ArticlePDF Available

Physiotherapy and the shadow of prostitution: The Society of Trained Masseuses and the massage scandals of 1894



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 the 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 healthcare.
Elsevier Editorial System(tm) for Social Science & Medicine
Manuscript Draft
Manuscript Number:
Title: Physiotherapy and the shadow of prostitution: The Society of Trained Masseuses and the massage
scandals of 1894
Article Type: Article
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:
Title: Physiotherapy and the shadow of prostitution: The Society of Trained Masseuses
and the massage scandals of 1894.
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
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.
Author Keywords: physiotherapy; history; massage; discourse; Foucault; profession
Abstract word count 206 words
Full text word count 7674 words
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.
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
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
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).
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.
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
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
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
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
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.
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
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
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
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
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.
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
Armstrong, D. (1995). The rise of surveillance medicine. Sociology of Health and
Illness, 17(3), 393-404.
Armstrong, D. (2002). A new history of identity. London: Palgrave Macmillan.
Barclay, J. (1994). In good hands: The history of the Chartered Society of
Physiotherapy 1894-1994. Oxford: Butterworth Heinemann.
Bland, L. (2001). Women defined. In L. Bland (Ed.), Banishing the beast: Feminism,
sex and morality (pp. 48-91). London: Tauris Parke Paperbacks.
Borthwick, A. M. (1999). Perspectives in podiatric biomechanics: Foucault and the
professional project. British Journal of Podiatry, 2(1), 21-28.
Bott, A., & Clephane, I. (1932). Our mothers. London: Victor Gollancz Ltd.
Brimblecombe, P. (2003). Historical perspectives on health: The emergence of the
sanitary inspector in Victorian Britain. Journal of the Royal Society for the Promotion
of Health, 123(2), 124-131.
British Medical Journal. (1894a). Astounding revelations concerning supposed
massage houses or pandemoniums of vice, frequented by both sexes, being a complete
exposé of the ways of professed masseurs and masseuses. London: British Medical
British Medical Journal. (1894b). Immoral 'massage' establishments. British Medical
Journal, 2, 88.
Chartered Society of Physiotherapy. (1894). Harley Institute, School of Swedish
Massage and Medical Electricity. Unpublished manuscripts, 'Historical' material,
reminiscences and personal papers collection (SA/CSP/P.1/3), Wellcome Institute Library,
Coburn, D. (1994). Professionalization and proletarianization: Medicine, nursing and
chiropractic in historical perspective. Labour/Le Travail, 34, 139-162.
Coveney, J., & Bunton, R. (2003). In pursuit of the study of pleasure: Implications for
health research and practice. Health, 7(2), 161-179.
Dagnall, J. C., & Page, A. J. (1992). A critical history of the chiropodial profession of
The Society of Chiropodists. The Journal of British Podiatric Medicine, 47(2), 30-34.
Davidson, A. I. (1986). Archaeology, genealogy and ethics. In D. Couzens Hoy (Ed.),
Foucault: A critical reader. Oxford: Basil Blackwell.
Dean, M. (1999). Governmentality. Thousand Oaks, CA: Sage.
Dew, K., & Kirkman, A. (2002). Sociology of health. Oxford: Oxford University
Foucault, M. (1977). Nietzsche, genealogy, history. In D. F. Bouchard (Ed.),
Language, counter-memory, practice. Ithaca: Cornell University Press.
Foucault, M. (1979). The history of sexuality: Volume one: An Introduction. London:
Allen Lane.
Foucault, M. (1980). The history of sexuality. In C. Gordon (Ed.), Power/knowledge:
Selected interviews and other writings: 1972-1977.(pp. 183-193). New York:
Harvester Wheatsheaf.
Foucault, M. (1981). The order of discourse. In R. Young (Ed.), Untying the text: A
post-structural reader. London: Routledge and Kegan Paul.
Galvin, R. (2002). Disturbing notions of chronic illness and individual responsibility:
Towards a genealogy of morals. Health, 6(2), 107-137.
