The Other McKenzie

Within the physiotherapy profession the name McKenzie resonates with greatness. New Zealand musculoskeletal physiotherapist Robin McKenzie revolutionised the worldwide treatment of low back pain in the 1980s and his work continues today through the McKenzie Institute International.  However there is another, less well known McKenzie, whose contribution to the profession of physiotherapy was arguably greater. Seventy years earlier, during the First World War, Canadian polymath Robert Tait McKenzie, was responsible for significantly accelerating the progress of the masseuse toward the physiotherapist we know today.

Through his commitment to the physical health of British, Canadian, American and their Allies soldiers during the First World War, R Tait McKenzie cemented electrotherapy and active rehabilitative exercise (including hydrotherapy) as fundamental pillars of the anglsospheric massage profession. Furthermore he provided the opportunity for those masseuses and masseurs to combine the physical interventions and to diagnose, treatment plan and progress patients.  With the experience gained from treatment on an industrial scale, they gained confidence with their new abilities, and emboldened by their success, the predominately female masseuses sought a new name to better describe the entirety of their skills; ultimately choosing ‘physiotherapy’.

This summary of the work of R Tait McKenzie is drawn from historian Fred Mason’s article, Sculpting Soldiers and Reclaiming the Maimed: R Tait McKenzie’s Work in the First World War Period (reproduced with permission)

Professional Career Prior to the War

Robert Tait McKenzie was born in Almonte, Ontario, in 1863, the son of a Scottish minister who had migrated to Canada. His professional career began in 1885, when he enrolled at McGill University to pursue a medical degree. Even before his graduation in 1892, he worked at McGill in a number of positions, such as Assistant Instructor and Instructor in Gymnastics.

In 1894, McKenzie submitted a proposal to the University senate to create the position of Medical Examiner, a position he himself assumed. In this capacity, he conducted physical examinations of all incoming undergraduates, and prescribed any remedial physical activities necessary to combat incipient disease and deformity.  Before leaving McGill in 1904, he added faculty duties such as Demonstrator in Anatomy, established a private medical practice in which he achieved some renown for the treatment of scoliosis, wrote extensively on matters pertaining to physical education and medicine, and began his artistic career as a sculptor.

In 1904, the University of Pennsylvania recruited McKenzie to become the Director of their new Physical Education Department. In Philadelphia, McKenzie continued with the medical examination of undergraduates and his academic writing. His sculpting career blossomed in this stage of his life with The Joy of Effort, a 46-inch diameter bronze relief of three hurdlers, taking a prize in the Olympic Art competition of 1912 and the Stockholm Organizing Committee setting it into the outside wall of the Olympic stadium for the Games.

In 1909 McKenzie wrote Exercise in Education and Medicine, the first text that attempted to completely cover the fields of physical education and exercise science. It included basic sections on anatomy and exercise physiology, overviews of the many systems of gymnastics in use at the time, and sections on physical activity as a means of therapy for people with a range of disabilities. Due to popular demand and rapid advances in the field, McKenzie completed a revised version in 1913 (published in 1917) with new sections on nerve pain and exhaustion, and rising means of physical therapy like hydrotherapy and radiant heat and light. This quickly went on to be tested on an unimaginable scale.

War Service, 1915 – 1918

McKenzie’s First World War military service encompassed only three short years, but they constitute the period in his life in which he had the most direct impact upon the greatest number of people. McKenzie volunteered for the medical service at the outbreak of war. He requested a leave of absence from the University, was granted the maximum allowable 18 months, and sailed with his wife for England in May, 1915. McKenzie did not realize his original plans of enlisting in the Canadian Army Medical Service, as application for the Canadian Expeditionary Force (CEF) could only be made through Ottawa. Unable to enter the Canadian Army, McKenzie instead enrolled in the British Royal Army Medical Corps.

The Army soon discovered he was a prominent physical educator and writer of text books. His commanding officer asked McKenzie if he knew of the “American McKenzie fellow” who wrote the book Exercise in Education and Medicine (the unit kept a copy in the mess as a reference). McKenzie had to admit to being the author of the book himself. Subsequently McKenzie was sent on an inspection tour of the south coast English training camps. On the tour, he identified two major problems: first, men in such poor physical condition that they could not undertake basic physical training, and second, injured men lingering in the hospitals, for whom remedial physical training could expedite recovery.  McKenzie developed programs to address both of these problems, which he then advanced to other Allied nations through his publications in medical and physical education journals.

McKenzie had some input into the evolution of a 21-day physical training course for soldier fitness, helping to modify the 1908 training manual still in use at the time. McKenzie’s familiarity with various systems of gymnastics from writing Exercise in Education and Medicine must have proved helpful. The newly developed system of basic training had roots in Swedish gymnastics movements and military drill, with special focus on bayonet work. The system moved recruits through introductory exercises, general exercises (bending, balancing, jumping, and marching), and “finishing exercises,” akin to the modern day “cool-down.”

To address the second major problem, the neglected rehabilitation of the wounded, McKenzie helped reorganize the system of convalescent camps in England. Promoted to Major, McKenzie took the Commanding Officer’s post at the Heaton Park Command Depot, the largest of the convalescent camps, capable of serving some 5,000 men.  At Heaton Park, McKenzie adapted or developed many forms of physical therapy. He achieved high success rates—in the first four months of his command at Heaton Park, some 1,200 wounded men returned to Class A (firing line) service, and during his full tenure there (until early 1917), nearly 50% of the Depot’s charges returned to some form of service.

