The History of Physiotherapy Education in South Africa June, 1961 P H Y S I O T H E R A P Y Paqe 3 E x tra c t o f Speech by P R O F . R A Y M O N D D A R T D ip lo m a C e rem o n y , P re to ria S c h o o l o f P h y s ilth e ra p y , 10th F e b ru a ry , 1961 I am sure th a t m a n y o f y o u , w h o a re a b o u t to e n te r y o u r professional care ers, m u s t h a v e b e en w o n d e rin g w hy a n ancient retired p ro fe sso r, w h o p o tte rs a b o u t w ith d e siccated fossils instead o f living p u ls a tin g p e o p le , s h o u ld h a v e b een chosen by y o u r Society a s its p re sid e n t. Well, like m o st o ld m e n ’s tale s, i t’s r a th e r a lo n g s to ry a n d goes b ack to o n e ’s b o y h o o d a t lea st h a lf a c e n tu ry ago. Then my m o th e r, w h o kn ew herself, like m o st m o th e rs, ho w to ru b aw ay p a in a n d m assa g e a ch e s, u se d to su m m o n m e to so othe som e o f h er ow n. L a te r, w hile a m ed ic al s tu d e n t in Sydney, I dissected w ith , a n d c o a c h e d s tu d e n ts o f M a ssag e and M edical G y m n a stic s. L a te r still, a fte r d iving in to a swimming p o o l, w hose e n d p ro v e d sh a llo w e r th a n I h a d im agined it to be, I h a d th e g o o d fo rtu n e to b e tre a te d by rone o f th e c o m p e ten t p ro d u c ts o f t h a t S chool. It m ay be su rp risin g to o to k n o w th a t th e w o rd P h ysio ­ therapy is o f such re ce n t o rig in t h a t it d id n o t even a p p e a r in the Encyclopaedia B ritannica (14th e d .), th a t w as c u r re n t in the decade 1929-1939 b e fo re th e S e c o n d W o rld W a r. U n til then w hat we c all P h y s io th e ra p ists w ere k n o w n as M asseuses and M edical G y m n a sts. Shakespeare m ak es Ju lie t say t o R o m e o : W hat's in a n a m e ? th a t which we c all a rose, by any other nam e w ould sm ell as sweet. T rue enough, b u t in th e ir legal p h ra se o lo g y th e R o m a n s said Nom en est quasi rei notam en, i.e. “ A n a m e is, as it were, the d istinguishing m a rk o f a th in g ” . S o I th in k it is worthwhile fo r m e to tell y ou a b o u t th e b a c k g ro u n d in South A frica o f the d istin g u ish in g m a rk o f th e th in g t h a t you go o u t to d a y to p ro u d ly b e a r th r o u g h o u t y o u r life. T h at will c a rry u s b a c k fo r a m o m e n t t o 1923; n e a rly 40 years ago w hen I a rriv e d in Jo h a n n e s b u rg to h e lp b u ild up o u r W itw a tersra n d M e d ica l S c h o o l th a t h a d s ta rte d fo u r years earlier. T h a t y e a r th e la te M iss B . G . A le x a n d e r, a splendid pe rso n ality a n d th e n M a tro n o f th e Jo h a n n e s b u rg G eneral H o sp ita l, h a d c o n v e n e d a C o n g re ss o f S o u th A fric a n nurses in Jo h a n n e sb u rg , w hich she a sk e d m e to a d d ress. A t th a t tim e each o f o u r f o u r p ro v in c e s h a d its se p a ra te M edical C ouncil. N o t u n til 1928, five y e ars la te r d id th e late D r. D . F . M a la n give us a single S o u th A fric a n M e d ica l C ouncil to c o n tro l th e s ta tu s a n d s t a n d a rd s o f m edical, c ental, nursing a n d all o th e r m ed ic al a u x ilia ry p e rso n n e l thro u g h o u t the U n io n o f S o u th A frica. T o d ay w hen we have such s p le n d id n u rs in g colleges in each o f the fo u r p rovinces c o stin g in th e a g g reg a te som e millions o f R a n d it seem s fa n ta stic t h a t S o u th A fric a h a d to aw ait a n o th e r 16 years u n til th e S econd W o rld W a r fo r the establishm ent o f th e S o u th A fric a