The Place of the Supplementary Health Personnel in the Medical Team (P re sid e n tial A d d re ss t o th e A n n u a l G e n e ra l M e e tin g o f W este rn P ro v in c e B ra n c h S .A .S .P ., 2 3 rd Ju n e , 1966). B y P ro fe ss o r B . B R O M IL O W -D O W N IN G , U n iv e rsity o f C a p e T o w n , P re sid e n t W e s te rn P ro v in c e B ra n c h , V ic e-C h a irm a n S .A .S .P . Page 2 P H Y S I O T H E R A P Y September, 1^66 M a d a m C h a ir, L a d ie s a n d G e n tle m e n , last y e a r o n a n o c ca sio n sim ila r to th is I w as ind iscre et e n o u g h to say th a t t h e te rm “ p re sid e n tia l a d d re ss” w as so re so u n d in g t h a t it seem ed as th o u g h a d e q u a te p re p a ra tio n a n d re se a rc h w as re q u ire d o f m e to give a fo rm a l a d d re ss . I w as in discreet e n o u g h to sa y th a t if su c h w as ex p ec te d o f m e th e n I w o u ld re q u ire a d e q u a te n o tic e to p re p a re su c h a n a d d ress. T h e re le v an t m in u te o f th e last A n n u a l G e n e ra l M e e tin g r e a d s : “ P ro fe ss o r B. B ro m ilo w -D o w n in g b e fo re h e s ta rte d to give h is a d d re ss , c o m m e n te d t h a t th e title “ P re sid e n tia l A d d re ss” w as r a th e r g ra n d io s e a s it re a lly e n ta ile d a n a d d re ss o f a b o u t th re e -q u a rte rs o f a n h o u r d u ra tio n a n d w h ich c o u ld b e p u b lish e d in a j o u r n a l ” . T h u s I s h o u ld h a v e re alised w h a t w as ex p ec te d o f m e w hen I w as a sk e d so m e six o r so weeks a g o a s to w hat n ig h t w o uld s u it m e f o r th e A n n u a l G e n e ra l M e e tin g a n d w h a t su b je ct I w o u ld c h o o se f o r m y p re sid e n tia l a d d re ss . O n th e s p u r o f th e m o m e n t a n d w ith o u t th in k in g I gave th e title “ T h e p lac e o f th e S u p p le m e n ta ry H e a lth P e rso n n e l in th e M e d ica l T e a m ” b e c a u se a t th a t tim e th e p ro b le m h a p p e n e d to be o ccu p y in g m y m in d in a r a th e r specific w ay. I still th o u g h t I m ig h t b e a b le to get a w ay w ith so m e so rt o f e x te m p o re , o ff th e c u ff e x p ressio n o f o p in io n o n th is v ery c o n tro v e rsia l subject. B u t y o u , M a d a m C h a ir, left m e in n o d o u b t as to w h a t w as e x p ec te d o f m e in a re ce n t in terview . Y o u m o re o r less sa id to m e “ yo u w a n te d a d e q u a te n o tic e , y o u h a v e h a d it, n o w we e xpect a p re sid e n tia l a d d re ss” . I will d o m y b e s t; it will last th ir ty m in u te s. T h e su bject “ T h e p lac e o f th e S u p p le m e n ta ry H e a lth P e rso n n e l in th e M e d ica l T e a m ” w hen I c am e to lo o k in to it is so w ide th a t h a d I given it m o re th o u g h t b e fo re a n n o u n c in g it as th e title o f m y a d d re ss I w o u ld h a v e b e en in tim id a te d to th e e x te n t o f a b a n d o n in g th e p ro je c t b u t h a v in g given y o u th e title I h a d to p ro c ee d . I h a v e b e e n g re a tly stim u la te d by m y in v estig a tio n s a n d w ish I h a d left m y se lf m o re tim e to go in to th e su bject in d e p th . In e x p ressin g th ese o p in io n s I tru s t th a t y o u w ill a ccept t h a t th ese a re m y p e rs o n a l view s. B y th e v ery n a tu r e o f th e p o sitio n I h o ld I h a v e t o w e ar m a n y h a ts . S om e o f th em directly th ro u g h m y office a n d o th e rs , f o r ex am p le, th e office o f H o n o r a r y P re sid e n t o f th e C a p e W e s te rn B ra n c h o f th e S o u th A fric a n Society