From gymnastics to splints and uterine massage, the history of physiotherapy takes in a surprisingly broad range of people and practices. Mechanotherapy's legacies can be seen in the ‘massage corps’ of the First World War who treated soldiers, as well as the rise of opportunities for women in medicine.
Medical manipulations and the history of physiotherapy
Words by Kay Nias
- In pictures
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From the therapeutic traditions of ancient China, India and Rome to the shamanic healing rituals of the Australian Aboriginals, African tribes and the Polynesians, medical manipulation techniques have been used in a diverse range of medical contexts for thousands of years. For centuries, and all over the world, bonesetters manipulated joints to aid healing.
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In early 19th-century Europe and North America, ‘mechanotherapy’ – which included exercises, manipulations and massage – became fashionable. Swedish gymnasts in particular were renowned worldwide for their expertise. They travelled across Europe opening private clinics for the rich, working in hospitals for the poor, and lobbying governments to improve standards of physical education and military training. British physicians who wanted to learn physical therapy techniques often went to Sweden to train.
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Swedish gymnasts were not the only experts in physical therapies. Bonesetters, rubbers and plaisterers offered treatments for a range of disabilities and complaints, such as stiff joints, sprains, dislocations and fractures. While denouncing such practitioners as ‘quacks’, orthopaedic surgeons in Britain began to assimilate their techniques into their own practice from the 1860s. This image shows the highly esteemed bonesetter Sir Herbert Barker instructing the British Orthopaedic Association on his methods in 1936.
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Massage, manipulation, exercise and splinting were often the only ways the medical profession could treat chronic disability, paralysis and pain. Early physiotherapy departments in Britain were called ‘massage departments’; they flourished in hospitals and were some of the only places that treatment was given to disabled people with low incomes. The image shows a ‘crawling class’, frequently undertaken in hospital massage departments to treat curvature of the spine.
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Mechanotherapy revolutionised fracture treatment. Until the interwar period, fractures were treated via prolonged immobilisation. This allowed bone to heal but often caused painful nerve damage and swelling. Surgeons began to incorporate mobilisation and movement into treatment. The image above shows a patient with a fracture wearing a skintight wrist plaster, enabling him to keep mobile and return to work quickly.
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Uterine massage gained international recognition between 1880 and 1910, and challenged standard medical procedures for issues like prolapses, tilted uterus, and nervous disorders. This extremely intrusive procedure may appear alarming, and was controversial in Britain, but was welcomed by many patients and the medical community as a more humane alternative to operations such as oophorectomy (the removal of an ovary), and clitoridectomy (the removal of the clitoris), which were common procedures at this time.
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Mechanotherapy also provided opportunities for women to get into medicine, as doctors increasingly devolved routine work to nurses and masseuses. The Society of Trained Masseuses was formed by a group of nurses and midwives in 1895 in response to a series of ‘massage scandals’ that threatened the professional and medical status of mechanotherapy.
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An array of exercise and vibration equipment was invented for physiotherapeutic use. The ‘velocipede’ above was one of the devices designed by Dr Gustav Zander to simulate the movements of Swedish gymnastics. By 1900 there were over 100 Zander ‘Medico-mechanical’ Institutes worldwide. Zander’s apparatus won medals at world exhibitions, and Zander was even nominated for the Nobel Prize in 1916.
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In wars before 1914, men injured in battle were discharged after emergency treatment, but the unprecedented scale of World War I meant that rehabilitation became a political and economic necessity. The Society of Trained Masseuses formed a ‘massage corps’ in 1914 and offered treatment to injured servicemen. By the end of the war hundreds of thousands of servicemen had received physiotherapy.
Advertisement reproduced in Jean Barclay, 'In Good Hands: the history of the Chartered Society of Physiotherapy 1894-1994' (Butterworth Heinemann, 1994), p.92..
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On 11 June 1920, the Society of Trained Masseuses was granted the Royal Charter. The Queen became an official patron and the Massage Corps was recognised by the War Office. Mechanotherapy had become firmly integrated into medical practice. In 1944, the society was renamed the Chartered Society of Physiotherapy, and it remains the main representative body for physiotherapists in Britain today. Modern physiotherapy has moved away from manual techniques that marked its beginning, but the legacy of mechanotherapy remains.
About the author
Kay Nias
Kay is currently a Medicine Galleries Research Fellow at the Science Museum. Before that she did a PhD on the history of physiotherapy at the University of Exeter. When not geeking out about history, she loves all things running, meditation and Cornwall.