Page Ten P H Y S I O T H E R A P Y
April, 1954.

P H Y S IO T H E R A P Y  IN RELA TIO N SH IP TO  
D ISEA SES O F THE CHEST

(International Congress Lecture)

B y  Sir C le m e n t P r ic e  T h o m a s, K .C .V .O ., F.R.C.S:
Surgeon to W estm inster Hospital.

IT  IS a privilege to me to be asked to address this Inter­national Congress, and especially so on this particular 
aspect o f  its work. We, here in London, are pleased to 
think that here is the birthplace o f  this particular form o f  
tfeerapy in relationship to thoracic disease, for, as far as 
my knowledge o f  the problem extends, it was in London 
that the first school o f  physiotherapy in chest diseases 
was founded in Brom pton H ospital in 1936. The credit 
for this must go to M iss Winifred Linton and my late 
colleague, Mr. J. E. H . Roberts, for in 1934 M iss Linton 
com menced work in St. Bartholom ew ’s H ospital, and 
consequent- upon the beneficial effects seen by Mr. Roberts 
o n  his cases he subsequently persuaded the staff o f  the 
B rom pton H ospital to invite M iss Linton to g o  to that 
hospital and continue her, work there. This was the com ­
m encement, and since that time the school so founded 
has spread its influence far and wide, and I believe it is 
fair to say that from it the gospel has spread throughout 
our whole country, if  not to the rest o f  the world, with 
the result that the physiotherapy units in the chest units 
here have becom e the envy o f  all who visit them. I do 
not know  whether all here present know that M iss Linton 
passed away on M onday last. She had retired and gone 
to live at D eal in K ent and was very happy, but there came 
on M onday a recrudescence o f  a previous illness and, 
mercifully, it was only a matter o f  hours before she passed 
away. Those w ho were privileged to know M iss Linton 
will agree with me that she was nothing short o f  a. remark­
able woman.

In the early 1930’s the large proportion o f  surgery 
was confined to the chest wall, and comprised such opera­
tions as thoracoplasty, the drainage o f  acute and chronic 
em pyemas, intrathoracic interventions being relatively 
uncom m on. In consequence o f this, physiotherapy was 
demanded chiefly in order to increase the m obility o f  the 
chest wall and to correct deformities. These m odest demands 
o f the surgeon were more than amply filled, the whole 
general tone o f  the patient and not least his m orale was 
improved out o f  recognition.

A s the scope o f  surgery increased, the demands on the 
physiotherapist likewise became larger, both as to time 
and energy, and in this respect both these therapeutic 
arms grew together in their potentialities and in the results 
they achieved. T he position today is such that we feel 
very strongly that the patient has not the sam e opportunity 
o f  a sm ooth and uneventful recovery if  he is deprived o f  
the advantage o f good  physiotherapy, both pre-operatively 
and post-operatively.

Physiotherapy, to be fully effective, should com m ence 
before operation and, within reason, for as long a tim e as 
possible. It is my practice to have the patient in hos'pital 
for a full week before operation. This serves tw o functions. 
Firstly, time is given for the observation o f  the patient and 
for him to get to know  and have confidence in those who 
will take care o f  him, both nursing and m edical personnel, 
and, secondly, this also gives time for pre-operative treat­
ment, not the least o f  which is physiotherapy. D u ring this 
pre-operative stage bad respiratory habits can be eliminated 
and respiratory efficiency can be increased enorm ously, 
and at the sam e tim e the patient can be instructed in the 
exercises he will have to carry out during the post-operative

period. It is no time to get used to the bed, nurses and 
respiratory and postural exercises in the painful immediate 
post-operative stage; these things are better dealt with 
before the operation. I am sure both the patient s and 
the surgeon’s outlook can be completely changed, if the 
patient is assisted by careful pre-operative preparation. 
It follow s, o f  course, that the post-operative treatment is 
equally important, if not more so, and it is in this phase 
that the resources o f  both physiotherapist and patient are 
tested to the full; on this period o f  treatment its efficacy 
in the main will be judged. . . .

