June/ 1958. P H Y S I O T H E R A P Y Page Seven Some Uses of Heat and Exercise in the Obstetric and Gynaecological Unit (These treatment .notes are■ based on extracts from a talk given by Dr. D. M . Lithgow, Specialist in Gynaecology at Edenvale Non-European Hospital, who has kindly consented to allow them to be used in the Physiotherapy Journal.) Physiotherapy is generally an adjunct to other methods of treatm ent in gynaecological cases and the two treatm ents which are most often called for are those which use heat, in all its forms, and exercises. H eat and exercises may be used singly, together o r combined with other physio-therapeutic measures. PA RT I. f Heat Therapy covers a very wide field, and it is best considered under the differing headings o f radiation, con­ duction, convection and conversion. 1. Radiation. Radiant heat and infra-red rays fall under this heading, and are used for the mildly and frankly infected abdominal and perineal wounds in the m aternity unit. In most hospitals both in South Africa and overseas, staphylococcal infections have proved a plague in the last few years. Now, at Edenvale with the use o f a new and improved antiseptic (Hibitane) a stringently controlled central sterilising unit, a rigid scrub-up routine with Phisohex, and properly ventilated theatres, the number o f these mildly infected wounds has lessened con­ siderably. 2. Conduction. H ot sitz baths, followed by half strength Eusol irrigations, are mainly used for the treatm ent o f septic cases e.g. vesico­ vaginal fistulae and septic perineal wounds. A fter the septic condition has cleared, operations for the closure of the fistula o r repair o f the perineum are performed. Further physiotherapy is ordered later. 3. Convection. A ho t air cradle is o f some value in cases of gynae­ cological backache in the acute stage. / O f the num ber o f women attending hospital for treatm ent for bachache about 25% are caused by gynaecological conditions e.g. chronic cervicitis, param etritis, prolapse, endometriosis and chronic adnexal inflammations. A backache with a genuinely gynaecological basis can be distinguished in many instances from the backache caused by a slipped disc o r muscular rheumatism, by the great increase of pain at the menses. 4. Conversion. U nder this heading fall the diathermies—long wave, short wave and micro-wave. W ithout doubt this is the most useful weapon in the physiotherapists arm oury as far as gynaecological work is concerned. Short wave diathermy is the method chiefly employed in the following examples:— (i) Chronic Cervicitis which is one o f the commonest troubles in the N on-European. It is often a cause of infertility as well as backache and discharge. Treatm ent with silver nitrate, cauterization, o r conization and anti-biotics, is followed by short wave diathermy. In addition to the usual healing effects expected from short wave it seems to help the anti-biotics to perm eate to the more deeply seated and infected cervical glands. (ii) Subacute and Chronic Salpingitis, i.e. inflammation o r the tubes caused in 90% o f N on-E uropean cases by gonorrhoea, which in the female is a cruelly crippling and painful disease. Following an acute attack of Salpingitis the more chronic pyosalpinx and hydro­ salpinx cases are seen. It is these cases which come for treatm ent with S.W.D. (iii) L ate radiation effects observed in those cases of cancer o f the cervix which have been treated with deep X -Ray therapy and R adium can be ameliorated by further .. treatm ent with S.W.D. (iv) Stricture o f the rectum (Post lum phopathia venereum). Treated by short wave diatherm y follows dilation with a set of H eygar’s dilators. (v) Post-partum Chronic Lymphoedema, termed by some people, phlegmasia alba dolens, responds fairly well to S.W .D., which is given after paravertebral sympathetic block, in conjunction with massage. The extravagant claims m ade for the treatm ent o f amenorrhoea, endocrine disorders, and dysm enorrhoea, by S.W.D. are not fully established. An occasional case, however, may respond quite dram atically to such treatm ent. Contra-indications to Short Wave Therapy. (i) The acute episodes in cases of tubal infection are not treated by S.W.D. T he danger lies in causing a flare-up o f symptoms. Large pysalpinges, in particular, are apt to rupture and death from septic shock may follow. (ii) Cases of tuberculosis of the genital tract. (iii) Menses. (iv) Pregnacy. (v) Endometriosis. N.B.— If the patient seems worse after treatm ent suspect genital Tuberculosis, or endometriosis, and refer back to the medical practitioner. Amount o f treatment. Daily treatm ents by Short Wave Therapy are given for 2— 3 weeks, and in bad cases as many as 18 treatm ents are required. Anti-biotics and occasionally cortisone are used in addition. A t Edenvale, surgery is employed following the Short Wave D iatherm y course if palpable residual swellings remain after three weeks. If the patient is a young woman a salpingostomy (opening up the ends o f the tubes) is performed. With a w oman in her forties a hysterectomy plus removal o f the diseased adnexae is generally better, as it prevents the constant repetition ot symptoms. Ultra-Sonics, are not used at Edenvale Hospital for the treatm ent o f gynaecological conditions, as it is possibly dangerous when used in the region o f the ovaries. 