Page 10 Precision in Physiotherapy P H Y S I O T H E R A P Y September, 1964 JA M E S C Y R IA X , M .D ., M .R .C .P ., Ph y sic ian to th e D e p a rtm e n t o f P hysical M edicine, St. T h o m a s ’ H o s p ita l, L o n d o n . P h y s io th e ra p y evolved a t a tim e w h e n d o c to rs h a d n o t y et le a rn e d h o w to m a k e a c c u ra te d iag n o ses in soft-tissue d iso rd e rs. V ague c o n ce p ts h ad led to vague tre a tm e n ts , a nd no o n e w as a sh a m e d to p re sc rib e o r to a d m in iste r fo r exam ple, h e at, diffuse m assage o r g eneral exercises. N o w , o f c o u rse, this s o rt o f p h y sio th e ra p y is rig h tly re g a rd e d w ith in creasing scepticism , a n d is b e in g rep laced b y m eth o d s d ire c tly influencing th e lesion itself. A ll p a in a rises fro m a lesion, a n d it is a x io m a tic th a t a ll tre a tm e n t m u s t re a c h the lesio n a n d ex ert a beneficial effect o n it. R e ferre d p a in m ay m ea n t h a t th e p o in t o n w hich tre a tm e n t m u s t be c o n ce n ­ tra te d lies o u tsid e th e a re a o f p a in ; th e lesio n m a y well n o t even be fo u n d te n d e r. T h is d o e s n o t m a tte r if th e p h y sio ­ th e ra p is t b rin g s h e r a n a to m ic a l k n ow ledge a n d p a ir o f skilled h a n d s to b e a r o n th e p ro b le m , fo r, su p p lied w ith an a c c u ra te d iagnosis, sh e c a n n o w a d a y s give tre a tm e n t o f g re at precision. She c a n th u s afford im m e d ia te a n d lastin g benefit in d iso rd e rs in w h ich it h a d p re v io u sly b een th o u g h t th a t p h y sio th e ra p y h a d n o th in g to offer, a n d indeed th a t n o effective tre a tm e n t existed. T h e e ssentials a re th e re fo re a n a c c u ra te d iag n o sis a n d a p h y sio th e ra p ist w h o kno w s h ow to u se h e r h a n d s w ith pre cisio n . T h e fo rm e r is su p p lied by th e d o c to r, b u t the p h y sio th e ra p ist sh o u ld u n d e rsta n d his m e th o d s, since she uses the sam e e x a m in a tio n fo r th e assessm ent o f progress. T h e la tte r c an be ta u g h t to th e p h y sio th e rp ist, p ro v id ed th a t she u n d e rsta n d s th e p h e n o m e n a o f re fe rre d ' p a in , a n d is p re p a re d to b a se her tre a tm e n t o n a p p lie d a n a to m y ra th e r th a n a search fo r ten d e rn ess. U n fo rtu n a te ly , fo r decades it had b een re g ard e d as e n o u g h , in th e d iag n o sis o f soft- tissu e lesions, to p a lp a te th e p a in fu l a re a in se a rc h o f a localized te n d e r a re a — th e so-called n o d u le o f “ fib ro sitis” . T h is m isleading n o tio n has led to endless tre a tm e n t to the w ro n g s p o t; it is based o n in a d e q u a te c linical e x a m in a tio n o f p a tie n ts a n d ig n o res th e fa c t th a t w herever th e re is referred p a in th e re is a p t to b e re fe rre d ten d e rn ess to o . In d e ed , th e p o sitio n o f the te n d e r p o in t can be ju s t as m is­ leading as th a t o f th e p a in ; b o th m a y well b e referred. N o th in g , th ere fo re, is to b e gained b y in d iscrim in a te p a l­ p a tio n o f a p a in fu l a re a . T h e o rd in a ry m edical p rin cip les th a t ap p ly to th e e x a m in a tio n o f a ll tissues m u st b e follow ed — nam ely, th e a sse ssm e n t o f fu n c tio n . T h is h a p p e n s to b e easy in th e case o f th e m o ving p a rts , since e ac h tissu e w o rk s in a c h a ra c te ristic way. T h e p rim a ry fu n c tio n o f th e m o v in g p a rts is fo r th e bo n es to m ove a t th e jo in ts , a n d th e m uscles, activ ated b y nervous im pulses, to m ove th em . T h e o b jec t o f c