Gastaldo, D., & Holmes, D. (1999). Foucault and nursing: A history of the present.
Nursing Inquiry, 6(4), 231-240.
Gijswijt-Hofstra, M., & Porter, R. (2001). Cultures of neurasthenia: From Beard to the
First World War (Clio Medica 63). London: Rodopi Bv Editions.
Gordon, C. (1991). Governmental rationality: an introduction. In G. Burchell, C.
Gordon & P. Miller (Eds.), The Foucault effect: Studies in governmentality. Hemel
Hempstead: Harvester Wheatsheaf.
Grafton, S. A. (1934). The history of the Chartered Society of Massage and Medical
Gymnastics. Journal of the Chartered Society of Massage and Medical
Gymnastics(March), 229.
Hacking, I. (1981). How should we do the history of statistics? Ideology and
Consciousness, 8, 15-26.
Harrison, J. F. C. (1990). Late Victorian Britain. London: Fontana.
Hook, D. (2001). The 'disorders of discourse'. Theoria, June, 41-70.
Incorporated Society of Trained Masseuses. (1911a). How a joint or parts near a joint
are examined by a doctor. Unpublished manuscript (SA/CSP/P.4/1/6), Wellcome
Institute Library, London.
Incorporated Society of Trained Masseuses. (1911b). Massage paper. Unpublished
manuscript (SA/CSP/C.2/2/1/1), Wellcome Institute Library, London.
Incorporated Society of Trained Masseuses. (1912). Prospectus of the Incorporated
Society of Trained Masseuses. Unpublished manuscript (SA/CSP/P.1/3), Wellcome
Institute Library, London.
Katavich, L. (1996). Physiotherapy in the new health system in New Zealand. New
Zealand Journal of Physiotherapy, 24(2), 11-13.
Kunzle, D. (2004). Fashion and fetishism. London: Sutton Publishing.
McHoul, A., & Grace, W. (1993). A Foucault primer: Discourse, power and the
subject. Melbourne: Melbourne University Press.
Nettleton, S. (1992). Power, pain and dentistry. Buckingham: Open University Press.
Neve, M. (2001). Public views of neurasthenia: Britain, 1880-1930. In M. Gijswijt-
Hofstra & R. Porter (Eds.), Cultures of neurasthenia: From Beard to the First World
War (Clio Medica 63) (pp. 141-160). London: Rodolpi Bv Editions.
Nietzsche, F. (1989). On the genealogy of morals. London: Random House.
Osborne, T. (1996). Security and vitality: drains, liberalism and power in the
nineteenth century. In A. Barry, N. Rose & T. Osborne (Eds.), Foucault and political
reason: Liberalism, neo-liberalism and rationalities of government (pp. 99-122).
Chicago: University of Chicago Press.
Peterson, A., & Bunton, R. (1997). Foucault, health and medicine. London:
Ransom, J. (1997). Foucault's discipline: The politics of subjectivity. London: Duke
University Press.
Rose, N. (1985). The psychological complex: Psychology, politics and society in
England 1869-1939. London: Routledge and Kegan Paul.
Rose, N. (1993). Government, authority and expertise in advanced liberalism. (Vol.
22): Routledge, Ltd.
Rose, N. (1996). Governing 'advanced' liberal democracies. In A. Barry, T. Osborne
& N. Rose (Eds.), Foucault and political reason: Liberalism, neo-liberalism and
rationalities of government (pp. 37-64). Chicago: University of Chicago Press.
Sicherman, B. (1977). The uses of diagnosis: doctors, patients and neurasthenia.
Journal of the History of Medicine and Allied Sciences, 32, 33-54.
Smart, B. (1985). Michel Foucault. London: Tavistock.
Trollope, J. (1994). Britannia's daughters: Women of the British Empire. London:
Trudgill, E. (1976). Madonnas and Magdalenas: The origins and development of
Victorian sexual attitudes. London: Heinemann.
Turner, B. S. (1996). The body and society. London: Sage.
Vicinus, M. (1977). A Widening Sphere: Changing Roles of Victorian Women.