n N u rs in g C o u n c il by further legislation in 1944 b e fo re th e n e ce ssa ry p re ssu re could be b ro u g h t to b e a r u p o n th e p ro v in ce s to b u ild u p these e d u cational in stitu tio n s fo r n u rsin g . W h e n we see w hat has been d o n e b y o u r big h o sp ita ls d u rin g th e last decade in the w ay o f th e ir tra in in g a s well a s n u rse s, p h y sio ­ therapists, o c cu p a tio n a l th e ra p is ts , d ietician s, ra d io g ra p h e rs and o th e r p ersonnel, by ta k in g P re to ria H o s p ita l a lo n e , we realize th a t the fu tu re o f a u x iliary m ed ic al p e rso n n e l in South A frica is no w well assured. Back in 1932 th o u g h , I w as sh o c k e d to find t h a t th e e d u c a ­ tion o f all types o f a u x iliary m ed ic al services fro m n u rse s to kitchen staff w as n o b o d y ’s legal re sp o n sib ility . S o in a d d re ss­ ing the nurses assem bled a t th e C o n g re ss, I sa id th e y m ight imagine they were a p ro fessio n , b u t really th e y w ere ‘n e ith e r fish, flesh n o r good re d h e rrin g ’. N o b o d y in S o u th A fric a knew w hether n u rsin g e d u c a tio n w as se c o n d a ry e d u c a tio n a n d so fell u n d e r th e P ro v in c es o r w as h ig h e r e d u c a tio n a n d fell u n d e r th e U n io n G o v e rn m e n t. I a d v ised th e m n e v er to re st u n til they fo u n d o u t first o f a ll w hose re sp o n sib ility th e ir e d u c a tio n w as to be. T h a t g ra n d o ld lad y , as M iss B . G . A le x an d e r, p roved h e rse lf to b e , h a d b u ilt u p a sc h o o l o f N u rs in g a t th e J o h a n ­ n e sb u rg G e n e ra l H o s p ita l d e sp ite a ll th e d isc o u ra g e m e n ts she h a d e n c o u n te re d . I t w as h e r e n c o u ra g e m e n t a n d th e ste p s ta k e n s o o n a fte rw a rd s in A m e ric a a t Y a le U n iv e rsity , assiste d by th e R o c k e fe lle r F o u n d a tio n , to se t u p a u n i­ versity d egree c o u rse in N u rs in g t h a t led m e t o p ro p o s e in o u r fa c u lty in 1926 th e e sta b lish m e n t o f Science degree c o u rse s in N u rs in g a n d in M a ssag e a n d M e d ica l G y m n a stic s in th e U n iv e rsity o f th e W itw a te rs ra n d , i.e. ju s t th re e years a fte r th a t N u rs in g C ongress. I c o u ld n o t h a v e sh o c k e d m y clin ica l m ed ic al c o lleagues m o re. T h e y w a n te d t o k n o w if 1 w a n te d D o c to rs o f N u rs in g a n d M a ssag e t o o ; b u t w ith th e h e lp o f th e la te D r. R o n a ld P. M a c k en z ie a n d P ro fe ss o rs C lu v e r a n d W a tt, th e p ro p o sa ls p a sse d th ro u g h th e M e d ica l F a c u lty b u t w ere b lo c k e d by th e S e n a te o f o u r U n iv e rsity . E ig h t y e ars la te r, in 1934, I h a p p e n e d to b e th e U n i­ ve rsity ’s re p re se n ta tiv e o n th e S o u th A fric a n M e d ica l C o u n c il. A t its se c o n d m ee tin g t h a t o r th e fo llo w in g y e ar a c u rio u s situ a tio n a ro se. T h e c h ie f h o s p ita l in C a p e T o w n (th e n th e S o m e rse t H o s p ita l) h a d lo st its M a t r o n ; its B o a rd h a d b e en fo rc e d in to a c c e p tin g a h ig h ly q u alified b u t u ni- lin g u a l m a tr o n fro m G r e a t B rita in b e ca u se th e re w as no official reco g n ize d e d u c a tio n a l a u th o r ity fo r n u rse s in S o u th A fric a a n d n o a d v a n c e d e d u c a tio n o f n u rse s w h a tso e v er as M a tro n s o r S iste r T u to rs . A s th e S o u th A fric a n M e d ica l C o u n c il, e sta b lish e d b y th e 1928 A c