o f P h y s io th e ra p y a n d th e N a tio n a l H o n o r a r y V ice-P residency o f th a t o rg a n is a tio n , I h o ld in ­ direc tly th ro u g h m y p e rso n a l in te rests B u t to n ig h t I w a n t y o u to re g a rd m e as sta n d in g b e fo re yo u c o m p le te ly h a tle ss a n d m y sp a rse ly c o v e re d p a te e x p o se d e n tire ly to th e e lem ents. I sp e a k as m yself, e x p ressin g m y o w n th o u g h ts g a th e re d a f te r m a n y y e a rs o f in te re s t, by c h an c e, in th e so c alled “ aux illia rie s” b u t n o w sty led S u p ­ p le m e n ta ry H e a lth Services. T h e c h a n c e t h a t I re fe r t o is th a t firstly I h a v e a fa m ily in te rest in o p to m e try , (o p to m e t­ rists u se d to b e c alled o p tic ian s). S e condly in th e im m e d ia te p o s t W o rld W a r I I y e ars as th e su p e rin te n d e n t o f a large p ro v in c ia l h o s p ita l I w as c o n fro n te d w ith th e e te rn a l sh o rta g e o f “ a u x ilia ry ” staff. T h e re w as o n ly o n e a n sw e r a n d th a t w as to tra in th e m ourselves th u s I b e ca m e in te rested in th e tra in in g o f ra d io g ra p h e rs , (d iag n o stic a n d th e ra p e u tic ) a n d m edical tec h n o lo g ists a n d w as in stru m e n ta l in in tr o d u ­ c in g c o u rse s in th e s e p ro fessio n s in th e E a s te rn C ape. T h ird ly , im m e d ia tely o n th e a ssu m p tio n o f m y p re se n t p o s t I w as c alled u p o n to im p le m e n t th e tra in in g o f P h y s io th e ra ­ p ists a n d S iste r T u to r s in a u n iv ersity . H a d I h a d th e ex­ p e rie n ce a t th a t tim e w hich I h a v e to d a y , I d o n o t th in k I w o u ld h a v e h a d th e te m e rity t o even a tte m p t th e i n tro d u c tio n o f th ese c o u rse s in a n in s titu tio n such as o u rs w h ich is devoted a n d d e d ic a te d to th e hig h est s ta n d a rd s o f a c a d e m ic learn in g a n d so m e tim es lo o k s a sk a n c e a t v o c a tio n a l tra in in g , even o f m ed ical p ra c titio n e rs . B u t I a m g la d th a t I c a m e in at th a t sta g e o f m y c a re e r b e ca u se I a m n o w c o n v in c e d th a t a h ig h s ta n d a rd o f a c a d e m ic le a rn in g is th e g re a te s t and so u n d e st b a c k g ro u n d t o w h a t th e p u ris t a c a d e m ic ia n s call v o c a tio n a l tra in in g . F o u rth ly , a g a in b y c h a n c e I w as elected t o th e c o m m itte e o n th e M e d ica l C o u n c il w h ic h deals with th e S u p p le m e n ta ry H e a lth Services a n d fifth ly a g a in , by c h an c e, w ith th e efflux o f tim e I w as ele cte d C h a irm a n of th a t c o m m itte e . M y r a th e r w ide b a c k g ro u n d n o w s ta n d s m e in g o o d ste ad . Y o u w o u ld th in k th a t in m y p o s itio n it w o u ld b e easy for m e to define e x ac tly w h a t is m e a n t b y S u p p le m e n ta ry H e a lth Services. I t is o n ly w hen I c a m e to p re p a re th is p a p e r th a t I fo u n d m y se lf in n e ed o f such a defin itio n . I k n e w t h a t o u r o w n A c t, th e S o u th A fric a n M edical, D e n ta l a n d P h a rm a c y A ct o f 1928, h a d m a d e p rovision even fo rty y e a rs a g o f o r th e r e g is tra tio n o f w h a t we n o w term S u p p le m e n ta ry H e a lth P e rso n n e l, I th e re fo re th o u g h t it w o u ld b e q u ite safe to lo o k t o th a t A ct f o r a n a d e q u a te d e finition. B u t th e n e a re s t o n e c a n say is t h a t th e sc o p e o f th e C o u n c il u n d e r th e A c t in clu d e s all m a tte rs re la tin g to “ m