Page 2 P H Y S I O T H E R A P Y December, 1966 L O O K I N G A H E A D By R A Y M O N D A R T H U R D A R T , Em eritus Professor o f A natom y, University o f W itwatersrand I have occupied this presidential post for th e past six years and now look forward to an early retirem ent. The Society requires urgently som eone youthful and more actively concerned with all the advances taking place in the practice o f medicine in general and o f physiotherapy in particular. H e or she should be preparing your future. So I hope th at during the coming year the C ouncil will seek for my successor. My first presidential address to you in 1961 mentioned weightlessness, the unknow n phenom enon with which the second decade o f the second half o f this tw entieth century faced all adventurers into space. In th at year G herm an Titov, the R ussian astronaut told us for the first time “ It is easy to sleep in o uter space. T here is nothing to tu rn over on. Lim bs do n o t become num b. You feel as though you are on the top of a sea wave” . M ankind is still dealing w ith the complexities o f this new hum an medium. A stronauts have journeyed in space suits at the end o f tethering life lines connecting them with their space crafts whilst orbiting at terrific speeds around the earth. T he carrying out o f physical tasks under these abnorm al conditions is no t easy and the hazards o f spatial rad iatio n over lengthening time periods lie ahead. The A m erican m anned satellites have m et one another in space. Satellites have been sent out on sun-, and moon-circling circuits. T h e problem o f soft landings on the m oon have been solved but those o f navigating on its surface, o f returning to a m oon-orbiting craft and of returning to earth as well as those o f extended survival under all these varying con­ ditions are full o f dangers. T he w onderful thing to us all, I am sure, is that precarious as these adventures are, their solution is being tackled during our lifetime. T he means o f solving them are at hum an disposal to o w hatever their cost in m oney o r in hum an lives. M ankind is m ade th at way: they love jeopardy. These activities may seem far off and rem ote from Physio­ therapy but they are not. O n the contrary w hat the astronauts are able to do depends upo n their bodily fitness. T hat fitness is our objective and can be maintained only by what we learn about the tolerance of hum an bodies and minds. These tolerances are usually tested by experim entation at first upon o ther animals. T he Russians seem generally to have employed for such purposes dogs. T he Americans have utilized prim ates. T he next monkey will orbit the earth fo r a m onth. A t the present time prim ates are being in­ creasingly employed in all branches of biological research because o f their close relatedness to hum an beings. Sero­ logically and chrom osom ally as well as behaviouristically chaim panzees are m an’s nearest living relatives. L ast year it was the privilege of my wife to visit w ith me five o f the Regional Prim ate Research Stations in America, those on the M adison cam pus o f the University o f W iscon­ sin; in the M edical School o f the University o f W ashington in Seattle; in the O regon Prim ate R esearch C entre at P ortland, O regon; a t Davis R esearch C entre near Sacra­ m ento in C alifornia, an d a t the D elta Regional Prim ate R esearch C entre in C ovington, Louisiana. There is a Research C entre devoted to baboons alone at San A ntonio, Texas. A t A tlanta in G eorgia the Em ory University now has on its cam pus th e $3,000,000 Yerkes Regional Prim ate Research Centre for anthropoids chiefly chimpanzees, that used to form the Y erkes L aboratory at Orange P ark near Jacksonville. We visited it in 1958. A nother huge New England Regional Prim ate Research C entre is being built near Boston with the Boston University and M assachusetts Institute o f Technology and also th H arvard University itself nearby. The N ational Institute of H ealth has been responsible for prom oting the establishment o f all these centres spread right across the States from E ast to W est and from N o rth to South. T h e initial sum devoted to building them , I am told, was 8 1 8 ,500,000 T hey all have com puters. They are staffed with zoologists and veterinarians, anatom ists, physiologists, cytologists geneticists, pathologists and psychologists. T here is not a single aspect o f prim ate biology know n to science which is not being now o r will be in the near future tackled by some investigator. Few, if any, prim ates will escape full analysis during the rem ainder o f this century. I mention these m atters here because I think that every-1 body, who has to deal w ith hum an beings personally should at least be aw are of th e m anner in which our know­ ledge o f m ankind and his prehistoric background is being accum ulated and expanded at this stupendous rate. In the past our experim ental knowledge was built on m ore distant anim als like frogs and guinea-pigs; drugs and