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5 The Rediscovery of Rehabilitation, 1941-1950 Rehabilitation medicine's first fifty years had two phases. In the first and generally ignored phase, marginal medical practitioners organized around the use of electrical devices to treat acute diseases. The second phase covered the institutionalization of physical therapy from the beginning of World War I to the start of World War II. It included recognition by the militaryduring the First World War, organization of a professional association by physical therapy physicians, and creation of physical and occupational therapy. It concluded with the physicians gaining control over the allied occupations and moving toward medical specialty status in the late 1930s. However, none of these developments occurred because of a gradual growth in the knowledge or technical base of the rehabilitation field; reconstruction and rehabilitation did not become an "emergent" core function for physical therapy physicians during the 1920s and 1930s. Here we will describe a third phase in medicalrehabilitation 's history. If the first half-century of rehabilitation medicine was one of institutional change but therapeuticcontinuity, the 1940s brought institutionaland therapeutic changes that culminated in specialty status. War again escalated the de86 mand for medical services. For some physicians this resulted in a conflict between their imperialisticdesires to control new opportunities and their tendency to resist increasing practitioner supply. This was not a problem for physical therapy physicians. An imperialistic posture had been their way of life for half a century, and practitioner shortage had been a crucial problem impeding their growth. They thus welcomed the chance to recruit new members and were relatively unconcerned about the lowering of standards in training programs. While physical therapy physicians expanded their place in the military and the Veterans Administration (VA),they were not in the forefront of efforts to develop reconditioning and rehabilitation programs; innovation and program development came largely from those outside the physical therapy field. They did, however, incorporate new activities and alter their claims to expertise. World War II and Physical Medicine THE REDISCOVERY OF REHABILITATION 87 By the late 1930s physical therapy physicians were moving away from their original goal of becoming one part of a therapeutic triad for acute disease and toward the explicit pursuit of specialty status. Formal specialty recognition required physical therapy physicians to convince others that they possessed exclusive expertise over a specific set of medical problems or techniques. Although their position had improved, they still seemed a long way from establishing a claim to such special competence. Krusen's "watermark" presidential address to the American Congress of Physical Therapy in 1938 delineated physical therapy's gains: "the medical profession has come to realize that not only chemicals, biologic preparations and surgical procedures, but also physical agents, may be of great value in combating disease, relieving suffering, and shortening disability ."1 However, he acknowledged the field's continued marginality: "As pioneers in a new field of medicine, we have had to contend with ultra-conservative physicians who doubted each of our forward steps. . . . A physician may inquire how many of the elaborate devices which we employ in physical therapy are discarded after a few months. He does not seem to realize that we strive to employ the simpler physical procedures whenever it is feasible."2 His recommendations for increasing physical therapy's status in the medical profession included avoidance of the "spectacular," "halftruths ," and "over-enthusiasm," as well as improvement of their own research and "condemnation of unscientific literature."3 Most notable was Krusen's unequivocal statement about the specialty status of physical therapy. He noted that "despite what anyone may say to the contrary . . . physicaltherapy is a specialty." However, he also claimed that the field should not be limited to physical therapy specialists, but that general practitioners should use simple physical therapies in their practices. "Just as the average physician may do his own urinalysis and blood counts but depends on the clinical pathologist for Wassermann reactions and blood chemical studies , so may he use an infra-red lamp or contrast baths in his own office. He may rely on the specialist in physical therapy for the more complicated procedures, such as fever therapy, or corrective exercises."4 In his speech, Krusen resurrected the strategy first enunciated in 1896 which sought to convince all to adopt physical therapy techniques while also claiming a special sphere of competence. This provided a way for a marginal group like physical therapy physicians to pursue control over a segment of the market without alienating the still powerful general practitioners on...


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