ankle. — 
 The patient sits with his foot strapped in place. The range 
 of movement is regulated by a thumb screw on the crank. 
 The handle is turned by the patient or operator, for this 
 stretching movement, which should precede the voluntary 
 active movements of the ankle. 
 
82 RECLAIMING THE MAIMED 
 
 15. Inversion and Eversion of Foot. — (i) The patient 
 walks on the inversion ridge, Fig. 75, a definite distance, with 
 hand rail support. 
 
 (2) Ditto for eversion. Both (i) and (2) are stretching 
 movements, and should precede (16). 
 
 (16) The patient is seated with the foot and leg strapped to 
 the apparatus, Fig. 76. Evert the foot against the weight on 
 the cord, and note the range of the movement on the pro- 
 tractor, and the total weight raised. Reverse this ratchet and 
 repeat for inversion. 
 
 16. Dorsiflexion of ankle. — The patient sits or stands with 
 his foot strapped to the footpiece. Fig. 77. Flex the ankle, 
 raising the weight. The extent of the movement may be 
 estimated by the number of clicks, the exact measurement 
 noted on the protractor, and the total work done is easily 
 calculated. 
 
 17. Rotation of the knee. — (a) The patient is seated with 
 the foot strapped to the footpiece, and the leg against the 
 brace, Fig. 78. He ad- or abducts the foot, rotating the 
 knee, the extent of each movement being marked on the 
 protractor, (b) The patient stands with the knee locked in 
 extension as ad- or abduct the foot. Fig. 79. This move- 
 ment measures hip rotation, if care be taken to keep the 
 pelvis fixed. In either position, the movement of the flexed 
 ankle is slight. 
 
 18. Knee flexion and extension. — Triplicate machine. 
 Exercise i. Face to the machine, strap the foot to the floor 
 attachment. Movement : Flex the knee against resistance. 
 
 Exercise 2. Face from the machine, strap the foot to the 
 floor attachment, the flexed leg and cord in the same line. 
 Movement : Extend the knee against resistance. 
 
 19. Hip ad- and abduction. — Triplicate machine. Exer- 
 cise I. Side to the machine, the foot strapped to the floor 
 attachment. Movement: Adduct the thigh, keeping the 
 knee straight. 
 
RECLAIMING THE MAIMED 
 
 83 
 
 f'iG. 76. — Eversion and inversion of ankle. Note the 
 fixation of the leg, also the scale and pointer marking 
 the angle of movement. 
 
84 
 
 RECLAIMING THE MAIMED 
 
 Fig. 77. — Exercise for foot drop. Note scale and pointer to record 
 angle of movements on left side, and fixation of leg near the knee. 
 
RECLAIMING THE MAIMED 
 
 85 
 
86 
 
 RECLAIMING THE MAIMED 
 
 Fig. 79. — Rotation of hip — the knee extended and the 
 pelvis fixed. 
 
RECLAIMING THE MAIMED 87 
 
 Exercise 2. Side from the machine, foot strapped to the 
 floor attachment. Movement : Abduct the thigh, keeping 
 the knee straight. 
 
 20. Hip flexion and extension. — Exercise i. Face to the 
 machine, foot strapped to the floor attachment. Move- 
 ment : Extend the thigh with the leg stretched. 
 
 ^L .ir^ .j-'^>^ 
 
 Fig. 80. Fig. 81. Fig. 82. > 
 
 Exercise 2. Face from the machine, foot strapped to the 
 floor attachment. Movement : Flex the thigh, keeping 
 the knee straight. 
 
 21. Thigh flexion, knee flexion, foot dorsiflexion. — Patient 
 steps through the rungs of a horizontal ladder with par- 
 allel bar arm rests. The ladder is made adjustable for 
 
 Q ^ 
 
 <R ^ ^|\ 
 
 -jC-^- d--> -iv-^- 
 
 Fig. 83. Fig. 84. Fig. 85. 
 
 height at one end, and raised, to increase the movement re- 
 quired to raise the foot over each rung. This is especially 
 useful for leg amputation cases. Fig. 86. 
 
 22. (9) Thigh extension, knee extension, foot planta- 
 flexion. — The bicycle trainer with an increasing load of 
 distance or friction. 
 
 General exercises : walking, hill climbing, dancing, kicking 
 a football or hockey puck, balancing, skipping. 
 
RECLAIMING THE MAIMED 
 
RECLAIMING THE MAIMED 
 
 89 
 
 In the treatment of stumps, a sheath should be attached 
 and the various pulley weight movements carried out as 
 if the limb were intact. 
 
 Amputations. — The reeducation of amputation cases 
 begins with the preparation of the stump, and fitting of the 
 
 Fig. 87. — The bicycle is arranged with adjustable pedals and resistance. 
 It can also have motor for passive movement. Hart House. 
 
 artificial limb for comfort, and for the correct bearing of 
 the w^eight. The patient should first learn to balance, 
 which may be made safe if he be suspended by a belt under 
 
90 
 
 RECLAIMING THE MAIMED 
 
 the arms, working from an overhead trolley or by grasping 
 a bar. This inspires confidence, and prevents falls, espe- 
 cially in amputation at the thigh, where the balance is very 
 difiicult to get. The patient then progresses to the use of 
 
 Fig. 88. — Amputated case learning control on the balance beam. 
 
 Sticks and progression on a smooth surface. He should dis- 
 card crutches from the first. This is very important. He 
 then learns to walk on a smooth, level surface with one stick 
 only, to clear obstacles, like the ladder rungs already de- 
 
RECLAIMING THE MAIMED 91 
 
 scribed, and finally to walk through soft sand on uneven 
 ground, up and down inclines, and over obstructions. 
 
 Lynn Thomas worked out an excellent plan at the Prince 
 of Wales Hospital, for limbless men, at Cardiff, where, with 
 the help of a landscape gardener, he constructed a sort of 
 golf course, with suitable bunkers to illustrate the diffi- 
 culties a limbless man would have to overcome. In the 
 grounds, the walks were graded in slopes from one to twelve 
 up to one in three, mounds of earth covered with shrubs 
 were constructed, an artificial pond with a bridge to be 
 crossed, a stile and gate, paths, built on a slant, tilted to right 
 and to left. All such devices add interest to the process 
 of perfecting the patients in the use of their artificial limbs, 
 and supplement, and gradually replace, the more simple 
 developmental work of the treatment room. 
 
CHAPTER VIII 
 GYMNASTICS AND GAMES 
 
 The object of gymnastics is to reeducate control, alert- 
 ness, accuracy, speed, and strength in men who have lost 
 them through neglect, injury, or the enforced idleness of 
 hospital life. 
 
 The whole tendency of daily life in the hospital is to make 
 men sluggish in mind and body. Discipline is relaxed, and 
 their stamina, physical, mental, and moral, suffers in con- 
 sequence. In a table of gymnastic exercises, the enforced 
 discipline is not the least important part of the treatment in 
 refitting them to take their place, either in military or civil 
 life. 
 
 Gymnastic exercise should be considered as a part of the 
 treatment, and should count as a parade. Patients should 
 be classified according to their physical condition and require- 
 ments, and this classification given to the instructor. 
 
 Class I. Fit for duty. Able to take gymnastic tables i 
 and 2, for convalescents, gymnastic games and marching, 
 running, jumping, manual and vocational work. 
 