edical p ra c titio n e rs , d e n tists, in te rn s, m ed ic al a n d dental stu d e n ts , m asse u rs, s a n ita ry o r h e a lth in sp e c to rs, fo o d in­ sp e c to rs a n d o th e r classes o f p e rso n s c o n c e rn e d w ith the tre a tm e n t o r p re v e n tio n o f p h y sic al d efects o r disease in m a n .” O u r c ritics h o ld th a t it is q u e s tio n a b le w hether S ection 32 (h e re p a ra p h ra s e d ) o f th e A c t gives th e C ouncil th e rig h t to e sta b lish a n d k eep re g iste rs (v o lu n ta ry o r o th e r­ wise) f o r c a te g o rie s su c h as o rth o p a e d ic m echanicians, su rg ic al a p p lia n c e m ak e rs, c h iro p o d ists, d ietician s, m edical tec h n o lo g ists, p h y sio th e ra p ists, ra d io g ra p h e rs e tc . a n d claim th a t th e in te n tio n w as m erely t o re g iste r a n d c o n tro l persons em p lo y e d b y p u b lic a u th o ritie s c h a rg e d w ith th e e n forcem ent o f p re sc rib e d h e a lth re g u la tio n s , p o in tin g o u t th a t o f the c a te g o rie s specifically m e n tio n e d , re g iste rs h a v e o n ly been e stab lish e d f o r two classes, viz. H e a lth In s p e c to rs a n d F o o d In sp e c to rs. M o re o f th is a n o n . So even o u r o w n A ct d o e s n o t p ro v id e a c le a r definition. W e d o k n o w fro m th e A ct th a t o n ly m ed ic al p ra c titio n e rs, in te rn s a n d d e n tists w h o a re d u ly re g iste red b y th e C ouncil a re legally e n title d t o p ra c tis e th e ir p ro fe s sio n in th e R e p u b lic a n d S o u th W est A frica . I n te rm s o f th e A c t p e rso n s not re g iste red b y th e C o u n c il, w ho “ f o r g ain, p ra c tis e a s m edical p ra c titio n e rs , in te rn s o r d e n tists as th e c ase m a y be or p e rfo rm a n y a c t specially p e rta in in g to th e c a llin g o f a m ed ic al p ra c titio n e r o r d e n tist o r p re te n d b y m e a n s w h a tso ­ e v e r h o ld th em selves o u t t o be m ed ic al p ra c titio n e rs , interns o r d e n tists as th e case m ay be (w h e th e r o r n o t p u rp o rtin g to b e registered) shall b e g u ilty o f a c rim in a l offence a n d liable o n c o n v ic tio n to a fine n o t e x ceeding R 2 0 0 .” So y ou can see th a t it is o f so m e im p o rta n c e t o define w h o is a legitim ate p ra c titio n e r a n d w h e re d o e s h e ta k e his p la c e in th e h ealth te a m . I n d a y s g o n e b y a m ed ic al p ra c titio n e r c o u ld perform a ll th e a c ts p e rta in in g to h is a r t ; b u t o v e r th e y e a rs, as m a n ’s k n o w le d g e h a s in cre ased so h a s it b e co m e in cre asin g ly im ­ p o ss ib le fo r a n y o n e p e rs o n t o b rin g to h is p a tie n t th e full b enefit o f m ed ic al a n d o th e r scientific k n o w le d g e. T h e re has b een a n in c re a sin g n u m b e r o f c ateg o rie s “ o f p e rso n s c o n ­ c e rn e d w ith th e tre a tm e n t o r p re v e n tio n o f p h y sic a l defects 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. ) r disease i n m a n ” . In sp ite o f w h a t th e c ritics sa y th e S o u th m a y b e p lac ed in m y c a re , a n d f o r th e p u b lic w e a l; th a t I African M edical C o u n c il h a s c re a te d a n d h o ld s registers o f will h o ld in d u e re g a rd th e h o n o u ra b le tra d itio n s a n d o few er th a n 19 different c a te g o rie s o f such p e rso n s. o b lig a tio n s o f th e p ro fessio n o f p h y sio th e ra p y , a n d will 11 . r C !