Advanced ASSOCIATE EDITORS OF DEPARTMENTS. GYNECOLOGY AND METALLIC ELECTROLYSIS.-G. Betton Massey, M. D., CONSTITUTIONAL DISEASES.-Francis B. Bishop, M. D., Washington. RADIOTHERAPY.-J. D. Gibson, M. D., Denver. PHOTOTHERAPY.-Margaret A. Cleaves, M. D., New York. RADIOGRAPHY.-Herman Grad, M. D., New York. THERMOTHERAPY.—David E. Hoag, M._D., New York. HYDROTHERAPY.-Curran Pope, M. D., Louisville. DIETETICS.-Sigismund Cohn, M. D., New York. THERAPEUTIC EXERCISE.-Watson Lewis Savage, M. D., New York. MECHANICAL VIBRATION-THERAPY.-Frederick H. Morse, M. D., Boston, CLIMATOLOGY.-Boardman Reed, M. D., Philadelphia. STATIC ELECTRICITY.-J. H. Burch, M. D., Baldwinsville, N. Y. REVIEW OF FRENCH CURRENT LITERATURE.-Amédée Granger, M. D., OPHTHALMOLOGY AND OTO-LARYNGOLOGY.-W. Scheppegrell, M. D., New 1908 A. L. CHATTERTON & CO. OCT 261912 PHYSIOLOGICAL LAWS RELATING TO THE EFFECTS OF PHYSICAL MEASURES AS EMPLOYED IN THERAPEUTICS.* BY WM. BENHAM SNOW, M. D., NEW YORK. The reader of current medical literature can but be impressed with the fact that among the writers who employ physical measures in therapeutics there is a wide diversity of opinion as to the best method of meeting the varied indications. Often it may be true that there are more ways than one of accomplishing the same result, but in any event there is an underlying principle which governs the action of measures physiologically in their effects upon a certain pathological process, whereby one measure or combination of measures would be better than another. In other words, in relieving a pathological process or condition by physical measures, some one, or combination of the various methods, from the nature of things, best conserves the purpose. The diversity of opinion now existing in the methods employed is misleading to the student who sets out to investigate physical therapeutics, and leads to a degree of uncertainty of action which is derogatory to the accurate acquisition of the knowledge of how and what to do with these measures. The reason for the differences of opinion and method on the part of the present-day operators may undoubtedly be explained from the fact of self-education in the employment of one or more methods without considering others, and without exercising a definite recognition of a point of view as to the physiological effects of the other modalities as well as of those employed. In other words, to the present time a larger part of the work in physical therapeutics has been done along empirical lines, the empirical lines of clinical experience, with reference to their rational indications. * Read on September 18, 1907, before the American Electro-Therapeutic Association at Boston, Mass. It will be readily seen that the most important study in order that the employment of these measures may be most effective, is the discovery of correct points of view-lawsbased upon the scientific recognition of physiological and physical effects as well as from the clinical results wrought upon abnormal conditions. While it will often be very difficult to determine the exact modus operandi of the various modalities upon the cell, or the neuro-muscular mechanism, or circulatory apparatus, it can be largely determined, and clinical experience demonstrates what is of equal importance-the practical result, which when uniformly repeated establishes the law. The effects upon metabolism cannot be observed except that the functions of an impaired organ or part are restored, which is significant. It is important to know that a modality when employed to restore functions, is likely to accomplish the end in view without detriment in some way to some other organ or function-a two-edged sword-as experience has taught us to consider many of the most used pharmaceutical remedies. It will be readily seen that this might occur from the injudicious use of such agents as the x-ray, the large amperage employed with the continuous current, as well as an indiscreet use of most if not all of the physical measures. It therefore becomes apparent that the advanced physician who would employ these measures in therapeutics must do so with a knowledge of their physiological action, therapeutic indication, and a keen insight into the methods of application of every one of the measures included in the category of physical therapeutics. With these premises in mind, it is apparent that every one of the collaborators who have been pathfinders, as it were, and who have each in some instance developed better qualifications in the use and understanding of the action and application of one or more of the modalities, has done so more or less to the exclusion or proper recognition of others. It therefore behooves each one to consider the broader scope in the interest of honest investigation and inquire if he is not in the rut employing too narrow lines in the choice of methods. to the detriment of his patients' best interests. The statement may be boldly made that at this time every investigator is more or less narrow in his prejudices and con ceptions of the value of some of the physical methods. The object of this paper is to call attention to these facts and to urge upon the members of the Association the importance of an organized effort, looking to the development and establishment of a course of investigation and comparison of methods which will determine in the future definitely studied lines of action, which will make the paths easier for the hosts who must soon adopt the use of these measures for humanity's sake. If the laboratories of our great hospitals and our colleges were open to research work in this field and were making careful comparative studies of physiological effects and clinical results, the problem of investigation and study might be in a large measure provided for; but as it is, these institutions are not giving their attention to these studies but pursuing industrious research, particularly in the field of bacteriology and serum-therapy; and to their credit be it said, we are indebted to them for many discoveries which have added greatly to the possibility of diagnosis and success in a still small but growing field of therapeutics, adapted to prophylaxis and the treatment of infectious diseases. When the value of physical therapeutics is more positively demonstrated, as it will be by the dissemination of a more definite and precise notion of its scietific importance, these institutions will likewise aid in the investigations. Until then, the burden of responsibility must fall upon the comparatively small number of the members of the profession who are comprised in those who have already become impressed with the vast field which is in time to be occupied by physical therapeutics. It devolves largely, then, upon the members of our organized associations and congresses devoted to these subjects to carry out these researches. While this could be accomplished in a very large measure by the establishment of a great research institution, provided with laboratories and clinical facilities for making comparative studies-clinical and physiological, in lieu of the endowments necessary to meet this most desirable opportunity for investigation, it is important that some other organized effort be made to further the research and elucidation of these important questions. In the past history of this Association it has too often |