The role of neurasthenia in the formation of the physiotherapy profession

ABSTRACT

Background: Neurasthenia was one of the most commonly diagnosed disorders in the later years of the 19^th century. Its most widely used treatment, known as the Rest Cure, relied heavily on physical therapies, but little is known about the practitioners who administered the treatment. In this paper, I argue that the nurse-masseuses who delivered the massage and electricity so vital to the success of the Rest Cure, used the opportunity to develop approaches to treatment that would form the backbone of the physiotherapy profession in England after 1894. Methods: Extensive primary and secondary texts were drawn from a wide range of sources and critically reviewed. Findings: This study argues that the management of neurasthenic cases in the 1880s and 90s created the conditions necessary for the development of the profession’s relationship with medicine and the establishment of new practice roles for women, and that these would play an important role in shaping the physiotherapy profession in Britain after 1894. Read through the critical sociological writings of Magali Sarfatti Larson and Anne Witz, I argue that the work of the nurse-masseuses can be seen as a complex gendered negotiation between the need to be deferential to the dominant male medical profession; distinct from emerging notions of the angelic, motherly nurse; obedient, technically competent and safe. The creation of a space in the clinic room for a third practitioner who could deliver a different form of care to the doctor or the nurse, established an approach to practice that physiotherapists would later adopt almost without amendment. Discussion: I argue that this approach owes much to the work done by nurse-massueses who established and tested its principles in treating cases of neurasthenia.

KEYWORDS:

• Neurasthenia
• massage
• 19^th century
• physiotherapy
• rest cure

Acknowledgments

The author would like to thank the reviewers for their help in developing the paper and recommending additional sources.

Declaration of Interest

The author declares no conflict of interest.

Notes

1. The trend for doctors to ‘refer’ treatment on to others was in fact a very recent trend. Prior to 1860, medicine had largely been a ‘bedside’ practice with the doctor using nurses largely as additional house servants or attendants. With the development of ‘scientific’ nursing after 1870 and the growth of more professional roles for women, a new class of professional practitioners emerged that the doctors could delegate to. This made the massive expansion of modern healthcare possible, and also gave doctors a new role as arbiter, patron and governor of a host of new professional entities.

2. ‘Rubber’ was a commonly used 19th century colloquial term for a masseuse or masseur.

3. It should be noted that many masseuses worked in chaotic, demanding conditions. Many arrived with little training. Mennell (1915) suggests some were ‘unnecessarily violent’, while others saw ‘magical results’ (Grant, 1916; Leeming, 1919).