t, w as th e b o d y n o w c h a rg e d w ith re g iste rin g (a n d w ith lay in g d o w n th e m in im al s ta n d a rd s o f e d u c a tio n fo r) n u rse s, m idw ives a n d o th e r m edical au x iliaries th e C a p e H o s p ita l B o a rd h a d re q u e ste d th e C o u n c il to e stab lish c o u rse s , fo r th e a d v a n c e d tra in in g o f n u rse s to ta k e h ig h e r p o s ts such as M a tro n s , S iste r T u to r s a n d so fo rth . T h e M e d ica l C o u n c il h a d n o m e c h an ism fo r e sta b lish in g such h ig h e r n u rsin g tra in in g so its executive c o m m itte e h a d re c o m m e n d e d t h a t th e C a p e H o s p ita l B o a rd b e in fo rm e d a c c o rd in g ly . T o th is I o b jec ted b e ca u se , a lth o u g h th e y d id n o t h a v e th e p o w e r to set u p su c h a tea c h in g m ec h an ism , a f o r tu n a te se c tio n o f th e A c t m a d e it th e ir d u ty to r e p o rt to th e M in is te r (w h o w as a lso th e M in iste r o f E d u c a tio n ) a n y m a tte r t h a t c a m e t o th e ir n o tic e t h a t affected adversely th e m a tte rs w ith w hich th e C o u n c il h a d b e en c h arg e d . T h e y w ere th e n in fo rm e d o f w h a t th e J o h a n n e s b u rg M e d ica l S c h o o l h a d trie d to d o eig h t y ears e a rlie r; a n d w hich, h a d . th e y n o t b e en f ru s tra te d b y ig n o ra n t pe o p le , w o u ld h a v e re n d e re d th e C a p e H o s p ita l B o a rd ’s a p p lic a tio n u n n e ce ssa ry . W h e n th ey a sk e d w h a t s h o u ld b e d o n e I su g ­ g ested t h a t th e y a p p ro v e in p rin c ip le w h a t th e M e dical F a c u lty h a d trie d t o d o ; a n d , i f a p p ro v in g , in fo rm th e un iv ersities h a v in g M e d ica l S c h o o ls t h a t th e M edical C o u n c il re g a rd e d th e h ig h e r e d u c a tio n o f n u rse s as th e ir p r o p e r fu n c tio n ; a n d in fo rm th e m a ls o a b o u t th e n eed fo r su c h tra in in g t h a t h a d c o m e to th e C o u n c il’s n otice. T h is, in d u e c o u rse , h a p p e n e d . I h a d le a rn e d in th e m e a n tim e th a t S o u th A fric a w as n o t rip e fo r a rra n g in g fo u r-y e a r d egree c o u rse s in N u rs in g , b u t we c o u ld give U n iv e rsity D ip lo m a s a fte r o n ly o n e y e a r o f c o n c e n tra te d tra in in g . S o th e y e a r 1938 saw th e e sta b lish ­ m e n t o f N u rs in g D ip lo m a c o u rse s a t b o th C a p e T o w n a n d Jo h a n n e s b u rg M e d ica l S c h o o ls; a n d since 1939, 152 nurses (a n d th e p u b lic a n d th e h o sp ita ls th e y h a v e served) have R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) pro fite d by th is h ig h er e d u c a tio n th ro u g h th e h o ld in g o f D iplom as in N ursing fro m th e U n iv e rsity o f th e W itw a ters- • ra n d alone. E v en b e tte r th in g s, as fa r as P h y s io th e ra p y w as c o n ce rn ed , w ere to follow . A t th e N u rs in g C o m m itte e o f th e M edical C o u n c il— o f w h ich M iss A le x a n d e r w as th e n C h a irm a n — tw o re q u ests c am e m e a n tim e fro m p riv a te in d iv id u a ls (o r b u sin ess syndicates) fo r th e re co g n itio n o f tra in in g schools fo r M a sseu rs w hich they p ro p o se d to set u p in Jo h a n n e sb u rg . F a m ilia r n o w w ith th e g re a te r a d v a n ta g e s b o th to S o u th A frica a n d to its n u rsin g p ro fessio n th ro u g h h a v in g dip lo - m ates tra in e d in m edical schools it w as un n e ce ssa ry to ex p la in w h a t it w o uld m ea n to th e c o u n try to h a v e its