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Physical Therapy at Bath War Hospital: Rehabilitation and Its Links to WW1
Bath had a longstanding reputation for innovative medical treatments, including hydrotherapy. Due to a shortage of medical and nursing staff in the British army, the War Office was in need of civilian practitioners. After consulting with Bath hospital authorities, a committee was formed to negotiate with the War Office. A local businessman, Alderman Cedric Chivers, paid for the entire cost of the building that became known as the Q Block, and sponsored the electrical and mechanical equipment inside it.
Most of the appliances were manufactured by local engineers in Bath. Bath War Hospital was a local initiative, which makes it less surprising to find this painting in the body of art from a local artist who was concerned with motifs representing the town. The hospital was opened in April —the Q Block in November When the management transferred from the Ministry of War to the Ministry of Pensions, the facility was renamed the Bath Ministry of Pensions Hospital in ; it closed in In March , a local newspaper published four photos illustrating orthopaedic treatment carried out in the former Bath War Hospital.
The depiction of the masseuse in the center of the painting is remarkably similar to a masseuse in another photo; even the clock in the center back of the painting resembles the clock in the photo. These images served the artist most likely as models. Since Horton could have only had access to the images after the end of the war, the painting came most likely into being in or later. Whether the three photos stuck to the back of the painting are part of the same series of images published in the newspaper is unclear.
While the workshop drawings titled Flexion and extension ankle, and Flexion and extension of fingers resemble the images on the right side of the painting, it is possible that a previous owner or commissioner rather than Horton added them to the frame. This person probably had close links to the hospital, and also attached the label to the front of the wooden picture frame that honors J.
Physical Therapy Perspectives in the 21st Century - Challenges and Possibilities
Macalister, Esq. The room serves as a physical therapy department for wounded soldiers, and holds electrotherapy equipment, whirlpool baths, mechanical exercise machines, and therapy beds. Five men at the right side, two men at the left, and two at the center back of the image exercise using mechanical exercise machines. In the center, a masseuse mobilizes the hip and knee of a man lying on a therapy bed; behind her stands another woman in nursing uniform who seems to support a man using one of the mechanical exercise machines.
Three men, seated in the back center left of the picture, wait for their turn. They appear engaged in activities even while they wait. One is depicted reading, and one is looking into the center of the room with a booklet on his lap; the third is half hidden behind a dividing wall.
Behind the therapy bed in the center right, a man is seated with his arm in a whirlpool bath resembling the bath in one of the photographs stuck to the back of the painting. On the wall to the right is a panel for control of magnitude and type of electric current. Most of the men are fully dressed wearing blue suits, white shirts, and red ties. The male figure facing the viewer in the middle right section of the painting is Dr.
King Martyn, the physician in charge. He overlooks the application of light therapy for a man who seems so severely injured that two nurses are needed to carry out the treatment—one to prop him up on a chair and the other to apply the bath. A dominant vertical post frames the scene. The increase in the number of wounded soldiers leading up to encouraged the War Office to boost investment in therapies that promised to restore function in wounded bodies, enabling men to either re-join the military forces or find long-term employment as civilians.
Advancements in technology had paved the way for modern industrial warfare, causing devastation and violence of unprecedented scale during WW1.
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Medicine had long contributed its part to these public debates by advocating for compulsory military training and health programs for the poor to ensure adequate manpower for the army. Here, the nurse questions his masculinity should he disregard her standards of cleanliness and openly express pain. Her expectations of manliness represent regulations from eighteenth-century hygiene movements and a Victorian and Edwardian ideal of masculinity defined by military heroism.
While medical agendas shaped normative ideals in society, the very same ideals informed the culture of medicine. Medicine had, historically, allied itself, for the most part, with the military as a means to gain recognition as a profession and to preserve medicine as a male domain. As a result, medical practice followed a masculinized vision of medicine based on values framed in military language—such as active , brave , and courageous. Horton, however, puts two women wearing nursing uniforms into a central position in her painting. Her expertise in electro-mechanical therapy—and her adaptations to electrical appliances that helped optimize their effects—were regarded highly in Bath.
Cook, A. The image challenges traditional power relations by contradicting the notion of Victorian masculinity, according to which the attributes active and strong are associated with men, while women are considered passive and weak. By placing two women at the center of the painting, Horton presents them as having a pivotal role in war medicine, which contradicts more common views of the nursing discipline as a profession of considerably lower social status than the higher male-dominated stratas of medicine.
The image can, therefore, be perceived as a feminist painting. The vast number of wounded soldiers in WW1 accelerated the development of new rehabilitation methods. Common concerns about racial degeneration and the decline of masculinity prepared the ground for a return to ancient Greek beauty ideals of the male body that seemed a promising response to the desire to reconstruct the wholeness of bodies and restore stability in society.