linical e x a m in a tio n is thus, to d e te rm in e , firstly, a b o u t w h a t jo in t th e lesio n lies, a n d , secondly, w h e th e r a n in e rt o r a c o n tra c tile tissue is involved. O nce these tw o m a jo r p o in ts a re d e cided, accessory tests m u st be used in a n a tte m p t to n a rro w th e d iag n o sis d ow n to a single sp o t. Selective Tension T e n s io n b rin g s o n o r ag g rav a te s p a in in lesio n s o f th e m oving p a rts . D ia g n o sis dep en d s o n th e asse ssm e n t o f fu n c tio n a n d is th e re fo re a p p ro a c h e d in d ire ctly by a p p ly in g selective ten sio n to e a c h o f th e m o v in g tissues in tu rn . F ro m these responses a p a tte rn em erges th a t identifies p recisely the tissue a t fa u lt. S e a rch fo r ten d e rn ess is a v o id e d so f a r as is possible, b u t, if it p ro v e s necessary, if it is confined to the stru c tu re a lre a d y identified b y this stu d y o f fu n c tio n as c o n ta in in g th e lesion. W hen a n u m b e r o f m o v em e n ts a re tested, som e a re fo u n d to b e p a in fu l, w e ak o r lim ite d , o th e rs n o rm a l. T h e n egative side o f th e e x a m in a tio n is as im p o rta n t as th e po sitiv e , since, if o n e m o v em e n t in d ic a te s th a t a lesio n lies in a c e rta in p o sitio n , it follow s th a t a ll m o v em e n ts th a t d o n o t affect th a t p a r t o f th a t tissu e m u st be o f fu ll ra n g e , p a in le ss a n d stro n g . H e n c e in te rp re ta tio n is based o n th e p a tte rn — th a t is, c o n g ru o u s p o sitiv e findings a t o n e p o in t b a la n ce d b y n e gative findings elsew here. T h e m ain d istin c tio n w hen th e m o v in g p a rts a re e x am ined is betw een th e c o n tra c tile stru c tu re s (m uscle a n d te n d o n ) a n d th e in e rt stru c tu re s (capsule, lig a m en t, b u rs a , d u ra m a te r, n e rv e -ro o t o r n e rv e -tru n k ). S tro n g , re sisted c o n ­ tra c tio n w ith th e jo in t held still a p p lie s te n sio n o n m uscle a n d te n d o n o n ly ; stre tc h in g in th e o p p o site d ire c tio n m ay h u r t to o . P a in a ris in g fro m in ert stru c tu re s a p p e a rs on stre tc h in g only. E X A M IN A T IO N O F F U N C T IO N Six different sets o f d a ta a re c o rre la te d , as fo llo w s : 1. Active movements T h e s e give a co m b in e d in d ic a tio n o f th e ra n g e o f m o v e ­ m en t, m uscle p o w e r, a n d sta te o f v o lu n ta ry c o n tro l. Since ra n g e a n d p o w e r a re assessed se p a ra te ly la te r, th e ir c h ie f v irtu e is to in d ic a te w illingness. M a rk e d disc rep a n cy betw een o n th e o n e h a n d th e ra n g e o f a ctive m o v em e n t, a n d o n th e o th e r h a n d e ith e r th e ra n g e a tta in e d passively o r m u sc u la r stre n g th , in d ic a te s a p sy chogenic d iso rd e r. 2. P a ssiv e m ovements T h ese in d ic a te th e sta te o f th e in e rt stru c tu re s w ith o u t in tro d u c in g c o m p lic a tio n s d u e to m uscle p o w e r a n d w illing­ ness. C a p s u la r p a tte rn ; I f th e e n tire fib ro u s c u ff a b o u t a n y jo in t is fo u n d c o n tra c te d , a rth ritis is p re sen t. T h e lim ita tio n o f m o v em e n t fo u n d c o rre sp o n d s to th e c a p s u la r p a tte rn , T h is is different fo r different jo in ts , b u t m a in ta in s c o n ­ s ta n t p ro p o rtio n s a t a n y o n e jo in t. F o r e xam ple in a rth ritis a t th e sh o u ld e r, if a b d u c tio n is say 45 degrees lim ited, la te ra l r o ta tio n w ill be 60 degrees lim ited b u t m edical ro ta tio n o n ly 15 degrees lim ited. N o n -c a p s u la r p a tte rn : I f th e k n o w n p ro p o rtio n s a re n o t fo u n d , lig a m e n to u s sp ra in , in te rn a l d e ra n g e m e n t, b u rsitis , n e o p la sm , c o n tra c tu re s o f a n e x tra -a rtic u la r stru c tu re , o r hy ste ria is p re sen t. 3. R esisted m ovements O n e m o v em e n t is tested fo r e ach g ro u p o f m uscles. T h e p a tie n t c o n tra c ts th e m u sc le w ith a ll his stre n g th w hile th e e x am in er a p p lie s su c h a d egree o f re sista n c e th a t th e jo in t its e lf d o e s n o t m ove. T h e sta te o f e ac h m u sc le is th u s assessed in iso la tio n . I f a full a n d p a in le ss ra n g e o f passive m o v em e n t exists a t th e re le v a n t jo in t a n d o n ly o n e resisted m o v em e n t h u rts , a m u sc le lesio n is p re sen t. I f several c o n ­ tra d ic to ry re sisted m o v em e n ts h u rt, th e m uscles a re u n ­ affected. P a in le ss m u sc le w eakness w ith o u t increase o f p a in c h a ra c te ris e s c o m p le te r u p tu r e o r a n e u ro lo g ic a l c o n ­ d itio n . A te n d o n o u s lesio n c a n n o t give rise to lim ita tio n o f p a ssiv e m ov em e n t. 4. P a in fu l a rc I f a te n d e r s tru c tu re lies betw een tw o b o n y surfaces it c a n be p a in fu lly squeezed w hen th ey a re a p p ro x im a te d . A p a in fu l a rc re su lts— th a t is, p a in a t th e m id -ra n g e o f a m o v e m e n t, d isa p p e a rin g as th e ex trem es a re a p p ro a c h e d . F o r e xam ple, in s u p ra s p in a tu s a n d in fra s p in a tu s ten d in itis a n d in su b d e lto id b u rsitis , th e lesio n lies betw een the a c ro m io n a n d th e g re a te r tu b e ro s ity o f the h u m eru s. T h ere - 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. ) Septem ber, 1964 P H Y S I O T H E R A P Y Page 11 t e x t b o o k o f O R THO PAEDIC M EDICINE b y JAMES CYRIAX, m .d ., m .r .c .p . Physician to the Departm ent o f Physical Medicine, St. Thomas’s H ospital, London VOLUME ONE d i a g n o s i s o f s o f t TISSUE L E S IO N S f o u r t h e d i t i o n VOLUME TWO T R EA T M E N T BY ^ M A N I P U L A T I O N A N D M A S S A G E SIXTH EDITION D iso rd e rs o f th e m o ving p a rts p re s e n t special d iag n o stic p ro b lem s. In th is w o rk D r. C y riax d eals w ith th e m u ltip lic ity o f soft tissue lesions likely to be fo u n d in e ac h reg io n o f th e b o d y a n d describes a system o f clinical e x a m in a tio n w hereby th e so u rc e o f a p a in c an be precisely lo c a te d — a n essential p re lim in a ry to a c c u ra te tre a tm e n t. 735 p p . D e m y 8vo, 135 line d raw ings, 40 h a lf-to n e p late s, R 6.40 A n in d isp en sab le tex tb o o k fo r th e p ra c tis in g p h y sio th e ra p ist. T h e b a sic prin cip les o f m a n ip u la tio n a n d m assage a re c arefully c o n sid ere d , a s a re in d ic a ­ tio n s fo r a n d a g a in st tre a tm e n t. T h e m a n u a l m eth o d s a d v o c a te d are those p ra ctised a t St. T h o m a s ’s H o s p ita l, each te c h n iq u e b e in g clearly d e scribed and illu stra te d w ith a fu ll h a lf-to n e p late . T h e p lac e o f tra c tio n is e m p h a size d a n d th e re a re u seful c h a p te rs o n lo ca l in je c tio n o f h y d ro c o rtiso n e , m assa g e in p la s tic su rg e ry a n d frictio n fo r varicose ulcers— “ T h is te x tb o o k h a s g re a tly im pressed m e a n d I w o u ld a d v o ca te th a t every p ra c tisin g p h y sio th e ra p ist sh o u ld re a d it.” — B ritish Journal o f P hysiotherapy 375 p p . D e m y 8vo, 120 h a lf-to n e p la te s, R 3.50. C A S S E L L M E D I C A L B O O K S H EIN EM ANN & CASSELL (S.A.) (PTY.) LTD. P.O. Box 275 