M a s­ seuses also tra in e d in M edical S chools, a n d th e H o s p ita ls to w hich th e M e dical S chools w ere a tta c h e d , ra th e r th a n in p riv a te tea c h in g estab lish m en ts. In d u e c o u rse th e tw o U n iversities th en h a v in g M edical S chools w ere in fo rm e d a b o u t w h a t h ad h a p p e n e d a n d the decisions th e S o u th A frica n M edical C o u n c il h a d tak e n . W ith in a b rie f p e rio d th e U n iv e rsity o f th e W itw a te rsra n d h ad e stab lish e d a th re e -y e a r’s c o u rse fo r a D iplom a in M a ssag e and E le ctro th era p y . Its first th re e d ip lo m a te s a p p e a re d in 1940. A fte r 14 d ip lo m a s in M assage a n d E le c tro th e ra p y had been a w a rd e d in 1940 a n d 1941 th e U n iv e rsity o f the W it­ w a te rsra n d c h an g e d the n a m e to D iplom a in Physiotherapy. Seventeen w ere a w a rd e d in 1942 a n d 1943. W o rd o f this w a r-tim e c h an g e in n a m e m u st have sp re a d fast, w hile it w as still im p e n d in g , b e ca u se th e C h a rte re d Society o f M assage a n d M edical G y m n a stic s in G re a t B rita in also c h anged its n a m e to th e C h a rte re d Society o f P h y sio th e ra p y in th a t sam e y e ar, 1942. M e anw hile o u r , U n iversity h a d also a g ree d to a w a rd a B .S c. (P hysiotherapy) if th e c o u rse w ere e x te n d ed to fo u r y e a rs; a n d b eg in n in g in M a rc h 1944 n o less th a n 198 P h y sio ­ th e ra p ists h a v e since received th a t degree. So o u r U niversity h as p ro d u c e d 229 p h y sio th e ra p ists a lto g e th e r, a n d b ecam e th e first w ith in th e C o m m o n w e a lth — as fa r as m y k now ledge goes— to a d o p t th is n o m e n c la tu re a n d to a c c o rd th e high a ca d em ic s ta tu s o f a degree to y o u r p ro fessio n . T o d a y h o w e v er, I h e a r t h a t n o less th a n six universities in C a n a d a a w a rd degrees o r d ip lo m a s in P h y sio th e rap y . C o m in g ju s t w hen they w ere so b a d ly n eeded, o u r physio- th erp ists p lay e d a significant p a r t in th e re h a b ilita tio n ne ce ssitate d by th e S econd W o rld W a r. T h ey served alo n g w ith th is c o u n try ’s first m edical p o s t-g ra d u a te D iplom ates in Physical M edicine, w h o w ere also p ro d u c e d a t th e U niversity o f th e W itw a te rsra n d d u rin g th e W a r. T hey w ere th e d o c to rs in c h arg e o f m o s t o f th e v a rio u s m ilita ry p h y sio th e ra p e u tic u n its th a t h a d b een e stab lish e d in S o u th A frica. T h is re h a b ilita tiv e w a r w o rk m a d e it a p p a re n t also th a t tra in in g in O c c u p a tio n a l T h e ra p y h a d to be u n d e rta k e n . W e s ta rte d it in 1943 a n d th e first fo u r D iplom ates in O ccu­ p a tional T h era p y a p p e a re d in 1946. T o d a y th e re a re 81. J o h a n n e s b u rg is th e re fo re very p ro u d th a t its M edical S chool, chiefly th ro u g h the energy a n d e n te rp ris e o f D r. E . B. W o o lf, w h o w as re cently elected a S e n a to r in th e U n io n P a rlia m e n t, w as re sp o n sib le fo r th e early a n d ra p id e v o lu tio n o f th e speciality o f P hysical M e dicine a n d the tra in in g o f its 300 au x iliary m edical p e rso n n e l in these tw o fu n d a m e n ta l fields o f th era p y . • T h e ra p id e x p a n sio n o f o u r first tw o m ed ic al schools sh o w ed t h a t th e m edical n eeds o f S o u th e rn A frica c o u ld n o t b e m et by such o v e rcro w d e d schools as C a p e T o w n a n d J o h a n n e