Strength and science: gender, physiotherapy, and medicine in early-twentieth-century America.

This article explores the development of post-World War I allied medical professions in the United States, and more specifically the rise of physiotherapy as it was used to rehabilitate maimed soldiers. Unlike other female health care professionals of the time, physiotherapists engaged in intra-gender conflicts with white-collar women rather than attempting to gain independence from medical men. Driven to be distinct from other female professionals, physiotherapists created a unique post-Victorian identity, defining their practice as requiring both strength and science, which challenged the convention of seeing women as the weaker, more nurturing sex. Their story, however, is not one of simple triumph. Eager to medicalize and professionalize their field, by 1935 they subordinated themselves to physician supervision, losing what little professional autonomy they had acquired during the 1920s. Yet, by extending their professional sphere of influence over disabled soldiers, these therapists became physical manipulators of the male body and purveyors of knowledge regarding the definition and treatment of disability.

Scholars who study the history of female physicians, social workers, and public health nursing during the 1920s have tended to tell the story of medical professionalism as one in which white-collar men and women held opposing gender-specific views on how expert knowledge should be utilized and disseminated. The most frequently cited example of this divide is the controversy surrounding the 1921 Sheppard-Towner Maternity and Infancy Act. (1) As scholars usually narrate the story, on one side of the debate were the women who worked for the Children's Bureau and who supported the Act, believing that federal dollars should be allocated to state health centers in order to improve, among other things, the nation's infant mortality rate. On the other side stood the elite male physicians of the American Medical Association (AMA), who roundly condemned the Act as an "imported socialistic scheme," which directly threatened their free market ideology of private practice. Indeed, in 1922, the AMA House of Delegates voted unanimously to denounce the Sheppard-Towner Act, declaring it a form of state medicine. (2)

But this story of stark gender conflict does not capture the entire domain of health care professionalism during the early twentieth century. At the same time that women in the Children's Bureau engaged in ideological and political battles with the AMA for control over the nation's health, a small group of female physiotherapists actually courted the medical profession's favor and cooperation. (3) Only one year after the AMA publicly condemned the Sheppard-Towner Act, women leaders of the American Physiotherapy Association (APA) invited Ray Lyman Wilbur, then president of the AMA, to give the keynote address at the national physiotherapy conference. APA president Dorothea Beck enthusiastically introduced Wilbur to the stage, assuring him that it was the goal of her association to "give the medical profession a band of trained women whose ideals, personality, and technical training are all that the physicians and surgeons of the American Medical Association can wish." (4)

The APA's congenial relationship with Wilbur and the elite men of the AMA complicates the typical historical narrative of professional antagonism between the sexes during the 1920s. Physiotherapy represents a different kind of female professionalism--one that concerned itself more with achieving autonomy from other white-collar women than it did with gaining independence from white-collar men. (5) Other female-dominated health occupations that arose alongside physiotherapy during the war, such as occupational therapy and dietetics, drew support from medical men. (6) But as occupations steeped in the womanly spheres of arts, crafts, and home economics, these other professions also achieved legitimacy through the backing of women's charity networks. By contrast, physiotherapists did not seek support from women's clubs or female associations for professional uplift; rather, physiotherapists legitimized their profession almost solely by association with the medical profession.

To secure the medical profession's support, physiotherapists created a post-Victorian gender identity, making them distinct from traditionally female health care workers. Unlike educated women of the nineteenth century who accepted their lot as the weaker yet more nurturing sex, physiotherapists thought of themselves as strong women who possessed specialized knowledge. Whereas nurses treated patients at the bedside, physiotherapists worked in gyms and performed manual rehabilitative therapy with the goal of reshaping weakened and disabled male bodies, making them stronger and fitter for the theaters of war and industrial work. Physiotherapists believed that their unique combination of brains and brawn gave them authority over the disabled body. To place physiotherapists in the larger context of women's history, then, one must be willing to see physiotherapy as a reaction against Victorian notions of womanhood, creating a discontinuity with the conventional role of female caregivers.

This article traces the development of physiotherapy from its beginnings during the First World War to its establishment as an allied medical field, under the direction of physicians in the early 1930s. Throughout this time period, physiotherapists faced repeated challenges to their professional identity and territory. Because the first generation of practitioners had degrees in physical education, physiotherapists struggled to establish themselves as legitimate health care providers in a field where nursing had long been the accepted occupation of most women medical assistants. Nurses, however, did not pose the only threat. As physiotherapists moved from the circumscribed sphere of well-defined governmental jobs to the unregulated private marketplace, they witnessed an exponential growth of competitors, the most threatening of which was chiropractic. Throughout their travails, physiotherapists looked to organized medical men--who, during the 1920s, had achieved remarkable legal and political control over the health care field--for guidance and professional support. The campaign for a medical alliance reached its peak in 1930, when a battered, yet more mature, physiotherapy profession made its practice entirely reliant on physician prescription, losing what little professional autonomy they had achieved during the 1920s.

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