Page 4 P H Y S I O T H E R A P Y March, 1959 THE FIELD OF CRIPPLE CARE The N ational Council for the Care o f Cripples in South Africa TH E p r a c t i si n g p h y s i o t h e r a p i s t, p a r t i c u l a r l y if a t t a c h e d t o a p r o v i n c i a l h o s p i t a l , m u s t w o n d e r w h a t g o o d p u r p o s e is se rve d by a v o l u n t a r y o r g a n i s a t i o n su c h a s the N a t i o n a l C o u n c i l fo r th e C a r e o f C r i p p l e s w i t h its nine R e g io n a l C r i p p l e C a r e A s s o c i a t i o n s , a n d ho w in a n y w a y sh e is c o n ­ ce r n e d wit h it. E a rly D a y s. T o a n s w e r th e q u e s t io n , o n e m u s t delve b ac k in to h is to ry a bit. P r i o r t o 1937 t h er e w as bu t a sm a ll g r o u p o f p e o pl e in C a p e T o w n , t h e O . F . S . a n d t h e c o m m i t t e e s for t h e H o p e H o m e s in J o h a n n e s b u r g , d e v o t i n g t h e i r en er g ies t o the C a r e o f C r i p p l e s in S o u t h A fri ca . T h e r e we re b u t f o u r o r five O r t h o p a e d i c s u r g e o n s a v a i l a b l c to se rve the U n i o n a n d S o u t h W es t Af ric a. A p a r t f r o m o n e o r t w o tr a i n e d O r t h o p a e d i c nu rs es in p r i v a t e i n s t i t u t i o n s t h e r e we re n o n e in th e c o u n t r y . A s i m i l a r p o s i t i o n exis ted w i t h O r t h o p a e d i c t ec h n i ci an s . A n o t h e r s e ri o u s difficulty in t h o s e ea r l y d a y s w'as the s h o r t a g e o f b e d s fo r l on g t e r m o r t h o p a e d i c p a t i e n t s , o f w h o m m a n y we re c h i l d r e n . T h i s m e a n t t h a t t h e benefit f r o m the skilled s u r gi ca l a t t e n t i o n th a t w as a v a i l a b l e , w a s f re q u e n tl y m in im is ed . T h e s a m e a p p l i e d t o th e p o t e n t i a l benefits o f s o u n d o r t h o p a e d i c nu r si n g , o c c u p a t i o n a l t h e r a p y a n d the use o f p h y s i o t h e r a p y in the t r e a t m e n t p r o g r a m m e . L o rd N uffield. It w a s a n up hi ll s t r u g g l e b u t in 1937 d u e t o m o r e t h a n o n e a p p r o a c h b ei n g m a d e t o L o r d Nuffield, a m un ifi cc nt gift o f o v e r £1 0 0, 00 0 w as m a d e t o S o u t h A f ri c a by thi s g re at m a n . t o s t i m u l a t e int er est in t h e w o r k f o r th e C a r e o f C r i p p l e s , b o t h o n th e levels o f v o l u n t a r y o r g a n i s a t i o n s a n d G o v e r n m e n t D e p a r t m e n t s . L o r d Nu ffi eld 's de s i re w a s f o r a living o r g a n i s a t i o n r a t h e r t h a n t h a t this m o n e y be sp e nt p r o v i d i n g hos pi tal s. A n i n s t i t u t i o n w o u l d a l m o s t en ti re ly lose its valu e. A'ithout t r a i n e d p e r so n n e l b ei n g a v ai la bl e, a n d w i t h o u t a n e t w o r k o f se rvices le a d i n g u p t o h o s p i t a l i s a t i o n a n d to th e vital a f te r - c a r e o f O r t h o p a e d i c p at i e n t s d i s c h a r g e d f r o m h o sp i t al s . T h u s it w a s j u s t b e f o re t he S e c o n d W o r l d W a r t h a t a m e m o r a n d u m p r e p a r e d fo r t h e Nu ffield T r u s t e e s in di c a t e d i m o n g o t h e r t h i n g s t h a t t h e f o l lo w in g w as es se n ti al for S o u t h A fri ca . 