 Class II. Fit for light duty. Able to take gymnastic 
 tables I and 2 for convalescents, walking, light games, no 
 running or jumping, light vocational work. 
 
 Class III. Unfit for duty. Under individual treatment 
 and unfit for class work or games. Each case to be judged on 
 its merits. 
 
 92 
 
RECLAIMING THE MAIMED 
 
 93 
 
 Men who have lost an arm or hand, or who have a stiff 
 knee or ankle, may be put in class II and go through such 
 exercises as are within their power, standing fast when they 
 come to an exercise beyond their power, and going on when 
 the next movement is given. This is much better than ex- 
 cusing them, or putting them in classes by themselves, and 
 
 Fig. 89. — Slow balance exercise. Knee raising. Heaton Park. 
 Note that three men are standing fast. 
 
 there should be constant and repeated inspections by the 
 medical officer to see that no injury is done, and also that all 
 exercises within their power are done. 
 
 Between five and ten per cent of hospital cases have some 
 irregularity of heart action, and the treatment by electricity 
 and water must be accompanied and gradually replaced by 
 progressive exercise. These irritable hearts are frequently 
 
94 RECLAIMING THE MAIMED 
 
 but symptoms of general nervous disturbance or exhaustion. 
 For them, exercise must begin with caution, and the load be 
 increased with care. A rise in the pulse rate, persisting 
 twenty-four hours, is the signal of overwork. At Heaton 
 Park we found the greatest benefit from faradism, long-con- 
 tinued sedative baths every second day, followed by rest. 
 On alternate days, these patients had gymnastic exercises as 
 in tables i and 2, and slow walking of one half to one mile. 
 As the need for men in the firing line was urgent at that time, 
 they were then tried on a table of exercises, including running 
 and jumping, and were also tested on a four-mile march. 
 About thirty per cent, only, were able to stand it, and were 
 passed as fit. The others showed a return of symptoms that 
 remained latent under the lighter forms of exercise. 
 
 At the Hampstead Military Hospital for the heart, where 
 only difScult cases were sent, about fourteen per cent were 
 returned to the firing line, but nearly fifty per cent were made 
 fit for some form of military work. Graduated exercises have 
 shown at both places, not only that they cause improvement, 
 but that they form admirable tests for estimating fitness for 
 duty. It is often possible to state, after physical examination 
 alone, that a man is unfit for duty, permanently, but it is 
 never possible to decide, after physical examination alone, 
 that a patient will be fit. The reaction to exercise forms the 
 deciding test. 
 
 In sanataria for tuberculosis, a patient in whom the tem- 
 perature has become normal is prepared for work by light 
 exercise, principally walking, and, as soon as he has reached 
 the stage when a half hour's walk twice a day causes no signs 
 of relapse, he is allowed to take up the lighter forms of voca- 
 tional training. In many men, suffering from the effects of 
 irritating gas, the bronchitis and functional spasm, asth- 
 matic in character, can be greatly benefited by slow, controlled 
 breathing exercises. 
 
 Among the cases suffering from shell shock, exercises of 
 
RECLAIMING THE MAIMED 
 
 95 
 
 equilibrium present peculiar difficulties, and concentration, 
 confidence, and courage can be well cultivated by the balance 
 beam. 
 
 The period of debility following typhoid, dysentery, or 
 other exhausting diseases will be greatly shortened by start- 
 ing them early on progressive gymnastic exercise, sufficiently 
 
 Fig. go. — Slow deep breathing exercises. Heaton Park. 
 
 vigorous to tone up the flabby muscles, without causing too 
 great exhaustion. 
 
 The following two tables are compiled for use in hospitals 
 and convalescent camps, the exercises being selected from 
 the Aldershot tables for recruits. They cover, in a system- 
 atic way, the various regions of the body, with the thorough- 
 ness that characterizes the Swedish system, but quick and 
 jerky movements, likely to strain an injured joint, are 
 
96 
 
 RECLAIMING THE MAIMED 
 
 avoided. The progression is from partial to complete move- 
 ments of the joints, e.g. from knee bending to full knee bend- 
 ing, and they contain no jumping or running exercise. In 
 all cases of class I, and most cases of class II, they can be 
 done in addition to treatment and vocational training, for 
 their object is not only medical, but disciplinary, and it is of 
 
 Fig. 91. — Balance exercises on the elevated beam. Heaton Park. 
 
 the utmost importance for the instructor to insist on exact- 
 ing smartness and discipline. The time occupied should not 
 exceed thirty minutes, as the attention of these patients soon 
 tires, and, in many cases, the time should be considerably 
 reduced. They should be done daily, the first table for two 
 weeks, and the second for two weeks more. In the second 
 table, quickening exercises and running games can be in- 
 creasingly used, in preparation for the free games and occu- 
 pations into which the patient is gradually initiated. 
 
RECLAIMING THE MAIMED 
 
 97 
 
 Table I. {A) Introductory Exercises 
 
 Leg exercise. 
 Neck exercise. 
 Arm exercise. 
 
 Trunk exercise. 
 Leg exercise. 
 
 {a) Feet close ; (h) heels raise. 
 
 Head backward bend. 
 
 {a) Hips firm ; {b) arms bend ; 
 
 (c) arms bend, arms upward stretch. 
 Feet close, hips firm, trunk turning, 
 (a) Hips firm, foot sideways place ; 
 
 {b) feet astride place. 
 
 {B) General Exercises 
 
 Preparation for span Feet astride, arms upward stretch 
 
 bending. (taken free). 
 
 Balancing exercise. Hips firm, knee raise. 
 Lateral exercise. Feet close, hips firm, trunk bending 
 
 sideways. 
 Abdominal exercise. Hips firm, foot sideways place, trunk 
 
 bending forwards. 
 Marching exercise. Quick march ; (later) on the toes 
 
 march. 
 "Practice class arrangements ; in two ranks fall in, number- 
 ing, opening, and closing ranks. 
 
 (C) Final Exercises 
 
 Heels raise. Arms raising sideways. 
 
 The movements in this table should be done slowly and 
 evenly. The instructor should avoid taking up much time 
 with individual correction. 
 
 Emphasis should be placed on exactness and accuracy of 
 movement and on mental alertness and promptness of re- 
 sponse to command. 
 
 H 
 
98 
 
 RECLAIMING THE MAIMED 
 
 Table II. 
 Leg exercise. 
 
 Neck exercise. 
 
 Arm exercise. 
 
 Trunk exercise. 
 
 Leg exercise. 
 
 {A) Introductory Exercises 
 
 Hips firm, heels raising and knees 
 
 bending (latter quickly). 
 Head bending backward (later head 
 
 turning) . 
 {a) Arms bend, one arm upward, one 
 
 arm downward stretch; {h) arms 
 
 bend, arms sideways stretch. 
 Hips firm, foot sideways place, trunk 
 
 turning. 
 {a) Feet close and full open ; {h) hips 
 
 firm, foot placing sideways. 
 
 {B) General Exercises 
 
 Preparation for span 
 bending. 
 
 Balancing exercise. 
 
 Lateral exercise. 
 
 Abdominal exercise. 
 
 Dorsal exercise. 
 Marching exercise. 
 
 Feet astride, arms upward stretch, 
 trunk backward bend (slight move- 
 ment only). 
 
 Hips firm, leg raising sideways ; (later) 
 backward and forward. 
 
 Hips firm, foot sideways place, trunk 
 bending sideways ; (later) feet close, 
 one arm upward and one arm down- 
 ward, trunk bending sideways. 
 
