The Great War Advanced the Science and Methods of Physical Therapy

Physical Therapy at Bath War Hospital
Elizabeth Horton, c.,1918

The First World War produced a huge number of injured disabled soldiers. During the war, military physicians realized that it was not enough to merely treat the limbs of the wounded soldiers; it was also necessary to train them to use their remaining abilities to their greatest capacity. Rehabilitation of these men was needed both to sustain nations' wartime mobilization efforts and to insure the wartime wounded became productive citizens when peace returned.  

Consequently, the development of rehabilitation medicine accelerated during and immediately after the First World War. The war’s unprecedented scale of casualties, in combination with an increased survival rate of the severely injured due to medical advances, left a high number of soldiers with both mutilated bodies and minds—and posed a major challenge to  medicine at the time. The war created a demand for new techniques and trained professional "physical therapists" to help injured soldiers regain function. Every combatant nation of the war had to deal with this challenge. History is filled with ironic examples of the "benefits of war,"  and physical therapy is one such case. Postwar, civilian doctors hospitals around the world, having observed the benefits to the injured soldiers, began to incorporate the new techniques into patient recovery care and add rehabilitation services and professional units to every hospital's mission statement and organization chart.

Accounts of the explosive growth of this new medical specialty during the Great War are highly fragmented and unsystematic. So, for the remainder of this article, we will focus on one interesting case study I discovered that highlights the British approach at the innovative Bath War Hospital. I think the article by physical therapist Heide Pöstges gives a feel for the challenges the medical staff faced and how they responded creatively and energetically.

The City of Bath had always been famous as a centre of healing, and its medical research and learning was much needed to treat the wounded soldiers who became patients at the War Hospital. Dr. Preston-King, the Mayor of Bath when war was declared and again in 1918, had previously introduced X-rays to the Royal United Hospital with the Bath engineer John Rudge. The Bath War Hospital was able to be similarly equipped, thanks to the generosity of Alderman Cedric Chivers, who paid for the entire cost of a building and equipment that became known as Q Block. He also provided electricity free of charge via a wire connected to his book binding works. X-rays were essential for locating bullets before surgery and in the diagnosis of gas gangrene.

Whirlpool Bath Room, Exterior of Q Block,
and Radiant Heat Room

Elizabeth Horton’s painting at the top of the page is a unique record of one of the best-equipped rehabilitation facilities in a British war hospital during WWI. It depicts the interior of Q Block at Bath War Hospital in Bath, South West England—near Bristol—where injured soldiers received applications of massage, mechanotherapy, electrotherapy, hydrotherapy, and light therapy.  Most of the appliances were manufactured by local engineers in Bath. The Bath Surgical Requisites Association, supported by 290 volunteers and temporarily housed in Chivers's premises near the hospital, made many appliances for injured soldiers, including artificial limbs.

Q Block had more to offer than X-rays. By the end of WWI, nearly 2 million British soldiers had been permanently disabled, over 40,000 of whom had lost limbs. Q Block, under the charge of Dr. King Martyn and his chief nurse, Marjorie Clark, was able to offer a range of therapies, such as whirlpool baths, electrical treatments and massage, to aid the recovery of wasted muscles and tissues, twisted limbs and stiffened joints, and to treat shell shock. Comparatively few military hospitals possessed such a facility, and soldiers were sent from other establishments to benefit from the treatments offered. Shown below are 13 workshop drawings of gymnasium equipment by Elizabeth Horton.   

Ankle rotation; flexion and extension of the ankle; flexion and extension of elbow joint; and pylons

Bath Hospital's staff attempted to apply many of the European innovations growing out of 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 19th century.

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.  

The saddle crutch; slings for
attachment to any form of crutch

Advances in exercise programs and massage therapy were strongly influenced by the “movement cure” developed by the Swedish physical educator Dr. 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. Jonas Gustaf Wilhelm Zander took Ling’s approach a step further by developing the first mechanical equipment to control the exact weight-resistance needed to optimize development of individual muscles. He created gymnastic appliances for different movements; his equipment collections became internationally known as Zander Institutes. Bath War Hospital was one of the few hospitals in Britain in possession of an almost complete Zander Institute.  Some of these machines are shown here.

Rotation of shoulder joint; attachable belt for stretching contracted hamstrings; flexion and extension of knee; rotation of wrist joint; flexion and extension of fingers; exercise for weak thumb and fingers

During the war, the Q Block and its then state-of-the art equipment, received many visits from respected experts—and royalty, including King George V and Queen Mary, who were impressed with the innovative treatments provided.

Bath Hospital Patients and Therapists

The work of the Bath War Hospital did not cease with the signing of the armistice in 1918. When the Ministry of Pensions took over the hospital in November 1919 the total number of cases admitted was 24,333. Of these, 18,710 reached the hospital in 124 convoys from the Midland Road Station, the last of which arrived on 30 June 1919. 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 1919; it closed in 1930.

Thanks to Nick Verville, PT, at Kaiser Richmond for inspiring this article while he was working me hard.

Sources:  "Physical Therapy at Bath War Hospital: Rehabilitation and Its Links to WW1," European Journal of Physical and Rehabilitation Medicine, 2015 June; 51(3):331-6; "The rise of physical therapy: A history in footsteps," Archives of Medicine and Health Sciences; Bath War Hospital Website.