All the attending professionals are bathed in sunlight coming in from the large windows, as if the war had never happened. The sunlight coming through the windows is perhaps a visual reference to healing attributed to the three natural remedies of air, sunlight, and water—a concept that originated in the Alps and found supporters among the British middle-class in the years leading up to WW1.
Applying natural remedies from outside the body, as opposed to relying on the therapeutic effects of intervening inside the body, have been popular in Greece, Rome, and other parts of the world since ancient times.
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The focus on the person as a whole made the application of these therapy forms attractive for the treatment of soldiers with permanent injuries, since the medical emphasis on improving the function of individual body parts failed to deliver satisfying outcomes. In European towns where medical doctors had a strong influence on the spa culture, a systematic approach to physical therapies that included a combination of bathing, electrotherapy, exercising, and massage had become part of the treatment provided in hospitals by the end of the 19 th century.
In the s, the British Medical Journal BMJ began to publish articles on the clinical effectiveness of massage; hospitals across Great Britain employed an increasing number of masseuses. The first masseuses were nurses who completed additional training provided by physicians or senior masseuses at mainly London-based training schools. While early members were predominantly nurses, an increasing number of women began to take up massage—including the application of various physical therapies—as a career on its own.
Electrotherapy became increasingly popular to treat symptoms attributed to nervous ailments, which were believed to be a side-effect of industrialization and modern life. During the war years, the scope of its application broadened rapidly to include, for instance, testing and stimulating muscles. Pehr Henrik Ling, who distinguished between active movements encountering resistance and passive movements performed on the body, such as rubbing—a precursor to massage.
Swedish physician Dr. He created gymnastic appliances for different movements; his equipment collections became internationally known as Zander Institutes. Many soldiers came to Bath War Hospital with severe injuries that caused muscle weakness and limited mobility. Zander machines enabled them to gradually improve their physical strength and range of movement, easing the transition to outdoor team sports, which were closely connected to national identity in Britain and believed to reconnect soldiers with their civilian lives. The painting helps viewers see early developments in rehabilitation as attempts to restore damaged masculinity through providing opportunities for men to get active and rebuild their physical strength.
Horton depicts all soldiers, including those waiting for their turn, as engaged, which contradicts Dr.
The similarities between the photos published in the local newspaper and the painting reveal the meticulous care the artist took to achieve a realistic representation of the electrical and mechanical equipment in use at the hospital. While her quest for realism represents classical ideals, the painting itself shows the potential of technology to heal as opposed to causing destruction and violence.
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Here, reconstructing the body is aligned with modernity. The image of recovering soldiers actively exercising or having their limbs exercised by masseuses draws attention to their resilience as well as to their weakness and, ultimately, to their continuing sacrifice for the nation. The facial expressions of all figures in the image are shown in an emotionally neutral way, which idealizes the beauty of restoring and re-activating the male body. The image can be interpreted as an example of attempts at the time to re-evaluate endurance as courageous, softening the concept of heroism without posing a serious challenge to the normative masculine ideal.
At the same time, the imagery of heroic sacrifice provides meaning to the suffering not depicted in the painting. Many soldiers admitted to the hospital were, for instance, Australians with little or no previous connection to the residents of Bath. The civilian contribution to Bath War Hospital was, nevertheless, a chance for civilians to become heroes themselves. The notion of heroic self-sacrifice helped to make the irreparable harm industrial warfare had done to body, mind, and civil life more bearable and meaningful.
At the same time, the idealized active and reconstructed male body helped to put an end to the devastation by rendering individual suffering invisible, thereby avoiding the feared decline in masculinity. Idealized imagery of such bodies intended to help the nation as a whole come to terms with the consequences of the war and reconstruct a civilization thought to be lost. Early developments in rehabilitation, particularly physiotherapy, took place against this background of war and recovery.
It was mainly grounded in a masculinized vision of medicine framed around activity, courage, and bravery, as opposed to domestic values such as peace, compassion, and care. Physical Therapy at Bath War Hospital urges us to take a closer look at how political developments and social expectations have informed rehabilitation practices. The author wishes to thank Dr. Francis Duck for being so generous in sharing his historical resources and knowledge about Bath War Hospital.
A big thanks is offered as well to Jon Benington, manager at Victoria Art Gallery, for his useful guidance. This work is licensed under a Creative Commons Attribution 4. Heide is Director of Innovation and Training at Bridges Self-Management, where she develops, facilitates and evaluates training and improvement programmes in health and social care.
Your email address will not be published. In this essay, Dr. Nicole Piemonte shares her journey and lived experience that undergirds her research, teaching, and writing. She skillfully paints a portrait of why we need the integration of the humanities in all of our health professions. This essay also provides us with a window into her writing, which is passionate and compelling. She integrates key concepts from philosophy into the analysis of the work of health professions with both clarity and grace.