Bloomington, Indiana University Press.
Vicinus, M. (1985). Reformed hospital nursing: Discipline and cleanliness. In M.
Vicinus (Ed.), Independent women: Work and community for single women, 1850-
1920 (pp. 85-120). Chicago: University of Chicago Press.
Wainwright, E. M. (2003). 'Constant medical supervision': Locating reproductive
bodies in Victorian and Edwardian Dundee. Health & Place, 9(2), 163-174.
Weir Mitchell, S. (1877). Fat and Blood, and how to make them. Philadelphia, J.B.
Lippincott, & Co.
Wicksteed, J. H. (1948). The growth of the profession: Being the history of the
Chartered Society of Physiotherapy 1894-1945. London: Edward Arnold & Co.
... Two New York physicians who had studied massage therapy in Sweden brought massage therapy to the United States in the 1850s (Rogers, Shaffer, & Smith, 2006). By the 1880s, massage was undergoing a revival in Britain; Swedish massage became an important feature of nursing work and a "diverse array of variously trained massage therapists were practising throughout the country" (Nicholls & Cheek, 2006, p. 2340. However, the inconsistent system of education and questionable quality of some massage therapists, false advertising claims by some massage therapists (Fritz, 2006) and an oversupply of masseurs and masseuses in the large cities (Nicholls & Cheek, 2006), along with the implication that "massage establishments were merely a front for brothels" (Nicholls & Cheek, 2006, p. 2340) during the massage scandals of 1894, eroded the legitimacy of massage therapy. ...
... By the 1880s, massage was undergoing a revival in Britain; Swedish massage became an important feature of nursing work and a "diverse array of variously trained massage therapists were practising throughout the country" (Nicholls & Cheek, 2006, p. 2340. However, the inconsistent system of education and questionable quality of some massage therapists, false advertising claims by some massage therapists (Fritz, 2006) and an oversupply of masseurs and masseuses in the large cities (Nicholls & Cheek, 2006), along with the implication that "massage establishments were merely a front for brothels" (Nicholls & Cheek, 2006, p. 2340) during the massage scandals of 1894, eroded the legitimacy of massage therapy. ...
... By the 1880s, massage was undergoing a revival in Britain; Swedish massage became an important feature of nursing work and a "diverse array of variously trained massage therapists were practising throughout the country" (Nicholls & Cheek, 2006, p. 2340. However, the inconsistent system of education and questionable quality of some massage therapists, false advertising claims by some massage therapists (Fritz, 2006) and an oversupply of masseurs and masseuses in the large cities (Nicholls & Cheek, 2006), along with the implication that "massage establishments were merely a front for brothels" (Nicholls & Cheek, 2006, p. 2340) during the massage scandals of 1894, eroded the legitimacy of massage therapy. ...
Full-text available
Background The use of massage therapy, a complementary and alternative medicine modality, is widespread and growing. However, little is known about why consumers choose and continue to use massage therapy, in most cases at their own expense. In addition, the characteristics of the therapeutic encounter and outcomes that provide satisfaction to the client, and encourage them to return for further treatment are unknown. Aims and objectives The purpose of this thesis was to determine why repeat users of massage therapy use and choose massage therapy, and investigate what they value in the therapeutic interaction and outcomes to return to massage therapy. The primary aim was to investigate: (1) the elements of the therapeutic encounter that are valued by clients and therapists; the importance and influence of comfort, contact, connection, and caring within a massage therapy session; and the importance of health outcomes for massage therapy clients; and (2) explore the drivers for why people continue to seek or reinitiate massage therapy. As a precursor to this, the utilisation and practice patterns of massage therapy in New Zealand by qualified massage therapists were investigated. Methods A two-phase, sequential mixed