 {a) On the hands down (by numbers) ; 
 {h) on the back down (ground permit- 
 ting) ; (later) with the leg raising. 
 
 Hips firm, foot sideways place, trunk 
 forward bend, trunk downward bend. 
 
 Hips firm, with knee raising quick 
 mark time. 
 
 (C) Final Exercises 
 
 Hips firm, foot sideways place, trunk turning. Heels 
 raise. Arms raising sideways and upwards. 
 
RECLAIMING THE MAIMED 
 
 99 
 
 Patients unable to perform single movements should 
 stand at ease. 
 
 The time taken by these tables should not occupy more 
 than half of the hour set apart for exercise. The second half 
 should be taken up with games and recreation, in which 
 
 Fig. 92. — High knee raising through wire entanglements at the double. 
 
 Heaton Park. 
 
 discipline does not play a prominent part. These should 
 consist of: i. Dancing steps forward, backward, and to the 
 sides, first taken to count, and then to music, and combined 
 into series or dances. 2. Tag garner, like three-deep, hunt the 
 slipper, dodge ball. 3. Relay races, medicine ball passing, 
 and message relays, and games for general development, such 
 as golf, tennis, handball, basket ball, cricket, baseball, and 
 swimming, for which* may be substituted, in special cases, 
 sports for development of the upper extremity, like billiards, 
 bowling, quoits, or sports for developing lower extremities, 
 like walking, dancing, soccer, and cycling. 
 
100 RECLAIMING THE MAIMED 
 
 The following series shows a progression suitable for men 
 who have to begin with the simplest movements, and feel 
 their way to more difhcult and complicated combinations. 
 The instructor should always be on the watch to prevent men 
 from undertaking movements which their disability might 
 make dangerous. 
 
 I. Jumping and Dancing 
 
 Jumping the rope. Men in file. Two men take the ends 
 of a rope eight feet long, and walk back, one on either side 
 of the file, dragging it, the men jumping the rope as it passes. 
 Repeat at the double. 
 
 Jumping the swinging rope. Men in a circle. The in- 
 structor, in the center, swings a shot bag, attached to a rope, 
 the men jumping it, as it is let out, and the speed increased. 
 
 Dancing steps. 
 
 /?> ^F>s y?x ?\^ '• ^^^^' together. 
 
 *J^ \\/ (1/ v// Jump and point to 
 
 I / \ \ W / / left. Jump and point 
 
 tL 1 "> II ^^ L to the right. 
 
 """^ "^'V "" ''^ 2. Heels together. 
 
 ■ ^'^" Jump and point to 
 
 the left, turning the heel out. Jump and touch left heel. 
 
 Jump and point to the right, heel out. Jump and touch 
 
 right heel. 
 ^ p C^ 3. Heels together. 
 
 (I) ^^ ^w O J^^P ^^^ toMoh left 
 
 li y/ i\ y-i heel. Jump and bring 
 
 j' 'V V I mJ I l^^t foot across right, 
 
 -••L w'. 7* «••••' k. .'-^ pointing and touching 
 
 Fig. 94. the toe. Jump and 
 
 kick to the left. 
 This is a simple series and excellent for balance, coordina- 
 tion, and rhythm. They should be done slowly at first, to 
 command, and then to music. 
 
RECLAIMING THE MAIMED 101 
 
 Tag games. 
 
 These should be made progressive, beginning with squat 
 tag, in which the player saves himself from being tagged by 
 squatting in the full ^ 
 
 knee bend position. > jv ^fV yf^ ^>. 
 
 This may be varied by ( | / \ \ > \ \ > Qj 
 
 having him take the \/ \\ \\ \ ^%^ ^ 
 
 arms upward stretch || I \-^ */\ l ' 
 
 position, and so secure *''*'*• "^ ' ' . *^' ' 
 
 a gymnastic effect, in ^^' ^^' 
 
 addition. In cap tag, a cap or ball is passed from man to 
 man, and the man who is "it" tries to tag the holder. 
 
 A simple and popular game is the Bogey Man. In this, 
 a player, chosen as the Bogey Man, stands at one end of the 
 yard, the other players stand at the opposite end. At a 
 signal from him, they run, trying to pass him and reach the 
 opposite end of the yard. He tags one or two, and they 
 go with him to his side of the yard, and help him. The 
 play is repeated until all the runners are caught by the 
 Bogey Man and his helpers. The last one caught begins a 
 new game. 
 
 A more highly organized form of this game is Prisoner's 
 Base. In this, the play field is about thirty by seventy-five 
 feet. A line across the field at each end marks the base of 
 each team. At the right of each base a small space is marked 
 off as a prison. The teams each consist of about ten players. 
 The object of the game is to make prisoners of the players on 
 the opposite team. Any player may be made a prisoner by 
 an opposing player who left his base later than the first player 
 did. For instance, a player of Team No. i leaves his base, 
 and advances toward the base of Team No. 2. Having left 
 his base, he may be tagged by any player on Team No. 2. 
 When, therefore, an opposing player runs out to tag him, he 
 quickly retreats to his own base before being tagged. If he is 
 tagged before reaching his base, he is a prisoner, and is put 
 
102 RECLAIMING THE MAIMED 
 
 into the prison of Team No. 2. If, however, a player of his 
 own team runs out to support him, and this new player (who 
 left his base later than the pursuer) succeeds in tagging the 
 player from Team No. 2, then this one is a prisoner, and is 
 placed in the prison of Team No. i. 
 
 When a prisoner is made, the captain of the team designates 
 a player whose duty it is to guard the prison. The capture 
 of three prisoners by one team wins the game. Prisoners 
 may be freed when one of the players succeeds in tagging a 
 prisoner without himself being tagged. If there are two 
 prisoners, they may grasp hands and stretch out toward their 
 team, thereby facilitating their release. If, then, the first one 
 is tagged, they are both free. 
 
 Two circle games may be mentioned : The Beetle Is Out, 
 and Dodge Ball. 
 
 In The Beetle Is Out, the players form a closed circle, 
 shoulder to shoulder, facing inward, and having their hands, 
 with palms open, behind their backs. One of the players is 
 outside the circle. He carries a handkerchief with a knot 
 tied in one end of it or a stuffed bag. Running around the 
 outside of the circle, he puts the handkerchief into the hand 
 of one of the players, if possible, without being noticed by 
 the others. When the leader calls, "The beetle is out," the 
 one having the handkerchief turns and strikes his right-hand 
 neighbor on the back with the knot, the neighbor seeking to 
 avoid the blows by running around the circle, until he regains 
 his former place. The pursuer now starts around the circle, 
 placing the handkerchief in another man's hand, and the 
 game continues as before. 
 
 In Dodge Ball the men are divided into teams. Team A 
 stands inside a circle forty-five feet in diameter, while Team B 
 stands outside the circle, and attempts to throw a basket ball 
 so as to strike one of the members of Team A. If any player 
 of Team A is touched by the ball on the fly or bounce, a point 
 is scored for the outer team. If a player is struck, he remains 
 
RECLAIMING THE MAIMED 103 
 
 in the game, and the game continues without interruption for 
 three minutes, when the positions are reversed, and Team A 
 throws the ball at Team B , and the team securing the greatest 
 number of points during the game shall be the winner. 
 
 There are an infinite number of relay races, beginning with 
 passing a medicine or basket ball, the players remaining in 
 place, and going on to running and carrying relays. The 
 following is a simple progression. 
 