W e have learned—and chiefly from physiotherapy 
— that m ovement after operation is beneficial. Although 
painful to begin-w ith, movement decreases the length o f  
time during which pain persists. Encourage the patient 
to m ove as soon as possible after operation and he will 
in a matter o f  days get rid o f the pain arising from the 
injury inflicted by surgery. There is also the important aspect 
o f  'the confidence the patient himself will get as a result 
o f  his recovery. Patients may be ill when we operate, 
but we now  consider that they are no m ore ill after opera­
tion than before a properly conducted operation.

One o f  the happenings against which we often have to 
fight is the practice o f nursing sisters w ho m ake invalids 
o f  the patients after operation, so that their m ovements 
are restricted. I tell my patients that the bed belongs to 
them and I insist on them moving necks, legs, arms, &c., 
every d a y  also they can do five-finger exercises and even 
cycling in bed. All this gives a patient confidence to work 
rapidly towards recovery. ' .

Anyone, who has had a severe operation, especially 
if ill for som e time beforehand, finds the thought o f  getting 
well too distasteful for words! This question presents 
itself as a steep hill up which the patient has not the energy 
to climb. I tell patients that that hill is som ewhat unusual; 
that when they get a quarter-way up it is not h alf as steep 
as it seemed, and when they are half-way up it is no hill 
at all. Very important aids to recovery are the restoration 
o f confidence and the urge to get well which you physio­
therapists inject into your patients not only because o f  your 
cheerful presence but as a result o f  the enthusiasm you 
com municate to 'them in the carrying out o f  the exercises, 
so that they really are glad to undergo them.

It seems to me that there are two essentials to success 
in this particular field. Firstly, the quality o f the personnel 
engaged in the task and, secondly, the form ation o f  a 
school. T o analyse the first pre-requisite, the quality o f  
the personnel. It would be out o f  place for m e to try to 
outline the requirements o f the technical training which 
is necessary, or for me to stress its necessity; there is over 
and above this technical efficiency a further requirement, 
and that is enthusiasm for the work, and m ore than this, 
too is the personality that so communicates this enthusiasm 
to the patient that the patient is, as it were, lit by it and glows 
in response. All the great physiotherapists have this 
quality, and to see them at work, as has been my privilege, 
is indeed an inspiration. It has been said that such qualities 
cannot be acquired, that they are inborn, ̂ nd, if they are not 
present nothing can communicate them. This I refuse 
to believe; example is the best preceptor, and I ’m sure 
that to work with one who has this power to com municate

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April, 1954. P H Y S I O T H E R A P Y

is in itself the m eans o f  transformation. This ability to 
treat your patients as human beings is difficult. M any 
people stand on  a high perch and pontificate. That is all 
wrong. Y on never get' anywhere with patients in that way 
Once you have the enthusiasm , the drive, and can com ­
municate that enthusiasm  to your patients you will succeed, 
always bearing in m ind that you treat' your patients as 
human beings.

Given a good personnel, then the foundation o f  a 
school is the next pre-requisite. Let m e hasten to explain 
that there are tw o types o f  sch ool: on e desirable and the 
other essential. T he desirable o n e is the training school 
where young physiotherapists are trained. A s in other 
walks o f  life, the educational, establishm ent depends for 
its elevated status not merely, or by any means, on the 
quality o f  its teaching staff but also on the critical quality 
o f  its students; be they o f  a sufficiently inquiring mind, 
they will so keep their teachers on their toes that the latter 
m ust perforce keep them selves well informed i f  only not 
to lose face. ■ Seriously, however, this critical faculty sur­
rounding a school, and the opportunity to discuss problems 
with on e’s colleagues, form probably the greatest asset 