1. O n e c o - o r d i n a t e d C r i p p l e C a r e o r g a n i s a t i o n t o c o v e r the w h o l e U n i o n , wi th a n A g r e e d policy, w h ic h s h o u l d as f ar as pos si bl e inf lue nce P ro v i n c ia l G o s e r n m e n t A d m i n i s t r a t i o n in re spect o f Cr i p p l es . 2. T h i s w o u l d r e q u i re a N a t i o n a l C o u n c i l , a n d p r o vi nc ia l c o m m i t t e e s ( o r as so c i a t i o n s ). 3. S u i t a b l e O r t h o p a e d i c H o s p i t a l s a n d o r t h o p a e d i c d e p a r t ­ m e n t s in all first g r a d e ho sp i t al s , w i t h speci ali st s t a ff a n d finan cia l p r o v i s i o n f o r this. 4. T h e need w a s a c u t e f o r P r e - g r a d u a t e t e a c h i n g o f O r t h o p a e d i c P ri n c ip l es in th e Un iv er sit ie s, a n d P o s t - g r a d u a t e t r a i n i n g in o r t h o p a e d i c su rg er y . 5. W o r k s h o p s fo r t he p r o v i s i o n o f a p p l i a n c e s : o u t - s t a t i o n s ( o r t h o p a e d i c cli ni cs i n c l u d i n g t h o s e in R u r a l a r ea s ) a n d f ee d er services. M e a l tim e in an O rth o p a e d ic Hom e. G ood nou rishing food, sound tre a tm e n t and lo sin g care and efficient nursing help these ,<>oungs(crs on the long road to h a b ilita tio n : it takes a team w o rk of the therapists, the nurses, the teacher, the m edical personnel and voluntary org a n isa tio n behind them to produce the fin a l results. In a d d i t i o n e d u c a t i o n a l facilities fo r c h i l d r e n in o r t h o ­ p a e d i c w a r d s , w a s r e q u i r e d es p ec i al l y in lo n g t e r m cases, a n d in re sid en ti al s c h o o l s a n d f o r h o m e - b o u n d cas es becau se re si d en t i al o r h o s p i t a l a c c o m m o d a t i o n w a s a l r e a d y o v e r ­ c r o w d e d . 6. Phy sic al r e h a b i l i t a t i o n w i i h o u t e c o n o m i c r e h a b i l i ta t io n left p a t i e n t s t o fa ce a w o r l d w h i c h lab ell ed a p a t i e n t with a n y r es id ua l c r i p p l i n g as s o m e t h i n g for t h e s c r a p he ap. E m p l o y e r s th e r e f o r e r e q u i re d t o be e d u c a t e d t o t he c o n c e p t o f t h e v al u e o f u ti li zi n g p a r t i a l ly d i s a b le d pe rs on s . N a tio n a l C o u n c il fo r th e C a r e o f C rip p le s in S o u th A fric a . L o r d N u f fi e l d 's gift c o u l d no t poss ibly c o v e r all o f these needs, but h a v i n g laid the f o u n d a t i o n did serve as a st i m u l u s t o S .A ., a n d o n e o f the first i t em s f o r w h i c h t h e need be ca m e i nc re as in gl y ev i d e n t w a s t h a t o f a " N a t i o n a l C o u n c i l " . A c c o r d i n g l y in 1939 t h e N a t i o n a l C o u n c i l f o r t he C a r e o f C r i p p l e s in S o u t h A f ri c a w a s f o r m e d wi th a vi ew t o: 1. E n s u r e a n a t i o n a l o r t h o p a e d i c ( C r i p p l e C a r e ) servi ce for C r i p p l e s . In o r d e r t o d o this, th e co u n c i l m u s t initiate a n d a ls o c o - o r d i n a t