Remembering the Reconstruction Aides
The American Physical Therapy Association (APTA) set a new record at the February 2018 Combined Sections Meeting, as over 17,000 attendees convened to learn, connect, and enhance their skills. APTA now has over 100,000 members across the country.
As we celebrate this milestone, we also commemorate the 100th anniversary of the first physical therapists in the United States, the reconstruction aides who were civilian employees of the Medical Department of the US Army during World War I. Marguerite Sanderson oversaw the first reconstruction aides, or "re-aides," in the newly created Division of Physical Reconstruction. Mary McMillan was appointed the first re-aide in February 1918 and organized the Physiotherapy Department at Walter Reed General Hospital. Of the original 18 Aides, 16 went on to form the American Women's Physical Therapeutic Association, which later became the American Physical Therapy Association with McMillan as president.
Mary McMillan, one of the founders and the first APTA president, wearing her reconstruction aide uniform. (World War I era, 1918-1920)
Here are some little-known facts about these pioneering women.
They may not have been in combat, but re-aides still had to fight against Victorian-era attitudes toward women.
One early battle was about a uniform of bloomers rather than impractical skirts. Spoiler alert: They lost. According to Mia Donner Jameson:
Miss Sanderson was ahead of her times but was not able to overcome some of the objections of the 'men on the Hill,' i.e., the Senators and Congressman. One of her aims was to get us 'uniformed' in bloomers instead of skirts which she thought would be more practical for the mud and rain we might encounter. (1)
These women would be jealous of today's more functional work attire.
Because much of their treatment included massage, the re-aides faced some unique challenges providing care to male soldiers. In 1918, Sanderson delivered a speech titled "The Massage Problem," expressing her concern that doctors, nurses, and patients alike might construe therapeutic massage as "medically dubious" at best and illicit at worst. The re-aides sought to address this by requiring professional physiotherapy education, treating only those who were medically in need of care and "assuming command of drill and sporting events," in which the women played against recovering soldiers. (2)
Obviously, the able-bodied re-aides usually won. The games served to "demonstrate the prowess" of the female re-aides and motivate the soldiers in their recovery. The Orthopedic Advisory Council that established the rehabilitation program intended for the college-educated female re-aides to, unlike nurses, avoid "sentimental pampering" of their patients that would hinder recovery. (2)
Even though the first re-aides were college educated, their clinical education was on-the-job training.
When the United States entered World War I in 1917, Army Surgeon General William Gorgas recognized the lack of formal education in physical rehabilitation, according to Col Emma Vogel, one of the first re-aides. He met with educators, and emergency courses were initiated at several schools of physical education or gymnastics.
After graduating in 1919 from the Normal School of Physical Education in Battle Creek, Michigan, and a stint treating Spanish flu patients, Ruby Decker was hired as a re-aide and assigned to Fort Sherman in Ohio, where she attended "lots of lectures and in-service training." She also made a point of reading the manual for every machine there was (such as electrotherapy) and looking up unfamiliar medical terminology, such as "ankylosis," rather than ask a physician. (3)
Anatomy lab, Reed College, 1918.
Although they were congratulated by the Secretary of War for their "meritorious service," the re-aides—unlike Army nurses—were not granted "veteran" status after the war.
After the war ended, Secretary of War Newton D. Baker wrote to Marguerite Sanderson:
In reviewing the work of the Medical Department of the Army during the war in the months that have followed the armistice, it has seemed to me that perhaps not enough recognition has been given to the group of men and women who accomplished such striking results in the way of reconstruction of the unfit and damaged men of our Army.
Of this group, I learn that you rendered conspicuously important service. Your assistance to the orthopedic surgeons in helping them lay plans for the training of women to undertake the reconstruction of injured men in the hospitals; your management of their duties and your efforts to fit them into the military establishment—all were to such good purpose that much pain was relieved, and the number of hospital days for many men was lessened, and the amount of their permanent disability was greatly reduced. This was a distinct contribution to the Army and to the country. (personal communication, February 1921)
Despite recognition from such a high level, re-aides, along with dieticians employed by the Army during the war, were not granted full veteran status and benefits until 1981.
Reconstruction aides treat soldiers at Fort Sam Houston, Texas, 1919.
The re-aides gave credibility to physical rehabilitation interventions and had a great impact on advancing professional practice.
According to Col Emma Vogel, prior to WWI physical therapy techniques (then delivered by physicians) were not trusted by mainstream medicine, but the re-aides' work with the Army lent credibility:
Scattered groups of enthusiasts practiced electrotherapy in one area, hydrotherapy in another, and massage and manipulation in another.… After the war, there became available several hundred physical therapists and an increasing number of physicians who had their first indoctrination in physical therapy while serving in the Army. As a result, civilian practice in this field was given a tremendous impetus.
At this early stage, there was no scientific research on the effectiveness of interventions. The American Women's Physical Therapeutic Association was formed to maintain "professional and scientific standards" for physical therapy practitioners, encourage advanced study, disseminate medical literature, to help members get jobs, and "sustain social fellowship."
They knew they were pioneers.
Writing to Re-Aides in New York City awaiting transport to Europe, Mary McMillan said:
You people act as inspiration to new course groups. Remember you are the first, pioneers every one of you, so hold up that standard good and high, and march right ahead into Berlin. I'll meet you there, if not before. (4)
Reflecting on her WWI experience in 1976, Mia Donner Jameson wrote:
Perhaps the present-day physical therapists do not realize the early struggles we of those days went through, but we made it, and it was worth it. (5)
As we head toward APTA's centennial anniversary in 2021, let us be thankful and proud of those who came before us.
- American Physical Therapy Association. The Beginnings: Physical Therapy and the APTA. Alexandria, VA: American Physical Therapy Association; 1979:5.
- B. War's Waste: Rehabilitation in World War I America. Chicago: University of Chicago Press; 2011.
- Nestor B, for University of Texas Medical Branch Physical Therapy Alumni Association. A Personal History of Physical Therapy: Memories With Ruby Decker [VHS]. Galveston, TX: University of Texas Medical Branch Physical Therapy Alumni Association; 1988.
- American Physical Therapy Association. The Beginnings: Physical Therapy and the APTA. Alexandria, VA: American Physical Therapy Association; 1979:19.
- American Physical Therapy Association. The Beginnings: Physical Therapy and the APTA. Alexandria, VA: American Physical Therapy Association; 1979:35.
"Reconstruction aides awaiting transport overseas to U.S. Army hospitals, typically spent two weeks in the New York staging area learning military drills. Here, on July 4, 1918, a group in wool suits and capes prepares to swing onto Fifth Avenue as a band strikes up the cords of 'Onward Christian Soldiers.'" Source: Healing the Generations: A History of Physical Therapy and the American Physical Therapy Association,” by Wendy Murphy (1995), p. 57.