methods approach was adopted. Initially, a qualitative approach was used. Two telephone focus groups (n = 16) were conducted with providers (massage therapists) and three telephone focus groups (n = 19) were conducted with repeat users (clients) of either relaxation, remedial or sports massage services. Subsequently, themes were used to develop two specifically designed questionnaires. Practising members of Massage New Zealand (MNZ) (massage therapists: n = 66) and their clients (n = 646) were sampled. Results Focus group findings identified six valued elements of the culture of massage therapy care as well as four key drivers for repeat use of massage therapy. The survey response rate was 71.7% (n = 92) for massage therapists and 57.4% (646/1125) for massage clients. The survey of therapists highlighted a number of practice patterns: most therapists are female, NZ European, and hold a massage diploma; and massage therapy was both a full and part time occupation. The majority of massage therapists practised solo but used a wide and active referral network, and commonly used therapeutic / remedial / deep tissue, relaxation, neuromuscular therapy, and sports massage techniques. Common issues or conditions for which massage therapy was used by clients were neck / shoulder pain/problem, relaxation and stress reduction, back pain/problem, and regular recovery or maintenance massage. The essence of massage therapy involved a client-centred partnership approach to massage care, modulated by comfort, contact, connection, and caring. Drivers for returning to, or continuing with massage therapy were a regular appointment, positive expectation, positive experience and positive outcome. Data were used to build a descriptive model of the valued elements of massage therapy encounter: purposeful, participatory, process factors, person centered partnership, and product categories were highlighted. Conclusions This thesis provides an informative insight into the practice and repeat utilisation of massage therapy by MNZ therapists and their clients. Furthermore, the description of and insight into the massage therapy encounter highlights elements of process, product, and the therapeutic relationship in massage therapy. These make an original contribution to the literature on massage therapy and provide the foundation and direction for subsequent studies.
... Im Schatten eines vom British Medical Journal im Jahr 1894 losgetretenen Massageskandals, welches in einem Editorial "unmoralische Massage-Anstalten" anprangerte, und einen Großteil der angebotenen Massagen mit Prostitution gleichsetze, entstand im selben Jahr die "Society of Trained Masseuses". Das British Medical Journal hatte empfohlen, eine Vereinigung für jene zu gründen, die eine Ausbildung in Massage und Zertifikate der Befähigung zur Berufsausübung erhalten hatten (Nicholls and Cheek, 2006). Vier Londoner Krankenschwestern und Hebammen-Masseurinnen waren dieser Aufforderung nachgekommen, mit dem Ziel, "Massage zu einem sicheren, sauberen und ehrenhaften Beruf zu machen, und es soll ein Beruf für britische Frauen sein" (Grafton, 1934, in Nicholls andCheek, 2006). ...
... Das British Medical Journal hatte empfohlen, eine Vereinigung für jene zu gründen, die eine Ausbildung in Massage und Zertifikate der Befähigung zur Berufsausübung erhalten hatten (Nicholls and Cheek, 2006). Vier Londoner Krankenschwestern und Hebammen-Masseurinnen waren dieser Aufforderung nachgekommen, mit dem Ziel, "Massage zu einem sicheren, sauberen und ehrenhaften Beruf zu machen, und es soll ein Beruf für britische Frauen sein" (Grafton, 1934, in Nicholls andCheek, 2006). Im Zuge dessen warben sie für medizinische Anerkennung, legten einen Lehrplan und Prüfungsinhalte fest, und entwickelten einen professionellen Verhaltenskodex. ...
... Es wurde erwartet, dass die Masseurinnen sich schlicht kleideten, keinen Klatsch über Patient*innen verbreiteten, Stimulanzien, welche sie in den Häusern ihrer Patient*innen angeboten bekamen, ablehnten, sowie dass sie keine Medikamente empfahlen (und damit in das Terrain der Medizin eindrangen). Tarife für Massagen sollten in Übereinstimmung mit den Berufsregeln eingehoben werden (Nicholls and Cheek, 2006). ...