e a n d c o r r e l a t e su c h se rvices i n a u g u r a t e d by v o l u n t a r y b o d ie s , g o v e r n m e n t d e p a r t m e n t s a n d i n s ti tu ti on s w o r k i n g in t h e int er est o f C r i p p l e s ; e n c o u r a g e ex p a n s i o n , a n d h el p m a i n t a i n it; f o r m u l a t e a n d assist in i m p l e m e n t i n g po li cie s sinc e 80 °, , o f p e r m a n e n t C r i p p l i n g is p r ev en ta bl e, p r o m o t e a n d s u p p o r t m e a s u r e s f o r ea r l y d i sc o v e ry and t r e a t m e n t , a n d t o act in a n a d v i s o r y c a p a c it y . 2 . T o p r o m o t e sc h e m e s f o r th e t r e a t m e n t , e d u c a t i o n , tr a i n in g , e m p l o y m e n t a n d ge n er al w el f ar e o f c r i p p l e s : 3. T o be th e official c h a n n e l f o r c o m m u n i c a t i o n in m a t t e r s o f g e n e r a l polic y b e tw ee n c o n s t i t u e n t C r i p p l e C a r e bodies, t he G o v e r n m e n t a n d P r ov in c ia l a u t h o r i ti e s . 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. ) March, 1959 P H Y S I O T H E R A P Y Page 5 Special G r an t s. Since th en C o u n c i l h as m a d e g r ea t s tr id es , p a r t i c u l a r l y af ter t h e w a r . a n d a m o n g o t h e r t h i n g s h a s p r o s i d e d g r a n t s for the sub si di ze d t r a i n i n g of: Orthopaedic surgeons, orthopaedic nurses, technicians for m aking and fitting orthopaedic appliances. Sudsidized salaries for: qualified welfare w orkers and aftercare sisters d o in g essential urban, sub-urban and district Cripple C a r e W o r k . M a d e g r a n t s t o w a r d s : t r a n s p o r t o f a b o v e : e s t a b l is h i n g A f t e rc a re H o m e s a n d m a i n t e n a n c e o f t h e m ; M i s si o n H o s ­ pi tals a n d o t h e r I n s t i t u t i o n s e n g a g e d in O r t h o p a e d i c Ser vice s, an d t o w a r d s e s t a b l is h i n g a n d m a i n t a i n i n g O r t h o p a e d i c clini cs; th e t r a i n i n g o f p h y s i o t h e r a p y t u t o r s : a d v a n c e d stu dy o v er se a s in o r t h o p a e d i c s w h e r e su ch w as n o t a v a i l a b l e t o selected p e r s o n s in thi s c o u n t r y su c h as o c c u p a t i o n a l t h er ap i st s , qua lified o r t h o p a e d i c nu r se s , a n d p h y s i o t h e r a p i s ts . R ehabilitation o f C rip p le s. 1̂ T h i s C o u n c i l l a k e s th e initi ati ve a n d a l s o a n ac ti v e part f t n e g o t i a t i n g w i t h S t at e D e p a r t m e n t s f o r se rvices an d ^ p ro j e c t s in the w el f ar e of, sha ll we say, r e h a b i l i ta t io n o f cripples. A le a d i n g o r t h o p a e d i c s u r g e o n , w h o is a m e m b e r o f this C o u n c il has sa id : “ In thi s sp h e r e o f phys ica l d is a b il i t y t h er e a r e still t h o u ­ s a n d s o f cases in S.A . f o r in st a n c e , re q u i ri n g d is c ov er y by s u rv ey cl in ics ; r e c o n s t r u c t i v e su r g e r y t o m e n d th e resu lt s o f a c c i d e n t s a n d i n j u r y ; e d u c a t i o n ; v o c a t i o n a l t r a i n i n g an d pl a c e m e n t in e m p l o y m e n t . T h u s a l t h o u g h m u c h