 1. Men in file. The ball is passed back between the legs. 
 The last man carries it forward and repeats. This is done 
 by lines in competition. 
 
 2. Men in file. The ball is passed back over the head, and 
 the last man carries it forward as before. 
 
 3. Men in file, all but three, A, B, and C, who are facing 
 the file five yards away. At the signal, the first man runs 
 with the ball, circles A, and gives him the ball. A circles B, 
 
 Fig. 96. 
 
 and gives him the ball. B circles C, and gives him the ball. 
 He runs back to No. 2, circles him, and gives him the ball, 
 and then takes his place in the rear. 
 
 4. Men in file except A, who is five yards in front of No. 
 I. A message is given confidentially to A in each file. A 
 runs to No. i and brings him back, repeating the message 
 on the run. No. i runs to No. 2, repeating the message as 
 they run, and so on till the whole file is transferred to the 
 other side. 
 
 ^*v ..^ > y ^y ^/ 
 
 t 
 
 Fig. 97, 
 
104 RECLAIMING THE MAIMED 
 
 In addition to these difficult relays, are shuttle relays, 
 potato races, and other varieties, described in reference books. 
 
 The medicine ball is the most useful single piece of ap- 
 paratus. It should be at least twelve inches in diameter, and 
 
 ? f 4 -P 
 
 17 yi \\ /\ -!"=?. 
 
 9 
 
 
 Fig. 
 
 may be stuffed with anything to bring the weight up to ten 
 pounds or over. Passing relays can be arranged, illustrating 
 the different methods of throwing and catching the medicine 
 ball, in a circle, in lines, or individually. 
 
CHAPTER IX 
 TREATMENT BY OCCUPATION 
 
 Treatment by occupation differs from all other forms 
 already described, in that the remedy is given in increasing 
 doses with its patient's improvement. It is the final stage 
 in his progress, to which all the others lead up. 
 
 In England and France, where great numbers of wounded 
 were thrown on the community at once, the country houses, 
 given by the public-spirited owners as auxiliary Red Cross 
 Hospitals, too often became nurseries of the "hospital habit." 
 Men who came to them keen, well-disciplined, and alert, 
 too often lapsed in an atmosphere of indulgence and hero 
 worship into disorderly loafers, seeking a grievance in every 
 regulation made for their control. Their natural hunger for 
 movement became lost in a progressive lethargy of mind 
 and body. To combat this growing evil the Surgeon Gen- 
 eral, Sir Alfred Keogh established Command Depots, where 
 men were again put under strict discipline, but in which 
 treatment by physical therapy took the place of regular 
 military training. A beginning was made by establishing 
 workshops in them, at Tipperary, under Lieutenant-Colonel 
 Sims Woodhead, R.A.M.C., to give both treatment and oc- 
 cupation, and this plan was soon extended to others. In 
 the orthopedic centers, convalescent camps, and many 
 hospitals, notably at Roehampton, Netley, and Brighton, 
 they are increasingly used as part of the treatment ; and the 
 Military Hospitals Commissioners made occupational ther- 
 
 105 
 
106 RECLAIMING THE MAIMED 
 
 apy and vocational training an integral part of the scheme 
 of treatment in their chain of hospitals across Canada. 
 
 A distinction is frequently drawn between occupational 
 therapy and vocational training. In the former, the move- 
 ments are given as treatment, and the work done is a sec- 
 ondary consideration. The patient saws wood because the 
 arm muscles can thus be contracted and relaxed a definite 
 number of times. It is really a gymnastic exercise done 
 with a saw. 
 
 In vocational training the object is to make a good box 
 by sawing the board in definite lengths, and the arm exercise 
 is secondary, though essential. It is a question of emphasis, 
 and it is impossible to draw a sharp line of distinction in 
 most cases. Wherever the emphasis is laid, every man is 
 benefited by occupation that keeps both his mind and body 
 busy. 
 
 Hospital life gives plenty of time for introspection and 
 consequent depression, and to many a returned soldier this 
 acts as a poison, counteracting all attempts to bring him back 
 to normal mental and physical condition. He becomes 
 discouraged, and, worst of all, he becomes content to sit 
 with folded hands, bereft of ambition or purpose in life. 
 
 The purpose of occupational therapy is threefold : 
 
 1 . Physical : To carry on the improvement in muscular 
 strength and control, obtained by treatment, and to apply 
 it to the varied movements that the carpenter uses in han- 
 dling his tools or the gardener in cultivating his land. 
 
 2. Vocational : To give him an education directed to 
 make him able to keep a set of books, or take a position in 
 business where the handicap of a missing leg or an impaired 
 arm will not be felt. 
 
 3. Moral, or self-disciplinary: To give courage to begin 
 life over again, sometimes in a new trade or business. To 
 give him that self-respect that makes him want to stand on 
 his own feet, and not be dependent on charity or the efforts 
 
RECLAIMING THE MAIMED 
 
 107 
 
 of others, to give him ambition to shake off the deadening 
 effects of his long period of enforced idleness, and to under- 
 take the necessary training for a trade or occupation from 
 which he can make a living. 
 
 The direction of his treatment, with certain medical re- 
 strictions, should be put in the hands of an officer, trained 
 
 Fig. gg. — A class in bookkeeping. M. H. C. Hospital, Canada. 
 
 in vocational guidance, whose knowledge of various indus- 
 tries and the training necessary for them would be brought 
 into service. The patient should be examined by a board, 
 of which this vocational officer is a member. His past his- 
 tory should be obtained by questions about the kinds of work 
 he has done, his stability, as shown by the length of time 
 he has held jobs, his reasons for changing, his preferences 
 
108 
 
 RECLAIMING THE MAIMED 
 
 and dislikes, and his general intelligence. On a basis of 
 the information obtained, combined with a review of his 
 medical and military history, he should be advised as to the 
 work best suited for his case. He would then register for the 
 class decided upon and report just as he would for a parade, 
 and he must be kept under military discipline, for his own sake. 
 
 Fig. ioo. — Mechanical workshops put at service of the M. H. C. by 
 AIcGill Universit^^ Montreal, for returned soldiers. 
 
 The vocational officer must have instructors in charge of 
 each branch taught. They may be got from the schools 
 or colleges in the neighborhood, or in some cases, they may be 
 obtained from the camp or hospital itself. They must be 
 made responsible to him for their department, and carry it 
 on under his direction. The courses given will, of necessity, 
 vary somewhat with local conditions, but they include : 
 
RECLAIMING THE MAIMED 
 
 109 
 
 1. School work. The preparation of students for civil 
 service examinations, bookkeeping, ofi&ce work, stenography, 
 and typewriting. 
 
 2. Draughting. The making of mechanical and ar- 
 chitectural drawing and plans, lettering and painting, . and 
 modeling in plasteline or clay. 
 
 Fig. ioi. — Repair shop for automobiles. M. H. C, Canada. 
 
 3. Printing and bookbinding. The use of tools and 
 processes of binding books, lettering, tool work on leather, 
 knotting and splicing, th^ processes of printing, and lin- 
 otype. 
 
 4. Woodwork. The use of tools and the making of simple 
 articles in wood, going on to making apparatus like arti- 
 ficial limbs, toy making, cabinet making, and allied trades 
 of upholstery, varnishing, and polishing. 
 