___i__ _____ D___________ ____, r ,_j do nothing inconsistent therew ith: and th a t I will be loyal Categories o f . S “ P P ™ n to th e U n iv e rsity a n d e n d e a v o u r to p ro m o te its w elfare with the South A frican M e d ica l a nd D e ntal C ouncil. a n d m a in ta in its re p u ta tio n .” Number on . D ate o f first Register, 31sf -K w as sta te d t h a t th is w as a b la ta n t a tte m p t b y the m edical Cateeory Registration Dec. 1965 profession to introduce a “closed shop” . As events prove, . ,q 4q a. this objection was not supported, and the declaration is C h i r o p o d i s t s ............................. y 7 7 re q u ire d o f o u r d ip lo m a te s. T h r o u g h o u t th e ages it h a s been Dieticians . . ................... difficult to convince the public th a t legislation and the es- p o o d In sp e ct .................... I. ; ta b lish m e n t o f e th ic a l co d es a re p rim a rily in th e p u b lic H ealth in s p e c to rs . . . . ^ 0 :>i in te rest a n d n o t in th e in te rests o f th e p ro fessio n s. I t is in- M asseurs • • •• •• te re stin g to lo o k a t th e difference b e tw ee n e th ic s a n d M edical T e c h n o lo g ists . . jy iU 48 J e tiq u e tte . So o fte n th ese tw o te rm s a re h o pelessly c o n f u s e d ; O ccupational th e r a p is ts m b . 1 / 2 m ed ic al e thics, m ed ic al e tiq u e tte . M e dical e th ic s we find is a O ptom etrists . . . . . . . 0 referen ce to d u ty , w h a t o u g h t to b e d o n e , th e rig h t th in g , th e O rthopaedic M e c h a n ic ia n s . . 949 95 p ro p e r thing> f a d e ce n t Bth i„ g> th e in esca p ab le d u ty , th e O rthoptists . . .................... o b lig a tio n (shall we say to th e p u b lic ? ). W h e n we lo o k a t p h y siotherapists .................... 945 (111) 705 e tiq u e tte it is c o n fo rm ity , tra d itio n a lis m , . o rth o d o x is m , P s y c h o lo g i s t s . ........................... 6 fo rm a lism ; th a t is b e in g fa sh io n ab le. W h en we sp e a k o f Psycnom etr s s .................... e thics we sp e a k o f o u r d u ty , a n d o u r d u ty is p rim a rily to R a d io g ra p n ers . . « y ) o u r p a tie n t a n d th ro u g h o u r p a tie n t to th e p u b lic a n d K S c m S S S s : : i « 9 r n through the public to our own professions. Speech T h e r a p i s t s .................... 1951 106 I t is difficult to legislate f o r c ro o k s b u t a ll t h e e n a c tm e n ts S upplem entary D ia g n o stic th a t o n e h a s c o m e a c ro ss a re p rim a rily devised fo r th e p ro - R a d io g ra p h ers .................... 1961 344 te c tio n o f th e p u b lic a g a in st th e ir o w n g u llibility, to p ro te c t Remedial G y m n a sts . . 1961 5 th e m fro m th e b la n d ish m e n ts o f p e rso n s w hose eth ic al .---------------;------ ;----------------------------------------------------------;----- s ta n d a rd s , th a t is w hose ideas o f d u ty a n d o b lig a tio n , m a y 19 C ategories w ith a to ta l o f . . . . 3,042 o n re g iste r n o t b e all t h a t sh o u ld b e desired. T h e re a re m a n y p e o p le ;---------------- - ; ~ b o th p ro fessio n al a n d la y w h o find it difficult t o distin g u ish (i) N u m b e r h a s re m a in e d th e sa m e since 1952. be tw ee n p h y sio th e ra p y a n d c h iro p ra x y a n d it is o n ly b y th e (ii) O ne o n ly o p to m e tris t w as re g iste red u n til 1959. m a in te n a n c e o f th e hig h est e th ic a l s ta n d a rd s , th e stric t (iii) 17 P h y sio th e ra p ists re g iste red in 1945. obe d ie n ce to scientific p rin c ip le a n d p re ce p t t h a t will re su lt (iv) R e g is tra tio n o f R a d io g ra p h e rs ceased in 