useful w o r k is b ei n g d o n e by v o l ­ u n t a r y "C rip pl e C a r e ’, a n d by S t a t e a n d Pro vi nc ia l D e p a r t ­ m en ts , t h er e a r e still m a n y g a p s a l o n g th e a s s e m b l y line o f p r o d u c i n g r e h a b i l i ta t e d cit ize ns , th a t u rg e n t l y need filling. S ur ve y cli nics in a r e a s s u c h as G e o r g e , W o r c e s t e r , T h a b a ' N c h u . W o l m a r a n s s t a d , E r m e l o , S t a n d e r t o n , R u s t e n - bu r g. P i e t e r s b u r g , W i t b a n k , h a v e s h o w n t h a t in ever y c o m m u n i t y t h er e ar e d o z e n s o f d is a b le d p e r s o n s w a i t i n g fo r a n o p p o r t u n i t y t h a t d o e s no t d e v e l o p in t i m e for th eir p a r t i c u l a r needs. T h e d e f o r m e d foo t is d i s c o v e r e d at th e ag e o f 30 w he r e a s it c o u l d have been c u r e d at the ag e o f 10. A m a n w i t h l epr osy w a s d i s c o v e re d w h e n his h a n d s a n d feet we re recovered wit h septic sores a n d his h a n d s we re so a n a e s t h e t i c A i a t re -c o n st r u ct iv e s u r g e r y w a s no t w o r t h w h i l e . T h e child ’w i t h t he d e f o r m e d s p in e is d i s c o v e re d w h e n t he d e f o r m i t y has b e c o m e fixed a n d c a n n o t be c u r e d . T h e m a n w h o c o u l d ha v e been bac k at w o r k w it h a g o o d ar tificial l i m b p o t t e r s a b o u t for h a l f a life t im e d r a g g i n g a l o n g a useless limb bu t f o r g e t t i n g t h e use o f his b r a i n a n d his o t h e r t h r ee he a l t h y e xt re m iti e s. T h e s e t r a g e d i e s ar e u n e a r t h e d at d e c e n t r a l i z e d o r t h o p a e d i c clinics ini ti ate d by C r i p p l e C a r e A s s o c i a t i o n s , wit h this C o u n c i l ’s assi sta nce . T h e m e c h a n i c a l ag e o f m o t o r b i k e s a n d m o t o r dr iv en g ad g et s is p r o d u c i n g m o r e d i s a b le d p e op le t h a n p o l i o o r T . B . ever did. In pr og re s si ve c o u n t r i e s su r g i c a l T u b e r c u l o s i s ho s p i t a l s ar e be i n g c o n v e r t e d t o a c c i d e n t un it s. In i n d u s t r y t her e a r e 250 ,000 a c c i d e n t s p er y e a r in S . A . —a l m o s t a 1.000 a c c i d e n t s per da y , c o s t i n g 21 m il lio n m a n - d a y s per yea r. Life’s u n c e r t a i n t y is p r o v e r b i a l . O n e m i n u t e y o u a r e alr i g h t, an d a n h o u r l a t e r y o u ' r e lying in a h o s p i t a l bed h a v i n g a b l o o d t r a n s f u s i o n , y o u r life bl ig ht ed by a n a c c id en t. T h e ab il it y to face d is a b ili ti es is in h er en t in all o f us. N a t u r e gives us t he c a p a c i t y t o face th e stresses w h e n we h a v e t o face th e m , bu t help is r e q u i r e d , so t h a t r e h a b i l i ta t io n o f t h e d i s a b l e d p e r s o n s is the u l t i m a t e a i m o f t h e N a t i o n a l C o u n c il f o r th e C a r e o f C r i p p l e s . W e w an t t o sec ever y d is a b le d pe r so n r e s t o r e d t o the m a x i m u m phys ic al, p s y c h o ­ logical a n d soc ial r ec ov er y possible. F o r t hi s p u r p o s