,o f any teaching institution. O bviously not every physio­
therap y unit can have such a teaching school, but it can 
have a school for patients; this can be, and I know  is, 
established even- though there be only one physiotherapist. 
Therapy can be and is being carried ou t both as individual 
sessions and in the form o f  a class. Individual sessions 
are, o f  course, necessary when the patient is bedridden, 
and are invaluable. T he class, however, has m any advan­
tages. Firstly, m any patients can be instructed at the same 
time, and in this way there is a great saving o f  specialist­
time. Secondly, it is^a go o d  thing for the patient that he

Page Eleven

can leave his ward, the alm ost cloistered atm osphere o f  
his ward, and cariy ou t this m ost essential part o f  his treat­
ment away from it; added to this, he will often, in such a 
class, meet with patients w ho have com e direct from their 
hom es and will immediately be returning to their hom es 
and in this way he is m ade conscious o f  his relationship 
to his ow n hom e and the reality o f  his shortly returing there 
com es nearer. Thirdly, there is a certain com petitive air 
abou t such a class, which tends to increase the enthusiasm 
o f  each individual. In this way the class has a distinct 
advantage over individual treatment; in the latter th e patient 
is apt to consider him self as unique, whereas in the class he 
knows he is just one o f  m any and, m ore important, he

* can see patients getting back to norm al who have under­
gone the sam e procedure as himself. I em phasize that the 
establishment o f  a school is very helpful and valuable 
even though there m ay be one solitary physiotherapist 
spending , the morning taking classes and perhaps in the 
afternoon giving individual treatment.

A ll that has been said has unconsciously been related 
to the surgical aspects o f  diseases o f  the chest, but it applies 
with alm ost equal force to those diseases which are pre­
dom inantly in the realm o f  the physician, and this, o f  course, 
m ust be so, as the whole aim End object o f  physiotherapy 
is to m ake the body as efficient as possible, in the particular 
connection we are considering, in order to enable the patient 
t o -use the full potentialities o f  his cardio-respiratory reserve, 
a factor which really is as necessary in diseases having a 
medical connotation' as those involving surgery in their 
treatment, although it is right to say that the dramatic 
results occur, in the main, follow ing surgery. I am often 
however, struck by the thought that a large number o f  us 
in so-called health, and possibly not a few physiotherapists

A N E W  
A P P R O A C H  TO  
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A sample \ ) f  Rubiguent is available on request.

5,4 STAT ,EAST L O ND ON

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Page Twelve P H Y S I O T H E R A P Y April, 1954.

them selves, could do with a large draught-,of this.m edicine.
Speaking as a thoracic surgeon, I feel that we cannot 

be grateful enough, first, to the pioneers w ho started p h ysio­
therapy and, secondly, to those w ho are now  carrying on  
the good work. Incidentally, it w ould not be a. bad plan 
if  you as physiotherapists gave the m edical personnel 
breathing exercises. It is really a horrible thought that 
we have been going o n  for 50 years not know ing the way 
to breathe properly. A nd it is also true that probably 
som e o f  the physiotherapists— seeing that the bulk are o f  
the fair sex— could do with a little o f  their ow n  medicine. 
W om en, generally speaking, are the worst breathers o f  all. 
They have an idea that it is im polite to push the diaphragm 
out when breathing.

SITUATIONS VACANT
Pretoria & N orthern Transvaal Cripples’ Care A ssociation. 

School for Cerebral Palsied Children.
Q U A L IF IE D  P H Y SIO T H E R A P IST  

SPEECH  T H E R A P IS T  & O C C U P A T IO N A L  T H E R A P IS T  
A pplications are invited for the above posts at the salary 
scale o f  £350 x  30— £560. C om m encing salary according 
to qualifications and experience plus C.O .L. -A pplications 
to reach the Secretary, 33 Court Chambers, Andries Street, 
not later than 30th April, 1954. . Phone: 3-1123.

* * . * *
Pretoria en N oord-T ransvaalse Kreupelsorgvereniging- 
Skool vir Serebraalverlamde Kinders.