s b u rg h a d becom e. T h e P re to ria M edical S chool was s ta rte d in 1944 a n d w as follow ed a t six-year in te rv als by the D u r b a n M e dical S chool in 1950 a n d th e S tellenbosch M edical S chool in 1956. S o o n th e S alisbury M edical School will o p e n in R h o d e sia. T h e d ecade 1939-1949, so fa r as th e J o h a n n e s b u rg M edical S chool w as co n ce rn ed , w as u n fo rtu n a te ly th o se o v e r­ c ro w d ed y e ars o f w a r a n d its a fte rm a th ; classes h a d even to be q u a d ru p lic a te d . W e have never yet b een in a p o sitio n o f be ing a ble to e stab lish a se p a ra te S chool o f P h y sio th e ra p y a n d to tra in as m a n y p h y sio th e ra p ists as we w a n te d ; we h ave n e v er h a d ro o m in Jo h a n n e sb u rg . Page 4 P H Y S I O T T h e e x p a n d in g p ro fessio n , how ever, h a d to have e x p an d ­ ing fo rces o f p h y sio th erp ists a n d o th e r a u x iliaries a n d the need w as seen by D r. W oolf. So, b e w ith th e a id o f D r R . I. R e tie f a n d W . W ak s, I u n d e rs ta n d , w as largely re sp o n ­ sible fo r y o u r S c h o o l’s existence w ith its first a dm ission of ten stu d e n ts in 1949. T h e P re to ria M edical S chool p ro b a b ly h a d to o m any staffing p ro b lem s o f its ow n in th e first fo u r y ears o f its existence to ta k e th e sam e s o rt o f p a te rn a l in te rest in the fo u n d in g o f y o u r S chool th a t o u r A n a to m y a n d Physiology ' D e p a rtm e n ts did in J o h a n n e sb u rg . T o d a y , how ever, your S chool a lso has th e a d v a n ta g e o f se curing its tra in in g jn A n a to m y a n d Physiology fro m these d e p a rtm e n ts o f y our U niversity. E v ery y o u n g School h as its te e th in g tro u b le s; Y o u r first P rin c ip a l, M iss M . E m slie, M .C .S .P ., S up e rin te n d en t P h y s io th e ra p ist a t th e P re to ria H o s p ita l re tire d a fte r a b o u t tw o y e ars a n d w as successfully succeeded fo r six years by M rs. S. B old, M .S .C .P ., w ith M iss H in z as A s sista n t; b ut in 1957 we c a rrie d M iss H in z o ff to Jo h a n n e s b u rg a n d Mrs. B old re tire d in 1958. T h a t p u t y o u r S chool in ra th e r a sore p light u n til Miss B o d o a n o , M .C .S .P . cam e o u t fro m E n g la n d -w ith M iss A. J., S avin M .C .S .P . (T ea ch e r’s C ertificate) in Ju n e , 1958, a n d in t th e s h o rt in te rv en in g space o f tim e has b u ilt up y o u r School w ith its six fully qualified tea ch e rs in P h y s io th e ra p y — one a p ro d u c t o f y o u r o w n S chool— a n d 73 stu d e n ts in training. A t y o u r first d ip lo m a cere m o n y in 1952 ten students received certific ates; o n the last tw o oc ca sio n s th ere have b een 21. U p u n til to d a y 112 p h y sio th e ra p ists have qualified fro m th is S chool a n d a re d o in g the excellent w o rk th ey have b een d o in g fo r a d e ca d e b o th here in S o u th A frica a n d over­ seas alo n g sid e o u rs fro m Jo h a n n e sb u rg . B efore m a n y years th e to ta l o u tp u t o f th e T ra n s v a a l th e ra p y schools will be over h a lf a th o u sa n d . U n til this y e ar y o u r D ip lo m a has been a P re to ria H ospital C ertificate, b u t no w th e e x a m in a tio n s have co m e u n d e r the D e p a rtm e n t o f E d u c a tio n , A rts a n d Science, a n d a N ational D iplom a C ertificate is a w a rd e d . T h e School is, how ever, a P ro v in c ia l S chool u n d e r th e D e p a rtm e n t o f M edical Ser­ vices. By offering stu d e n ts c o n