e we ne ed tr a i n e d pe r so n n el . T h e W i t - w a t e r s r a n d U n i v e r si t y n e e d s a pr o fe s so r i al c h a i r o f t r a u m a t i c a n d o r t h o p a e d i c su r g er y . T h e t r a i n i n g c o u r s e fo r p h y s i o ­ t h e r a p i s t s . o c c u p a t i o n a l t h e r a p i s t s , r a d i o g r a p h e r s , sp e ec h t h e r a p i s t s , o r t h o p a e d i c m e c h a n i c i a n s a n d soc ial w o r k e r s h a s t o be f u r t h e r d e v e l o p e d a n d e x p a n d e d . T h e r e is a g r ea t s h o r t a g e o f t h es e t e c h n i c i a n s in th e field o f R e h a b i l i t a t i o n . ’’ P re se n t d a y A c tiv itie s o f C rip p le C a r e A s so c ia tio n s . N ev er t h el es s, a s c o n t r a s t w i t h th e d e a r t h o f ‘C r i p p l e C a r e ’ acti vi ti es in 1937. t o d a y C o u n c i l h a s nine r e g i o n a l C r i p p l e C a r e A s s o c i a t i o n s c o v e r i n g the f o l lo w in g a r e a s : S . W . A ., N . T r a n s v a a l , S. T r a n s v a a l , O .F .S .. N a t a l , w it h t he C a p e di vi de d in f o u r — B o r d e r , E a st e r n P ro v i n c e, W e s t e r n C a p e a n d N o r t h e r n C a p e . T h e s e re g io na l a s s o c i a t i o n s wit h dir ect r e p r e s e n t a t i o n o n C o u n c il have f o r m e d m a n y s u b - a s s o c i a t i o n s , o r local c o m m i t t e e s t h r o u g h o u t t h e i r r egi ons in a n effort t o i n a u g u r a t e a n d h e l p t o m a i n t a i n C r i p p l e C a r e Ser vi ces in th ei r ar ea s , bu t t he r e is a vas t a m o u n t still t o be do ne . O n e o f the i m p o r t a n t f ea tu re s in a s o u n d C r i p p l e C a r e service is ea rl y t r e a t m e n t . M a n y d ise ase s ca us e c r i p p l in g as d o a c c i d e n t s a n d s o m e te n d e n c i e s t o d e f o r m i t y a r e c o n g e n i t a l , yet ea rl y t r e a t m e n t in all ca t e g o r i e s c a n pr eve nt p e r m a n e n t c r i p p l in g f r o m d e v e l o p i n g , in at least 8 0 % o f s u c h pa ti en ts. Paralvscd and confined 10 a w heel*chair fo r five years, it was a wonderful day when the lo cal C rip p le C are Association found this p atie nt and arranged tra n sp o rt fo r him to be taken to c lin ic s fo r e xa m in a tio n and >uhseq‘ient ph>siotherapy tre a tm e n t in a o u t-p a tie n t departm ent. U n ly one « h u has been so handicapped can appreciate the toy o f being m obile again. 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. ) T h u s fin d in g th e c r ip p le o r p o t e n tia l c r ip p le , a n d a s s is tin g th e p a tie n t t o o b t a i n c o r r e c t a t t e n t i o n a n d t o f o llo w t h e c a s e th r o u g h t o s a tis f a c to r y r e h a b ilita tio n , ( o r in- th e c a s e o f a c h ild , h a b ilita tio n ) is o n e o f th e i m p o r t a n t f u n c tio n s o f “ C r ip p le C a r e ” in S o u t h A fric a . E d u c a tio n o f th e P u b lic . A v e ry v ita l, b u t n o t s o w e ll k n o w n f a c t o f C o u n c il ’s w o rk , is t h a t o f e s s e n tia l p u b lic ity t o e d u c a te th e p u b lic a s to th e im p o r ta n c e o f h e lp in