1958 w ith th e in th e c le a r defin itio n o f th e p ro fe s sio n as a g a in st th e q u a c k , in tro d u c tio n o f th e c a te g o rie s : D ia g n o stic a n d T h e ra - I f th e so c alled q u a c k s m a in ta in t h a t d iscipline to scientific peutic. fact a n d p re ce p t th e n th e y will e m e rg e fro m th e d a rk n e ss o f T hus it will b e seen t h a t th e p lac e o f th e “ a u x ilia ry ” h a s q u a c k e ry a n d be re co g n ise d as p ro fessio n s. M a k e n o m is ta k e assumed a n ev er in cre asin g im p o rta n c e w ith th e p a ssa g e o f th e d istin c tio n b etw een q u a c k a n d p ro fe ssio n is v ery fine, time. T h e re is n o d o u b t th a t to d a y th e p u b lic w o u ld b e sa d ly ® u r legislators, w ith a ll th e ir fa rsig h te d n ess, h a v e m a d e it bereft if th e services o f th e su p p le m e n ta ry h e a lth p e rso n n el extre m e ly difficult to se c u re a c o n v ic tio n in a c rim in al c o u rt were, fo r o n e re a s o n o r a n o th e r, t o be w ith d raw n . B u t a t th is v ery se c tio n w hich I h a v e tw ice b e fo re q u o te d . T h e the sam e tim e we h a v e to b e o n o u r g u a rd a g ain st q u a ck e ry . fre e d o m o f th e in d iv id u a l still is p a ra m o u n t. A n d a fte r m o re I have given y o u th e p ro v isio n in th e A ct w hich m a k e s it a th a n a h u n d re d y e ars o f legislative c o n tro l q u a c k e ry , o r criminal offence f o r p e rso n s t o e n g ag e in m ed ic al p ra c tic e w h a t w e te rm q u a c k e ry , still prevails. T h e ex te n sio n o f th is leg isla tio n t o p ro v id e f o r c o m p u lso ry S J S f w S r e g i s t r a t i o n o f su p p le m e n ta ry h e a lth p e rso n n e l a n d th e re b y people o f th e c o m p e ten c y t o p ra c tis e th e ir p ro fessio n . distin g u ish q u a c k fro m p ro fe ssio n is b e co m in g a h a rd y . O ver th e la s t h u n d re d y e ars, o n e c o u ld a lm o st say since a n n u a l. Y e a r a fte r y e a r I h a v e to ld y o u o f th e a tte m p ts m a d e ‘the e stab lish m en t o f th e G e n e ra l M e d ica l C o u n c il o f th e to m a k e r e g is tra tio n o f su p p le m e n ta ry h e a lth p e rso n n e l c o m - U nited K in g d o m , in th e E n g lish sp e a k in g w o rld th is system p u lso ry . Y o u r so ciety since 1927 h a s likew ise b een c o n c e rn e d of reg istra tio n h a s b een a c c e p te d as a n in d ic a tio n o f w h o jn th e sa m e e ffo rt f o r it w as in t h a t y e a r t h a t m e m b e rs o f shall b e e n title d to p e rfo rm m ed ic al a cts to th e benefit o f P a rlia m e n t a n d th e M in is te r o f H e a lth w ere inte rv iew e d b y the p a tie n t. B u t d o n o t let us b e deceived in to a sense o f y o u r th re e fo u n d e r m em b e rs in a n a tte m p t to o b ta in regis- false security b y believing th a t th e c o n c e p t o f o rth o d o x tr a tio n f o r m a sse u rs, a s y o u w ere th e n k n o w n , w ith th e S o u th medicine is u n iv ersally a c c e p te d e ven a m o n g s t th e intelligen- A fric a n M e d ica l a n d D e n ta l C o u n c il u n d e r th e p ro p o s e d A ct sia. W e c a n n o t be c o m p la c e n t, sit b a c k a n d th in k th a t th e 0 f 1928. A s y o u a ll k n o w y o u r fo u n d e rs succeeded in e sta b - status achieved by th e m ed ic al a n d a llied p ro fessio n s m u st lishing th e p rin c ip le o f re g is tra tio n a lb e it o n a v o lu n ta ry basis, be a cc eptable to all. T h e re a re th o s e w h o re fu se to a cc ep t th a t E n d e a v o u rs t o e x te