Massage in Nursing

Medicine's hoary roots lie firmly planted in the shamans' practices since earliest men and women treated illness and injury. Nursing does not have its roots in the ancient shamanic practices of magico-religious rite and ritual, but rather has grown almost in spite of the institutions of male medical practice. Nursing first emerged from a lack of male attention toward caring for the sickly poor. One of the earliest examples is the practice of midwifery. It has historically been a female dominated vocation because male physicians didn't want to be bothered with such things until the forceps were invented in the 17th century.

The first healing institutions were the temples of ancient civilizations. In China, "halls of healing" were established adjacent to the religious temples, and massage was a part of the treatment administered in these charitable establishments. In Egypt and Greece, people went to temples with their sickness or lameness more to pray to the temple gods than to seek healing care from other humans. But healing care was given, and it often included some massage administered by adept slaves. At first these slaves were men, but over time women came to control the temple healings.

During the Christian era women administered to the sick poor because physicians wanted nothing to do with them since they couldn't pay for their services. Women of the Church nursed people with any kind of disease. As the disciples of Christ began organizing churches, deaconesses appeared. They were usually mature and widowed women who assisted the clergy. Included among their duties was nursing for the poor sick; over time their nursing duties became their primary job. During the medieval period we find no mention of nursing among the deaconesses since the Church's emphasis was on healing the soul, not the body.

Modern nursing arose not from ancient roots or healing practices, but from the outpouring of empathy to wounded soldiers on the battlefield. The first instruction in nursing began during the middle of the 19th century, but it didn't come from hospitals, mainstream physicians or even teaching institutions. Nurse training in modern times began in the tent wards found on the battlefield in the Crimean War from 1854 to 1857. Nurse Florence Nightingale (1820-1910) established the first organized cadre of women working on and near the battlefields that provided nursing care to wounded and ill soldiers. Before Nightingale made her bold and controversial step, the great and small armies of the world provided but paltry medical care to wounded and sick soldiers on the battlegrounds. The best care they might receive was from a lone physician and his assistant or two doing their best amidst the ravages of war upon hundreds and often thousands of soldiers.

When Nightingale and her small cadre of nurses made their way to the Crimean War, with no help from the men of power or those at war, it marked the world's first battlefield nursing care given by women. Thus began the grand tradition of modern nursing and women's dominance of this area of medicine.

In Nightingale's book, Notes on Nursing, published in 1859, she makes no mention of massage as a nursing modality even though massage was included in her training school for nurses as early as 1860. Perhaps the first training school for nurses was established in 1883 at the sanitarium at Battle Creek, Michigan by Dr. John Harvey Kellogg where he was medical director. Massage was an important part of nurse training at the sanitarium and in Kellogg's 1895 book, The Art of Massage he provided what is now a classic massage curriculum. Little more than a decade later massage was a regular part of nursing education everywhere until it began its gradual decline in the late 1920s until nearly disappearing from nursing curriculum by the 1950s.

Nurse Mary McMillan, the founder of American physical therapy, was a strong proponent of massage during and after World War I, but her profession moved in step with medicine resulting in a declining use of hands-on modalities such as massage.

In England, Irish practitioner Louisa Despard's textbook for massage was used in nursing schools for nearly 30 years after first being published in 1911. Between 1895 and 1935 there were dozens of books published by physicians, nurses and lay practitioners devoted to the study and instruction of massage for physicians, manual therapists and nurses. In 1921 the International Society of Medical Hydrology was formed in England as a professional and political organization aimed toward legitimizing spa medicine, of which massage was a part.

In both of the World Wars massage was used by the nursing corp as part of their post-war injury therapies. Today there is a national organization of nurses who practice massage as a primary modality, but the mainstream of nurses working in hospitals don’t have the time or the training to administer massage to their growing patient load. When massage is done by a hospital nurse today it is often done surreptitiously out of a deep conviction by the nurse that touching her patients is a healthy thing to do.

The bush nurses of Australia, New Zealand and Tasmania braved the territory they went into that was completely undeveloped and they braved the criticism of their male counterparts in medicine, the doctors, and they were not welcomed by the missionaries at first because they weren't bringing Christianity, but nursing. But although they brought their caring hands and hearts to the remote areas of these countries as early as 1911, they left no record that massage was one of their tools even though evidence shows they were trained in the art. In England nurses were trained in the art of massage and records show it was used as early as 1890 by them in England. Massage among European nurses was done in conjunction with medical gymnastics, and eventually led to the development of physiotherapy as it did physical therapy in the United States. A number of well known nurses, Mary McMillan among them, studied and worked in Europe at a time when massage was a primary modality for treating returning soldiers from the war against the German Czar. From this experience, the U.S. Army developed the Reconstruction Department which was staffed by the nursing corp.

The National Association of Nurse Massage Therapists, established in the early 1990s, has revived the use of massage among nurses within the modern medical establishment, and has helped create a specialty within the broader field of nursing for massage therapy. Thus massage has secured its historic place within the ranks of nurses, but it is a movement still on the outer edges of mainstream medical practice, which is dominated still by the male practitioner."

Robert Noah Calvert is the founder and CEO of Massage Magazine. The material for this column comes from the World of Massage Museum's collection and Calvert's book, The History of Massage, published in February 2002 by Healing Arts Press.