G E K W A L IF IS E E R D E  F IS IO T E R A P E U T , 
S P R A A K T E R A P E U T  E N  A R B E ID S  / 

BE R O E P ST E R A P E U T  
A pplikasies .w ord gevra vir bogenoem de p oste teen die 
salarisskaal van £35 0  x  30— £560. Aanvangsalaris volgens 
kwalifikasies en ondervinding plus ’n lew enskostetoelaag. 
A pplikasies m oet die Sekretaresse, 33, Court Chambers, 
Andriesstraat, bereik m e 'later dan 30 April 1954.

T elefoon : 3-1123.
* * . * * ^ 
P H Y SIO T H E R A PIST  (Fem ale)

F or M ine N a tiv e  H o s p ita l,-to  assum e duty as so o n , as 
possible after 1st April, 1954. C om m encing salary £35 
per m onth, plus cost o f  living allow ance (approxim ately 

■£10 per m onth), free board and lodging. A nnual and long 
leave privileges. Please apply to C h ief M edical Officer, 
P.O. B ox 1056, Johannesburg.

_  * - * * * ( 5 /
' P H Y SIO T H E R A PIST  wanted,. for clinic in Pretoria from 

1st M ay if possible. Further details from—
P.O. B ox 1122, Pretoria.

FOR SALE
P r i v a t e  P r a c t i c e  in rapidly expanding industrial tow n 
and area within easy reach o f  Johannesburg. Apply P . 015, 
Physiotherapy D e p t., G eneral H ospital, Johannesburg.

S ie m e n s  U l t r a t h e r m  in perfect condition after 182 hours 
use. Only 10-15 hours use since fitting a new valve. What 
offers? Apply P. 016, Physiotherapy Departm ent, General 
H ospital, Johannesburg.

P E R S O N A L — c o n t in u e d  f r o m  p a g e  7.
N e w  members on  the A d dington staff are M iss M. 

Gebers, M iss R . M cM illan and M iss A . Caley.
M iss P.. L ovely is leaving shortly on  a visit o f  several 

m onths to England.
Mrs. Joan C oop er has gone to Canada w ith her husband. 
M rs. T hom p son (Pat K ing) gave birth to a son in 

Decem ber 1953. ■

R H O D E S IA  R A ILW A Y S M E D IC A L  D E P T . 
(N o. M .D . 442)

Vacancy for Lady Physiotherapist.

A p plications are invited for the post o f  L A D Y  
P H Y S IO T H E R A P IS T  at the Railw ay Surgery, Bulawayo, 
on  the Salary Scale £490— £30— £840 per annum (pension­
able) plus a variable C ost o f  Living A llow ance, at present 
23% o f  basic pay.

The C om m encing rate will be according to experience 
but w ill not exceed the third notch.

U niform  allow ance o f  £18 per annum . Quarters not 
provided. Previous, experience essential.

Further inform ation supplied to suitable applicants.

A p plications stating age, previous experience, marital 
status and nam e o f  Training Sch ool, w ith cop ies o f  recent 
testim onials, should be forwarded to the

C H IE F' M E D IC A L  O FF IC E R ,
R h odesia R ailw ays, P.O . B ox 792, Bulaw ayo.

E D I T O R I A L — c o n t i n u e d  f r o m  p a g e  1.

W hat a relief it would be to the Out-Patient 
Departments o f  General Hospitals to know that 
those patients could receive expert treatment in a 
centre o f  this_kind, rather, than dragging back and 
forth to the Department three times a week and 
not making much headway. . Som e progress very, 
well as out-patients, but we are bound to admit 
that it is ■ impossible in our overcrowded, in­
adequately equipped, and understaffed Depart­
ments really to give o f  our best to patients requiring 
lengthy and specialised care.

The problem o f  the arthritic is o n e ' o f  which 
the fringe has hardly been touched in South Africa, 
and it is well to remind ourselves o f it, , now that 
we are having so many discussions about rehabili­
tation. It is high time a little more publicity was 
given to this possibly unspectacular but most/ 
disabling disease. - '

Advertising Space Available

Apply: 
Hon. Treasurer: Mrs. M. LEVY, 

105, Acacia Road, 
Blackheath - Johannesburg.

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