n d th e v o lu n ta ry re g is tra tio n u n d e r th e the su p p le m e n ta ry services h a v e a chieved p ro fe s sio n a l A ct to c o m p u lso ry re g is tra tio n h a s th u s fa r p ro v e d u n ­ status. I n th e e n d e a v o u r t o e sta b lish leg isla tio n f o r th e av ailin g . B elieving th a t m ed ical tre a tm e n t s h o u ld b e re g a rd e d protection o f th e p u b lic we a re c o n s ta n tly c o n fro n te d w ith a s a w hole, e very e n d e a v o u r h a s b e en m a d e t o k e ep th is the acc u sa tio n th a t we a re p ro te c tin g o u r o w n in te rests. I u n d e r th e M e d ica l, D e n ta l a n d P h a rm a c y A c t. T h is c o n ce p t shall n e v er fo rg et w h e n th e re g u la tio n s f o r th e tra in in g f o r Qf ho lism h a s n o t b e e n fo llo w ed in o th e r c o u n trie s , I n th e the D ip lo m a o f P h y s io th e ra p y a t o u r o w n U n iv e rsity w ere U n ite d K in g d o m , fo r in stan c e, th e y h a v e th e O p tic ia n s A ct first in tro d u c e d ex ce p tio n w as ta k e n to th e d e c la ra tio n w hich 0 f 1958 a n d th e P ro fe ssio n s S u p p le m e n ta ry to M edicine is required o f e ac h o f o u r d ip lo m a te s, n a m e ly : A c t o f 1960, to n a m e b u t tw o. T h e se a cts to g e th e r w ith th e “ I, A .B ., so le m n ly d e c la re th a t, as a p h y sio th e ra p ist leg islation p ro v id in g fo r a G e n e ra l D e n ta l C o u n c il as well as holding th e d ip lo m a in p h y sio th e ra p y o f th e U n iv e rsity o f a G e n e ra l M e d ica l C o u n c il in a d d itio n to th e N u rs in g C ape T o w n , I w ill n o t u n d e rta k e a n y tre a tm e n t except C o u n c il a n d M id w ife ry C o u n c il, h a s in d ee d fra g m e n te d th e un d e r th e d ire c tio n o f a re g iste red M e d ica l P ra c titio n e r; m edical a d m in istra tiv e c o n tro l in th e U n ite d K in g d o m . I do. th at I will exercise m y p ro fe ssio n t o th e b est o f m y k n o w - tru s t t h a t we in th is c o u n try will n o t b e te m p te d in to th e ledge a n d a b ility fo r th e g o o d o f a ll p e rso n s w h o se h e a lth e sta b lish m e n t o f a m u ltitu d e o f c o u n cils a n d th e fra g m e n - September, 1966 P H Y S I O T H E R A P Y Page 3 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 4 P H Y S I O T H E R A P Y September, 1966 t at io n o f the c o nt r ol o f “ pers on s co nc e rn ed with th e t r ea t­ ment or pr e ve nt io n o f physical defects o r disease in m a n ” . Personally I feel th at with the est abl ish m net o f the N u r s in g Cou nc il we hav e gon e far eno ugh . Ear li er I m en ti on ed the difficulties I have in definition o f a cts perta ini ng to s u p pl e m e n ta r y he al th personnel. I a m a m u s ed a n d en v io us o f the pro visio ns with in the Opti cia ns Ac t which sim ply states “ a pe rso n w h o is not a registered medical p r a c t i t i o n e r o r a registered op h t h a l m ic op t ic i an ” shall no t test the sight o f a n o t h e r person. It w ou ld be indeed a h a p p y da y if we could m ak e a similar provision within the field o f p h y s io th er a py a n d o t h e r s u p pl e m e nt ar y heal th p e r ­ sonnel. It would be indeed a h a p p y d a y if the functions o f all s u p pl e m e nt ar y health perso nnel could be so clearly defined. I n ge neral w he n we l ook to these p e rso ns “ co nc e rn ed in th e t r ea tm e nt o r pr e v en tio n o f physical defects or disease in m a n ” with the 19 different categories recognised in this c o u n tr y we mu st a pp rec iat e the