Full-text available
Das Ziel dieser Dissertation ist es, ethische Situationen in der internationalen Physiotherapie in Art, Umfang und Häufigkeit ihres Auftretens zu untersuchen, ebenso wie Faktoren, die in ethischen Entscheidungen von Physiotherapeut*innen international eine Rolle spielen, um solide Wissensgrundlagen für praxisnahen Ethikunterricht in Grundstudium und kontinuierlicher professioneller Entwicklung zu schaffen. Es wird auch untersucht, ob Physiotherapeut*innen im Grundstudium/ in der Grundausbildung, und auf welche Art, Physiotherapeut*innen weltweit über ethische Kodizes und Rahmenkonzepte für ethische Entscheidungsfindung lernen. Ein solches Wissen kann physiotherapeutischen Berufsvertretungen in der Leitlinienentwicklung dienen, Bereiche für weiterführende Forschung identifizieren, sowie Physiotherapeut*innen in allen Weltphysiotherapie-Regionen in ihrer ethischen Praxis unterstützen. Die Dissertation basiert auf zwei internationalen Online-Umfragen, deren unterschiedliche Aspekte in sechs Veröffentlichungen berichtet werden. Die erste Umfrage untersucht Art, Umfang und Häufigkeit von ethischen Situationen in allen fünf Weltphysiotherapie-Regionen, und ethische Lerninhalte des Grundstudiums/ der Grundausbildung. Die zweite Umfrage untersucht die Sichtweisen von Physiotherapeut*innen auf verschiedene individuelle, organisationale, situationelle und gesellschaftliche Faktoren, die in ethischen Entscheidungen eine Rolle spielen, und erforscht weitere Faktoren, die in ethischen Entscheidungen des beruflichen Alltags der Teilnehmer*innen eine Rolle spielen, sowie die Wege des Lernens über berufsethische Aspekte. Veröffentlichung I beschreibt die Häufigkeit des Auftretens 46 verschiedener ethischer Situationen im Alltag von Physiotherapeut*innen, die der internationalen Literatur entnommen, und die in vier Kategorien gegliedert wurden: (A) Interaktion zwischen Physiotherapeut*in und Patient*in (19 Items); (B) Physiotherapeut*innen und andere Angehörige von Gesundheitsberufen einschließlich anderer Physiotherapeut*innen (10 Items); (C) Physiotherapeut*innen und das System (5 Items); und (D) Berufliche und wirtschaftsethische Situationen (12 Items). Ein Mangel an Ressourcen, der die Qualität der physiotherapeutischen Behandlung beeinflusst, und Ungerechtigkeit im Zugang zu Physiotherapie für Menschen, die diese Behandlung benötigen, werden als am häufigsten auftretende ethische Situationen weltweit erlebt und kommen durchschnittlich öfter als monatlich vor. Ethische Situationen innerhalb des Systems (Kategorie C) werden von Physiotherapeut*innen international am häufigsten erlebt. Rund drei Viertel der internationalen Stichprobe lernte in ihrem Grundstudium/ ihrer Basisausbildung über ethische Kodizes, rund die Hälfte der Stichprobe lernte über Rahmenkonzepte für ethische Entscheidungsfindung. Lernen über ethische Kodizes ist mit dem selteneren Erleben ethischer Situationen assoziiert. Veröffentlichung II berichtet über die große Bandbreite und Komplexität der gelebten ethischen Erfahrungen der Teilnehmer*innen. Rund 40% der in den Daten identifizierten Problemstellungen bezogen sich auf die Interaktion mit Angehörigen anderer Gesundheitsberufe inklusive anderer Physiotherapeut*innen (Kategorie B), die übrigen Daten verteilten sich mit je rund 20% auf die Kategorien (A), (C) und (D). Über ein Viertel der Antworten der Teilnehmer*innen bezog sich auf drei ethische Situationen: Fehlverhalten Angehöriger anderer Gesundheitsberufe (inklusive anderer Physiotherapeut*innen); Mobbing oder Belästigung von Physiotherapeut*innen; und Konflikt mit anderen Angehörigen der Gesundheitsberufe über das Patient*innen-Management. Vier neue Themenbereiche von ethischen Problemstellungen wurden identifiziert: Mangelnde Anerkennung der Rolle und Position von Physiotherapeut*innen im Gesundheitswesen; Wirtschaftliche