To determine the level of treatment needed, camp staff divided cases into three classes, with designation as follows: The First Class Matter is distributed to regular military hospitals … where an operation or a short course of treatment gets them right, and after ten days’ leave, they go back to the fighting line. The second class matter requires an additional stay at a convalescent hospital…in which they receive treatment by physical means, including exercise, in addition to the usual hospital treatment, and a large proportion of these men again find their way to the front. The Third class matter, however—the cases too tedious for the hospital and convalescent camp—are more difficult to provide for and dispose of.

McKenzie frequently described in his writings the nine types of injuries commonly seen in home front convalescent camps. These included healed wounds with dense scar tissue, physical wounds of the nerve, old wounds with protruding parts, joint injuries, functional heart cases, exhaustion, shell-shock, “hysterical” stiffness, and general weakness.  Somewhat unusually for a First World War physician, McKenzie considered cases of shell shock, hysterical stiffness, and other functional neuroses to be “very real conditions, beyond the patient’s control in most cases” and advocated they be treated with light forms of physical activity.

Treatments used in the Depots included standard ones like physical activity, massage, and passive movement, and other more unusual, but no less useful treatments, such as electrotherapy, the application of dry heat, and hydrotherapy. McKenzie himself designed and implemented many of the machines used for active and passive movements. For example, one physiotherapy device, known as the “armtable,” had work stations for all parts of the arm, including shoulders, elbows, wrists, and fingers. A person using the device started on one end and rotated through, exercising specific areas needing individual attention. 

McKenzie tailored individual exercises to each soldier’s needs, with treatments as sophisticated as getting below-the-knee amputees to walk across a low balance beam, both for the benefits of movement and the development of co-ordination. Groups of soldiers also undertook exercise therapies at Heaton Park and the other camps. Men with similar cases performed gymnastics and drill movements by “squads,” sequential movements done on the commands of an instructor. Major McKenzie assumed a supervisory role over these depots, later split into training camps, dealing solely with the physical training of healthy soldiers, and orthopaedic camps aimed at the treatment of the ill and wounded.

Post-discharge Rehabilitative Work

McKenzie returned to Pennsylvania in early 1917 when his 18 months of leave expired.  At the request of the Military Hospitals Commission, he undertook an inspection tour of the Canadian Military Convalescent Hospitals, helping them with plans for rehabilitative equipment. By the middle of 1917, the US entered the war, and McKenzie received an invitation to Washington to consult at the Walter Reed Hospital, where he made recommendations on the lay-out of therapeutic equipment. McKenzie also spoke at the opening of the Clinic for the Functional Reeducation of Soldiers, Sailors, and Civilians in New York in July of 1918, a clinic largely modelled on his own design plans.

McKenzie used his wide experience in the theories and methods of treating and rehabilitating soldiers throughout the war as the basis for volumes of academic writing during the war period. These he re-wrote into the influential book, Reclaiming the Maimed: A Handbook of Physical Therapy. While McKenzie directly helped thousands of men in the camps of England, many more received assistance from other physicians employing the methods outlined in this book, arguably the definitive work in the area. Both the United States’ departments of the Army and the Navy adopted Reclaiming the Maimed as their official rehabilitation manual, the Surgeon-General’s Department advocated its use, and the government of France utilized it in the effort to rebuild its nation’s youth.

In the introduction to the book, McKenzie wrote:

The calamity of war has been necessary to startle the profession into a realization of the wide field that should be occupied by physical methods in the treatment of disease. The sporadic wounds that peaceful life produced have been multiplied in our military hospitals into groups, the exception has become the ordinary; torn and mangled bodies have had to be patched and remade, and functions lost or weakened gradually coaxed back toward the normal, by means hitherto despised, or ignored by too many physicians and surgeons.”

These “despised and ignored” methods would form the basis of modern physiotherapy.

Commemorative Sculpture after the War

After the war, McKenzie withdrew from the medical field somewhat. He gave up his private practice, and his subsequent writing focused more on physical education than medicine. He maintained his involvement with medical associations like the new American Physiotherapy Association, but otherwise moved away from medicine.

At war’s end, McKenzie received commissions to do a number of commemorative statues, and put so much determination into his work that he likely had little time for anything other than his duties at the University.

As a collective, McKenzie’s commemorative art shares a number of common themes. Youth, high spirits, determination, and dedication to a cause can all be read across McKenzie’s war-related commemorative sculptures. To the one, they suggest a very positive vision of the wartime experience. The central figure in each of the major memorials is whole in body and completely unscarred in spirit, either responding to the call to duty without hesitation, or marching home in victorious celebration. Barry Fair, the curator of a recent exhibit of McKenzie’s art, drew links from McKenzie’s athletic works to his war works, stating that “These again centred on his ideals of youth and beauty, and appeared to ignore entirely the horrific side of the wartime ideal.”

Conclusion

R. Tait McKenzie’s work during and after the First World War stands as a unique contribution in military and medical history, spanning physical training, rehabilitation, and commemoration. Through the work of this Canadian doctor, who lived and worked primarily in the United States, Britain more effectively executed her war efforts in the First World War with fitter men, and more soldiers who returned to the front after becoming casualties.

On both sides of the Atlantic, thousands of veterans disabled in the war owed a debt to McKenzie, for a return to better physical function either directly by his hand, through devices and techniques of rehabilitation developed by him, or through advice given in his publications. Similarly, McKenzie’s work in sculpture offered healing and consolation to those who came in contact with it in its time. His sculpture suggested that the sacrifices had been worth it after all, at least in that initial period in the 1920s. Through sculpting men in flesh and clay, and rebuilding bodies and spirits, McKenzie’s work truly made a difference to many people, communities and nations in need.

References:

Mason, F. (2010). Sculpting Soldiers and Reclaiming the Maimed: R. Tait McKenzie’s Work in the First World War Period. Canadian Bulletin of Medical History, 27(2), 363–383. https://doi.org/10.3138/cbmh.27.2.363