Cape Town — P.O. Box 1190, Johannesburg fore, ten d e rn ess o f a n y o f th ese th re e stru c tu re s m a y give rise to a p a in fu l a rc. In th e case o f th e te n d o n s , th e a rc is associated w ith p a in o n re sisted a b d u c tio n a n d la te ra l r o ta ­ tio n respectively. I f th e b u rs a is a t fa u lt n e ith e r o f these resisted m ov em e n ts h u rts. S ince th e sim p le st a n a to m ic a l c o n sid era tio n s in d ic a te c le arly w here th e tissue, since it lies in a p in c h a b le p o sitio n , m u st lie, a n a rc is a v a lu a b le localising sign. 5. P a in a t one extrem e ^ T h is m ay b e p ro d u c e d b y sq ueezing o r b y stre tc h in g o n e Structure. A ccessory tests serve to show w h ic h o f these alte rn a tiv e s o b ta in s. 6. P a lpation T h is m a y reveal w a rm th ; if so, th is fa c t in d ic a te s activity. A ctivity is fo u n d in : re c e n t in ju ry o r o p e ra tio n , fra c tu re , in te rn al d e ra n g e m e n t, n e o p la sm e ro d in g b o n e , b lo o d in the jo in t, rh e u m a to id o r g o u ty a rth ritis , a n d b a c te ria l in fection. F lu c tu a tio n in dicates fluid, w hich m ay be c le a r effusion o r b lood. Synovial th ickening, c re p itu s , lo o se b o d ies, cysts, oste o p h y te s a n d b o n y e n la rg e m e n t a re d e te c ta b le b y p a l ­ p a tio n . T en d e rn ess serves to in d ic a te th e e x ac t site o f a lesion o n ly if p a lp a tio n is confined to th e tissu e a lre a d y singled o u t by stu d y o r th e d ia g n o stic m o v em e n ts as th a t affected, a n d c an b e c a rrie d o u t o n ly if th e tissue a t fa u lt lies w ithin re a c h o f th e e x a m in e r’s finger. In , say a disc-lesion, p a lp a tio n o f m uscle o r sp in o u s p rocesses fo r ten d e rn ess is q uite p o in tle ss, fo r th e lesio n is e n tire ly o u t o f reach. C O N F IR M A T IO N R a d io g ra p h y se ld o m clarifies a d iag n o sis in lesions o f the soft tissues a n d m ay p ro v e m o st m isleading, a m in o r osseo u s d ev iatio n fro m th e n o rm a l b e ing re g ard e d as re le v an t w hen c linical e x a m in a tio n w o u ld have show n som e q u ite o th e r d is o rd e r to be p re se n t. O n ly w hen the ra d io g ra p h ic a p p e a r­ a nces c oincide w ith th e c linical d iag n o sis sh o u ld th ey be given full w eight, u n less a n o v e r-rid in g disease is u n e x p ec ­ ted ly d isclosed. L o c a l a n alg esia p ro v id e s the o n ly m e a n s o f d isp ro v in g o r con firm in g a lo c a liz a tio n a rriv e d a t clinically, a n d in a ll cases o f d o u b t sh o u ld be induced a t once. A fte r th e in je c tio n w h a tev e r m o v em e n t h a d b een fo u n d p a in fu l is tested a gain. P S Y C H O G E N IC P A IN P a tie n ts w ith p a in fo r w hich n o o b jective signs a re fo u n d to a c c o u n t a re n o rm a lly se n t fo r d iag n o sis to a d e p a rtm e n t o f p h y sic al m edicine. A m o n g st the m a n y w ith p a in s in the tr u n k o r lim b s th ere a re su re to be som e w hose tro u b le is in fa ct e m o tio n a l. T h e y set u p su sp ic io n by a g a rb le d h isto ry a n d , o n c lincal e x m in a tio n , id en tify them selves a t once by the n u m b e r o f in co n siste n c ie s th a t th e y offer. T h e n e a t p a tte rn th a t the p a tie n t w ith a n o rg a n ic lesio n p re se n ts is replaced by a series o f se lf-c o n tra d ic to ry a lle g atio n s. I t is n o t the a bsence o f p h y sic al signs th a t e n a b le s a c o n fid e n t d iag n o sis o f n e u ro sis to b e m a d e ; it is th e evidence affo rd ed by m u tu a lly in c o n s is te n t findings. T h e