their dosages were based on rodent units an d the like. In the not too distant future we will know the flora and fauna o f all our prim ate fellows, their relative susceptibilities to all human com plaints and their individual and to tal relevance to the understanding of hum an behaviour, com m unication and idiosyncracies. In this aggregation and synthesis o f knowledge relevant to m an, which you will be witnessing, I have been mentioning Am erica because the initiative there is so spectacular, but such research is not confined to that country. T he Russians and the Japanese are scarcely less busily employed and the m ore alert E uropean countries, like G erm any and England are doing their share. France, H olland and Belgium as well as Africa participate also but their resources are not so great nor their interest, as yet, so deep. T heir contributions will nevertheless be considerable. Parallel w ith these close, com parative studies run those about hum an developm ent before and after birth, during infancy and adolescence, m aturity and old age. Y ou are all familiar with Berta B obath’s work at the W estern Cerebral Palsy C entre in L ondon. T he work of Sherrington, M agnusi F u lto n and th e generation o f physiologists and clinicians' they represent is now resulting in the advantages taken of the inborn reflexes inherited from th e piscine, amphibian, reptilian and generalised m am m alian stages o f man’s inheritance for the relief and betterm ent o f the existence of those who happen to be handicapped. M ost o f your w ork is naturally, like that o f the doctors and nurses, concerned w ith the sick and th e convalescent, the crippled and the a g ed ; and very good work it is as your year’s reports show. But, ju st as medicine has its public health and preventive aspect as well as its relieving and rehabilitative, so Physiotherapy’s future too lies in what it can do to prevent the development o f physical incapacity and prolong th e enjoym ent o f fitness by hum anity. So I find even m ore prom ising the discoveries that have been made in Am erica in Philadelphia by th e collaborative rehabilitation w ork instituted by th at team composed o f medical practi­ tioners, neurologists, nurses, physiotherapists, speech therapists, educationalists and research w orkers, which has built up the Institutes for the Achievement o f H um an Potential. They have been working together for tw enty-three years. W hen they began nearly a q u arter o f a century ago they confess they had never seen, nor heard o f a single b rair 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. ) ujld who had ever got well. Their jo in t w ork has injured cn .ge(j brain-injured children’s conditions m ore not only [jUt jt has also transform ed th e lives o f the scientinca patjents brought to them so radically, both hundreds intellectually, th at is has opened up new physically^ ecjucati0n o f all norm al children. p6T h i m p r o v e m e n t o f their physical conditions liberated • itaneously and unexpectedly the breathing and vocalisa- s im ulc“ ese chiidren and l e d spontaneously to their m astery n ° h and incidentally o f their reading. Some o f you may mber that in M ay last year the magazine section o f the K dav Times carried over three successive issues the story how D r. G lenn J. D om an and his wife w ith a team o f 100 erts had helped 400 brain-dam aged children to learn to C d He had show n how any child o f tw o years and rea ' d s could, an d should be taught to read if it could be Hone in such a way th a t they enjoyed it. T he article also fated that when the Sunday M irror introduced its readers E n g l a n d to th a t inform ation six m onths earlier, 17,000 people applied to take p a rt in the experiment. The Sunday Times also offered to give away 50 full sets of the large, printed, alphabet cards required by the D om an method but I im agine they were so overwhelmed by applica­ tions that they did no t to m y knowledge follow up the matter, which has such fulm inating potentialities. The problems th a t such basic discoveries can cause are overwhelming. L ast m onth the E ducational Policies C om ­ mission o f the N ational E ducation A ssociation in A merica proposed that “ all children should have the opportunity to go to school at public expense beginning at the age o f fo u r” . This has been endorsed by th e President, an d also by th e Secretary for H ealth, E ducation and Welfare (see Time 1.7 .66). “ Time said th e Question is no t w hether but when it will come.” “The idea is not new. T he N atio n al P.T .A . has been urging earlier schooling since 1898. T he Federal G overnm ent financed nurseries to provide w ork for ad u lt supervisors during the D epression and to free m others fo r defence work in World W ar II .” But despite this “ N early h alf the N a tio n ’s school districts do not now have kindergartens; across the United States ab o u t 5,000,000 m ore four and five-year olds would be added to school rolls . . . to operate tw o m ore grades