The phrase, “Physiotherapy First” could be interpreted as a call-to-action to prioritize physical treatments over pharmacotherapy and surgery. Use of the phrase is likely presumed to reflect the modern physiotherapy profession’s progression into primary care, the growing physiotherapy research base of high value care, and the concomitant confidence accompanying them. However the phrase was first published 130 years ago.
In 1894 Dr Edward Playter gave a presentation at the last semi-annual Meeting of the Rideau and Bathurst Medical Association, in Ottawa, Canada titled,
Physiotherapy First: Nature’s Medicaments before Drug Remedies; Particularly Relating to Hydrotherapy.
At the time, the word physiotherapy did not exist in the English language, and the profession we know today did not exist beyond the progenitor practices of nursing, midwifery, bonesetting, massage, medical gymnastics, hydrotherapy and electrotherapy.
In writing about the collective use of natural therapies Playter (1894) himself claims to have coined the term physiotherapy, “having never observed it in print”. However he may be playing clever, for the word ‘physiotherapie’ had been published much earlier in Germany, and Playter was well aware of the German leadership in the field of natural therapies. Indeed Playter references leading German experts and practices at least eight times in his presentation, which was later published in the Journal of the American Medical Association.
Nevertheless, Playter described the anglicized word ‘physiotherapy’ as the application of natural remedies, and his presentation explored the benefits of pure air, sunlight, diet, rest, mental influence [psychology], electricity, massage, kinesitherapy [exercise] and what he considered most important, water. He thoroughly investigated the history and described the benefits of hydropathy, including particular reference to the German “Schott method of treating chronic heart disease by the use of warm baths and muscular exercises”.
Playter’s motivation for advocating ‘physiotherapy first’ followed a familiar refrain to the earlier hydropathists and natural therapists of Germany, and the physio-medicalists of the United States of America. Specifically, it was strong concern regarding the medical profession’s overprescribing of medication. He said,
..while we still continue to pour in drug remedies as our sheet anchor in the treatment of disease, the schools especially wave before us, .. the endless and ever increasing drug formulae of the Pharmacopoeia as the Alpha and Omega of resource in therapeutics, leaving us to find out for ourselves in practice, through years of most bitter, most destructive experience, the futility and danger of most drug remedies.
In particular, Playter expressed concern for the medical profession’s educational practices that prioritised medications. He said,
It is not my intention to make a tirade against drug remedies. Some of them are of undoubted value in certain diseases… But I would like to deliver a vigorous tirade against the practice of the text-book makers and of the schools giving these remedies first place, usually, instead of the last, in the Materia Medica.
It is important to reiterate that Playter was not railing against pharmacotherapy but rather its primacy in the curriculum and practice of medicine. Thus he proposed that instead, natural remedies, ie., physiotherapy, be given priority.
References
Playter E. (1894). Physiotherapy first: Nature’s medicaments before drug remedies; particularly relating to hydrotherapy. Montreal Medical Journal, 22, 811-827. https://www.canadiana.ca/view/oocihm.8_05178_71/2