Faktoren, welche die therapeutische Praxis bestimmen; Mangel an Regulierungs- und/oder Akkreditierungspolitik und –infrastruktur; und Politische Bedrohungen. Veröffentlichung III beleuchtet Unterschiede der Ethikausbildung in Grundstudium/ in der Grundausbildung und der Häufigkeit ethischer Situationen innerhalb Europas und im internationalen Vergleich. Ethische Situationen im professionellen und wirtschaftlichen Kontext (Kategorie D) werden in Europa signifikant weniger häufig erlebt als im internationalen Vergleich. Veröffentlichung IV vertieft den Blick auf ethische Situationen und das Lernen über berufsethische Aspekte innerhalb der europäischen Region mit einem Vergleich der deutschsprachigen Länder mit dem Rest Europas. Physiotherapeut*innen aus den deutschsprachigen Ländern lernen signifikant weniger oft über ethische Kodizes und Rahmenkonzepte für ethische Entscheidungen, als Physiotherapeut*innen in Rest-Europa. Veröffentlichung V analysiert die Antworten der Teilnehmer*innen auf eine optionale offene Frage der Umfrage 2, welche Faktoren in ihren ethischen Entscheidungen eine Rolle spielen. Ein Spektrum von 43 verschiedenen Faktoren innerhalb fünf übergeordneter Themen (Individuelle, relationale, organisationale, situationelle und gesellschaftliche Faktoren) konnte identifiziert/konstruiert werden. Komplexität und Diversität ethischer Situationen und den verschiedenen Prozessen ethischer Entscheidungsfindung spiegeln sich deutlich in den Ergebnissen dieser Studie wieder. Veröffentlichung VI befragt Physiotherapeut*innen in allen fünf Weltphysiotherapie-Regionen zu ihrer Sicht auf Faktoren, die in ethischen Entscheidungen eine Rolle spielen, und zu Wegen des Lernens über berufsethische Aspekte. Die höchsten Zustimmungswerte erhielten die Aussagen, dass ethische Entscheidungsfindung mehr Fähigkeiten erfordert, als nur einem Ethikkodex zu folgen, und jene hinsichtlich der hohen ethischen Anforderungen der sozialen Rolle von Physiotherapeut*innen. Verschiedene Faktoren, die in ethischen Entscheidungen eine Rolle spielen, werden von Physiotherapeut*innen verschiedener Weltregionen hinsichtlich Zustimmung und Ablehnung signifikant unterschiedlich bewertet. Die vielfältigen Arten und Weisen berufsethischen Lernens der Teilnehmer*innen umfassen formelle und informelle Bildungswege, welche sich in Qualität und Quantität zwischen den einzelnen Weltphysiotherapie-Regionen signifikant unterscheiden. Physiotherapeutische ethische Theorien und Praxis müssen an den lokalen Kontext angepasst werden, und sowohl im Grundstudium/ in der Grundausbildung als auch im Laufe der kontinuierlichen professionellen Entwicklung vermittelt werden. Berufsethische Bildung ist ein individueller Faktor, der in ethischen Entscheidungen von Physiotherapeut*innen eine Rolle spielt, und der die Häufigkeit des Erlebens ethischer Situationen beeinflusst. Nichtsdestotrotz darf der individuelle Einfluss von Physiotherapeut*innen auf ethische Situationen und deren Lösungen nicht überschätzt werden, da organisationale, relationale, situationelle und gesellschaftliche Faktoren in ihrem Entstehen und bei ihrer Lösung eine nicht unbedeutende Rolle spielen. Es bedarf auf diesen Ebenen zusätzlicher Handlungen befähigter Entscheidungsträger*innen. (Weiter)Entwicklungen von ethischen Kodizes und Rahmenkonzepte für ethische Entscheidungen müssen den internationalen Gegebenheiten und Erfahrungen von Physiotherapeut*innen angepassten werden, damit Inhalte formellen Lernens als praxisrelevant anerkannt werden. Kollaborative Lernumgebungen, die wechselseitiges Lernen und (internationalen) Erfahrungsaustausch und Reflexionsmöglichkeiten bieten, sind informelle Lernoptionen für kontinuierliche berufsethische Entwicklung, genauso wie niederschwellige Bildungsangebote, wie zum Beispiel frei zugängige Forschungsberichte und Online-Datenbasen und –Kurse.
... The roots of physical therapies may have begun centuries ago in Northern Africa (1) though in the United Kingdom, physiotherapy as a profession emerged in the late 1800s under somewhat dubious origins (2). While the profession has moved away from association with puritanical scandals, there are still some troubling aspects of physiotherapy that remain scandalous despite our more than one hundred years of movement. ...
Full-text available
Power and unearned privilege in the profession of physiotherapy (PT) reside in the white, Western, English-speaking world. Globally, rehabilitation curricula and practices are derived primarily from European epistemologies. African philosophies, thinkers, writers and ways of healing are not practiced widely in healthcare throughout the globe. In this invited perspectives paper, we discuss the philosophies of Ubuntu and Seriti, and describe how these ways of thinking, knowing, and being challenge Western biomedical approaches to healthcare. We believe implementing these philosophies in the West will assist patients in attaining the health outcomes they seek. Further we call for Western professionals and researchers to stand in solidarity with their African counterparts in order to move towards a diversity of practitioners and practices that help to ensure better outcomes for all.
... The statement implies that there is a lack of both in our profession, and it ignores the historical nature of the problem. Law-abiding massage therapists have been grappling with standards of practice at least since the massage scandals of 1894, (12,13,14,15,16) and yet the problem still persists despite the various laws that have been imposed on our practices and profession. ...
Full-text available
This document is a rebuttal to Perpetuating Victimization with Efforts to Reduce Human Trafficking: a Call to Action for Massage Therapist Protection by Rosenow and Munk that appeared in the March issue. The paper is to be applauded for providing a massage therapist’s viewpoint on the issue of human trafficking guised as massage, and concisely summarizing the main impact on the profession. The solutions involved, however, are problematic, as is the underlying view that licensing practitioners and their businesses is de-signed to protect the massage therapist and trafficking victims. Finally, this commentary suggests a regulatory solution that should be implemented for any re-porting process to be successful.
... Contudo, suas origens assomam aos meados do século XX, quando em meio a 2ª guerra mundial, houve a necessidade de reintegrar à sociedade funcional, aqueles que outrora foram mutilados no combate (CREFITO 3, 2011). Se regressarmos no tempo podemos notar a presença desse saber em momentos importantes de necessidade mundial, como após a revolução industrial, principalmente na Inglaterra, ainda identificados como massagistas, com atuação nas famosas Casas de Massagem (NICHOLLS; CHEEK, 2006), ou até em eventos mais locais, como no surto de Poliomielite no Brasil (REIS;TEIXEIRA, 2016). ...
Physiotherapists interested in the profession's future have turned in recent years to historical evidence to understand how the physical therapies were practiced before the advent of modern healthcare. However, studies to date suggest that their practice was largely confined to social elites, and those from working-class or poor populations rarely, if ever, experienced them. To test this theory further, this study focuses on British sailors during the Napoleonic wars (1803-1815). Utilizing historical and semi-fictional accounts, this study shows that healthcare on board naval fighting ships concentrated almost entirely on the prevention of disease, and the medical and surgical management of acute trauma. Even though sailors experienced shocking levels of traumatic injury, none appear to have experienced any form of physical therapy. This study supports the argument that prior to the 20th century, the physical therapies were luxuries available primarily to those with surplus time and money, and that widespread access to physiotherapy has relied on state-sponsored universal health coverage. It follows, then, that the decline of universalized healthcare may have profound implications for many marginal groups in society, as well as the physiotherapy profession itself.