110 
 
 RECLAIMING THE MAIMED 
 
 5. Mechanics. The use of tools for working in iron, brass, 
 and tin. Plumbing and steam fitting. 
 
 6. Electricity. Wiring and the construction and repair 
 of electrical apparatus. 
 
 7. Motors. Driving and repairs of motor cars. 
 
 Fig. 102. — The poultry farmers of Alberta, Canada. 
 
 8. Gardening. Lectures and practice in the care of 
 flowers and truck gardens, each man being given his own 
 patch of ground to cultivate. 
 
 9. Farming. Lectures and practice in poultry raising, 
 beekeeping, cheese making, dairy and general farming, and 
 fruit growing. 
 
 Hospitals should be affiliated with technical schools and 
 colleges, as much as possible, so that their equipment may 
 be employed for teaching purposes. In this way expert 
 teaching is easily obtained, and the necessity of extensive 
 equipment is avoided. For small institutions this is not 
 
RECLAIMING THE MAIMED 
 
 111 
 
 always possible, and a standard outfit should then be supplied 
 for each trade taught. 
 
 If the experience of the Canadian authorities may be 
 taken as a guide, less than ten per cent of all men require re- 
 education in a new occupation. The majority of cases that 
 come before the vocational officer suffer from medical, 
 
 Fig. 103. — Wounded Canadian soldiers returned to the land. 
 
 rather than surgical, disabilities. Rheumatism, chronic ne- 
 phritis, neurasthenia, and tuberculosis are common, some- 
 times more than one being present. 
 
 Every case must be considered individually, but the am- 
 putations seem to form a class by themselves. They must 
 first be trained to use the artificial limbs supplied to them 
 by the hospital. They begin with the use of a sheath for 
 the stump and exercises with pulley weights, to strengthen 
 
112 
 
 RECLAIMING THE MAIMED 
 
 U 
 U 
 
 ^ 
 
 •m 
 
 u 
 
 O 
 
 
 
RECLAIMING THE MAIMED 
 
 113 
 
 the weakened musdes, followed by practice with the leg or 
 arm, as already described. The artificial hand or arm issued 
 will depend on the occupation chosen. Better than the 
 " Pince Universelle " of Amar or the German '' Kellar 
 Hook " is the cleverly designed " Salary Hook " or clamp 
 
 P'iG. 105. — Amar's universal pincer. 
 
 issued by the Canadian government for heavy work ; the 
 Dorrance hook is valuable for light work, and the imitation 
 hand is ornamental for Sunday. The Cams arm is seldom 
 used except by an expert. When the trade to be taught is 
 decided upon, he begins at once and takes an increasing 
 
114 
 
 RECLAIMING THE MAIMED 
 
RECLAIMING THE MAIMED 
 
 115 
 
 number of hours per day. In a roll kept of graduates from 
 Roehampton and the London Polyclinic, legless men became 
 electrical workers, moving picture operators, telephone work- 
 ers, switchboard, attendants, motor engineers, munition 
 workers, carpenters, clockmakers, and salesmen. Armless 
 men became electrical workers, switchboa_d attendants, car- 
 penters, storekeepers, laboratory assistants. The legless 
 
 Fig. 107. — Blind Irish Guardsman at work as a masseur. 
 Heaton Park. 
 
 men averaged in wages about nine dollars a week ; and the 
 armless, about eight dollars. This shows the results of the 
 special training available in one institution, but the range of 
 instruction can be infinitely extended for both armless and 
 legless men. 
 
 The blind have naturally received sympathy and attention. 
 Sir Arthur Pearson, at St. Dunstans, has done pioneer work. 
 They can be taught boot repairing, mat making, net making, 
 
116 RECLAIMING THE MAIMED 
 
 basketry, simple carpentry, poultry farming, market garden- 
 ing, salesmanship, and massage. The use of the dictaphone 
 has opened typewriting to them, and there is little difficulty 
 in obtaining work for them. 
 
 The vocational officer must be familiar with the prospects 
 for placing men in their chosen occupations, and much of 
 his work will be in this field through employers of labor and 
 committees. The placing of men whose training is complete 
 is best done by the vocational officer, through local civilian 
 committees. Every effort must be made to induce men to 
 undertake and follow up their training, by both rewards and 
 penalties. The American government has organized this 
 part of the reclamation work so that the man who refuses 
 to take any form of training may have his pension reduced, 
 whereas compliance with its regulation will give him a good 
 living in addition to the very liberal insurance arrangements 
 that have replaced the old pension system. 
 
CHAPTER X 
 MASKING OF FACIAL DEFORMITY 
 
 Among the most distressing cases met with in military 
 surgery are those in which the face has been so destroyed 
 as to defy the best efforts of the plastic surgeon. The jagged 
 fragment of a bursting shell will shear off a nose, an ear, or a 
 part of a jaw, leaving the victim a permanent object of re- 
 pulsion to others, and a grievous burden to himself. It is 
 not to be wondered at that such men become victims of de- 
 spondency, of melancholia, leading, in some cases, even to 
 suicide. 
 
 After plastic surgery has done its best, and there remains 
 nothing but a living gargoyle, much may still be done to 
 make him presentable enough to mix freely with his fellows, 
 and to earn his livelihood, without that constant humiliation 
 to which his appearance would subject him. 
 
 The reclaiming of these maimed now passes out of the 
 hands of the surgeon and the vocational officer, for here the 
 sculptor must supplement their combined efforts by his skill 
 in modeling masks so constructed, colored, and attached to 
 the face as to successfully hide these hideous deformities. 
 Many mediums have been tried ; solid rubber, gutta percha, 
 papier mache, and plaster ; but thin copper best fulfills the 
 requirements, being pliable, strong, light, and durable. The 
 wound must be soundly healed, so that no further shrinkage 
 or other distortion will take place, before starting the sculptor 
 on his part of the work. 
 
 117 
 
118 
 
 RECLAIMING THE MAIMED 
 
 The technique to be followed will vary slightly with the 
 preference of the operator. Captain Derwent Wood, A.R.A., 
 whose pioneer work in this branch of reconstruction at the 
 3d London General has earned such well-deserved praise, 
 
 models directly on 
 a plasteline base, 
 although such a 
 procedure might be 
 disastrous to one of 
 less experience. The 
 essentials of the 
 technique are con- 
 tained in the fol- 
 lowing procedures. 
 
 I. The deformed 
 part of the face, 
 and the surround- 
 ing regions are lubri- 
 cated with white 
 vaseline, taking care 
 to fill the hair spaces 
 in the eyelids, and 
 the eyelashes. A 
 quick-setting plas- 
 ter of paris is mixed, 
 and, when it is of 
 the consistency of 
 thick cream, it is 
 gently painted over the sound tissue, with a soft brush, 
 until the surface is covered. Care must be taken to leave 
 a breathing space at the nose and mouth, and to see that 
 the face is not unnaturally drawn or wrinkled from nervous- 
 ness. The plaster is strengthened and thickened, until it 
 forms a sheet about one inch in thickness. When this has 
 become set, as shown by the heat, it is carefully drawn off. 
 
 Fig. 108. — Destruction of the face from the 
 
 bridge of nose to the lower jaw. 
 (Case referred to author by Dr. W. L. Clark.) 
 
RECLAIMING THE MAIMED 
 
 119 
 
 2. This mold, or negative, is well soaped with green soap, 
 oiled, and a cast, or positive, is made, and trimm.ed to the re- 
 quired shape and thickness. This serves as a record, or 
 original of the deformed face. Fig. 109. 
 