tra c ts , w hereby they u n d e r­ ta k e to w ork fo r th e P ro v in c e fo r th ree y e ars in re tu rn for th e ir th ree y ears o f tra in in g , th e M edical Services h o p e to m a in ta in th e p h y sio th e ra p e u tic services th a t all th e ir larger h o sp itals re q u ire to d ay . So m u c h fo r th e T ra n s v a a l: w h a t is th e p o sitio n elsew here in th e U n io n ? T h e U n iv e rsity o f C a p e T o w n in itiate d its th ree -y ea r D iplom a in P h y siotherapy c o u rse in 1958 with M iss M a rg a re t R o p e r fro m E n g la n d , as its T ea ch e r and p ro d u c e d its first seven D ip lo m a te s last y e ar (1960). As yet ne ith e r the O .F .S . n o r N a ta l h ave e stablished separate, schools. ( P e rh a p s o n e d a y in P re to ria to o , a degree c o u rse will be e stab lish e d in P h y s io th e ra p y a n d m ay b e a lso in O c cu p a tio n a l T h e ra p y . G ra d u a lly p e o p le a re realiz in g th a t in a sp u tn ik - lu n ik world', w here N e w Y o rk is n e a re r to u s by je t th an C a p e T o w n is by tra in , n o w o m a n can go fa r p ro fessionally w ith o u t as s o u n d a basic tra in in g in m a th e m a tic s, physics a n d ch em istry as possible. T h e re a so n s I h a v e b een re ca llin g som e o f these early facts a b o u t h ow P h y siotherapy c am e to be estab lish e d in S o u th A frica a re several. In th e first p lace I w a n ted you to realize ho w re ce n t yet ho w p o te n t is the w h ole o f w hat y ou h a v e b een lea rn in g in S o u th A frica a n d th e re fo re how f o rtu n a te y o u a re to b e p io n ee rs in y o u r c h o se n p rofession. Y o u a re d e te rm in in g collectively its fu tu re r e p u ta tio n fo r v alu e a n d usefulness in P re v e n tiv e a n d C u ra tiv e M edicine th ro u g h o u t th is vast c o n tin e n t o f A frica. A second re a so n w as to sh o w the h ig h ideals th a t the in itia to rs o f th a t e d u c a tio n h a d , a n d c o n tin u e to re ta in fo r y o u r p ro fessio n al sta tu s. F ifty y ears a g o in A u s tra lia m assage tra in in g involved th e d issection o f th e h u m a n b o d y . F ro m experience I k new h ow im p o rta n t fo r m y frien d s am o n g st th e m asseuses th is w a s; I .could n o t im agine th a t a n y th in g less w o uld be the b est fo r p h y sio th e ra p ists in S o u th A frica. ( C ontinued on page 5) H E R A P Y June, 1961 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) June, 1961 P H Y S I O T H E R A P Y Page 5 T R E A T M E N T N O T E S SO M E SU G G ESTIO N S IN THE REH ABILITATIO N OF HEMIPLEGICS E. J E N N IN G S , M .C .S .P . A. In E arly Flaccid S ta g e: (1) Teaching the pa tie n t to roll over by them selves onto their unaffected side. T h ree a c tio n s :— (a) L ifting th e affected a rm a cro ss th e chest. (b) W riggling the toes o f the unaffected side u n d e r the T en d o -A c h ille s o f th e o th e r fo o t a n d so o b ta in in g leverage to b rin g th e affected leg over. (c) G ra sp in g the side o f th e bed to w a rd s w hich she w a n ts to tu rn , a n d th e n p u llin g w ith the a rm a nd leg and a t the sam e tim e tu rn in g the head. See D ia g ra m I. (2) Use o f rope atta c h e d to the lower corners o f the bed. T h e length o f th is ro p e m u st be a d ju s te d to be ju s t long e n o u g h fo r the p a tie n t to re ac h w ith h e r o u t ­ stretched unaffected h a n d . A p a d d e d a re a in the m iddle o f the ro p e facilitate s the g ra sp ; this can be k e p t in p o sitio n by a d hesive stra p p in g . T h e p