g c r ip p le s t o h e lp th e m se lv e s. O n e m a y s a y t h a t r e h a b i l i ta t io n b e g in s w ith p r e v e n tio n o r fin d in g a c r ip p le a n d d o e s n o t e n d . u n til t h e a d u lt is fu lly e s ta b lis h e d a s a s e lf- s u p p o r tin g m e m b e r o f h is c o m m u n ity . I n t h e c a s e o f a p h y s ic a lly h a n d ic a p p e d c h ild h is p h y sic a l, a n d e m o tio n a l h a b i l i t a t i o n is n o t c o m p le te u n til h e h a s b e e n p r o v id e d w ith e d u c a tio n a n d su ffic ie n t tr a in in g to e n a b le h im t o b e c o m e a s a tis f a c to ry w a g e e a r n e r . F ilm s a n d P u b lic ity . T o d is s e m in a te in s tr u c tiv e in f o r m a tio n , th is C o u n c il m a in ta in s a la rg e l ib r a r y o f film s o n C r ip p le C a re to a c t a s a n i n f o rm a tiv e s tim u lu s t o t h e g e n e ra l p u b lic , a n d to e n c o u r a g e c r ip p le s o r p a r e n t s o f c r ip p le s t o s e e k tr e a tm e n t, a n d t o p e rs e v e re w ith tr e a t m e n t , e v e n th o u g h a t tim e s it m a y se e m in te r m in a b le . I t s s t a f f a n d r e p re s e n ta tiv e s t h r o u g h o u t t h e U n i o n a n d S .W .A . g iv e ta lk s a n d a r r a n g e film s h o w s t o th e g e n e ra l p u b lic w h e n e v e r e v e n a s m a ll g r o u p c a n g a t h e r to g e th e r f o r th e ' p u r p o s e . I t issu es illu s tr a te d p a m p h le ts a n d f o r th is p u r p o s e , w ith t h e p a t i e n t s ’ p e r m is s io n , t h e s ta f f ta k e s m a n y h u n d r e d s o f c o n v in c in g p h o to g r a p h s . A n e w se rie s o f in s tr u c tio n a l p a m p h le ts h a s n o w b e e n in itia te d , th e first o n e k n o w n a s “ F o o t C o m p la in ts a n d F o o t H y g ie n e ” , w h ic h is d is tr ib u te d t o th e p u b lic w ith o u t c h a rg e . T h e C o u n c il is r e s p o n s ib le f o r a g o o d ly n u m b e r o f p u b li­ c a tio n s in t h e in te r e s t o f C r ip p le s . I t a ls o su c c e e d s in iss u in g p re s s a n d r a d io re le a se s in c o n n e c tio n w ith th e ir w e lfa re . It is o b v io u s th e n t h a t t h e N a t i o n a l C o u n c il f o r th e C a re o f C r ip p le s h a s a lr e a d y a s s is te d in in itia tin g a c o n s id e ra b le v a rie ty o f se rv ic e s, b u t m uch m ore is still t o b e d o n e . T h e r e a r e m a n y p e o p le in th e c o u n tr y w h o w o u ld n o t to d a y b e d o in g C r ip p le C a re W o r k i f it h a d n o t b e e n f o r th e s tim u lu s a n d a c k n o w le d g m e n t, e n c o u r a g e m e n t a n d f in a n c ia l a s s is ta n c e g iv e n b y t h e N a t i o n a l C o u n c il f o r th e C a r e o f C rip p le s . N A T I O N A L C O U N C I L F O R T H E C A R E O F C R I P P L E S . F ilm — “ D y n a m ic P o s t u r e ” (1 6 m .m . s o u n d - c o l o u r r u n n in g tim e a p p r o x im a te ly 2 0 m in u te s ). T h is film h a s b e e n a d d e d t o th e N a t i o n a l C o u n c il f o r th e C a r e o f C r ip p le s film l ib r a r y a n d is a v a ila b le o n lo a n f o r s h o r t p e r io d s . T h e film w a s