Rosalind Paget was one of the original four founders of the Society of Trained Masseuses which later became the Incorporated Society of Trained Masseuses, in 1920 the Chartered Society of Massage and Medical Gymnastics, and ultimately, in 1944 the Chartered Society of Physiotherapy. She was the first Chair of Council of both the Society of Trained Masseuses (STM) and the Incorporated Society of Trained Masseuses (ISTM), as well as Director of Examinations. Paget was also a member of Council and Honorary Member, later Vice-President of the Chartered Society of Massage and Medical Gymnastics (CSMMG) and Chartered Society of Physiotherapy (CSP).    

Introduction

The name of Mary Rosalind Paget, always known as Rosalind, as neither she nor anyone else ever used her first name, may be known to some, particularly those with an interest in the founding and early development of the physiotherapy profession in the United Kingdom. However, what many physiotherapists might not know is that this very remarkable, exceptional and talented woman was also a pioneer in the establishment and development of the nursing profession, and in particular the role and professionalisation of midwifery. She was also a strong supporter and activist in the cause of women’s suffrage and a committed social reformer, having close ties with her social reforming and campaigning cousin, Eleanor Rathbone as well as the Rathbone family (Hannam, 1997).

Early Years

Rosalind Paget was born on 4th January 1855, the year after the outbreak of the Crimean War, at the Rathbone’s mansion, Greenbank House in Liverpool (which is now part of Liverpool University) to Elizabeth Paget (nee Rathbone) and John Paget. John was a barrister-at-law, police magistrate and author based in London. He was a wealthy man and came originally from a well-known Leicestershire family, his father having been Member of Parliament for Ibstock and Humberstone in Leicestershire. John was a member of the Commission appointed to enquire into the conduct of the Crimean War, the circumstances of this and also Rosalind’s childhood generally strongly affected her adult attitudes.

…the family atmosphere in which Rosalind grew up was strongly influenced by the events of the time, and imbued with a spirit of service to others which made a lasting impression on her ….in addition, the emergence of this new and influential social class was beginning at last to open the way for young ladies of education to embark on careers that had previously been closed to them…from all this was to come a new professionalism in the caring services, led by women whose status, wealth and influence allowed them to be both independent of the need to earn a living, and also to convince those who would have been slow to change” (Rivers, 1981).

Rosalind Paget was brought up mainly in her family’s London home but also frequently visited the Rathbone home in Liverpool. In 1865, when ten years of age her social reformer uncle, William Rathbone MP, who served as Member of Parliament from 1865 to 1895 for the parliamentary constituencies of Liverpool, Caernarvonshire in Wales and finally the constituency of Arfon, also in Wales, took her to visit Brownlow Hill Infirmary in Liverpool which was a workhouse under the provisions of the Poor Law. Here she met the well-known nursing superintendent at the time, Agnes Jones, a meeting that would have a life-long impact on Paget’s life and commitment to social reform. Together with these experiences Paget was well educated, was also a gifted artist, an accomplished pianist and had a very good mezzo soprano voice.

Nurse and Midwife

Before commencing her training in nursing and midwifery Paget had wanted to develop her artistic skills and possibly become an artist, but this was strongly discouraged by her family. At the age of nineteen in 1874 (Barclay, 1994) she began her district nursing training and in 1875 she undertook nursing training at the Westminster Hospital in London; apparently also in the face of much opposition and against the wishes of her family. In 1877 Paget returned to Liverpool to increase her nursing experience and during 1878-79, she worked at Pendlebury Children’s Hospital near Manchester in charge of two medical wards as ward sister. The Superintendent, Miss Eva Luckes, who later became Matron of the London Hospital, Whitechapel wrote:

“Sister Rosalind, without exception, is the best hospital sister I ever saw. She understands the work as thoroughly as she likes it. She has plenty of system and keeps her nurses well up to the mark” (Rivers, 1981).

In 1880, Paget was based at the London Hospital where she remained for much of the time until 1889; in 1882-1884 she completed her formal training and was awarded her full nursing qualification certificate. During her time at the London Hospital she worked as a Nursing Sister gaining experience on every ward and also took charge of the outpatient department for which skills and experience in all branches of nursing was necessary. This breadth of practice and knowledge gave her the skills to supervise her less experienced and junior staff. In 1890 Paget became the first Queen’s District Nurse and Inspector; yet another incidence of her many significant achievements and contributions to nursing.

The earliest reference to Paget learning massage (at that time also known as  medical rubbing) was in 1886 when Miss Luckes, the Matron, sent her together with Miss RP Fynes-Clinton (who became a life-long friend of Pagets) for lessons from Miss Elizabeth Buckworth who was an experienced masseuse and massage teacher. At that time massage was gradually becoming incorporated into nursing. On return from their training, they were officially named as masseuses at the London Hospital. Paget wrote of the experience,

About this time patients were being treated for neurasthenia by bed-stuffing and massage, for Dr. Weir Mitchell. I, and my friend Miss Fynes-Clinton, both sisters at the London Hospital, were sent by Matron to learn how to massage by Miss Buckworth (a delightful teacher and a superb rubber). After this we did a good deal of massage and taught the private staff. Some of our nurses made very good masseuses…” (Wicksteed, 1948).”