 3. From this model, a glue mold, or negative, is made. 
 
 4. Several casts may now be made from this mold, and 
 colored by water color, to match the plasteline, which is 
 used in the next 
 
 process. 
 
 5. With the 
 patient present, 
 and by reference 
 to photographs, 
 the missing nose 
 is modeled on one 
 of these casts, 
 great care being 
 taken to imitate 
 the surrounding 
 surface texture 
 and match it, 
 especially at the 
 edges. It is safer 
 to model this in 
 plasteline, over 
 the plaster, rather 
 than on a plaste- 
 line squeeze, as described later, if at all possible, because 
 the hard plaster prevents one making the possible error of 
 going too deep in modeling a hollow. Where a missing eye 
 has to be reproduced, another process is necessary at this 
 stage. 
 
 6. A piece mold must be made from the cast (4). It is 
 prepared with French chalk, and (6 A) a plasteline squeeze 
 made. The sculptor then opens the eye by modeling it from 
 
 Fig. 109. — Cast of the face of patient in Fig. it 
 
120 
 
 RECLAIMING THE MAIMED 
 
 Fig. iio. 
 
 Wax cast of remodeled parts in 
 the same patient. 
 
 life (6 B), because the 
 eye was closed during 
 the taking of the origi- 
 nal mold over the face. 
 
 7. A glue mold must 
 then be made, from this 
 plasteline cast of the 
 remodeled • eye, the 
 sound one, and 
 
 8. A cast is made 
 from this, as in 4, the 
 process going on as in 5. 
 
 9. When the missing 
 features have been 
 
 modeled to the satisfaction of the sculptor and the patient, 
 a glue mold is made of the restored face, from which 
 
 10. A cast in wax is made and worked on, or retouched, if 
 necessary. Fig. no. 
 
 11. The wax is now carefully coated with bronze powder, 
 or plumbago, connected by copper wire with the cathode of 
 a dry cell battery, and placed 
 in a galvano deposit bath of 
 sulphuric acid and sulphate 
 of copper, between two 
 copper plates connected 
 with the anode. It is left 
 there until a film of copper 
 one thirty-second of an inch 
 in thickness is deposited, 
 a process lasting four or 
 five hours. This is a pro- 
 cess in which many failures 
 are likely to occur, until a 
 good deal of experience is 
 gained. 
 
 Fig. III. — Eye and socket attached 
 to glasses, showing hinges at temple 
 and artificial lashes. Captain Der- 
 went Wood. 
 
RECLAIMING THE MAIMED 121 
 
 12. The wax is now melted out, and the metal mask 
 trimmed and tried on. Every advantage must be taken of 
 natural lines and wrinkles of the face, to hide the borders. 
 The nostril holes are opened, as well as the eye slit, which 
 masks the missing eye. 
 
 13. The mask is then electroplated with silver by dipping 
 in a solution of nitrate of silver, and 
 
 14. When the eye has to be replaced, the artificial glass 
 eye is matched with the good eye, or, better still, a blank one 
 
 Fig. 112. — Mask for Fig. 108, colored and with glasses attached ; 
 mustache and whiskers in place. Patient in Fig. 108. 
 
 is painted to match, and then placed, and held in place, be- 
 hind the open lids, by wire clips, like the setting of a jewel in 
 a ring. This fitting requires great care and patience. 
 
 15. The mask is now given a coat of color, and the com- 
 plexion is matched with great care, using oil colors with a 
 wax medium. The success of this will depend entirely upon 
 the artistic skill of the painter. 
 
 16. When this is completed, a pair of spectacle frames, 
 with heavy rims, are fitted on over the mask, and the nose 
 
122 
 
 RECLAIMING THE MAIMED 
 
 piece is riveted through the copper, or soldered to hold them 
 in place. When a cheek is replaced, it may be necessary to 
 have a pin from the spectacle frame to the mask, to give the 
 gentle pressure necessary to keep it in place. Fig. 112. 
 
 17. Eyebrows can be made with real hair, or by painting 
 them, and eyelashes are best made, in the experience of 
 
 Derwent Wood, of 
 tin foil, cut in thin 
 strips, colored and 
 soldered to the edge 
 of the eyelid. They 
 can also be set with 
 real hair in a groove 
 of the lid, and held 
 by wax. 
 
 When any dis- 
 charge from the 
 eye, nose, or sali- 
 vary glands is pres- 
 ent, dressings can 
 be put within the 
 mask, and renewed 
 as required, for the 
 mask is put on and 
 off with the spec- 
 tacles. In some 
 cases, where the 
 lower jaw is gone, 
 
 Fig. 113. — Mask in place on patient in Fig. io8. 
 
 this is very important, because the saliva is constantly drib- 
 bling, and, in these cases, it may be necessary to have an 
 additional fastening for the mask about the neck. Fig. 114. 
 A lost ear can be modeled in plasteline, using its mate for 
 comparison, and the process continued as already described, 
 except that it must be attached by spirit gum to the face, as 
 actors do with false whiskers, taking care to have a good 
 
RECLAIMING THE MAIMED 
 
 123 
 
 sized bearing surface. The mask will require to be re- 
 colored from time to time, as it wears, or becomes soiled, but 
 it should last three or four months, with reasonable care, 
 without this attention. 
 
 The illusion should be complete at a couple of yards' dis- 
 tance, except that where an eye is replaced, it cannot close and 
 open, and a squint ap- 
 pears, unless the patient 
 takes the precaution to 
 look his friend full in 
 the face. By means of 
 these masks, horribly 
 disfigured men have 
 been able to accept and 
 hold positions as chauf- 
 feurs, elevator attend- 
 ants, clerks, and, in fact, 
 any position involving 
 appearance among their 
 fellows, who are quite 
 unconscious of the grisly 
 gap present beneath this 
 fair exterior. Timidity 
 and self-consciousness 
 disappear, as they find 
 that they are no longer 
 objects of repulsion to 
 every onlooker. Self- 
 respect returns, depres- 
 sion departs, and physical health follows the upward trend 
 of their spirits. 
 
 The process, simple as it may sound, is really rather dif- 
 ficult, and can only be brought to a successful result by a 
 high degree of sculptural skill, with infinite patience in 
 trimming down^ building up, altering, and adapting; with 
 
 Fig. 1 14. — Loss of lower part of face, mask 
 held by glasses and neck ribbon. Der- 
 went Wood. 
 
124 
 
 RECLAIMING THE MAIMED 
 
 many failures, before these strong metal films will conform 
 to the remaining parts of the face, both in form and texture. 
 The operator who is not a sculptor, and a sculptor of imagina- 
 tion, at that, will inevitably fail. 
 
 Fig. 115. — Loss of nose with mask in place. Case referred to the author 
 by Dr. W. L. Clark. 
 