p r o d u c e d b y B e c k e tt H o w o r t h , m .d ., in a s s o c ia tio n w ith t h e G r e e n w ic h H o s p ita l A s s o c ia tio n a n d s p o n s o r e d b y t h e A s s o c ia tio n f o r th e A id o f C r ip p le d C h ild r e n , N e w Y o r k . I t s p r a c tic a l a p p r o a c h t o th e s u b je c t o f p o s t u r e in r e la tio n t o e v e r y d a y life m a k e s it a n in s tr u c tiv e film f o r te a c h e rs , s c h o la r s a n d h o u s e w iv e s, a ls o s u ita b le f o r sh o w in g t o a ll b r a n c h e s o f th e m e d ic a l a n d p a r a - m e d ic a l p r o fe s s io n s a n d g e n e ra l p u b lic . “ D y n a m i c P o s t u r e ” is t h e te r m u se d t o in d ic a te c o r re c t b o d y p o s itio n in a c tio n , a n d in p r e p a r a t io n f o r a c tio n , in o r d e r t o p re v e n t a v o id a b le s tr a in a n d j a r . R e q u e s ts f o r l o a n o f th e film s h o u ld b e .m a d e _ to :- = _ _ _ T h e F ilm L ib r a r i a n , N a t i o n a l C o u n c il f o r C a r e o f C r ip p le s , P .O . B o x 10173, J o h a n n e s b u r g . Page 6 E a s t e r S ta m p F u n d C a m p a ig n . T h e r e a re m a n y g r e a t d o c to r s , th e r a p is ts , o r th o p a e d ic m e c h a n ic ia n s a n d so c ia l w o r k e rs w h o a r e n o w d e v o te d to th is c a u s e b e c a u s e o f t h e in itia l in te re s t o f o u r C o u n c il. T h e C e re b r a l P a ls y w o rk b e in g d o n e in m a n y c e n tr e s in th is c o u n tr y is a s s is te d b y a sp e c ia l D iv is io n o f t h e N a tio n a l C o u n c il. T h e R e h a b i li t a t i o n o f C o lo u r e d d is a b le d in th e C a fd a I n d u s t r i a l T r a i n i n g sc h e m e in th e C a p e is a n o t h e r e x a m p le , w h e re m o n e y f o rm th e p r o c e e d s o f th e E a s te r S ta m p F u n d h a s m a d e it p o s s ib le t o c a r r y o n . T h e N a t i o n a l C o u n c il’s in c o m e is d e riv e d a lm o s t e n tire ly f r o m its a n n u a l E a s te r S ta m p C a m p a ig n , c o n d u c te d fro m M a r c h 1st f o r s e v e ra l w e e k s in t h e la r g e r to w n s a n d lo n g e r in th e c o u n tr y a re a s . T h e field w o r k in m a n y r u r a l c lin ic s, t h e d e c e n tra liz e d se rv ic e s a s s o c ia te d w ith a f te r c a r e t o p e r s o n s a lr e a d y tre a te d , t h e o r t h o p a e d ic w o r k s h o p s a n d m e d ic a l s c h o o l d e p a r tm e n ts a r e t o s o m e e x te n t in d e b te d to L o rd N u ffie ld f o r his g re a t g ift, a r e d ire c tly a n d in d ire c tly in d e b te d a s w e ll to th e p u b lic w h o h a v e f ro m y e a r t o y e a r c o n t r i b u te d to o u r a n n u a l d r iv e f o r f u n d s in t h e E a s te r S ta m p F u n d C a m p a ig ™ | W h ile th e C o u n c il ’s a ffilia te d c r ip p le c a r e a sso c ia tio n s ? re c e iv e s o m e s u b s id ie s f r o m p r o v in c ia l d e p a r t m e n t s fo r c e r ta in a s p e c ts o f th e ir w o r k , t h e C o u n c il is d e p e n d e n t o n th e s u p p o r t o f t h e p u b lic f o r its m a jo r w o rk . F r o m th e p ro c e e d s o f th e E a s te r S ta m p