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. ) Page Eight P H Y S I O T H E R A P Y iiV j9 5 8 . W O R LD CONFEDERATION FOR PHYSICAL T H ER A PY Ethical Principles for Physical Therapists The need for physical therapy is universal. The service o f the physical th era p ist is, therefore, unrestrict by considerations o f nationality, race creed, colour, politics or social sta tu s. The activities and relationships o f physical therapists must vary widely i n the many cou n tries and spheres in which they are pursued and each national organisation must be free to make its own detailed code o f ethics to which it may require its members to conform . H eat and Exercise— Continued fr o m Page 7. PA RT II. The second m ethod o f treatm ent favoured for gynae­ cological conditions is th at o f Exercise— here again divided into breathing exercises, assisted, free and resisted exercises. 1. Breathing Exercises. Breathing exercises are given as a prophylactic measure against chest com plaints following abdom inal operations. In the B antu respiratory troubles, particularly after C aesarean Section, seem to arise very quickly, and pre- and po st­ operative breathing exercises, together with leg exercises for the prevention o f thrombosis, are o f definite value. If, in spite o f these exercises, atelectasis occurs th e use o f a vibrator and back clapping'w ill loosen secretions and prom ote healthier action o f the lungs. 2. Assisted exercises. In the treatm ent o f post-natal dropped foot, -w hich is known by v a rio u s . names, from “ obstetrical palsy” to “ traum atic neuritis o f the puerperium ,” -assisted exercises are used, following electrical stim ulation by the current m ost suited to the condition. (In a very slight case, surging faradism will be tolerated, but in a bad case one o f the progressive currents will be required.) The B antu patient on the whole has a sm aller pelvis, from the obstetric capacity point o f view, than the E uropean. Consequently the pressure effect o f the engaging h ead is m ore severe on the large lum bo-sacral nerve trunks which cross the alae o f the sacrum. D am age to these nerve trunks, which form p a rt o f the great sciatic nerve, account fo r the comparatively large num ber o f dropped foot cases seen in N on-E uropean hospital practise. 3. Free exercises. These include the well known ante- and p o st-n atal exercises about which so much has already been w ritten. D ysm enorrhoea is greatly im proved by free exercises. In similar cases am ong E uropean women ballet lessons have proved helpful. W omen suffering from this disability enjoy “free exercises.’’served in this fashion. 4. Resisted exercises. The use o f Kegels perineom eter can be described as a “ resisted exercise.” Inserted vaginally it is used at E denvale with marked success in causes o f cystocele, rectocele a n d p ro ­ lapse; and, in conjunction with faradism , in cases o f stress incontinence, a lax pelvic floor, or for general to n in g o f the levator ani in elderly hysterectomy cases. Inserted rectally it can be used to im prove an o -rectal tone and continence after cancer operations, w here the removal o f the bladder, uterus and vagina has becom e necessary. In conclusion it can be truthfully said th a t with accurate diagnosis and well controlled therapy, great im p ro v em en t in all types o f gynaecological cases is possible by th e use o f heat and exercises. The following general p rin c ip le s , to which all Memho O rgam satiops of the W o r l d C onfederation for PhvsiSi T herapy have declared th eir ad h eren ce, will serve as a euid to n ational organisations i n building up their individnJi Code o f Ethics: - al 1. Physical Therapists re c o g n is e not only the responsi bilities but also the lim ita tio n s o f their professional functions. They th e r e f o r e only treat those patients referred to them by a reg istered medical practitioner 2. Physical T herapists c a r r y out with loyalty and the utm ost skill any p h y s ic a l treatm ent prescribed by a registered medical p ra c titio n e r which is aimed at restoring, improving o r m aintaining the mental and physical fitness of the p a tie n t. ' 3. Physical Therapists m a in ta in at all times the highest • standards o f know ledge a n d skill. -4. Physical T herapists' r e s p e c t the culture and religious beliefs o f their patients a n d associates. 5. Physical Therapists c o -o p e ra te loyally with their ■ physical therapy co lleag u es and with members of allied health professions a n d they sustain the confidence o f the patient in all m e m b e rs o f the health team. 6. Physical Therapists, h o l d in confidence all persona] inform ation entrusted t o them and will nor discuss a p atien t’s affairs with o th e r s than those responsible for the patient’s care. 7. Physical Therapists reco g n ise that failure of a colleague to conform to the e th ic a l principles o f the profession is detrim ental to the p a ti e n t and therefore such conducil should be reported to t h e proper authority. Unethical conduct should, how ever, never be reported in the presence o f patients o r associates. 8. Physical T h erap ists' s h a r e responsibility with other citizens and members o f o ther professions in meeting the needs o f the public i n m atters o f health, and should participate in all governm ental and voluntary efforts to meet those needs. 9. Physical Therapists do n o t perm it their names to be used in connection with th e . advertisem ent of products or with any other form o f self-advertisement except as expressly authorised b y the Code o f Ethics of their national association. 10. Physical Therapists believe th at ju st remuneration for their services should b e received, but they may accept only such com pensation o r professional fee as the contract, actual or im plied, provides. 11. Physical Therapists a d h e re at all times to s t a n d a r d s of professional and p erso n al ethics which reflect credit upon the profession. 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. )