INDEX 
 
 Abdominal congestions, 43 
 
 Abrasions, 18 
 
 Adhesions, 45, 5, 61, 62 
 
 Aldershot, 95 
 
 Amar's universal pincer, 113 
 
 Amputations, 89, 90 
 
 Ankle, circumduction, of 62 
 
 treatment of, 81 
 
 stiff, 93 
 Appliances, mechanical, 66 
 Arc light, 37 
 
 Architectural drawing, 109 
 Arm, exercise for, gS 
 
 lost, 93 
 Armless men, vocations for, 115 
 Arthritis, chronic, 21 
 Artificial eyebrows, 122 
 Artificial eyes, 121 
 Artificial hands, 113 
 Artificial limbs, in, 89 
 
 making of, 169 
 Artificial masks, 117 
 
 Back, massage of, 64 
 Balance, 90 
 Baths, 94 
 
 cabinet, 100 
 
 contrast, 51 
 
 electric, 51 
 
 hot, SI, 49 
 
 immersion, 53 
 
 local, 50 
 
 local electric light, 43 
 
 medicated, 53 
 
 Baths, Schnee, 53 
 whirlpool, 3, 50 
 Bicycle apparatus, 89 
 Blinded men, vocations for, 115 
 Bookbinding, 109 
 Bookkeeping classes, 107 
 Bullet wounds, 3 
 Bursitis, 22 
 
 Card system, 9 
 Case history, 9 
 Cell, galvanic, 11 
 
 in series and parallel, 13 
 Chronic pains, 22 
 Circulation, 50, 56 
 Circumduction, 62 
 
 of wrist, 74 
 Claw foot, 62 
 Combined currents, 31 
 Command Depots, 105 
 Condenser, 32 
 Contractures, 5 
 Convalescent camps, 105 
 
 exercise for, 95 
 
 D. A. H. Treatment, 7 
 Dancing, 100 
 
 Debility, treatment of, 7, 53 
 Degeneration, reaction of, 27 
 Diathermy, 33 
 Disabled, trades for, no 
 Dorrance hook, 113 
 Douche, 47 
 Dysentery, 95 
 
 I2S 
 
126 
 
 INDEX 
 
 Effleurage, 54, 59 
 
 Elbow, flexion and extension at, 77 
 Electrical treatment, objects of, 10 
 Electricity, 93 
 
 application, 20 
 
 burns, 20 
 
 static, 34 
 
 units, definition of, 12 
 Electrotonus, 17 
 Endurance, cultivation of, 65 
 Extension, 63 
 Exercise appliances, 73 
 
 abdominal, 98 
 
 after dysentery, 95 
 
 after typhoid, 95 
 
 Aldershot tables, 97 
 
 arm, 98 
 
 armless men, 93 
 
 fit for duty, 92 
 
 heart cases, 94 
 
 in convalescent camps, 95 
 
 in shell shock, 94 
 
 in tuberculosis, 94 
 
 leg, 98 
 
 light duty, 92 
 
 mechanical, 98 
 
 neck, 98 
 
 unfit for duty, 92 
 Exhaustion, 94 
 Eyebrows, artificial, 122 
 Eyes, artificial, 121 
 
 Facial deformity, 117 
 Faradic coil, 23 
 Farming, training for, no 
 Fatigue, 50 
 Fibrositis, 22 
 Finger board, 70 
 
 machines, 70 
 Finger pulleys, 72 
 
 treadmill, 73 
 Flat foot, 62 
 Flexion, 62, 63 
 Foot, treatment of, 82 
 
 Foot, exercise for, 84 
 Fractures, 59, 54 
 Frost bite, 21 
 
 Galvanometer, 17 
 Galvanic battery, 14 
 
 application of, 18 
 
 care, of, 20 
 Galvanic current, 10 
 
 effects of, 15, 17, 21 
 
 interruptions of, 16 
 
 reversal of, 16 
 Games, 99, 92, loi 
 Gardening, training for, no 
 Golf course, 91 
 Gymnastics, 92 
 
 Hand, lamp, 40 
 
 newspaper exercise for, 79 
 Hart House, 68, 89 
 Hearing, loss of, 5 
 Heart action, 93 
 
 cases exercise for, 94 
 Heaton Park, 94, 99 
 High frequency, 32 
 Hip, massage of, 63 
 
 exercise for, 86 
 
 treatment of, 82 
 Hospitals, exercise for, 95 
 
 Red Cross, 105 
 Hot baths, 46 
 Hydrotherapy, field of, 45 
 
 Induction, 23 
 Injured nerves, 2 
 Inspections, 93 
 
 Intoxications, treatment of, 43 
 Ionic medication, 21 
 
 Joint, shoulder, 77 
 Joints, movements of, 65 
 
 reeducation of, 68 
 
 stiffened, 58 
 Jones, Sir Robert, 63 
 
INDEX 
 
 127 
 
 Kellogg's apparatus, 43 
 Keogh, Sir Alfred, 105 
 Knee, flexion of, 82 
 
 massage of, 63 
 
 stiff, 93 
 
 Legless men, vocations for, 115 
 Ley den jar, 32 
 Limbless men, gi 
 Lumbago, 22 
 Lynn Thomas, 91 
 
 Masks, artificial, 117 
 Massage, 51, 54 
 
 Mennell's book on, 59 
 
 of muscles, 65 
 
 time for, 60 
 Mechanical classes, 108 
 
 workshop, 108 
 Mechanics, training for, no 
 Measurements, 68 
 Medical switchboard, 31 
 Melancholia, 117 
 Mental treatment, 5 
 Molds for face, 119 
 Motor repairs, training for, no 
 Movements, passive, 60 
 
 active, 65 
 Muscles, massage of, 65 
 Myositis, 22 
 
 Neck, exercise for, 98 
 
 massage of, 64 
 Nerves, injuries to, 2, 45, 51 
 
 degeneration of, 27 
 
 treatment of functional, 5 
 Nervous disturbance, 94 
 Neuralgia, 39, 35 
 Neurasthenia, 53 
 
 treatment of, 47 
 Neuritis, 35 
 
 Occupation, treatment by, 105 
 Occupational therapy, 106 
 
 Pains, referred, 39 
 
 Paralysis, 51 
 
 Passive movement, 59, 60 
 
 Pearson, Sir Arthur, 115 
 
 Petrissage, 55 
 
 Physical therapy, application of, 2 
 
 case taking, 9 
 
 plan of department, 7 
 
 sequence of, 7 
 Post-operative conditions, 5 
 Primary and secondary waves, 27 
 Printing, 109 
 Pronation, 62, 75 
 
 Radiant heat, 39 
 Reeducation, 5, 65, in 
 Rest room, 8 
 Rheumatism, 22, 39, 56 
 Rotation, shoulder, 62 
 
 Saint Dunstan's Hospital, 115 
 Salary hook, 113 
 Scars, 58, 60, 59, 56, 54 
 
 healed, 5 
 Scar tissue, circulation of, 39, 51 
 
 treatment of, 3 
 Sciatica, 22 
 Sculptor's work, 117 
 Septic wounds, 5 
 Shell shock, exercise for, 94 
 
 description and treatment, 6, 47 
 
 electric treatment of, 35 
 Shoulder, treatment of, 68 
 
 flexion and extension, 77 
 
 machines, 70 
 
 rotation of, 62, 77 
 
 stretching of, 78 
 Sight, loss of, 5 
 Sinusoidal current, 16 
 Speech, loss of, 5 
 Sphygmomanometer, 69 
 Sprains, 54 
 
 treatment of, 59 
 Steam compress, 43-44 
 
128 
 
 INDEX 
 
 Strength, 65 
 Stumps, 5g, 89 
 
 painful, 45, 51 
 Supination, 62, 75 
 
 Tapotement, 56 
 Thennophore, 44 
 Thigh, exercise for, 87 
 Thumb, exercises for, 73 
 Toy making, 109 
 Trades for disabled, 109 
 Treatment by apparatus, 67 
 Treatment of bullet wounds, 3 
 Trench foot, 2 1 
 Tuberculosis, 94, 112 
 
 exrercise for, 94 
 Typhoid, 95 
 
 Vibration, 57 
 
 Vocational training, 2, 106 
 
 Vocations for armless men, 115 
 
 for blind men, 5 
 
 for legless men, 115 
 
 Whirlpool bath, action of, 3 
 Wood, Capt. Derwent A.R.A., 118 
 Woodhead, Lieutenant Colonel Sims, 
 
 R.A.M.C, 105 
 Wounds, old septic, 5 
 
 shrapnel, 60 
 Wrist, movements of, 74 
 
 machines, 70 
 
 Zander machines, 66 
 
 Printed in the United States of America. 
 
