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The health congress
PUBLIC HEALTH We can be guided by : J 1. Muscle tenderness. Whilst this is present, massage and electricity is dangerous and will cause a set-back. 2. If muscle tenderness is not present, reeducation may be attempted, but must be stopped after one or two contractions if the muscle is tiring, or discontinued pro tern. if the muscle is found weaker the next day. Muscle tenderness is often absent and so pure trial and error must be adopted. 3. Sometimes tenderness is so prolonged that we must disregard it and proceed carefully with re-education. Re-education and not physiotherapy is meant, i.e., active assisted contractions by highly trained helpers rather than massage and electricity.
Treatment in the Ambulatory Period Having decided that a halt in observable recovery has now occurred for three months, the question of ambulation arises. Remember that we are still, however, in the stage of recovery and that just as a too hasty education will do harm so will too hasty ambulation. The use of apparatus may support a paralysed muscle but by its wei.ght drag on the joints above and cause retrogression thereby, or they may, because of effort, interfere with a newly-recovered opposite limb or back. If so, return the patient to bed. On the other hand, at a later stage walking without supports to a particular muscle may throw it back so that it takes months to pick up what it has lost by a patient leaving off the iron for a day. All this shows that very definitely is the stage of recovery still present--the unwarranted measures appear to cause further hypera~mia in the cord, just as when, in an earlier stage, massage is given to tender muscles, and may at this stage even cause spread of paralysis to other neighbouring groups. With these observations in mind, there is little to support the Sister Kenny method of passive movements, and no apparatus. She did, however, get good results in many.cases by individual muscle re-education training, m spite of her discards rather than because of them. Her treatment was of the uplift type, which no doubt is important in a modified form from the first, and can be aggressively used later, and it is probable that many of her old cases had been previously over-immobilised. There has thus perhaps been a tendency to urge ambulation as a means of " brightening up the patient," but I feel that this is a very false aim if no regard is paid to the more important principles of motor recovery. Moreover, as in so many things, disciples are more vociferous than the 246
MAY teacher, and the convert to the Kenny principles has so often used her methods prematurely.
Reeommendations More institutional accommodation and the realisation of how great a part it plays in fostering maximum recovery in the early years of the disease, must be considered essential. To prevent waste of money, time, personnel, and to promote the best interests of the patient, however, the prolonged treatment must be supervised with discretion, knowledge and balance aided by a very knowledgeable band of masseuses and medical gymnasts. I regard this disease as one of the best arguments for long-stay accommodation under ideal conditions, and think that a heavy responsibility is upon us to wheedle as much recovery as possible in this disease, which responds so inadequately to specific therapy.
THE HEALTH CONGRESS The preliminary programme of the Health Congress, which is to be held at Scarborough this year from July 3rd to 8th, has been issued by the Royal Sanitary Institute. The Right Hon. the Earl of Harewood, K.e., C.C.V.O., is the President of the Congress. Among the subjects to be discussed are the following:Reorientation of the Public Health Services. The Problem Child, the Difficult Parent, the Awkward Family. Evacuation Schemes and the Health and SanitaryProblems arising therefrom. Health Visitors and Midwives in relation to Air Raid Precautions. The Cancer Bill, 1938. Modern Methods and Treatment of Cancer. Modern School Design. The Municipal Engineer and Public Health. Practical Methods in Clean Milk Production. Tuberculosis and other Important Diseases of Fowls. The Financial Structure of the National Health Insurance Scheme. Some Aspects of Sick Absence in Industry. The Need of a Broader Conception of Hygiene in Industry. Rural Hygiene in the Tropics. The Sanitary Provisions of the Model Building Byelaws. The Factories Act, 1937. Atmospheric Pollution. Whither National Health Insurance? The Congress is expected to attract a record attendance. Already nearly 800 official delegates have been appointed by Government departments, foreign and dominion governments and municipalities, local authorities, etc., in Great Britain. At the Health Exhibition arranged in connection with the Congress, the exhibits will include foods, sanitary appliances, and various appliances illustrating municipal activities and hygiene in the home.
Treatment in the Ambulatory Period Having decided that a halt in observable recovery has now occurred for three months, the question of ambulation arises. Remember that we are still, however, in the stage of recovery and that just as a too hasty education will do harm so will too hasty ambulation. The use of apparatus may support a paralysed muscle but by its wei.ght drag on the joints above and cause retrogression thereby, or they may, because of effort, interfere with a newly-recovered opposite limb or back. If so, return the patient to bed. On the other hand, at a later stage walking without supports to a particular muscle may throw it back so that it takes months to pick up what it has lost by a patient leaving off the iron for a day. All this shows that very definitely is the stage of recovery still present--the unwarranted measures appear to cause further hypera~mia in the cord, just as when, in an earlier stage, massage is given to tender muscles, and may at this stage even cause spread of paralysis to other neighbouring groups. With these observations in mind, there is little to support the Sister Kenny method of passive movements, and no apparatus. She did, however, get good results in many.cases by individual muscle re-education training, m spite of her discards rather than because of them. Her treatment was of the uplift type, which no doubt is important in a modified form from the first, and can be aggressively used later, and it is probable that many of her old cases had been previously over-immobilised. There has thus perhaps been a tendency to urge ambulation as a means of " brightening up the patient," but I feel that this is a very false aim if no regard is paid to the more important principles of motor recovery. Moreover, as in so many things, disciples are more vociferous than the 246
MAY teacher, and the convert to the Kenny principles has so often used her methods prematurely.
Reeommendations More institutional accommodation and the realisation of how great a part it plays in fostering maximum recovery in the early years of the disease, must be considered essential. To prevent waste of money, time, personnel, and to promote the best interests of the patient, however, the prolonged treatment must be supervised with discretion, knowledge and balance aided by a very knowledgeable band of masseuses and medical gymnasts. I regard this disease as one of the best arguments for long-stay accommodation under ideal conditions, and think that a heavy responsibility is upon us to wheedle as much recovery as possible in this disease, which responds so inadequately to specific therapy.
THE HEALTH CONGRESS The preliminary programme of the Health Congress, which is to be held at Scarborough this year from July 3rd to 8th, has been issued by the Royal Sanitary Institute. The Right Hon. the Earl of Harewood, K.e., C.C.V.O., is the President of the Congress. Among the subjects to be discussed are the following:Reorientation of the Public Health Services. The Problem Child, the Difficult Parent, the Awkward Family. Evacuation Schemes and the Health and SanitaryProblems arising therefrom. Health Visitors and Midwives in relation to Air Raid Precautions. The Cancer Bill, 1938. Modern Methods and Treatment of Cancer. Modern School Design. The Municipal Engineer and Public Health. Practical Methods in Clean Milk Production. Tuberculosis and other Important Diseases of Fowls. The Financial Structure of the National Health Insurance Scheme. Some Aspects of Sick Absence in Industry. The Need of a Broader Conception of Hygiene in Industry. Rural Hygiene in the Tropics. The Sanitary Provisions of the Model Building Byelaws. The Factories Act, 1937. Atmospheric Pollution. Whither National Health Insurance? The Congress is expected to attract a record attendance. Already nearly 800 official delegates have been appointed by Government departments, foreign and dominion governments and municipalities, local authorities, etc., in Great Britain. At the Health Exhibition arranged in connection with the Congress, the exhibits will include foods, sanitary appliances, and various appliances illustrating municipal activities and hygiene in the home.