Massage and Medical Electricity
(Faom A MEDICAL CORRESPONDENT.) THE object of the following information is to enable the public to realize the position that massage, medical electricity, artificial light, and remedial exercises occupy in medical practice, and so to protect themselves from the administrations of people whose unqualified efforts may result in serious harm.
The first point to be clearly emphasized is that none of the above methods of treatment, important though they undoubtedly are, are included in the curriculum of the medical student, or the examinations that qualify him as a medical practitioner. That is to say that the average doctor, on his entry into general practice, is not qualified to supervise the methods of those to whom he sends his patients for physical treatment. Thus he is in a very difficult position, for which he, individually, is in no way responsible. At the same time, the patient has some grounds for caution. To explain these grounds I will select special instances.
In the first place, we may consider massage, medical electricity, and remedial exercises.
The practice of treatment under these headings was, until a few years ago, in a state of chaos. Any layman who felt an interest, or saw possibilities of profit, set up in practice as a masseur or masseuse, bought some sort of apparatus, and practised his method without any sort of qualification at all. The Chartered Society of Massage and Medical Gymnastics then came into being, and instituted a considered curriculum and public examinations in massage, medical electricity and Swedish remedial exercises. The organization of this Society was a big undertaking, and has been well carried out, and we are deeply indebted to it, because through its auspices a great advance has been made, and it must be completely exonerated from any of the criticism that appears below. The practice of massage, as carried out by those who have passed the qualifying examination, appears to be on a satisfactory basis, and does not call for any particular comment here. In the hands of these skilled operators it is very valuable, and, on the whole, free from danger.
Medical electricity, however, is a subject to which particular attention should be called. The massage students who pass the electricity examination of the Chartered Society are qualified to administer treatment by the Faradic and Sinusoidal currents, and the Galvanic current (including " ionization "), and it is a rule of the Society that they must do so under the direction of a doctor. These types of electrical current are fairly free from danger to the average patient, especially if we exclude the region of the head. There is another type of current, however, which should not be employed by a masseuse, except in the actual presence of a qualified doctor. I allude to the type that is known as diathermy. The diathermy current is of immense benefit in proper hands. In fact it is, in my own opinion, destined to play a great part in therapeutics. Nevertheless a very slight departure from the correct methods of adminis- tration may be attended with grave danger to any tissue or organ through which it passes, because in its passage through them much of its energy is converted into heat. When it is explained that the heating of the deep tissues of the body, including the most vital and delicate organs, may take place without the production of any sensation to the patient, the insidious nature of the danger will be at once apparent. Should a certain degree of condensation occur (as it may very easily do through careless administration) in the passage of the Diathermy current through any particular part, injury up to complete destruction of masses of tissue may ensue. For example, ulceration, with subsequent adhesions and obstruction, may be caused in the intestines, such effects coming on after a lapse of time, so that the condition is a complete mystery to all concerned. The writer has seen a- joint that had been treated with diathermy by an unqualified administrator which was completely and permanently fixed by the sealing of the tissues, although the patient had experienced absolutely no warning pain. On account of its danger, diathermy has been intentionally ruled out of the teaching and examination of the massage students, and it is right that the public should know this before they seek it at the hands of any person other than a qualified doctor.
With regard to artificial light treatment : this has followed closely on the work of Augustus Rollier in the real sunlight at Leysin, and it is one of the greatest discoveries in the whole history of medicine. The results obtained in certain hands by artificial light have been sensational, and consequently reported and distorted in the public Press. Unfortunately a furore has been the result, the loudest clamour being from makers of apparatus for the production of artificial light. These have seen a large field for profit, and not unnaturally set out their wares with tantalizing brochures, showing householders basking in the rays of " artificial sunlight in the home," and giving just a sufficient smattering of information to the masseuses and other unqualified people who are buying these lamps in large numbers, so that there is now scarcely a district in London where artificial light treatment may not be obtained at their hands. Some of the firms alluded to have a wide reputation, and ought to know better.
Now, the dangers attending this administration are not confined to an inflammation of the skin. This, if excessive, may lead, and has led, to sad results, but a further danger is added when the patient is subjected to a chronic and unnoticed overdosage of the light. Under a moderate dosage of the artificial rays the same phe- nomenon is noticed that occurs under real sunlight, viz., that the skin is, after a certain time, enabled to undergo prolonged exposure to the light without inflam- mation. Then comes the danger of overdosage.
There is a factor produced in the skin cells under the action of light which is absorbed into the blood and distributed throughout the body. People, and especially sick people, vary greatly in their toleration of this factor, the effects of which are constitutional and often subtle, 30 that it is most important that the administrator should be qualified to observe them. Such qualification is only possible after a thorough training at a teaching hospital. In other words, only doctors and trained hospital nurses should be employed in this work, and patients are running a risk when they place themselves in any other hands. Even in the case of hospital nurses, these should only administer the light under the genuine direction of a doctor who has practical knowledge of the subject, and the procedure that is being adopted by some nurses, who are setting up private clinics of their own, is to be depre- cated. Again, the wholesale institution of artificial light by infant welfare clinics before trained staffs are available is premature.
In order to remove the above abuses in physical treat- ment, the London Clinic, which is to open its doors in a few days' time, will offer the fullest facilities to doctors and trained nurses who desire a thorough course of instruction in any or all of the branches of physical treatment. With its honorary medical staff, the Clinic can deal with 1,000 patients per diem. It is complete in every detail as a comprehensive teaching clinic for physical treatment run on the lines of a voluntary hospital, and we may confidently expect that through its auspices the present state of affairs, which forces the public into the hands of unqualified physiotherapists because they cannot find doctors to treat them, will soon disappear.
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