educators estim ate th a t it would take at least $2.75 billion a year to handle the extra children even w ithout build ing new classroom s” . Still “Already, Illinois Congressm an R om an Pucinski has nitiated legislation to provide $350 million next year as seed m oney’ to help States undertake early schooling for ill” . It is patent to every inform ed thinking person today that he world is in the throes o f a population explosion. Both Russia and C hina are dependent upon C anadian and Australian wheat. India cannot nourish her teem ing millions. We know w hat drought does to our own R epublic. The physical explosion m ust be m oderated and the droughts overcome by local effort and assuaged by over-production elsewhere. This is the w ork o f future com puters and m athe­ maticians. The physical explosion, however, is minim al com pared with the intellectual explosion we are in and which manifests itself in every departm ent o f hum an activity, w hether indivi­ dual or collective. We in our simple fashion divide hum an activities into various categories such as private (or domestic) and public (o r business). T hen we proceed to split these activities up fu rth er into w ork (which is tough and u n ­ pleasant) and play (which is supposed to be pleasant, restful and relaxing: but need not be if you are a soccer football player, or a referee, o r his wife). O ur w ork to o , like our sport, is m ulti-categoried. It is professional (or w hite-collared) and technical (or m anual); but with the grow th o f applied scientific gadgets the plum ber, carpenter, typist, secretary and electronic expert can earn more financial rew ard th an the nurse, the therapist or the pecember, 1966 Page 3 doctor. So there is a vast social explosion (o r a multiplicity o f them ) in progress through the disappearance o f nobility and the grow th o f electronics an d autom ation as well as the harnessing o f atom ic energy. This social explosion is not only breaking dow n the boundaries o f past social and n ational division but those too o f colour, race and religion. This does not m ean they will vanish in our lifetimes but they will gradually become less and less meaningful th a n they were to our fathers and g ran d ­ fathers. A s the E ditor-in-C hief o f the Christian Science M onitor, M r. E rw in D . C anham said last night at the University o f the W itwatersrand to the packed audience in the G reat Hall and adjoining halls: “ Present possibilities pointed to the tim e when all the w orld’s inform ation will be available through satellite com m unication, in any language, to anybody who wants it.” B ut the greatest explosion o f all, as I said, is th at of learning an d education. Literacy is still beyond the reach of 50 per cent o f hum anity and even those who have it do not have 50 per cent o f w hat hum anity needs in o rder to become rational. F o r as Benjam in S. Bloom , Professor o f E ducation in the University o f Chicago has put it “ H a lf o f a 17-year old ’s intelligence is developed by the time he is 4, and another 30 per cent between 4 and 8 . School at age 4 and 5 would help a child develop his language ability and a longer span o f attention, give him skills in learning how to learn and how to establish relationships w ith others” . T hose o f us who know th at advantages come in these respects to children who have had the privilege o f con­ tinuous education from N ursery School onw ards know that the only thing preventing continuity in hum an educa­ tion from infancy in m odern society is the lack o f essential institutions and th e appropriately skilled, educational personnel. W hy do I speak ab o u t these m atters to y o u ? Because the basic objective o f these early years o f hum an life should be the aquisition o f those physical bodily skills which land their failures into the laps and hands o f yourselves our therapists. These skills are the skills o f the erect posture; o f maintaining perfection o f poise in every attitude o f the body necessitated by th e use o f today’s instrum ents and utensils (and by the tools employed in handicrafts and sports) and also by aiming a t that perfection o f poise in the perform ance o f speech, music, dancing and the other m ani­ fold arts o f hum anity. Those teachers, their w orkroom s and playgrounds are still to be discovered but their prototypes, I believe, are to be found partly in our N ursery Schools; partly in the various a rt, dancing, swimming and gymnastic schools, which children a tte n d ; and partly in the apparatus, techniques and crafts whose m astery we inculcate in our therapies. One day we o r those coming after us will find them unified in schools for th e attainm ent o f hum an bodily and m ental skill. O ur param edical professions can do much to bring them into existence. PRESIDENTIAL ADDRESS delivered at 6th Annual National Council of the South African Society of Physiotherapy held in Pretoria, 4th September, 1966 P H Y S I O T H E R A P Y 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. )