Für ihre Promotion beschäftigte sich Andrea Sturm mit berufsethischen Herausforderungen in der internationalen Physiotherapie. In physiopraxis berichtet die Bildungs- und Erziehungswissenschaftlerin über die Entwicklung der Berufsethik und die Ergebnisse ihrer fünfjährigen Forschungsarbeit. Fazit: Weltweit am häufigsten beklagen Physiotherapeut*innen knappe Ressourcen und Zeitmangel, welche die Qualität ihrer Behandlung beeinträchtigen. Im deutschsprachigen Raum besteht zudem Reformbedarf beim Ethikunterricht in der Grundausbildung.
Purpose: Individuals have multiple intersecting identities, unique perspectives, and experiences which provide opportunities for new ways to interact, support inclusion and equity, and address the Sustainable Development Goals (SDGs). This commentary explores the diversity of the speech-language pathology workforce in Australia. Result: A survey of Australian speech-language pathologists (SLPs; n = 1,638) distributed in November and December 2021 explored personal characteristics and experiences of the workforce. Almost 30% of SLPs who responded reported having experiences or perspectives that were relevant to service users and a quarter described other lived experiences, which included disability, cultural and linguistic background, mental health, caring responsibilities, neurodiversity, and being LGBTQI+. Conclusion: This commentary affirms the value of diversity among allied health professions to enrich practice with individuals and communities. By understanding the diversity of the speech-language pathology workforce and perspectives of historically marginalised or invisible groups, the profession can introduce strategies to more meaningfully engage and support people with diverse backgrounds and perspectives in the workforce and enhance service equity and accessibility for people with communication and swallowing disabilities. This commentary focusses on SDG 3, SDG 4, SDG 8, SDG 10.
Full-text available
The phenomenon of child sex tourism (CST) is intensified by the increased mobility of people worldwide. Current approaches to fight CST predominantly focus on enforcing legislation and disrupting the cycle of demand and supply, yet they have proven largely ineffective. This paper highlights the enabling properties of CST spaces in Bali and takes a new approach by focusing on the ambiguity of place, authority structures and actors. The analysis identifies four CST spaces –private homes, brothels, spa massage parlours and orphanages –which enable the persistence of CST. Understanding the ‘socio-spatial properties’ of risk locations is key to disrupting and fighting CST more effectively. Key words: child sex tourism; Bali; risk locations; ambiguous spaces; enabling spatial properties
In his discussion of power, Foucault establishes a new, interpretation that challenges the typical view of power as a possession held by certain people and groups in a society. Foucault argues that it is the set of force relations that constitute a perpetual struggle among people as well as the strategies that people employ as they attempt to control the behavior of others. This differs from previous views of power in that it sees power as existing everywhere and deriving from everywhere. No person holds power. Rather, power is expressed in relationships between people. Related to this view is Foucault's argument that resistance is inextricably linked with power and also exists everywhere. No single point of power or resistance can be found. Each point at where power is exercised also reveals a point of resistance. Power is also intimately connected with discourse because discourse becomes a mechanism of power. Not only is discourse both an instrument and an effect of power, but discourse can serve both to liberate and oppress.
Introduction / Andrew Barry, Thomas Osborne, Nikolas Rose -- Liberal government and techniques of the self / Graham Burchell -- Governing "advanced" liberal democracies / Nikolas Rose -- Liberalism, socialism and democracy : variations on a governmental theme / Barry Hindess -- The promise of liberalism and the performance of freedom / Vikki Bell -- Security and vitality : drains, liberalism and power in the nineteenth century / Thomas Osborne -- Lines of communication
Genealogy "opposes itself to the search for "origins"". "The development of humanity is a series of interpretations. The role of genealogy is to record its history: the history of morals, ideals, and metaphysical concepts, the history of the concept of liberty or the ascetic life". "Among the philosophers idiosyncrasies is a complete denial of the body". "Where religions once demanded the sacrifice of bodies, knowledge now calls for experimentation on ourselves, calls us to the sacrifice of the subject of knowledge. The desire for knowledge has been transformed among us into a passion which fears no sacrifice, which fears nothing but its own extinction. It may be that mankind will eventually perish from this passion for knowledge. If not through passion, than through weakness."