EDITORIAL “For all the happiness mankind can gain Is not in pleasure, but rest from pain” Dryden (1631-1700) Pain has been experienced by each one of us and we spend most of our working lives trying to relieve pain, but what do we really understand by the term pain? Cassell’s Dictionary describes pain as bodily or mental suffering: a disagreeable sensation. It is derived from the Latin “poena” which means pain or penalty and even today the term s pain and penalty may be interchangeable. For example “under pain o f ’ means under threat of punishment or penalty. This may also indirect­ ly affect our patients who may feel guilty and wonder whether their pain was caused by something that they did or failed to do. As can be seen by the definition, pain is not only a physical problem but affects one’s whole being. If treatm ent is to be effective therefore an holistic approach is needed. The physi­ cal component of pain is often the one the medical team feels most com petent to treat, but this is only a small part of the problem. The emotional experience of the patient suffering pain together with his attitudes and beliefs must be considered if that patient is going to be able to manage his pain and LETTER TO THE EDITOR_________________ After reading Professor Tobias’ article on Professor Dart and his part in Physiotherapy l thought readers might be interested in hearing how it all began. In 1936 third year medical students were just beginning their year. Up until then the only way to train as a Physiotherapist was to go to England. A group o f us got together and approached Professor Dart with a view to starting a school in South Africa. He agreed to support us if enough students, who had completed their second year medicine, were interested. Four of us, Ester Paul, Leah Cohn, Marie Malherbe and Aileen Vos, formed the nucleus o f the new profession. For a short time a male student joined our ranks but the lure of easy money in a health studio proved irresistible and he left. Our course had the rather cumbersome title o f Diploma in Mas­ sage, Medical Gymnastics and Electrotherapy. We were determined from the beginning to make it of as high a standard as possible. The name Physiotherapy only came into being during the war. It was a four year course with the first two years being Medicine followed by two years practical and academic training at the Johan­ nesburg General Hospital. Staff were recruited, and two physiother­ apists in private practice, Miss Troughton and Miss Sutherland came to teach Massage and Medical Gymnastics. Dr W oolf took us for Electrotherapy and Dr Haydn for Medicine. W e attended lectures in Medicine and Surgery by staff at the hospital. Sh ortly afterw ard s a full tim e principal w a s a p p o in ted . M iss McMillan had been trained at Guys Hospital, London and Brompton Chest Hospital. She had a dynamic personality and set out to educate the medical fraternity. Every Saturday morning they were mobilised and we students were the. guinea pigs and, treated for every, disease and injury imaginable. The doctors’ reactions varied. The more cau­ tious ones insisted on monitoring all the treatments while others left it to us. W e went through all the departments, going on to the Children’s Hospital and the Maternity Home as well. Our equipment was primi­ tive compared to modem day standards. Shortwave was then Medium wave therapy. Wet pads were used to conduct the current and if the heat wasn’t watched a bum could result that started inside and especially his chronic pain. Over the years many pain clinics have been instituted throughout the world in recognition of the problem s that are associated with pain and to meet the need for a multi-disciplinary team approach in the m anage­ ment of chronic pain. A t the very interesting post-congress symposium held in Cam bridge in August 1991 many em inent speakers discussed the probable causes of pain and suggested how these may be m anaged. Some of these papers are discussed in the report back article. Both the physical and psychological aspects of pain management was stressed by many speakers and differ­ ent ways of assessing pain w ere put forward. A literature review of myofascial pain was undertaken and part one, which deals with an historical overview is presented. It is interesting to note that the concept of trigger points is not a m odern one. M ore and m ore use is being m ade of isokinetic exercises by physiotherapists both for the treatm ent of patients as well as in research. An inexpensive knee exercise, which was p ri­ vately constructed, is discussed and the results of tests are com pared to more highly sophisticated electro-m echanical systems. J C Beenhakker worked out and was difficult to heal. Faradic current travelled in little boxes and did double duty at the weekends for tired students' feet, especially after dances. ■ Ultra violet light was a tall standard lamp with a hood. T o light it had to be tilted to an exact angle to strike an arc. A s often happened it went out during treatment and we had to let it cool before we could light it again. Miss McMillan’s experience o f chests was invaluable. Chest surgery was in its infancy and there were no antibiotics to prevent infection and nearly all the postoperative lungs came back with emphysema. W e were able to speed up recovery considerably. It’s said that Physiotherapists should first experience the com ­ plaints before treating patients. When I think how blithely I used to exhort my post-operative gall bladders to breathe deeply straight after surgery: how bitter 1 felt when my time came. There were no swimming baths in our time so we used a large old-fashioned bath especially for the children with polio. W e decided that we should have representation on the SMC. I had to stand up in front o f a whole hall o f medical students and state my case. I now know why aspiring politicians are sent to tough areas for experience. We were due to write our finals in Decem ber 1939 but three weeks before the date I got mumps. With 25 percent o f the class out o f action we decided to wait and finally wrote in April 1940. Although we trained without the present day facilities the thor­ ough grounding we got has stood me in good stead in the following years of practice. Perhaps it can all be summed up in the words of one of my students at U C T som e years ago. When 1 told her I had qualified in 1940 there was a pregnant silence and then she said with aw e...“Mrs Allen, it’s like being taught by a National M onument.” Mrs Aileen Allen Bladsy 14 Fisioterapie, M ei 1992, dee! 48 no 2 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. )