system o f diag n o sis o u tlin e d a b o v e c an a lo n e e n su re th a t the re le v a n t facts em erge. T R E A T M E N T P h y s io th e ra p y is larg e ly c o n ce rn ed w ith th e m a in te n ­ a n ce o r r e s to ra tio n o f p a in le ss m o b ility . T h e re a re th ree w ays o f a ch ieving this e ffe c t: 1. E xercises (w e ll-tau g h t to a ll p h y sio th e ra p y stu d e n ts ); 2. D e e p m assa g e; 3. M a n ip u la tio n . D e e p m assage re su lts in a localized m o v em e n t im p a rte d to a tissu e b y th e p h y s io th e ra p is t’s finger. I t ex erts its effect o v e r a sm a ll a re a , a n d is a ll th e m o re effective fo r su c h c o n ­ 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 12 P H Y S I O T H E R A P Y September, 1964 c e n tra tio n ; b u t it h a s n o effect, say, h a lf-a n -in c h aw ay. D e e p m assa g e m o bilizes th e tissu e s o n ly a t th e p o in t o f tre a tm e n t a n d m u s t th e re fo re be a d m in iste re d w ith g re a t a cc u rac y . M a n ip u la tio n a ls o stre tc h e s o r m o v es tissues, b u t like d eep m assage is su ite d to o n ly so m e ty p es o f d iso rd e r. M o re o v e r, p ro p e r u n d e rs ta n d in g o f th e n a tu r e a n d p o s itio n o f th e lesio n a lo n e e n a b le s th e p h y sio th e rp ist to v a ry her m a n ip u la tiv e te c h n iq u e t o su it se p a ra te d iso rd e rs a n d p a tie n ts w ith differe n t degrees o f sensitiveness. T h e e m p lo y m e n t o f th ese m a n u a l te c h n iq u e s b rin g s a n u m b e r o f c o m m o n lesio n s, h ith e rto in tra c ta b le , w ith in th e sc o p e o f p h y sio th e ra p y . I t c a rrie s th e a d d e d a d v a n ta g e th a t th e situ a tio n n o lo n g e r p e rsists w h e reb y th e p a tie n t, a fte r m o n th s o f v ain p h y sio th e ra p y , finds re lie f a t th e h a n d s o f a la y m a n ip u la to r. T h is is a rid ic u lo u s s it u a tio n ; a n y p a tie n t c u ra b le by m a n ip u la tio n sh o u ld n e v er h a v e b e e n forced to go o u tsid e o u r tw o p ro fe s sio n s, b u t sh o u ld h ave received th is tre a tm e n t w ith in th e m ed ic al s p h e re as a m a tte r o f co u rse . P ro p e r d ia g n o s is follow ed b y p ro m p t a n d effective tre a tm e n t a lso a v o id s th e a lte rn a tiv e evil o f en d less lay m a n ip u la tio n in p a tie n ts w ho c a n n o t be benefited b y this m eans. E N V O Y A c c u ra te m a n u a l te c h n iq u es, b a se d on a n e x ac t d iag n o sis, h a v e b een th e th e m e o f M iss H ic k lin g ’s lec tu re s to y o u d u rin g th e s p rin g o f th is y e ar. I h o p e th a t y o u will a p p re c ia te a n d re m e m b e r h e r te a c h in g a n d e m p lo y o u r m e th o d s w ith th e p re c isio n th a t th ey deserve, ta k in g e q u a l tr o u b le o v e r the d iag n o sis as w ith th e m a n u a l te c h n iq u e , a n d a v o id in g th ese m e th o d s in u n s u ita b le cases as a ssid u o u sly as y ou will e m p lo y th e m in th e r ig h t case. I n th is w ay, a h ig h e r sta n d a rd o f p h y sio th e ra p y w ill b e e stab lish e d in S o u th A fric a th a n e x ists in a ny o th e r c o u n try in th e w orld to d a y , a nd m a n y p a tie n ts w h o , ye sterd a y , co u ld n o t b e helped w ill be afforded re lief to d a y b y p re c ise m a n u a l m ea su re s. G E N F IR S T N O N -E U R O P E A N P H Y S IO T H E R A P Y S C H O O L O n 4 th M a y , 1964, h isto ry w as m a d e in D u r b a n w hen th e first n o n -E u ro p e a n p h y sio th e ra p y sc h o o l w as o pened. T h e S c h o o l is a tta c h e d to th e K in g E d w a rd V III H o s p ita