fact th a t each c ate gor y is be com in g specialised in its respective place within the m edical tea m. As in all team s th ere mu st be a capt ain , so m e o n e w h o tak e s decisions (right or wrong) a n d wh o a ss um es the final a n d ultimate responsibility. I a m always impressed by the efficiency a n d precision o f the w or ki ng with in a sea going vessel. T h e c o ok do es his j o b , the q u a r t e r ­ m as te r his, the navigating officer his a n d so on, but ov er all s t a n d s the ca p t ai n ultimately responsible. H e m ay no t have the faintest idea o f w h a t is for br e ak fa st t o m o r r o w but sh o u l d the crew be dissatisfied it is the ca pt ai n w h o will be a ske d to explain. In the sa m e way the G e n er a l Officer c o m m a n d in g a vast a r m y m ay no t k n o w how to fire a twenty-five p o u n d e r g u n but he kn ow s the a d v an t ag e o f th e c o n c e n tr a t io n o f fire at a pa rti cul ar m o m e n t a nd expects the fire to be m ain ta in ed w he n he gives the orde r. At the sa m e time he w oul d be most unwise if he were not sure that his g u nn e ry officers were ad eq u a te l y t rai ned a n d th at there we re sufficient a m m u n i ti o n available to en ab le his o r d e r to be carried ou t . Y o u can see whe re I a m leading, th at the c ap t ai n o f the ship with his ultim ate responsibility, the general officer c o m m a n d in g a n a r m y with his ul tim ate res­ ponsibility c a n be likened to the position o f a medical p ra ct iti on er o f m od er n times with his responsibility over the pa tie nt as a whole. H e m ay not k n o w how to pe r fo r m the acts o f a medical technologist o r th a t o f a di agnostic r a d i o ­ g r a p h e r o r th at o f the physi ot her ap ist bu t he sho ul d kn ow the p a r t t h a t e ach o n e is to play in the ul tim ate care o f his pati en t. It is becom ing increasingly difficult to m a k e medical pr act iti on ers a w a r e o f the imme nse a n d varied potentialities o f the s u p pl e m e n ta ry heal th professions. I a m frequently t a k e n to o ne side a nd advised to include m o re o f this o r that in the tea chi ng o f medical stu de nts . U n f o r t u n a t e ly it is difficult to get m an y medical practit io ner s to recognise the so called auxiliaries no w as ha ving evolved to professions of th eir ow n. But by the sa m e t o k en one m us t preach a word o f w a rn in g to t he s u p p le m e n ta ry heal th professions no t to try a n d a ssu m e the po sition o f the cap ta in , but r a t h e r to e n su r e th a t th e c a p t a i n is fully cog nizant o f the potentialities o f his crew a n d by using th em to the fullest o f their ability a n d tak in g su ch advice as he m ay d e em fit, provi de a sm o o t h a n d safe passage for his pa tie nt s u n d e r his o ve r all direction. T h e c ur re nt strike o f se am en in the U ni te d K i n g d o m d e m o n ­ stra tes the da n g er s w he n things go aw ry between m an a ge m e n t a n d crew. I per son all y have sufficient confidence in both the ca p t ai n a n d the crew within the medical profession to be sure th at a similar sit u at io n will never arise between o u r pr ofes sions but that we shall always t og et he r place ou r p a ti e n ts ’ interests a b o v e th ose o f per son al interests o r pr ofe ss io nal sta tus , a n d co n ti n u e to fu nc tio n as a team w o r ki ng in close c o -o p e ra ti o n a n d m ut ua l respect. I tr u st th at we will all e nd or se the view expressed by the E d i t o r o f the L a n c e t in the final p a r a g r a p h o f his pa