a tie n t sh o u ld be given a c ro o k stick to b ring the ro p e w ith in her reach. M o st p a tie n ts will be a b le to sit u p w ith th e use o f this ro p e w ith in a few days. N .B . A single cen trally placed ro p e w ith a w ooden h andle is d a n g e ro u s, as th ere is n o side to side c ontrol. See D ia g ra m I. (3) F oot Board. T h is is a 4" c u b ic al piece o f w o o d , 6" lo n g e r th a n the span betw een th e legs o f th e bed. T w o sem i­ c irc u la r sc allops a re c u t o u t o f o n e side to fit a g ain st the legs o f th e bed a n d p re v en t it fro m slip p in g side­ ways. P R O F. R A Y M O N D D A R T (continued fr o m p age 4) T hirdly, I have d o n e it to sh o w ho w w o rd s ta k e o n the m eaning th a t we give to th em by th e s o rt o f lives we lead, a nd also how in te r-rela te d all p ro fessio n al p ro g ress h a p p en s to be. T h ere is a g re a t tendency a m o n g s t im m a tu re h u m a n beings to im agine th ey increase th eir ow n im p o rta n c e n o t by self-im provem ent b u t by de rid in g o th e rs ; o r by in sin u atin g th at groups o f w o rk e rs o th e r th a n th e ir o w n p a rtic u la r class are o f lesser value in th e general schem e o f things. Y o u will often h e a r superficial th in k e rs say “ O h ! w h a t c a n sh e k now a b o u t it? She’s o nly a n u rse ” , o r, “ H o w c a n he k n o w ? H e ’s only a lab o u re r, a s h o p a ssista n t, a b rick lay e r, o r w h a t n o t” . Jt was th ro u g h d o c to rs a n d n u rse s c a rin g fo r th e w elfare a nd elevated sta tu s o f all m edical a u x iliaries th a t led to w h a t has been d one so fa r fo r y o u a n d y o u r e d u c a tio n a n d th ro u g h you fo r sick S o u th A fricans. Finally, I h o p e th a t I have in d ic a te d , th ro u g h w h a t has ™n. behind a n d h a p p e n e d to y o u r p ro fessio n in S o u th Africa d u rin g th e p a st 40 y ears, so m e th in g o f the a v alan c h in g developm ents y o u c an a n tic ip a te d u rin g th e 40 y ears th a t n ow e in front o f y o u . T h o se de v elo p m en ts a re in y o u r h ands. Use: T h e b o a rd is placed o n th e floor a t e ith e r end o f the bed (head p re fe ra b ly , fo r height). T h e p a tie n t is b ro u g h t u p to it in a c h a ir a n d h e r feet a re p laced slightly a p a r t a g a in st it o n th e g ro u n d . T h is prev en ts h e r w eak leg fro m slip p in g u n d e r the bed a n d g reatly a ssists the p h y sio th e ra p ist in h e r efforts to get the p a tie n t to sta n d u p a n d sit d o w n a n d to b a la n ce in sta n d in g . T h e p a tie n t o f c o u rse pulls h e rse lf u p , b u t th e p h y sio th e ra p ist (sta n d in g o n the affected side) h o ld s th e h a n d in p o sitio n a n d e n co u ra g es th e p a tie n t to p u sh u p w a rd s w ith b o th legs. T h e w o o d e n b a r a lso prev en ts the bed fro m m oving. B . W alking S ta g e : A s s o o n as the p a tie n t can b a la n c e h e rself in sittin g a nd sta n d in g , w a lk in g is c om m enced. T h e re a re m an y m e th o d s; here a re a few w hich I have fo u n d u s e fu l:— (1) A ssisting on the affe c te d side. The p a tie n t supports h e rse lf in the parallel bars o r on a hand-rail round the room. N .B . B a ck w ard w a lk in g is a lm o st a s easy as fo r ­ w a rd s w alking. A c h a ir is placed a t e ith e r end o f the bars. T h e b a rs m u st be low e n o u g h fo r th e p a tie n t to lea n o v e r slightly to th e unaffected side. See D ia g ra m II R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )