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Title: Physiotherapy and the shadow of prostitution: The Society of Trained Masseuses and the massage
scandals of 1894
Article Type: Article
Section/Category:
Keywords: physiotherapy; history; massage; discourse; Foucault; profession
Corresponding Author: Mr David Nicholls, MA
Corresponding Author's Institution: Auckland University of Technology
First Author: David A Nicholls, MA
Order of Authors: David A Nicholls, MA; Julianne Cheek, PhD
Manuscript Region of Origin:
Abstract:
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Title: Physiotherapy and the shadow of prostitution: The Society of Trained Masseuses
and the massage scandals of 1894.
Abstract
In 1894 the Society of Trained Masseuses (STM) formed in response to massage
scandals published by the British Medical Journal (BMJ). The Society’s founders acted
to legitimise massage, which had become sullied by its association with prostitution.
This study analyses the discourses that influenced the founders of the Society and
reflects upon the social and political conditions that enabled the STM to emerge and
prosper.
The founders established a clear practice model for massage which effectively regulated
the sensual elements of contact between therapist and patient. Massage practices were
regulated through clearly defined curricula, examinations and the surveillance of the
Society’s members. A biomechanical model of physical rehabilitation was adopted to
enable masseuses to view the body as a machine rather than as a sensual being. Medical
patronage of the Society was courted enabling the Society to prosper amongst
competing organisations.
Using Foucault’s work on power we explore the contingent nature of these events,
seeing the massage scandals in context with broader questions of sexual morality,
professionalisation and expertise in late nineteenth century society. We argue that many
of the technologies developed by the founders resonate with physiotherapy practice
today and enable us to critically analyse the continued relevance of the profession to
contemporary health care.
Manuscript
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Author Keywords: physiotherapy; history; massage; discourse; Foucault; profession
Abstract word count 206 words
Full text word count 7674 words
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Introduction
Little has been written about the history of physiotherapy as a profession, and to date
there have been no critical accounts of the events surrounding the emergence of one
of the largest professional groups in Western healthcare. This is in contrast to the
attention that has been paid to nursing (Gastaldo & Holmes, 1999), medicine
(Armstrong, 1995), dentistry (Nettleton, 1992), psychology (Rose, 1985) and some of
the allied health professions; chiropody (Dagnall & Page, 1992), chiropractic
(Coburn, 1994) and podiatry (Borthwick, 1999).
Physiotherapy began as a profession in 1894, as a response to massage scandals
promulgated by the British Medical Journal. The formation, by four august Victorian
women, of the Society of Trained Masseuses (STM) would lead, eventually, to the
creation of the first and largest profession allied to medicine, and to the formalisation
of physical rehabilitation as a professional discipline.
It is surprising then that so little attention has been paid to the events surrounding the
formation of the Society – particularly given that scholars have pored over the events
of late Victorian England, showing this to have been an exceedingly rich period in the
history of social and political reform. Such events include the advancement of
women’s emancipation, the development of germ theory and sanitary science, social
problems of urban overcrowding, the effects of two foreign wars, and political
questions of sovereignty and government, classical liberalism and legal reform.
The events surrounding the formation of the STM have been detailed twice before, in
J.H. Wicksteed’s (1948) book, ‘The growth of the profession: Being the history of the
Chartered Society of Physiotherapy 1894-1945’, and more substantially in J.
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Barclay’s (1994) book, ‘In good hands: The history of the Chartered Society of
Physiotherapy, 1894-1994’. Both of these texts present excellent accounts of the
events surrounding the formation of the STM, but neither undertakes a critical
analysis of the social and political context that influenced the actions of the Society’s
founders.
One might ask for instance: why was there such concern to professionalise massage
practice at this particular time, when massage had been practised for centuries, in
many different societies and in many different ways? What circumstances conspired
to bring the massage practices of a few disreputable London institutions into the
spotlight and cause such moral outrage? What events allowed the formation of the
STM to be seen as the appropriate response to these scandals? And how did the STM
succeed in becoming the orthodox face of professional massage?
In this paper we attempt to address these questions by undertaking a genealogical
analysis of the documentary evidence pertaining to the period. We have attempted to
unravel some of the discourses that influenced the actions of the Society’s founders,
and present our analysis in a social and political context. We are not attempting here
to analyse physiotherapy practice, but rather the formation of the Society that sought
to regulate the work of its members and, in doing so, colonise the notion of what it
means to offer legitimate massage practice.
This paper has two principal goals: to present a genealogical analysis of the
discourses surrounding the massage scandals of 1894, and to write of these events in
such a way that they have relevance for the contemporary and future histories of
physiotherapy practice. As Foucault would put it, we aim to construct a history of the
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present.
Methodological approach
This paper represents part of a larger genealogical study into the emergence of new
forms of physiotherapy practice. A genealogical approach to Foucauldian discourse
analysis has been taken, in order to explore those facets of physiotherapy, as a human
science, that are ‘inextricably associated with particular technologies of power
embodied in social practices’ (Smart, 1985, p. 48). Genealogical studies provide a
framework through which we can explore ‘the history of morals, ideals, and
metaphysical concepts, the history of the concept of liberty or of the ascetic life, as
they stand for the emergence of different interpretations, they must be made to appear
as events on the stage of the historical process’. (Foucault, 1977, p. 152). From this,
the historical events that led to the formation of the Society of Trained Masseuses can
be seen as a ‘a cobbled patchwork of heterogeneous elements’ (Ransom, 1997, p. 88),
rather than a set of self-evident truths that expose the ‘essential’ basis of
physiotherapy practice.
Texts were generated for the study from primary and secondary sources: primarily
from the archives of the Chartered Society of Physiotherapy held by the Wellcome
Institute library in London. These texts included business reports, correspondence,
curriculum documents, minutes of meetings, newspaper reports, photographs and
promotional materials. Textual material, from 1894 to the outbreak of war in 1914,
was sourced for analytical interrogation. Secondary sources focused on historical
accounts of the emergence of the Society of Trained Masseuses (Barclay, 1994;
Grafton, 1934; Wicksteed, 1948).
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Data were critically analysed in the context of other political, social and historical
writing of the period. This reading focused largely upon the extensive literature
surrounding Victorian sexual morality – since it is this that exercised the minds of the
founders so profoundly.
A Foucauldian approach to data analysis was undertaken, utilising a combination of
approaches, that is, drawing directly from Foucault (1980, 1981) whilst also drawing
on strategies developed by Hook (2001) and Ransom (1997). These approaches to
discourse analysis reveal and trouble the nature of power. They explore the
‘domination, subjugation, the relationships of force’ (Davidson, 1986, p. 225) extant
within society. These forces operating in history ‘are not controlled by destiny or
regulative mechanisms, but respond to haphazard conflicts’ (Foucault, 1977, p. 155).
It is the desire to manipulate and control these errant forces that constitutes the action
of governments, working through various refined agencies to achieve political ends
(Dean, 1999). One such technology is the professionalisation of expertise through
which conditions of possibility are exercised. Organised professional expertise
engages in the definition, creation, modification, constraint and liberation of
discourses, through their ability to influence what can be said and what can not, what
is normalised and what is marginalised.
In undertaking a genealogical analysis of the data, rather than trying to produce a
definitive account of events, we have attempted to expose the sometimes hidden,
ubiquitous and multi-dimensional operations of power by constructing subjectivities
and material practices around the notions of morality, expertise and professionalism in
the emergence of physiotherapy.
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Instead of applying our analytical lens to a narrow set of circumstances, we have tried
to map the extra-discursive subjectivities, objects, strategies and regimes, so as to
trace the outline of discursive formations acting upon the Society and its founders.
For this reason, it would be fair to criticise the paper for ranging too far across a wide
body of textual material; however, our intention was to explore ways in which the
materiality of discourses are enfolded into social, political and historical realities,
rather than to present a detailed hermeneutic interpretative analysis of all the textual
elements (Ransom, 1997).
The conditions of possibility that allowed for the formation of the Society of
Trained Masseuses
There are many accounts of late Victorian political, social, governmental and
economic life, and in recent years this period has received extensive critical analysis.
Most notable are the texts which have considered the role of mass migration from
country to city, the rise of a new class of urban poor, the legislative shift to
governmental surveillance, the refinement of liberalism as a political and economic
strategy, the development of public health (especially urban sanitation), the impact of
the industrial revolution, the impact of war overseas and the pursuit of colonialism
(Harrison, 1990).
By the close of the nineteenth century, colonial governments wrestled with the
enormous complexity of rule across diverse sectors of the population, and in some
cases many miles from their own shores. The late nineteenth century is notable for
the sophistication of widespread governmental technologies that sought to ensure the
effective exercise of classical liberalism (Rose, 1993). Most notable amongst these
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rationalities of government were those committed to the ‘growth of mechanisms of
power in relation to the ability to observe, measure and subsequently to ‘know’ the
details of a population’ (Galvin, 2002). This conjunction of technologies of the body
with matrices of social institutions and bio-politics concerned itself with the
population ‘in which issues of individual sexual and reproductive conduct
interconnected with issues of national policy and power’ (Gordon, 1991, p. 5).
Governmental concerns to ensure the health, wealth and happiness of the population,
which had been at the heart of earlier rationalities of rule, now grappled with the
problem of maintaining positive knowledges of the population whilst reinforcing
people’s freedoms. Social welfare developed as an important vehicle for societal
reform, and materialised in particular forms of philanthropic, moralistic and
disciplinary regimes (Rose, 1996, p. 49). But the desire of governments to remove
themselves from direct control over the conduct of individual citizens and social
groupings enabled the emergence of professional organisations which acted as
intermediaries between the citizens and their government.
Professions acquired powerful capacities to generate ‘enclosures’ (Rose, 1996, p. 50)
which enabled them to implement disciplinary technologies, often with considerable
freedom of expression, whilst maintaining a governmental rationality of rule. The
individual and family were ‘simultaneously assigned their social duties, accorded
their rights, assured of their natural capacities, and educated in the fact that they need
to be educated by experts in order to responsibly assume their freedom’ (Rose, 1996,
p. 49).
Thus the latter half of the nineteenth century saw the widespread development of new
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professional groupings, each with their own intimate relationship with government,
and each problematising a section of the population. One such example is that of
public health, which developed as a discrete governmentality during the latter half of
the nineteenth century, as new professional roles became established (Brimblecombe,
2003). Public health exercised the attention of Victorian governments, partly from a
concern for the welfare of the slum-dwelling population, but also because ‘disease
was a public issue in so far as it affected public finances, particularly with regard to
the running of the Poor Law; but also because of the recognition that sectors of towns
infected by disease and squalor could have effects on more salubrious areas’
(Osborne, 1996, p. 106).
At the centre of the Victorian imagination about public health lay the subjectification
of women. Women occupied a number of diverse, often conflicting, subject positions
during this period, some of which will be outlined here, although there is no space to
enter into a wide-ranging discussion of the roles played by women in late Victorian
England. For more detailed analyses see Bland (2001) and Vicinus (1977). This paper
addresses only those issues directly relevant to the formation of the Society of Trained
Masseuses.
Between 1850 and 1900 there was a dramatic shift in the number and nature of
professional roles for women. While these occupations were often poorly paid, they
provided new opportunities for educated middle- and upper-class women. Key to this
shift was the growing acceptance of professional roles as a morally acceptable
alternative to the philanthropy of the leisure classes, which was also a feature of
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Victorian social reform (Vicinus, 1985). However, the increasing ‘freedoms’
achieved by women entering new professional roles like nursing and midwifery came
with a raft of regulatory strictures, which ensured that such roles were conducted in
the best interests of governmental reform.
One of the most significant discourses to impact upon the burgeoning profession of
nursing was that of women’s sexuality. Victorian society was distinctly ambivalent
about the relevance, function and potency of women’s sexuality. Women were at one
moment unable to experience passion, and at the next, weak-willed, impressionable
and hysterical (Trudgill, 1976). Women were the givers of life and the cause of
sexually transmitted diseases in men – ‘Behind the veneer of the dominant nineteenth-
century ideal woman – the domestic ‘angel in the house’ – lurked the earlier
representation of sexualized femininity: the Magdalene behind the Madonna’ (Bland,
2001, p. 58).
Rarely, throughout modern history, has there been such a concerted attempt to refine
rationalities of sexuality around a population. Foucault and Nietzsche both
considered this an intensely productive period in the history of sexual morality
(Foucault, 1979; Nietzsche, 1989). A great number of these rationalities revolved
around women’s sexuality. The confluence of an orthodox Christian morality with
the economic necessity of a healthy, morally pliable population and increased
domestic productivity; the increasing scientisation of women’s sexuality, and a
concern for the effective management of a diverse population of urban poor all
contributed to the progressive development of a range of technologies around the
sexual conduct of women.
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Women found themselves at the epicentre of these technologies because of the
construction of their sexuality. Women give birth to children, and so a matrix of
technologies was established to maximise the health and wellbeing of the child and
the mother (including the emergence of professional midwives who would monitor
and survey maternal and fetal health). It was then necessary to refine technologies
around the nurturing of children, and so homecare rituals (how to dress, eat, drink,
write, talk, etc.) were reinforced by a newly regulated professional class of women
school teachers. The same can be seen in the emergence of nursing as a vehicle for
the surveillance of a discrete body of the population, as part of the progressive
refinement of operations of government (Wainwright, 2003).
But our analysis focuses on the actions of a small number of educated late Victorian
women who occupied the middle- and upper-classes that would become so influential
in pioneering professionalism allied to medicine. They would have been used to the
commonplace constraints on women’s movements. However, it is in the nature of
these strictures - both metaphorical and physical - that we can explore the dynamic
interplay of material forces that helped to create a sense of alarm with the publication
of ‘Astounding Revelations Concerning Supposed Massage Houses or Pandemoniums
of Vice...’ by the British Medical Journal in 1894. This article would provide the
catalyst for the conditions necessary to enable the birth of the Society of Trained
Masseuses.
The massage scandals of 1894
During the 1880s massage was undergoing something of a revival, as Swedish
medical gymnasts and masseurs migrated to England. But in the absence of
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formalised training institutions, massage education was frequently provided on an ad
hoc basis by midwife/nurse masseuses, trained Swedish masseurs and interested
medical men. Prior to the formation of the STM, a diverse array of variously trained
masseuses and masseurs were practising throughout the country. Programmes of
instruction varied, from a few hours to full-scale apprenticeships. Salaries and
working conditions also varied widely across the country and, by 1894, massage had
become so popular as a vocation, it was largely felt that the market for masseurs,
particularly in large urban centres like London, was completely overstocked (British
Medical Journal, 1894b).
In the summer of 1894, the British Medical Journal published an editorial titled
‘Immoral “massage” establishments’ (British Medical Journal, 1894b, p. 88). This
report led to widespread interest in the national press, and later that year drew
comment in the House of Commons from the Home Secretary. The BMJ editorial of
July 14th 1894 was couched in language of moral outrage, claiming that ‘a good many
“massage shops,” ... are very little more than houses of accommodation’. The editorial
spoke of the ease with which women and men were working in the field, and others
utilising the services of massage, as a euphemism for prostitution.
Prostitution in Victorian London was rampant. Victorian society was so ambivalent
about prostitution that some authors argued that ‘the conditions of society itself meant
that for both working and upper classes it was inevitable’ (Trollope, 1994, p. 165).
For women, it was rarely the case that they were lured into vice; more often, they
were tempted by the ease with which prostitutes earned money, gained independence
and relieved themselves of their ‘purdah’. For the most men, prostitution was a
predictable outlet for ‘natural desires’ (women were not considered to possess such
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desires). Men would often have to spend ten to fifteen years accumulating sufficient
wealth before they could marry. Once married, the absence of acceptable forms of
contraception meant that their wives were either pregnant, recovering from
pregnancy, or subject to a moral imagination that projected them as ‘moral angels at
home’ (Trollope, 1994, p. 165). Many young men would have no morally or legally
sanctioned bed to go to.
But for many Victorians prostitution was abhorrent. Organised resistance came from
the church, but in the latter years of the nineteenth century a new form moral
discourse emerged – that of medicine. Disease was endemic amongst prostitutes.
Gonorrhoea, chancroid and, worst of all, syphilis were widespread. Their impact on
the young men of Victorian society was devastating – ‘by 1864 one out of every three
sick soldiers in the army was diseased’ (Trollope, 1994, p. 168). Its effects were felt
throughout society, at a time when Britain was aggressively pursuing its military
conquests, fighting insurgence in the colonies and driving industry in its cities and
towns. The country needed a strong, capable workforce, while syphilis brought
shame, weakness and deceit. And the shame was not merely personal, but was felt at
a national level when the country felt at its most vulnerable. ‘In these dens of infamy
the worst passions of a man or a woman are excited by treatment they are pleased to
call massage…We had thought that Christian England – especially the more
aristocratic portion of it – could have given better illustration of her much-vaunted
modesty for wicked France to peep at’ (British Medical Journal, 1894a).
Massage held a potential for the pursuit of sensual pleasure amongst the population
(Coveney & Bunton, 2003) aside from (or maybe because of) its association with
prostitution. For many Victorians, unused to intimate physical contact, massage must
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have been a highly sensual experience. Possibly as a result, massage was believed to
have profound effects on the body. These effects could be harnessed to heal a diverse
array of clinical conditions including curvatures of the spine, an array of nervous
complaints and neurological pathologies, infectious diseases, cardiovascular,
rheumatologic and skin disorders. But the sensual aspects of massage could not be
denied and, as Victorian England grappled with the need to regulate against sins of
the flesh, the power of massage became an obvious target for its regulation.
However, massage services were widely known to be a euphemism for prostitution,
and massage could not rid itself of the association with licentiousness. Men and
women advertised their services in the popular press in language that made it
impossible to distinguish between the legitimate and the clandestine. One would not
know with any certainty what ‘kind’ of massage was being offered or, indeed,
requested. The British Medical Journal reported that ‘there are only six out of the
many advertised … massage dens which can be counted as creditable’ (British
Medical Journal, 1894a, p. 6)
Massage provided a link to medicine, which, buoyed by the discoveries of ‘germ
theory’, felt able to make progressively more influential social commentary. Society
was becoming aware of the body not as passive in relation to nature, but as a mobile
vehicle for the transmission of disease (Armstrong, 2002), a point highlighted by the
belief that women – now more mobile – were the conduits for sexually transmitted
diseases. Women’s mobility was a challenge that needed restraint. The emergence of
refined disciplinary technologies of classical liberalism – particularly the
professionalisation of expertise, proved a useful vehicle for achieving this operation.
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Consequently, after publishing its concerns about the scandal of massage, the British
Medical Journal recommended that ‘…an association should be formed for those who
have gone through a proper course of instruction in massage and obtained certificates
of proficiency’ (British Medical Journal, 1894b, p.88). Within six months the Society
of Trained Masseuses was founded by four London-based nurse/midwife masseuses,
concerned with the public’s perception of their work, who sought to ‘make massage a
safe, clean and honourable profession, and it shall be a profession for British
women’(Grafton, 1934).
The Society’s response to the scandals
The actions of the Society’s founders cannot be seen as a necessarily obvious, logical
or inevitable response to the social and political climate of the time, but rather as
contingent upon their interpretation of a series of interwoven events. The four
principle founders, Miss (Mary) Rosalind Paget (who by now had ceased practice to
concentrate on her pioneering work with the Society of Therapeutic Masseuses and
gaining registration for midwives – a feat achieved in 1902), Miss Lucy Robinson,
Miss Annie Manley (the only non-midwife) and Mrs Margaret Palmer established the
Society in a formal meeting in December of 1894. At subsequent meetings they
courted medical opinion, established examinations, and developed a curriculum and a
professional code of conduct.
The founders’ first concern was to regulate the education, training, registration and
practice of masseuses, through the formation of a Society. The founding rules of the
society stated that no massage was to be undertaken except under medical direction,
and no general massage for men was to be undertaken; but exceptions may be made
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for urgent and nursing cases at a doctor’s special request. There was to be no
advertising in any but strictly medical papers (Barclay, 1994).
These rules were reinforced by a code of conduct which guided the masseuses to dress
plainly, avoid gossip about patients, refuse offers of stimulants at the houses of their
patients, avoid recommending drugs (and thus invading the terrain of medicine) and
charge fees in accordance with professional rules.
The society, in turn, set up a training curriculum, paying particular attention to
examinations (Rosalind Paget (later Dame), whilst practising little massage herself,
remained Chair and Director of Examinations for 20 years (Barclay, 1994). Students
were examined on practical subjects and rudimentary anatomy, but also on questions
of proper practice. The written examination on massage contained a ‘professional
practice’ question for over 20 years, until the Society had effectively established a
monopoly on authentic and legitimate massage practice. Such professional practice
questions included: ‘How may the personal habits of the masseuse be responsible for
success or failure in her profession?’ (Incorporated Society of Trained Masseuses,
1911b) and: ‘As a member of an honourable profession what do you consider to be
your duties and obligations to that profession and to your fellow members?’
(Incorporated Society of Trained Masseuses, 1914).
By discouraging contact between masseuses and male clients (unless in exceptional
circumstances), and by refusing to register male masseurs, the Society went a long
way to reassuring the medical establishment of its propriety. But these gestures were
nothing compared to the strenuous efforts of the founders to court medical patronage.
It was recognised early on that the Society would not survive without the support of
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the British medical establishment since, with the advent of germ theory and the
development of asepsis, medicine had become the principal voice in the political and
social campaign to rid the population of illness and disease. The founders were active
in garnering support from high profile doctors, including Surgeon-General Sir Alfred
Keogh, Robert Knox M.D., James Little M.D., Sir Frederick Treves (Sergeant-
Surgeon to H.M. the King) and the retired Past President of the Royal College of
Physicians, Sir Samuel Wilks. In fact, so successful were the founders in courting
medical patronage that they were soon able to list 79 ‘members of the medical
profession who had signified their approval of the aims and principles of the newly
‘Incorporated’ Society of Trained Masseuses within a Society prospectus
(Incorporated Society of Trained Masseuses, 1912).
And yet, the association between massage and medicine was more than simply
convivial. In developing its association with the medical fraternity, the Society
adopted possibly the most profound technology in their battle for authenticity and
respectability – that of the biomechanical basis of health and illness.
Biomechanical approaches to health and illness were nothing new. Physical
rehabilitation had been a feature of medicine and healing practices for centuries. In
England, any number of Swedish movement practitioners, bone setters and
orthopaedic surgeons were practising. But the biomechanical basis of illness had
never found such a useful purpose as in the fight for moral respectability.
The adoption of a physical rehabilitation model of practice served a number of highly
significant functions for the Society’s founders. It provided them with a vehicle to
interact with their patients without any suggestion of impropriety. The therapist was
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no longer concerned with the person as a sensual, aesthetic being, more as a collection
of mechanically orientated units. The therapist was now free to touch the patient with
impunity – under the umbrella of medico-scientific respectability. The physical
rehabilitation model brought the practice of massage in line with medicine and
allowed the Society to be carried along by a much more buoyant, organised medical
orthodoxy, from which it could borrow organisational systems and learn how to
maintain ‘appropriate’ relationships of objectivity and distance from patients. And, as
a pleasant side-effect, it gave Society members reflected respectability in the eyes of
the public.
It was from medicine that the Society’s members learnt to pay attention to the
microscopic technologies of biomechanical assessment that would convey the right
message to patients about the therapy that they were receiving. A curriculum
developed which focused upon the correct ‘attitude’ of the therapist towards
assessment. In the curriculum paper of 1911 on Swedish Remedial Exercises, the
‘gymnast’ was taught ‘How a joint or parts near a joint are examined by a Doctor’.
The notes go on to say that the ‘Gymnast must be able to do it in order to treat
intelligently, but is generally given history and diagnosis by doctor. In that case must
be careful not to ask too many questions’ (Incorporated Society of Trained
Masseuses, 1911a, p. 13).
Therapists were taught to conduct themselves in a particular way. They would dress in
uniform – reflecting elements of the physical cleanliness learnt from medicine’s
advances with germ theory, the moral cleanliness of religious orders and the domestic
attire of the middle-class housekeeper. They were encouraged to practise only during
daytime hours and, in time, to organise their clinic spaces within the grounds of
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hospitals. Their clinic rooms would be free from adornment and should convey a
message of sterility, objectivity and detachment. Each of these steps, though
innocently considered, represented a further refinement of the moral crusade to rid
massage of its seedy connotations.
Many of these refinements came in at the start of the new century but, in their
professional infancy, the nurse/midwife masseuses had been primarily employed in
the care of women in their own homes. These women, by definition, could afford to
employ a private therapist, and they were in all likelihood of a similar social standing
to their therapists. The therapist came to represent a model of respectability that
enhanced the desirability of massage as a professional career for young women. One
small but significant benefit to being a masseuse lay in the freedom it gave to do good
work.
Massage provided … fresh possibilities’ both for young women and, unlike physical
education, for those of more mature years. Being an old-fashioned rubber (a
colloquial term for an early masseuse) carried little kudos but training in anatomy and
physiology, working with the medical profession and treating women of good social
standing were much more appealing to the ‘new women’ of the age. (Barclay, 1994,
p. 18).
The liberation from redundancy for educated middle class women was not the least of
the benefits. Through the 1880s and 90s women’s fashions had become increasingly
restrictive:
That a woman should be prepared to be suffer in order to be beautiful is not
incomprehensible; but that she should put up with semi-strangulation of her vital
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organs in order to be fashionable would be past belief were it not demonstrable in the
history of more than one century (and even in pre-history: witness the wasp waists of
the Minoan period). To attain their seventeen-inch waists, the young ladies of the
’eighties and ’nineties submitted to a process of corseting so severe that it required the
assistance of another hand, stronger and more relentless than their own, to pull the
laces tight enough. … But many young women did irreparable harm to their health.
(Bott & Clephane, 1932, p. 192)
Corseting was justified on medical grounds as an excellent mode of support; however,
it carried a much more significant moral message: ‘The unrestricted body came to be
regarded in this period as symbolic of moral license; the loose body reflected loose
morals’ (Turner, 1996, p. 191). As with much Victorian morality, the corset
represented a paradox – enhancing an image of female beauty whilst visibly denying
the woman’s fertility (Kunzle, 2004). Apart from its effects upon the woman’s
internal organs – causing in some women a severe form of liver disease from
compression by the lower ribs, it caused immense pressure in the pelvis which
affected menstrual flow in puberty, uterine compression, and foetal damage. ‘In short,
the corset reduced the fertility of middle-class women by comparison with working-
class women who were less constrained by corsets. … Middle class men
(consequently) found an outlet for desire among working-class prostitutes’ (Turner,
1996, p. 191).
Of the less well reported clinical conditions associated with middle-class women of
the time, neurasthenia was unquestionably linked to their physical and metaphorical
constraint. First described by American neurologist George Beard in 1869, it existed
as a discrete diagnosis until it came into the domain of psychiatrists in the early part
21
of the twentieth century and mutated into neurosis. Neurasthenia was a condition
without an underlying cause that catered for a diverse array of symptoms of
‘sympathetic’ origin: malaise, nervous depression with functional disturbance,
headaches, unrefreshing sleep, scattered analgesia, morbid heats, and cold extremities,
dyspepsia and gastric atony (Gijswijt-Hofstra & Porter, 2001; Neve, 2001; Sicherman,
1977). In fact, neurasthenia presented a perfect medical diagnosis for women made ill
through corseting, lack of physical exercise and a dire need for liberation from mental
drudgery (Gijswijt-Hofstra & Porter, 2001).
The founders of the Society were ideally positioned to understand the needs of these
women because so many of the members were educated middle-class women of
similar social upbringing. Not surprisingly it was in this area that the Society
members first established a niche. Early Society curricula placed a great emphasis
upon the Weir Mitchell method – a range of techniques specifically designed to
provide a rest/work cure for neurasthenic patients.
The Weir Mitchell method was developed by one of America’s most eminent
neurologists - Dr. Silas Weir Mitchell (1829-1914). Weir Mitchell’s work, ‘Fat and
blood, and how to make them’ (Weir Mitchell, 1877), proved a powerful influence on
the Society founders’ early curricula. The mainstay of his approach focused on
returning the exhausted patient to full active health. The rest-cure method lasted for
between 8 and 12 weeks and involved a ritualised regime of confinement and
enforced rest, excessive feeding with milk and beef juices, regular massage and
occasional electricity to replace the need for exercise outdoors.
Society members were the ideal candidates to administer these treatments because
22
they were all women trained in massage with general nursing experience and so could
provide personal care to women confined for extended periods in their own bedrooms.
They were also women of similar age and social standing, and so could take over the
woman’s household duties whilst projecting a model of efficiency and organisation.
The therapist was taught to be firm with her patient – who was not allowed to rise
from bed other than for brief trips to the toilet. The patient was not allowed to deviate
from the prescribed programme, receive letters, read the paper or engage in
conversation during the course of her treatment.
The various responses of the founders to the massage scandals of 1894 illustrate an
array of more-or-less collective intelligences around the construction of authentic,
respectable practice in massage at the turn of the century. Many of the strategies
employed by the founders were not designed from a conscious will to ritualise their
practice, patronise medicine or influence the burgeoning independence of women, but
these were its material effects. By exploring the material practices of the founders it
is possible to glimpse the productive capacity of technologies of power to create
subject positions for the Society members that remain in a constant state of flux. The
founders’ actions may be seen as contingent upon the desire to offer a respectable
solution to the problem of massage and its connotations with inappropriate sexual
contact. In doing so, they created networks of meaning that resonate with practice
today.
Discussion
In this paper we have constructed a genealogical analysis of the events surrounding
the formation of the Society of Trained Masseuses. Central to this argument is
23
Foucault’s interpretation of the constructive capacity of power. Foucault encourages
us to ask not who has or does not have power, or who is the author of power or
subject to its influence, but rather how has power installed itself and created the
conditions of possibility that allow for real material effects to occur. ‘Power is nothing
more and nothing less than the multiplicity of force relations extant within the social
body’ (McHoul & Grace, 1993, p. 84).
We argue here that power was a creative influence in the formation and
transformation of the STM; the productive nature of power enabled biomedical, or,
more specifically, biomechanical discourses to emerge as a way for the founders to
attain social respectability for themselves and their work.
In privileging one set of discourses, other discourses, particularly those relating to
aesthetics, pleasure and sensuality, were marginalised. This can be seen in the micro-
technologies implemented by the founders to intervene and control the actions of
massage graduates and qualified members of the society (Dew & Kirkman, 2002).
Fundamental to the operation of power in society is its relationship with the regulation
of bodies, social institutions and politics (or more succinctly ‘biopower’). Here, the
development of registers and archives, methods of observation, techniques of
registration, procedures for investigation and apparatuses of control become essential
techniques in the operation of power (Hacking, 1981, p. 22).
Power becomes widely dispersed and quickly incorporates a wide array of mentalities.
It takes on the form of a capillary network of influence that both constructs and is
constructed by the actions of the various agents. Hence Foucault’s belief that power
relations are never a completed work, but always remain incomplete – constantly
24
responding to the changing subject and object positions adopted by individuals
(Peterson & Bunton, 1997).
It is our contention that physiotherapists adopted a biomechanical model of reasoning
that was simply one discursive construction amongst many – and while it may have
been a highly influential model, it was neither static nor immutable. It was clearly
influenced by questions of morality, bodily discipline, discourses of sexuality and
proper conduct. The actions of the founders also came at a time when new
professional discourses were being explored, with new surfaces upon which to
inscribe societal values.
Biomechanical discourses gave physiotherapists licence to touch patients, massage
and manipulate them, interact with them and treat them, whilst at the same time
addressing the vexed questions of legitimacy. They gave Society members a status
that allowed them to marginalise other competing organisations, such as the Harley
Institute which could not gain the necessary medical respectability (Chartered Society
of Physiotherapy, 1894-1912). They also provided a framework around which further
advances in physiotherapy could be assimilated. Electrotherapy, Swedish movement,
hydrotherapy, manipulative therapies, respiratory and later neurological therapies all
maintained a strong association with the biomechanical rationalities of human form
and function.
Clearly, the adoption of a biomechanical discourse was highly significant for
physiotherapists. One only has to look at the massage and movement texts utilised by
physiotherapy schools between 1915 and 1955 to see the way in which
physiotherapists utilised biomechanical discourses as disciplinary technologies. Most
25
of the texts pay meticulous attention to starting positions and detailed specifications of
movements, with a requirement to know the anatomical surface and deep anatomy,
kinesiology and biomechanics, supplemented by a growing attention to pathology.
Biomechanical discourses provided a basis to the profession and provided
physiotherapists with the ability to legitimise authentic practice.
Rather than seeing, as do some authors, the adoption of biomechanical discourses as
evidence that physiotherapy ‘sold its soul’ to medicine (Katavich, 1996), it would be
more useful to consider the formation of the Society as an active engagement with a
specific network of force relations. These relations combined to reveal the capillary
nature of power and its productive capacity to provide an authentic solution to the
questions of morality, professionalism and expertise in the delivery of massage and
movement therapies.
These dynamic, inter-connected, microscopic interests of power reveal a history of
physiotherapy that is somewhat more vibrant than has been presented before. In
dealing with social, political and economic questions of morality, bodily discipline,
and discourses of sexuality and proper conduct, the Society forged a professional
body that would successfully navigate a diverse array of power effects. In doing so,
the profession created new discourses – in this case ways of viewing the body and
interacting with it – that would come to represent orthodox practice in the field of
massage and manipulation.
Analysing the relevance of historical events to physiotherapy as a profession has not
been an esoteric exercise; it has important connotations for the way in which we
interpret the political, social, economic, governmental and practical milieu in which
26
we function as a profession today and in the future. Physiotherapists’ claims to truth
are no more stable or reliable than those of other professional groups, and the ability
to remain a respected health care professional depends, to some extent, on our ability
to understand that no professional orthodoxy has a monopoly on the truth.
Physiotherapy is enmeshed within a dynamic network of truth effects that are always
motivated by political ends. Whether this is a conscious process or not depends on
our ability to recognise the contingent nature of our decisions; and Foucauldian
discourse analysis provides a useful critical framework within which to develop this
consciousness.
Conclusion
In discussing the events surrounding the massage scandals of 1894 we have attempted
to offer a new perspective on the emergence of one of the largest professional groups
within western healthcare. Examination of the events leading up to the formation of
the Society of Trained Masseuses reveal the contingent nature of power relations at
work in the discursive construction of a profession as a profession.
Any analysis of events will be a partial account. No historical construction can be
absolute, and this paper does not set out to reveal the historical origins, or
philosophical essence of physiotherapy. Instead we have tried to provide an
alternative to the rather two-dimensional, transcendental histories of the STM that
currently exist by asking how the emergence of the profession of physiotherapy
became historically possible, what were the historical conditions of its existence, and
what relevance does this hold for physiotherapy practice today.
27
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