100 F I S I O T E R A P I E DESEMBER 1979 ETHICS IN HUMAN EXPERIMENTATION J. C. B E E N H A K K E R , B.Sc. (Physio.) (R and) D .P.E. (Rand)* A lth o u g h th e re is no n atio n al policy regarding ex­ perim ents done on hu m an subjects, research institutions, w hich include U niversities and train in g hospitals, usually have a review com m ittee to screen all proposed re ­ search plans. C ertain facto rs are considered b efo re perm ission is given, according to th e N u rem b u rg C ode and th e D ecla­ ra tio n o f H elsinki. 1. A ll experim ents m ust be done on anim als first, w herever possible, b e fo re the use o f hu m an subjects. 2. E xperim ents m ay o nly be done by scientifically qualified persons and the im portance o f the advance o f know ledge and any foreseeable benefits m ust be w eighed against the inherent risk of any experi­ m entation. 3. A ny physical o r m en tal suffering m u st b e avoided and every p ro tectio n against injury, d isab ility and death m ust be taken. 4. C onsent o f the subject m ust b e ob tain ed an d he m u st be in fo rm ed regarding the n atu re, purpose and risk o f the research. If the subject is a child, m entally retard ed etc., in fo rm ed consent m ust b e obtained fro m the guardian. Special care m ust be taken in cases w here the subject m ay b e in a dependable p o sitio n regarding the investigation, i.e. prisoner, student, su b o rd in ate etc., as such a subject m ay find it to his disadvantage to refuse perm ission. 5. T h e subject m ust feel free to w ithdraw his perm ission a t any stage o f the experim ent and the investigator m ust discontinue the research if a t an y stage it ap p ears to be h arm fu l to the subject. 6. In clinical trials, th e investigator is m o rally bound to give the p a tie n t the best possible treatm en t and o ne should n o t w ithhold any treatm en t if it m ay be o f benefit to the patient. A cq u isitio n o f new m edical know ledge should only be justified by its th erap eu tic value to th at p articu lar patient. L egally an investigator can be prosecuted according to th e com m on Law o f A ssault and, in civil cases, a signed consent does n o t absolve the investigator. In research on anim als, there are no in tern atio n al conventions governing experim entation although legally one is b ound by the A nim al P ro tectio n A ct w hich states th a t th ere shall be no unnecessary suffering. M any in ­ stitu tio n s have an A nim al E thics C om m ittee w hich ensures th a t anim als receive every consideration fo r th eir b o d ily com fort, ad eq u ate and satisfactory housing* ad eq u ate anaesthesia and analgesia and, w here necesl sary, effective eu th an asia m ust b e used. A nim als m ust be treated w ith kindness and be p ro p e rly fed and m ust receive m eticulous post-operative care as a p a tie n t w ould in any hospital. M an y scientific journals insist th a t all investigations involving hu m an and anim al subjects, w hich are re ­ p o rted in th e ir publications, m u st b e conducted accord­ ing to the above accepted m oral and scientific principles and they will refuse p ap ers w hich do n o t ad h ere to these principles. * S enior L ectu rer and A cting H ead o f D epartm ent, U n iv ersity o f the W itw atersrand. TREATMENT NOTE — A PLEA FOR MASSAGE P A D D Y C H A T T E R T O N , M .C.S.P.* H aving recently been on the receiving encl o f physio­ therapy, adm inistered by an “ oldie” like myself, I feel constrained to draw the atten tio n of youn ger and m ore recently tra in e d physiotherapists to th e trem endous benefit to the p a tie n t o f massage, reg ard ed by m any today as obsolete, unnecessary and tim e-consum ing. F o r those o f us trained before and during the Second W orld W ar o f 1 9 3 9 -4 5 (when physiotherapy really ex­ panded into the profession it is today) th e skill of good massage is still regarded as one of the m ost valuable m edia in our arm am en tariu m . I w ould be so bold as to say th a t o th er m odalities an d techniques com e an d go, b u t th a t massage will go on fo r ever! H ow ever, it m ust be objectively perform ed. H aving b een w ell instructed in th e m anipulations of “ effleurage, petrissage an d tap d te m e n t” by such great nam es in th e profession as Miss M ary H igham and Miss G ladys Sum m erhays, pioneers in the teaching profession, I w as fo rtu n ate later to attend a course in L ondon by D r Jam es C yriax, way back in 1952, thus adding “ C yriax transverse frictio n s” to th e m ore accepted massage m anipulations. * P rivate P ractitio n er, C ape Town. D r C y riax ’s “ exam ination o f the p a tie n t” is i n d i i | putably effective — he actually told us in relatio n tff- diagnosis of soft tissue lesions th a t “ physiotherapists m ust, because doctors can’t!” T h e physiotherapist’s hands are h er m ost valuable asset in assessing the n atu re, site and cause of th e lesion. She develops a sensitivity in her hands and fingers by assisting and resisting m ovem ent and by p alp atio n of so ft tissues — alm o st a 6th sense. Follow ing the observation and history of th e patient, D r C y riax ’s technique, requiring th e use o f th e physio­ th erap ist’s hands, was alw ays the sam e, nam ely passive m ovem ents, active m ovem ents and p alp atio n last, having decided by then w here the pain sho u ld be. “D o n o t prod w here the pain is” was a great m axim o f his. D uring the sixties, when she visited all th e branches of the South A frican Society of P hysiotherapy a course by M iss M aria E b n er, M .C .S.P., on “ connective tissue m assage” was also a valuable experience in the beneficial use o f th e p hysiotherapist’s hands. A lthough personally n o t a ttracted by th e technique, I was im m ensely im ­ pressed b y her division o f the back in to “areas” from glutei to occiput, her concept o f th e necessity to clear areas o f tightness in m uscle, and h e r accuracy in d eter­ m ining the causative areas o f re fe rre d pain. T h e use of 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. ) more conventional massage techniques, m ainly deep kneading, rolling and frictions, in the specific areas relating to th e cause and distribution o f th e pain, achieves m ost rew arding results; this is far m ore effective and lasting th a n electrotherapy in m any instances. T he benefit to th e p atien t of the physiotherapist’s hands is im m easurable as a means o f co n tac t to give him confidence. T he exam ination makes him aw are th a t som eone understands his problem . T hen com es the benefit from physical treatm ent, be it massage, m an ip u ­ lation, exercise or electrotherapy, or a com bination of any or all of these. But how often is massage considered as one of the available m odalities? H ow m any young physiotherapists have know n the satisfaction o f bringing relief and joy to th e p atien t by the judicious use of their hands w ith m assage? — actually feeling the easing o f an asthm a attack as the physiotherapist stands behind the p atient, who is sitting relaxed forw ard over pillows, and gently m assaging th e muscles o f his neck and shoulders to induce relaxation; reducing the swelling in DECEMBER 1979 101 an oedem atous arm after m astectom y, when the p atien t has possibly n o t been adequately instructed in p o st­ operative exercises; rem oving altogether in one treatm ent th e referred pain of an intercostal neuritis by firstly finding and then attacking the offending “nodule” !; stretching an unresolved haem atom a deep in the q u a d ri­ ceps group due to an old untreated rugby injury; giving m agical relief to “ tension” betw een the an terio r tibial and calf m uscles in th eir efforts to effect com pulsory m ovem ent in th e sub-talar and m id-tarsal jo in ts following an arthrodesis o f the ankle. C ertain ly o th e r m odalities are also effective in treating these conditions, b u t it is the massage th a t the p atien t will rem em ber and return for, should the condition recur. It is the careful selection o f th e co rrect m odalities for th e individual p atien t th at ensures the success of the treatm en t. T he sense o f satisfaction to the physiotherapist is the rew ard of our profession. T he value o f “th e laying on of han d s” , as in every other aspect of life, m ust never be underestim ated. P H Y S I O T H E R A P Y THE NATIONAL EXECUTIVE COMMITTEE, MAY