T 
 
 HE following pages contain advertisements of a 
 few of the Macmillan boolcs on kindred subjects 
 
Radiography and Radio-Therapeutics 
 
 By ROBERT KNOX 
 
 M.D. (Edin.), M.R.C.S. (Eng.), L.R.C.P. (Lond.) 
 
 Captain R.A.M.C. (T.), 4th London General Hospital (in Charge 
 of X-Ray Department) ; Consulting Radiologist, Great 
 Northern Central Hospital, London; Director, 
 Electrical and Radio-Therapeutic De- 
 partment, Cancer Hospital, London 
 
 Second Edition. Containing go Full-page Plates (One 
 i7i Color) and about 400 Illiistratiotis z« the Text 
 Super Royal 8vo. Cloth. In Two Volumes 
 
 Vol. I. RADIOGRAPHY Vol. II. RADIO-THERAPEUTICS 
 
 $g.oo Ready shortly 
 
 Vol. I., Radiography^ deals with general principles, forms of 
 apparatus and manipulation of same, technique of application, 
 and diagnosis. These chapters have all been considerably ex- 
 tended, and a very full description of stereoscopic radiography has 
 been given. One new section of immediate interest deals with 
 Radiography in War-time., and another describes the appearances 
 of Gas in the Tissues. The chapters dealing with the examination 
 of the Thorax and of the Alimentary System are each considerably 
 enlarged and illustrated with many new radiograms and diagrams. 
 
 Vol. II., Radio-Therapeutics., deals with X-Ray Therapeutics, 
 Radium Therapy, Radium and X-Rays combined. This section 
 is also very practical. Methods of treatment are given in detail 
 in order that readers may thoroughly grasp the principles of this 
 comparatively new therapeutic agent. 
 
 The section on Radium has been purposely enlarged in order 
 that the reader may gain a working knowledge of this important 
 agent. The chapter on Therapeutics will guide the reader regard- 
 ing the type of case in which Radium may be useful, and the 
 author goes fully into the important question of dosage. A valu- 
 able section on '^X-Rays and Radium in the Treatment of Injuries 
 and Diseases met with in Military Practice" appears for the first 
 time in this edition. 
 
 THE MACMILLAN COMPANY 
 
 Publishers 64-66 Fifth Avenue New Tork 
 
A Handbook of Antiseptics 
 
 By henry DRYSDALE DAKIN, D.Sc, F.I.C, F.R.S. 
 
 AND 
 
 EDWARD KELLOGG DUNHAM, M.D. 
 
 Emeritus Professor of Pathology, University and Bellevue Hospital Medieal 
 College; Major, Medical Officers' Reserve Corps, U. S, Army 
 
 i2nio, $1.2^ 
 
 The object of this handbook is to present a concise account of the chief 
 chemical antiseptics w^hich have been found useful for surgical purposes 
 during the present war. The unparalleled severity and frequency of 
 vi^ound infection found there has led to considerable advances in our 
 knowledge of these antiseptics, and of methods for their successful em- 
 ployment as found in Dr, Dakin's recent broad experience on the various 
 European war fronts. 
 
 The current European practice is here, for the first time, collected into 
 concrete condensed form. The book contains results of much of the 
 investigation carried out under the direction of the British Medical Re- 
 search Committee. 
 
 It also presents, yi^r the first time, unique methods of using certain dis- 
 infectants for the sterilization of drinking water and the disinfection of 
 hospital ships, together with simple apparatus invented by Dr. Dakin and 
 successfully used by him ti7ider actual war conditiojis with the French and 
 British Army Medical Services. 
 
 THE MACMILLAN COMPANY 
 
 Publishers 64-66 Piftli Avenue New Tork 
 
Technique of Operations on the Bones, 
 Joints, Muscles and Tendons 
 
 By ROBERT SOUTTER 
 
 A.B., M.D. (Harvard) 
 
 Instructor in the Hai-vard University Medical School ; Assistant 
 
 Surgeon to the Children's Hospital, Boston ; Surgeon-in-Chief 
 
 to the House of the Good Samaritan ; Surgeon to the Long 
 
 Island Hospital, Boston, and to the Massachusetts 
 
 State Hospital, Canton, etc. 
 
 Cloth, 8vo. ^04 illustrations. Price $^.Jo 
 
 This unique work contains only the most care- 
 fully tried methods for each condition. The Army 
 Surgeon will find it unusually helpful. Diagrams 
 and descriptions are given of many uncommon 
 pieces of surgical apparatus which are useful in com- 
 plicated conditions and in operations on fracture, 
 while methods in after-treatment, which are essential 
 in securing the best results, are also given. The 
 author also describes operative measures to correct 
 deformity, to improve function, and to restore loco- 
 motion in paralysis resulting from wounds or from 
 disease. 
 
 THE MACMILLAN COMPANY 
 
 Publishers 64-66 Fifth Avenue New York 
 
DEFORMITIES 
 
 INCLUDING 
 
 DISEASES OF THE BONES AND JOINTS 
 
 A Text-Book of Orthopaedic Surgery 
 By a. H. tubby, M.S. Lond., F.R.C.S. Eng. 
 
 Surgeon in Charge Orthopaedic Department, Westminster Hospital — Lecturer 
 on Chnical and Orthopaedic Surgery in the Medical School — Surgeon 
 to the Royal National Orthopaedic Hospital — Consulting Sur- 
 geon to the Seven-Oaks Hospital for Hip Disease, etc. 
 
 Two volumes, ill., 8°, $16.00 
 
 The work has been entirely rewritten and a definite plan, long under 
 consideration, has been carefully followed. This plan provides for the 
 grouping and arrangement of the various subjects on aetiological and 
 pathological bases, in preference to the less scientific regional classification, 
 adopted in the first edition. Thus, one section is now devoted to deform- 
 ities of congenital origin, another to those arising from static conditions, 
 a third to paralytic deformities, and so on, the subject being completed in 
 ten sections. 
 
 Many other works, written on " Orthopaedic Surgery," although they 
 have dealt with tuberculosis of the spine, have not included tuberculous 
 and many other forms and diseases of the bones and joints elsewhere. 
 And this, in spite of the obvious fact that in the practice of Orthopaedic 
 Surgery a surgeon is constantly called upon to deal with such morbid 
 conditions and their results. 
 
 THE MACMILLAN COMPANY 
 
 Publishers 64-66 Fifth Avenue New York 
 

 Wv^-u 
 
 COLUMBIA UNIVERSITY LIBRARIES (hsi.stx) 
 
 RD 131 IV1192 C.1 
 
 Reclaiming the maimed; 
 
 2002128594 
 
■'wmm 
 
 "wi/^mM