Treatment by means of mechanical therapeutics at the Edgar Allen Institute, Sheffield / by Rodolph Abercrombie.

  • Abercrombie, Rodolph.
Date:
[1912]
Catalogue details

Licence: Public Domain Mark

Credit: Treatment by means of mechanical therapeutics at the Edgar Allen Institute, Sheffield / by Rodolph Abercrombie. Source: Wellcome Collection.

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    rises to the horizontal, and the resistance is thus at a maximum; towards the end of the movement, when the muscle is fully contracted and therefore weak again, the lever rises nearly to the vertical, and the resistance is there-. fore again small. This correspondence beween the power of the muscle and the magnitude of the resistance throughout the movement is an essential feature of the Zander apparatus, and explains its success in the treatment of muscular paresis. It requires ‘great skill to preserve this pro- portion when resistance movements are given by hand. It is unquestionable that the best way to restore the power of weakened muscles is to exercise them. Massage, so often prescribed for this purpose, is comparatively of little value. Many of the cases of injury are sent for treatment by the surgeons concerned in the administration of the Workmen’s Compensation Act. An institution of this nature provides a means of giving the necessary treatment under supervision ; and cases the genuineness of whose symptoms is doubtful can be kept under observation. In Germany many Zander institutes are supported by funds provided by the public bodies admini- stering the Insurance against Accident Act of that country. Chronic joint affections.—Many cases of rheumatoid arthritis and osteo-arthritis are treated, with good results in suitable cases. The most favourable cases are those in which the acute phase of the disease is past. The treatment is directed to the correction of deformities, the increase of mobility in the joints, and the restoration of wasted muscles. Passive movements are chiefly used. The range of tolerable movement in the affected joint is ascertained, and this, at intervals, is very gradually increased. Painful and violent movements are apt to bring about a local re- crudescence. In certain cases vibrations are useful. This last method of treatment has stood the test of time in Sweden, and is of real value, notwithstanding the discredit cast upon it by the absurd pretensions of quacks. Oases of chronic articular gout have also been treated with success. A ffections of the nervous system.—In hemiplegia consider- able increase in muscular power may often be obtained by means of graduated active movements. Passive movements are used for the correction of contractures. In newrasthenia the treatment has been found of much value. Ordinated daily exercise results in improved appetite and sleep ; special movements are given (when indicated) for improving deficient respiratory power or remedying constipation. Vibrations often relieve the distressing cranial or abdominal subjective symptoms. In neuritis the mechanical treatment has proved of less value than manual treatment. Scoliosis.—Good results have been obtained by combining the Zander treatment with the movements of the usual Swedish medical gymnastics. Cardiac disease.—Treatment by movements is not much used in England for this condition, but the few cases treated have done well. The scope of the treatment cannot be discussed here. In outline it resembles the ‘‘ mountain- climbing cure.’”’ Mechanical therapeutics possess the advan- tage of being easily available, and of being susceptible of exact dosage. Chronic pulmonary affections.—In certain cases the treat- ment is of value in maintaining the elasticity of the thorax or in restoring its shape (e.g., after pleural effusion), Move- ments designed to improve the inspiratory or expiratory power may be given as indicated. General Policy and Method of Conduct of the Institute. The conditions mentioned above show that mechanical therapeutics possess a considerable field of utility. It thas been realised that the usefulness of the institution depends on the codperation of the practitioners of the neighbourhood. No cases whatever are received for treat- ment except through the introduction of a medical man. Both free and paying patients are treated, special hours ‘being reserved for the latter. Patients of limited means are treated at reduced fees, upon, the recommendation of the medical men sending them for treatment. Hitherto, this plan has worked well. The sums received in fees are to be devoted to the general purposes of the Institute. In addition to the patients sent by practitioners, cases are sent for treat- ment from the out-patient department of the Sheflield Royal Hospital and the Royal Infirmary. The Institute is to be controlled by an influential committee, upon which the medical profession is adequately represented. The staff consists of a medical director and three trained Swedish masseurs (one male and two female), who act as instructors in addition to performing massage. There are also two untrained attendants. Such a staff is capable of dealing with about 120 patients a day. The number of staff required obviously depends largely on the nature of the cases. In Sheffield the cases treated are mostly of a severe nature. The grave affections of an industrial and mining population require (though they do not always obtain) more attention than the minor ailments of the members of the leisured classes who frequent such institutes at Continental spas. The structure of the Institute and the apparatus have been presented to the city of Sheffield by Mr. Wm. Edgar Allen of that city, who has undertaken to defray the cost for a period of three years. After that time, hopes are entertained that the Institute will be self-supporting by means of public subscriptions and the fees obtained from paying patients. However that may be, the three years will enable the pro- fession of Sheffield to form an opinion upon the value of a method of treatment which has hitherto perhaps not aroused sufficient interest in this country. THE METROPOLITAN HOSPITAL SUNDAY FUND AND ST. GEORGE’S HOSPITAL. WE have had given to us for publication the following report made by Sir Thomas Crosby, M.D., Lord Mayor of London, to the Metropolitan Hospital Sunday Fund, of which he is President, with regard to the methods of expenditure at St. George’s Hospital. On receipt of this report the committee of the Fund made an award to the hospital. The situation is commented on in a leading article this week. Sir THOMAS ORosBy’s REPORT. The committee of the King’s Hospital Fund have withheld their grant to St. George’s Hospital on the ground that the amount expended upon the bacteriological and pathological departments is excessive and much larger than the pro- portion spent thereon at other hospitals. In order to carry out my undertaking at the last meeting of the Metropolitan Hospital Sunday Fund I visited the hospital on Feb. 12th, when I was met by the treasurer and some of the house committee, who placed before me an account of the work done in those departments, the cost of their maintenance, and the amount represented by that cost per occupied bed. Statistics obtained from other hospitals showing this proportion were also produced for com- parison. It was pointed out that the work of these departments is essential for the proper diagnosis and treatment of the patients of the hospital; that it is necessarily undertaken by skilled experts; and that in St. George’s Hospital all reports on clinical material are furnished personally by the bacteriologist and pathologist to the hospital, and not by students, or even by house physicians or house surgeons. The work includes examinations of blood, excretions, sputum, &c., post-mortem examinations, and the examination of various growths and tissues ; the preparation of vaccines, &c., besides the care of the museum, which is the property of the hospital; also a variety of chemical examinations. A careful investigation of the whole matter convinced me that the bacteriological and pathological departments of St. George’s Hospital are doing work which is recognised at all efficient hospitals as essential to the scientific diagnosis and treatment of disease ; that the amount expended upon it is in no way excessive, and does not represent a larger cost per occupied bed than is the case at many other London hospitals, although, as the accounts of these departments are not kept in a corresponding manner at different hospitals (various items being excluded, or included), it is difficult to show this in exact figures. The work of these departments is as necessary to the welfare of the patients as that of the electrical depart- ment, the X ray investigations, or the preparation of drugs ; and it involves most laborious processes, which can only be efficiently carried out by skilled and highly trained officers, with appropriate salaries. I am of opinion, after an investigation of all the facts, that the proportionate amount paid by the hospital and school for the upkeep of the laboratories is a fair and proper one, and that the sums expended upon these departments by the hospital are properly taken from the general funds, being for the direct treatment of the patients.
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