Foreign fields - physiotherapy's links to the First World War

Physiotherapists, then known as masseuses, came into their own during the first world war. Carol Harris looks at the role played by the Almeric Paget Massage Corps, which laid the ground for the CSP


An officer of the 10th Battalion Cameronians (Scottish Rifles) leads the way out of a narrow trench, near Arras, France, 24 March 1917. Photo: Imperial War Museum (Q5100)

When the First World War broke out in August 1914, the wealthy MP Almeric Paget and his wife Pauline Paget were among the first to offer their considerable resources to the British War Office.

The Pagets proposed that they fund a cohort of 50 trained masseuses to work with wounded soldiers.

The Almeric Paget Massage Corps (APMC) was established quickly – it helped that its secretary, the Honourable Essex French, was the daughter of Field-Marshal Sir John French, commander of the British army in Europe.

Payment was to be £2 weekly with an allowance for uniform, although most of the corps at this stage were from middle and upper class backgrounds, and volunteered to work unpaid.    

Corps members had to have the certificate of training issued by the forerunner of the CSP, the Incorporated Society of Trained Masseuses (ISTM), and the society’s council encouraged its members to join. Two of the new corps’ executive of three were ISTM members, including Essex French.

From September to November 1914, the 50 masseuses were sent to work in military hospitals in Britain. As the flow of casualties turned to a flood, the War Office asked the Pagets to fund a massage and electrical outpatient clinic in London.  

Sir Alfred Keogh, director general of the Army Medical Service, inspected the clinic which treated 200 patients a day, in March 1915. By the summer, 150 masseuses were working for the corps in 110 military hospitals and institutions.

In November, Sir Alfred announced that the corps would, in future, be funded by the War Office. Based in its current headquarters, the Pagets’ London home, the corps would now take over the running and organisation of all massage departments at military hospitals, command depots and convalescent camps in the UK.

Only members of the corps would be employed in military hospitals and an advisory committee would advise on standards, training and qualifications. The aims were to prevent staff without adequate training from working in the corps, and to protect the interests of patients and of the fast-growing profession.

This prompted a sharp reaction from those organisations not on the list, as well as the ISTM. The ISTM’s advisory committee met in early December 1915. One medical member, Grainger Stewart, said ‘the difficulty had arisen through the [War Office] handing the whole thing over to the Pagets. So long as it was a private corps, they could do as they liked but when it became the means by which all massage in the UK was done; it was a question for the nation.’

His comments reflected a general theme: by this time, the scale of the conflict was such that the enthusiasm and resources of volunteers were no longer enough to fight the war. Major reorganisation was needed to provide services on a national, coordinated scale. 

Many members faced hardship

The ISTM petitioned the War Office. Its requests included a representative board to run the service, standardised rates of pay, and rules of conduct ‘to be drawn up by someone understanding the professional and social needs of the workers.’ The society also objected to the War Office’s new rules for acceptable training – they were too broad to guarantee standards.

The society called an extraordinary general meeting in the new year. Members were angry. Increasingly, masseuses were joining as paid workers and many knew of colleagues who were facing severe hardship.

One such was Miss Grafton, a masseuse working from 10 to 12 hours a day, with only a light meal available at work, and living some distance from hospital. ‘She had aged greatly in one year. On £2/2/0 [£2.10 a week] [she] could not make provision for the future should she break down.’   

The masseurs were concerned that the momentum achieved through the wartime work of the corps should not be lost.

Miss Oswald commented that it was ‘not disloyal to try and provide for conditions after the war. The APMC had been raised for the war. Now, while the War Office was realising the value of massage, was the moment to approach them and ask for a permanent army massage service.‘

Name change

In December 1916 the name was changed to Almeric Paget’s Military Massage Corps. 

Demand for the corps continued to grow, and from 1916, it employed men blinded on war service who had trained for the ISTM certificate at the new charity of St Dunstan’s.

A second, lower grade of staff with less training was created to meet the overwhelming demand, on the understanding that this was for the duration of the war only.

In 1917, APMMC members were sent overseas for the first time, to work in Italy and France. In May, the Army Council issued new terms and conditions for corps members but few of the grievances aired by ISTM on behalf of corps members had been addressed.

The corps made its mark in other ways. In an exhibition at the new National War Museum (soon to be renamed the Imperial War Museum), corps member Sarah Chuck, head masseuse at Alder Hey Hospital on Merseyside, explained the organisation of her department: ‘At the present time the treatment staff at Alder Hey and its two Auxiliaries, Highfield Military Hospital and Dawpool Auxiliary Officers’ Hospital, consists of fifty-eight masseuses and five masseurs.

‘In the Massage and Electrical Departments, the masseuses are instructed in the special methods adopted for treatment of orthopaedic cases, and weekly tutorial classes are held by the Officer-in-Charge of the Massage Department.

‘Beginning her day’s work shortly after 9am, the masseuse works either in the Massage or Electrical Department until 12 noon, when she takes a half hour’s interval for lunch.

‘Again at 2.15pm a ten-minute interval enables her to partake of a cup of tea. At 4pm her day’s work is completed, and the careful and conscientious massage of eighteen to twenty cases certainly is a hard day’s work.

‘In the electrical department, although her duties do not require so much physical effort, the masseuse has to be constantly on the alert.

Whether she is stimulating muscles by the use of the “Bristow” coil or subjecting a limb to interrupted galvanism, ironization or a Schuee bath, diathermy or radiant heat, her constant attention to every detail is essential ... It is our practice to alternate massage and electrical work.

A masseuse will spend three months in the massage ward, and then will follow three months of electrical treatment. In addition at the Highfield Military Hospital remedial gymnastics are undertaken by masseuses.’

In February 1918, the king and queen visited the London clinic opened by the Pagets and a month later, the king saw the corps again as he toured command depots.

As the war ended, MPs questioned ministers about shortages of masseuses, the low pay and denial of pensions and war gratuities.

Pay  ‘inadequate’

In early 1919 the Liverpool Echo published a letter signed by ‘A group of military masseuses’. This said: ‘May we draw the attention of the public to the inadequate pay which Army masseuses are at present receiving and also to the general treatment meted out to them by the War Office?

‘In hospital we have neither rank nor status ... nor have we any definite place in the hospital staff despite our repeated efforts to obtain such, and as civilian subordinates our situation is a most unenviable one.

We are liable to be ordered at a moment’s notice to any hospital in the country. Unlike the nursing sisters we do not live in, and are thus faced with the problem of finding board and lodgings, the difficulty and expense of which in these days will be patent to all. And all this on £2 10s [£2.50] a week?

‘After petitioning the war office for over a year, for an increase of salary they have at last issued a new scale of payment, in which though in certain cases a paltry rise of 22s 6d [£1.12] a week – after every year’s service – is offered, yet in other cases salaries are reduced, so that some masseuses are offered less pay than hitherto. Then, again, there is no war gratuity whatever.’

Nearly eight million men came home permanently disabled. New charities for medical treatment and rehabilitation were formed and physiotherapy progressed.

A permanent peacetime massage and therapy service for the armed forces and disabled ex-servicemen was clearly needed. In January 1919, the corps was wound up and its members invited to join its replacement, the Military Massage Service.

In 1920 the ISTM became the Chartered Society of Massage and Medical Gymnastics and was granted a Royal Charter by King George V.

In the same year it amalgamated with the Institute of Massage and Remedial Gymnastics, and men were allowed to join. Olive Guthrie-Smith, one of the first volunteers with the corps and now a member of the new society’s council, was awarded an MBE for her wartime service.

The masseuses created a lasting impression on their patients. In a letter to the Times in January 1921, an ex-serviceman rebuked a magistrate who had said no self-respecting man would consent to be massaged by a woman, and no respectable young woman would massage a man.

‘It is a deliberate insult which will be keenly felt by the ladies of the Almeric Paget Massage Corps, who have voluntarily, for years now, been doing their duty in the most unselfish and unsparing fashion.

I write this in order that these ladies may still be assured of the gratitude and respect of many a disabled soldier.’ fl

Report from the Alnwick and County Gazette, 8 April 1916 ‘Convalescent Camps at Alnwick’

‘A visit to the encampment in the Pastures ... revealed a wonderful change in the ornamental approaches to B and C camps ...

The interior of every hut is now comfortably arranged and fitted up, and every week wounded men in a convalescent stage are arriving in the camps for treatment. Today (Friday) a draft of 91 men arrived.

The dowsing heat treatment is now in good working order, and some 123 men are massaged every morning, while 70 others are being attended to by the ladies of the VAD [Voluntary Aid Detachment], who dress their wounds.

The B and C camps at present are quite full with patients, and camp A has nearly got its full complement ... we noticed that the electric station in B camp was nearly completed.

The whole of the lighting for the four camps will be controlled from this station, which will save a great deal of trouble and labour and consequently be much more economical.

Its efficiency was brought into operation on Tuesday night, when there was a threatened air raid, all lights being immediately switched off.

‘Unfortunately for the soldiers, through the outbreak of German measles in the town, Alnwick has been declared “out of bounds” for at least a fortnight.’

Olive Guthrie-Smith was one of the first recruits to the Almeric Paget Massage Corps.

She became head of a staff of 40 masseuses at the Guards’ Command Depot at Sleaford in Lincolnshire, where she developed her work on weightless exercise.

A pioneer and founder of the physiotherapy profession, she was awarded an MBE in 1919 and returned to the Swedish Institute where she had trained to teach, taking over the school in 1928.

She later ran the department of physiotherapy at St Mary’s Hospital in Paddington, London, and was internationally recognised for her textbooks.

The Guthrie-Smith bed and Guthrie apparatus are named after her.

A member of the first CSP Council in 1920, she served on the training and examination committees for over 30 years and was an honorary fellow and vice-president.

Winifred Letts, a popular playwright, author and poet, was a member of the corps from 1915 and worked mainly in military camps in Alnwick, Northumberland, and Manchester.

In 1916, she wrote one of the best-known war poems, The Deserter, and published a collection of verse, Hallow-e‘en and Poems of War, which reflected her working life.

Almeric Paget, MP for Cambridge and the wealthy son of an English lord, and his wife, Pauline Whitney Paget, an American heiress, were committed to the cause of establishing medical massage as a profession.

Medical massage was gaining respectability but the term ‘massage’ was also associated in the public mind with ‘massage parlours’, a euphemism for brothels.

They were well-known as benefactors to war causes and held fundraising parties in the grounds of their home.

Pauline Witney Paget died in 1916, aged 42, after a brief illness, shortly after she had established a large Massage Department at the Miller General Hospital in Greenwich, London.

Her two daughters inherited her fortune and carried on supporting the Corps.

Almeric Paget resigned his parliamentary seat in 1917 and became a peer the following year.

As Lord Queenborough, after the war, he became treasurer of the League of Nations Union.

Carol Harris

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