TO SEPTEMBER 1979 F o u r m eetings o f this com m ittee have b een held since the C ouncil M eeting of A pril this year. M atters discussed at each m eeting include items carried over from p re ­ vious meetings th e im plem entation o f resolutions passed at C ouncil, finance, reports of sub-com m ittees, reports of special groups, b ran ch m atters and anything con­ cerning W .C .P.T. IT E M S C A R R IE D O V E R F R O M T H E P R E V IO U S N .E .C . The possibility of getting the T ertiary E ducation D iplom a (U nisa) accepted as a registrable additional qualification seem s a little nearer follow ing a meeting betw een th e D ean of the F acu lty o f E d u catio n a t U nisa, Mrs. M athias, Misses Bow erbank and Irw in-C arruthers. U nisa is giving as m uch co-operation as they can in this c o n n e c tio n . . . B T he list of approved employing au th o rities fo r regis­ t e r e d physiotherapists (i.e. authorities o ther th an regis­ tered physiotherapist or specialists in physical m edi­ cine) has been revised at the request o f the P rofessional B oard. T his now read s: D ep artm en t of H ealth, D e p a rt­ m ent of N atio n al E ducation, D epartm ents of C oloured and In d ian Affairs, D ep artm en t o f E d u catio n and T raining (B antu E ducation), D epartm ents o f D efence, Provincial A dm inistrations, M unicipalities, Benefit Societies, U niversities (provided th a t th e em ploym ent is in a teaching o r research capacity), N atio n al Council for th e C are o f C ripples and its affiliated bodies, and any o th er body subject to the approval o f N ational C ouncil e.g. H ospitals and E stablishm ents o f the M ining and o ther in d u stries, G eriatric Institutions, Institutions for the M entally a n d /o r Physically H andicapped. Physio­ therapists offered em ploym ent by any o ther body should con tact the N atio n al E xecutive C om m ittee. N egotiations are still proceeding in o rder to legalise the ad m in istratio n of certain drugs by physiotherapists. M rs. Jaholkow ski’s very com prehensive re p o rt on industrial physiotherapy was discussed by b o th the N atio n al E xecutive C om m ittee and the N atio n al C om ­ m ittee of R epresentatives and plans are under way to r Mrs. Jaholkow ski to visit the branches. T he latest invasion o f the scope of physiotherapy is the C ritical C are Society’s proposals fo r the establish­ m ent of a new profession in this country — respiratory technicians. T his does not appear, at this stage, to have support from any authority outside the C ritical C are Society, b u t the N.E.C., as well as w riting to the Critical C are Society, has m ade fu rth er representations through our H o n o rary V ice-Presidents and through the S.A. Society o f A naesthetists. T h e C h iro p racto rs’ A ssociation have subm itted a letter purporting to co u n ter our objections to the C h iro p rac­ to rs’ A ct. H ow ever, th eir letter in no way counters the m any am biguous points raised in the S.A .S.P’s m em o­ randum , p articu larly relating to the scope o f chiropractic and to the very m inim al penalties for m isconduct. T he M edical A ssociation is in agreem ent w ith o u r objections and has w ritten to the D e p a rtm e n t of H ealth, opposing the C h iro p racto rs’ A ct. IM P L E M E N T A T IO N O F R E S O L U T IO N S PA SSED A T C O U N C IL In o rder to involve o u r H o n o rary V ice-Presidents more in th e affairs of the Society it w as agreed to enlist their su p p o rt regarding the C h iropractors’ A ct and th e pro­ posed establishm ent o f respiratory technicians. A ction has b een tak en on all resolutions passed at C ouncil b u t few m atters have been finalised yet as we aw ait replies from various bodies. T he two m atters wh 'cn interest m ost m em bers are the question o f tax-deductible expenses and the possibility o f registering an ePali'®fte- D ue to th e recent re p o rt of th e F ranzen C o m m i s s i o n th ere is, u n fortunately, no possibility o f getting ttie pro­ visions of Section 16 o f the Incom e T ax A ct extended to include physiotherapists. . T h e State H erald has indicated th a t there « objection to the registration o f an ePaule“ u0p