September, 1948 P H Y S I O T H E R A P Y Editorial Page Three The Editor does not hold himself responsible for the views expressed by contributors. SINCE last going to Press many congratula­tory messages have been received. Although unable to reply to individual m em­ bers your Journal Committee wish to state that they are highly gratified at the reception Physiotherapy has obtained from members. To give prominence to recent important developments in the Transvaal, other editorial matter has had to be curtailed. It is felt that readers should be given the opportunity of. acquainting themselvees with the position, in view o f the fact that our profession, together with that o f other auxiliary professions, is likely to be vitally affected by decisions taken in this Province. FREE HOSPITALISATION On August 1st, 1948, a comprehensive Free Hospital Scheme (FHS) was introduced in all the hospitals controlled by the Transvaal Provincial Administration. For the first time in this country, free medical services were made available to all regardless o f race, creed, colour, or income. Chief criticism was provided by the Medical Council which was unanimous in its opposi­ tion to the scheme in its present form. The Council felt that a free service was being made available, not only to the p oor and lower income group, but also to a group which could well afford to pay for such a service. They pointed out that, as it stood, the scheme would impose considerable financial hardship on members o f the Medical Profession. These objections were over-ruled, and the F.H.S. is now a fait accompli. Although the limelight has been focussed primarily on the opposition put up by our friends the doctors, it must be realised that the Auxiliary medical professions are equally affected, including our own profession of Physiotherapy. Physiotherapists may support the Scheme, but they would like to know how it will affect them, whether they be employed in hospitals or in private practice. This is how the scheme operates : GENERAL PATIENTS On admission to a Provincial hospital, a patient may elect to be treated by a member ° f the hospital staff and have the services of a hospital consultant. A ccom m odation and all hospital services are provided free of charge. Alternatively, the patient is given the oppor­ tunity o f electing to be treated by his own doctor. In this case, although accom m odation and hospital services are free, he must pay the doctor for his services. To cover the contingency o f insufficient accom m odation being available in Provincial hospitals, privately-run Nursing Homes have placed 50 beds at the disposal of the Province. Before a patient can occupy one o f these beds, however, he must elect to be treated by his own doctor and have been admitted through recognised Provincial channels. The Province is responsible to the Nursing Home for payment o f accom m odation fees, etc. PH YSIOTHERAPY (a) Hospital Patients W hen a hospital patient is ordered physiotherapy he will receive it, as before. Should he require further treatment after he is discharged, he will continue to re­ ceive this via the Outpatients Depart­ ment. (b) Nursing Home Patients The position is not yet clear in respect to such patients. (c) Non-Hospitalised Patients Before a non-hospitalised person may receive free physiotherapy services, he must first be ordered such treatment by one o f the doctors in the Outpatient or Casualty Department o f a Provincial Hospital, and presumably must attend the hospital physiotherapy department. He cannot receive free physiotherapy m erely on the prescription o f his private doctor. COMMENT Assuming that the public takes full advantage o f the Scheme, physiotherapy ser­ vices in Provincial hospitals will have to be tremendously expanded. Staffs will require to be correspondingly increased in numbers as existing staffs are barely sufficient to cater for present needs, let alone for the increasing demands which will be made on them as the Scheme comes into full operation. Regrading and salary adjustments must follow in the course o f time. 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 Four P H Y S I O T H E R A P Y September, 1948 It is, however, the private practitioner of physiotherapy w ho will be m ost concerned. It seems obvious that h e/sh e will suffer con ­ siderable financial hardship. The loss suffered w ill be in direct proportion to the speed with which hospitals expand their physiotherapy services. W ith ou t some com pensatory plan, h e/sh e m ay have to give up the unequal struggle and seek a Provincial appointment. A t present the F.H.S. is confined to the Transvaal and affects m embers in that P ro­ vince only. If it is successful, the possibility exists that it will be extended through­ out the Union. (Free hospitalisation has already been approved in principle by the Orange Free State Provincial Executive Com ­ mittee, and the Central G overnm ent has sought inform ation regarding the Transvaal scheme w ith a view to its w ider application) . Physiotherapists therefore— in com m on with other m edical auxiliaries— feel that they are entitled to a responsible statement from the Provincial authorities on how the Free H os­ pitalisation Scheme will affect members of their respective Societies. The follow ing suggestion, w hich is based on the same principles as those involved in over­ com ing the question o f insufficient accom m o­ dation, m ay provide food for thought to all concerned. W here insufficient physiotherapy services are provided in Provincial hospitals, private practitioners could make their services avail­ able to the Province. Fees could conform to the Standard Rate as laid down by the South A frican Society o f Physiotherapists in June, 1948. The Province would be responsible for payment, provided that the patient passed through the recognised channels. This suggestion, which could be enlarged upon, offers several advantages: (1 ) The Patient would receive the treatm ent which he re­ quired with the m inim um delay. (2 ) The Physiotherapist Hospital employees w ould not be m ore overworked than at present. Private practitioners would not suffer the severe financial hardship w hich w ould be other­ wise inevitable. (3 ) The Hospital Department w ould be able to cater for hospital and outpatient requirements only and would not be congested w ith patients who take a perfectly correct advantage o f the Free H ospitalisation Scheme. (4 ) The Province would not require to embark on a large expansion programme. (5 ) The Suggestion could be extended, with m inor m odifica­ tions, to other professions. M edical auxiliaries in general and physio­ therapists in particular will await w ith keen interest an authoritative statement o f policy from Provincial sources. Treatm ent of Elbow Joint Injuries By L. M A C E D A V ID , M .B., F.R.C.S. (Ed.) Clinical Assistan t, Department of Su rgery, T ran svaal Mem orial Hospital for Children. M o r e than so y e a r s ag o H u g h O w e n T h o m a s ta ug ht his stude nts the d a n g e r s of s t r e t c h i n g and fo rc i b ly m a n ip u la t in g an elbo w joint w h ic h is. stif f as the result o f trau ma. S u c h t re a t m e n t is still bei ng pursued and is h a v i n g th e opposite e ff e ct o f that fo r w hi ch it w a s intended. T h e elbow jo in t is v e r y su sceptib le to injury. Im p a ir e d function, so obvi ous in mos t cas es, m a y be cau sed not o n ly b y a lesion w ith in the jo in t (i nt ra - art ic u la r) but b y so m e condition eithe r o f the soft tissues in the v i c i n it y o f the jo in t o r withi n the mus cle s w h ic h a cti vat e it (e x t r a - a r t ic u la r ) . I t can also be cau sed b y m in or s tra in s if t h e y ar e re pe at ed fr eq uen tly . T h e co m m on es t cause o f st if fne ss of the join t is adhes ion form at ion , e ith er in t ra - or e xt ra - ar t ic u la r. A n adhe sion is a pa th ological ba nd re s ul t in g fr om ex ud a t e br ou gh t about b y tr a u m a or in flammation (')• T h u s , a f t e r the in jur y, join t st if fne ss occurs because of adhe sion s of the c a p s u la r plication w hic h is the result of or ga n i sa t i o n of the e x ud at e in the p e ri art er ial tissues. 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. )