per “ T h e G r e a t e r Med ica l P r o f e ss io n ” : “ T h e u n an sw er abl e r e a s o n w hy we shou ld acc ept the so called auxiliaries as m e m b e rs o f the g re ate r medical profession, a n d welcome t h em as colleagues, is th at we w a n t th em to go on sha ri ng with us that very difficult, but very i m p o r t a n t professional cod e a c c o r d in g to which the patie nts interests co me first. I n a service which, a fte r all, exists solely for patients, this co de is as valid for the r a d i o g r a p h e r a n d the re cords officer as it is for the s u r ge o n : they shou ld eq ual ly accept, for ex amp le, the obliga tio n to respect professional confidence. We hav e a great tradi tio n, a n d we have a d u t y to pass it on to all o u r as sociates w h o will accept it. T h o u g h the practice o f medicine no w de pe nd s on so m an y w ho never went t h r o u g h o u r schools, the virtue need no t, a n d mu st not go ou t o f it” . M iss M ariorie M cD ow ell, M .C .S .P . Miss M a rj o rie M c D o w el l wh ose article on “ P h y s io t h e r ap y in Che st C o n d i t i o n s ” a p p ea r s in this J o u r n a l has recently t o ur ed So u t h Africa visiting all the m aj o r centres, lecturing a n d tea ching b ot h g r a d ua te s a n d students. She train ed at K i n g ’s College Hosp ita l in the early days o f the war, being ev ac u at e d to H o r t o n H o s p it a l at E p s o m whe re th ere was a c o m bi ne d C h e st Un it o f all the maj or L o n d o n Ho spita ls. It was here she first beca me interested in “ chests” a n d was always trying to get as m a n y chest patients as possible to treat . L at er Miss M cD ow ell gained general ex perience at Uni versity College Ho sp ita l, L o n d o n a n d in 1946 she went to B r o m p to n Ho sp ita l for Ch es t Diseases in L o n d o n , where she has been on a n d off ever since. D u r i n g h e r early training at B r o m p t o n she was f o rt un at e to be u n d e r Miss Winifred L in to n w h o st a rte d all the wo rk in chest ph ysi ot her ap y. I n 1948 Miss M c D ow el l train ed st ude nts in a Chest Unit at the H os pi ta l St. Pierre in Brussels a n d in 1951 spe nt some m o n th s in So u t h Africa a n d R h o d e s i a on ho lid ay and lecturing in Salisbury, Bul awayo, Jo h a n n e sb u r g , D u r b a n an d C a p e T o w n . T h is visit t em pt ed Miss M c D o w el l to visit o u r p a r t o f the worl d agai n in 1966. I n th e interval Miss M cD ow ell travelled a great deal trai nin g st u de n ts a n d tea ching p h y s io th er a p y for chests. In Ce ylo n in 1954-56 she did T.B. wo rk where th a t disease was pa rticularly rife at the time a nd incidently followed Miss M a r g a re t W h ite w h o is no w tea ching in C a p e To wn. A ft e r a sho rt spell in L o n d o n Miss M c D o w el l was off again, this time to Egypt. T h er e she hop ed to train students for T.B. wo rk , but t h o u g h she was t her e a ye ar she h a d few s tu d e nt s in trai nin g but m u ch chest w o r k to be don e. A ft e r he r recent visit to So u t h Africa Miss M c D o w el l is no w ba ck in B r o m p t o n pa rt- ti m e to help train s tu d e n ts who c om e fro m St. M a r y ’s Ho sp ita l f o r six weeks at a time in their final year a n d to help with n e w staff a n d post gra d u at e cou rses fro m time to time. Miss M c D ow el l is certainly o ne w h o has m ad e use o f her profession to see the world a nd before long we c an expect to h e a r o f he r travels once m o r e — possibly back to So u th Africa. 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. )