F u n d , it se ts a s id e a r e p le n is h m e n t o f its m a in f u n d s s u c h a s a clin ic fu n d , a c o n tin g e n c y f u n d a n d s o o n , a n d th e r e a f te r 6 0 % o f t h e n e tt p r o c e e d s is a u to m a tic a lly a llo c a te d b a c k t o its n in e re g io n a l a s s o c ia tio n s p r o - r a t a to w h a t is ra ise d in th e ir a r e a , a n d fo r u se in th e i r r e g io n a t t h e d is c re tio n o f th e ir o w n c o m m itte e . T h e C o u n c il a ls o m a k e s v a r io u s g r a n ts a s e n u m e r a te d e a r lie r in th is a rtic le . T h e c o lle c tio n o f f u n d s is d o n e la r g e ly b y v o lu n ta r y w o r k e rs . T h e C r ip p le C a r e S e c r e ta r y o r h e r R e g io n a l E a s te r S ta m p O r g a n is e r in e a c h r e g io n ra llie s a c o n v e n e r in e v e ry c e n tr e a n d in e v e ry s u b u r b w h o in t u r n is a s k e d to g a t h e r h e r frie n d s a n d th e ir frie n d s to g e th e r , t o im p le m e n t th e sa le o f E a s te r S ta m p s a n d ra is e m o n e y in e v e ry p o ss ib le w a y f o r t h e E a s te r S ta m p F u n d C a m p a ig n . T h e N a tio n a l C o u n c il f o r th e C a r e o f C r ip p le s a n d its E a s te r S ta m p o r g a n is a tio n is n o t u n m in d f u l o f t h e a c tiv e p a r t ’ t h e p h y s io ­ th e r a p is ts h a v e p la y e d in a s s is tin g in th e s a le o f E a s te r S ta m p s f o r m a n y y e a rs, a n d h e r e w ith e x te n d s its sin c e re th a n k s . B O O K R E V I E W “ B R E A T H I N G E X E R C I S E S ” b y G . M . S to re y P ublished b y Faber a n d Faber C o s t 8s. 6 d . n e t. M is s S t o r e y 's n e w b o o k “ B r e a th in g E x e rc is e s” fu lfils a g r e a t n e e d a n d w ill b e o f v a lu e t o a ll p h y s io th e r a p is ts . It is w ell a r r a n g e d a n d v e ry r e a d a b le , w ith c le a r d ia g r a m s w ell s itu a te d in r e la tio n t o t h e te x t. T h e first c h a p te r s d e s c rib e th e m e c h a n is m o f r e s p ir a tio n a n d th e fa c to rs in flu e n c in g b r e a t h i n g ; a n d t h e fo llo w in g c h a p te r s d isc u ss a n d c o v e r th e t e a c h in g o f r e la x a tio n a n d b r e a t h i n g ex e rc ise s in a v a r ie ty o f c o n d itio n s . D e t a i l s o f lo c a liz e d b r e a th in g e x e rc ise s a r e n o t given a n d o n e w o u ld th e r e fo r e n o t re c o m m e n d t h e b o o k fo r th o s e o n a t h o r a c ic su r g ic a l u n it. H o w e v e r , o n e is g iv en a n e x c e lle n t g e n e ra l id e a o f c o n tr o lle d b r e a th in g e x e rc ise s a n d r e la x a tio n w h ic h a r e so i m p o r t a n t in a ll tr e a tm e n ts , b u t e s p e c ia lly m e d ic a l c a s e s w h ic h a r e c o v e re d v e ry a d e ­ q u a te ly . T h is s h o u ld b e a u se fu l b o o k f o r s tu d e n ts a n d q u a lifie d p h y s io th e r a p is ts in g e n e ra l d e p a r tm e n ts w h e re t h e c h r o n ic b r o n c h itic a n d a s t h m a ti c p a tie n ts p r e s e n t s u c h a p r o b le m . March, 1959P H Y S I O T H E R A P Y 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. )