Source: Euro-American Medical Group

Physiotherapists made their early mark in Canada during both WORLD WARS, when they were recruited in large numbers to treat injured soldiers. Students trained in the key areas of early physiotherapy: massage, muscle function and occupational therapy.

In what seemed appropriate during wartime, but might raise a few eyebrows today, the fourth course--the one dealing with exercises for soldiers nearing discharge--was taught by army sergeants barking out orders in a gymnasium.

However, it was the transition to peacetime that proved even more challenging, according to Joan Cleather, whose book Head, Heart and Hands chronicles the rise of the profession in Canada. "Society at that time was not in favour of women in the general workplace," explains Cleather. "After the Second World War, many women were eased out of the occupations they had assumed during the war effort. In physiotherapy, however, there was resistance by many women to giving up their work."

In fact, in the 1920s, physiotherapy had already moved quickly to bolster the fledgling profession by founding the Canadian Physiotherapy Association (CPA) and using it to develop a more stringent set of educational standards and qualifications to augment the hands-on training acquired in the war years.

"In the early days, the women who entered into the profession came from good, quality families. They had to have strong characters and terrific determination to pursue careers in spite of family and community opposition," recounts Cleather. "Those who got through, banded together to face their families and the rest of the world; those who didn't have it, fell by the wayside."

One of those first pioneers, Esther Asplet, typifies the lengths that physiotherapists were prepared to go to in order to expand the scope of their profession.

In her native England, she had worked directly with an eminent physician. Once in Canada, however, she soon discovered that therapists were not part of the health care establishment. Not content with the status quo, Asplet set out to change things.

To do that, she set her sights on Dr. MacKenzie Forbes, one of the most prominent orthopaedic surgeons then working in Montreal. After several hours of shadowing Dr. Forbes, Asplet met him face-to-face in the outpatient clinic. When Forbes asked her what he could do for her, she quickly turned the tables and stated she had come "to find out what she could do for him."

Intrigued, or perhaps taken aback by the directness of Asplet's approach, Dr. Forbes invited her to join his staff. If Asplet's tactics lacked subtlety, her determination and skill helped open the medical door for other physiotherapists.

"You had to prove to individual doctors that you could produce results. If you did that, they were more likely to trust the next person coming along," says Cleather. "You were aware all the time that you had to live up to expectations; that you had to be better than good."

Perhaps the most oft-mentioned name in CPA annals is Enid Graham, considered by many the chief architect of the Association. It was Graham who ensured that physiotherapists were accepted members of the medical corps during the Second World War and who guided the profession through the tough times of the Great Depression, sometimes personally financing the CPA's efforts to expand the level and quality of training. She remained a driving force on behalf of physiotherapists until well into the 1970s.

A third name closely identified with the development of physiotherapy in Canada is Constance Beattie. A native of Brockville, Ontario, Beattie became the first physiotherapist to travel into the Arctic in 1949 to treat Inuit patients suffering from polio and measles.

In one of her last letters from the Arctic, she says her patients' measles "have gone and their residual paralysis is almost nil. Re-education of walking is impossible in an isolation hospital for the floor is contaminated."

The next news about Beattie, then only 24, was that her plane had gone down, killing all on board. She had been accompanying seven of her Inuit patients to a Winnipeg hospital before flying home for her wedding.

The commitment demonstrated by these pioneers of physiotherapy who came together to carve out their unique niche in health care was repeated again and again in Canada as the profession organized throughout the provinces and territories.

Margaret Hitchins, who continues to practice on a part-time basis, remembers how it all began in Newfoundland. Soon after her arrival from England in the 1950s, Hitchins became one of five physiotherapists who "adjourned to a vacant room" during an informal meeting, sat down on the carpet and founded the Newfoundland Chapter of the CPA.

"We were in our early- to mid-20s and only recently qualified," says Hitchins. "Where we'd come from, we hadn't expected to be part of an Association. Suddenly, there you were in Newfoundland, and you were part of the decision-making process...part of the establishment, simply because there hadn't been one before."

The contribution of physiotherapy to Canada's health care system is linked inextricably to the major changes that shaped the country. From treating returning war amputees of the World Wars through innovative therapies for the polio epidemics that swept communities in the 40s and 50s and the onslaught of new types of injuries associated with the widespread introduction of the automobile, physiotherapy has been there to meet the challenge.