l. I t w as d e cided to c o m m e n ce w ith 12 stu d e n ts , six m ale a n d six fem ale. T h e re w as c o n sid e ra b le c o m p e titio n fo r th e a v a il­ a b le places. A g o o d p a ss in th e m a tric u la tio n e x a m in a tio n w ith a high s ta n d a rd in M a th e m a tic s a n d E n g lish w as re q u ire d . T h e c o u rse is o f th re e y e a r s ’ d u ra tio n a n d th e stu d e n ts w ill stu d y fo r th e N a tio n a l D ip lo m a in P h y s io th e ra p y o f th e D e p a rtm e n t o f E d u c a tio n , A rts a n d Science. T h e sc h o o l is in c h arg e o f D r. A le x a n d e r a n d D r . B. V. S ch u lze a n d M iss G . H . Jo n e s, M .C .S .P . w ill b e th e P rin c ip a l. She w as vice­ p rin c ip a l o f th e M id d lesex H o s p ita l, L o n d o n , P h y sio ­ th e ra p y S c h o o l f o r th e p a s t 10 y e ars. M iss H e a th e r G o d fre y w ill a ssist w ith th e teaching. T h e official o p e n in g b y M r. E. C. W ilks, M .E .C . w as on 23rd Ju n e , a n d w as a tte n d e d by m e m b e rs o f th e N a ta l P ro v in c ia l C o u n c il. T h is p ro je c t h a d b een u n d e r c o n sid e ra tio n fo r a t lea st 12 y e ars a n d it is v ery gra tify in g to see it a c tu a lly in o p e ra tio n a t la st. T h e S o u th A fric a n S o c iety o f P h y s io th e ra p y w ish M iss Jo n e s and h e r S ta ff a nd S tu d e n ts every su ccess in th is g re at p io n e e rin g v e n tu re . A. C. MILLER & CO. ORTHOPAEDIC MECHANICIANS M a n u fa ctu re rs a n d Suppliers of: O R T H O P A E D IC A P P L IA N C E S , A R T I F I C I A L L IM B S , T R U S S E S , S U R G IC A L C O R S E T S , U R IN A L S , A R C H S U P P O R T S , C O L O S T O M Y B E L T S , E L A S T IC S T O C K IN G S , A N K L E G U A R D S , W R IS T G U A R D S , E L B O W G U A R D S , K N E E G U A R D S , L I G H T D U R A L C R U T C H E S F O R C H I L D R E N , W O O D E N C R U T C H E S , A N D M E T A L E L B O W C R U T C H E S . Phone 23-2496 P.O. Box 3412 312 Bree Street, Johannesburg E R A L S.A . F E D E R A T IO N O F B U S IN E S S AN D P R O F E S S I O N A L W O M E N T h e w o m e n m em b e rs o f th e S .A .S .P . have b een invited to b e co m e affiliated to th e S.A . F e d e ra tio n o f B usiness and P ro fe ssio n a l W o m e n — a n h o n o u r w hich y o u r S o c iety has g ra te fu lly a ccepted. C O U N C IL F O R T H E C A R E O F T H E A G E D M r. R o th b e rg , M iss A . S avin a n d M iss E. B o ttin g will re p re se n t th e S .A .S .P . a t th e B i-A n n u a l C o n fe ren c e o f the a b o v e C o u n c il la te r th is year. M iss A n n e S avin has c o n ­ se n ted to s p e a k a t th e A n n u a l G e n e ra l M e e tin g o f the Jo h a n n e s b u rg B ra n c h o n 18th A u g u s t, a t C o tte slo e . S.A . P A R A P L E G IC G A M E S I t w as decided a t a C e n tra l E xec u tiv e m ee tin g held in J u n e to se n d a te a m o f S .A . p a ra p le g ic a th le te s to th e G a m es in T o k y o . A te a m fro m R h o d e sia w ill a c c o m p a n y th e S o u th A frica n s. S om e o f th ese S p rin g b o k s w ere seen in a c tio n at th e W an d e rers, Jo h a n n e s b u rg , on S a tu rd a y , 15th A u g u st. B irth s T o M r. a n d M rs. K le m p (nee M a u re e n P u rv is) a son, R o ry C h a rle s o n 2 0 th M a rc h , 1964. T o M r. a n d M rs. M c K e a n (nee J u d y G ib b s), a son, R o b e r t S ean o n 2 9th F e b ru a ry , 1964. T o M r. a n d M rs. E lm e r C u rry , a se c o n d d a u g h te r, Je n n ife r on 7 th Ju ly , 1964. T o P ro fe ss o r a nd M rs . K . W a tso n , a d a u g h te r in A pril. 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. )