In 1887 a committee was set up to administer the use of a sum of money from the Women’s Jubilee Offering which had become available from Queen Victoria. On her Majesty’s suggestion the funds were to be used for the welfare of nursing and nursing establishments. According to the account set out by Rivers (1981), Florence Nightingale was “much concerned that this project should develop in accordance with her own ideas, and she and William Rathbone worked out proposals by which these could be put into effect”. As a consequence, the Queen Victoria’s Jubilee Institute for nurses was set up and the Metropolitan and National Nursing Association recognised as the Central Training Institute for district nurses in London.

The committee decided to elect a principal nursing officer and following this decision “references and testimonials” for Paget to fulfil this role poured in. Before she accepted the role Paget made it clear that she did not want a salary and could not commit herself to the role for more than a year or two. She was appointed on 1 January 1890 having spent a few months in 1889 in training to become fully qualified as a district nurse.

Paget also undertook a further three month training in midwifery at the British Lying-in Hospital, Endell Street, Holborn, London where she had qualified in 1885 with the Diploma of the London Obstetrical Society, beginning her association with the Midwives’ Institute, which later became the Royal College of Midwives, in which she quickly became very committed and involved as a leader in the provision of education and training. Her record of dedication and commitment to the Institute speaks for itself. She played a central part in ensuring that the Institute obtained its own headquarters which was seen as an important landmark in the status of the organisation and was made Treasurer of the Institute serving in this role from 1890 to 1930 and also dealt with much of the Institute’s administration. Paget founded, and was for many years proprietor and supported financially from her own funds, the Institute’s Journal “Nursing Notes” which later became the “Midwives Chronicle” in which she published the first full article on massage in 1887.

The Institute achieved Incorporation by the Board of Trade at the end of the 1880s and Paget was formally recognised as one of the Founders of the Midwives Institute as a signatory of the “Articles of Association”, having undertaken much of the work on preparing documentation and liaising with the solicitors who undertook the legal work. She was a key player in the administration of the whole campaign and process and learnt much from this experience in the development of the Institute which, undoubtedly would be crucially important in her later work as a founder of the STM and ISTM. An important purpose of working towards Incorporation of the Midwives Institute was to increase its status in the public perception and gain the backing of influential sponsors to support its objectives. Incorporation was also seen as a platform from which to develop the case for Midwives’ Registration and to assist the process of petitioning Parliament for this recognition and protection through the Law; an important landmark in the status of the profession.

Paget became a very strong campaigner for legislation to bring about the registration of midwives and in 1892 she gave evidence to the Parliamentary Select Committee on midwifery. However, it was not until the Midwives Act in 1902 that legislation made it an offence for anyone to practice as a midwife without proper certificated qualification, making it illegal for anyone not so qualified to describe herself, or practise as a midwife and through this legislation the Central Midwives’ Board was set up on which Paget served from 1902 to 1924 as a Board member. In 1903, she became only the second midwife to register with the Central Midwives Board. It is interesting to note that in the context of Registration, the Chartered Society of Physiotherapy did not achieve this until 1960 as a result of the Council for Professions Supplementary to Medicine Act 1960 (Jones, 1991).

Women’s Suffrage

Another example of Paget’s campaigning was her commitment to women’s suffrage. Her view, in common with the ideas of other leaders of the Institute, that midwives as a professional group could have a key influence on social change, was inextricably linked with support for women’s suffrage and the need to foster active citizenship (Hannam, 1997). Paget took a leading part in the Institute’s support for the campaign for women’s suffrage. She provided an important link between the Midwives Institute and the Association for Promoting the Training and Supply of Midwives, a lay group which had many suffragists amongst its membership.

When the suffrage campaign had revived and became more active after 1903 it was Paget who urged members of the Institute to participate in demonstrations for the vote, and an example of her leadership in the campaign was clear from her action in 1908 when she led 20 members in a suffrage procession under the banner of Florence Nightingale (Hannam, 1997).

Her views about women’s suffrage were drawn on’ by the suffrage movement as a whole. Paget continued as a leading member of the campaign for women’s suffrage for many years.

”In the period before 1914 Rosalind and the other leaders of the Institute sought to enhance the professional status of the midwife in a context in which policies to improve the nation’s health and women’s role in politics were both debated. The attitudes of the officers of the Institute on these issues were complex. They saw a role for both the state and midwives in fostering a sense of responsibility in mothers. As professionals, their influence was thought to be distinct from that of philanthropists since it was based on scientific training and was not concerned with moral rescue. They supported government legislation which aimed to improve maternity care and to provide financial assistance to mothers so long as it did not undermine the self-respect and the freedom of mothers to be attended by the midwife of their choice. As voters they could ensure that legislation was passed which provided an improved environment and support for maternity care. (Hannam, 1997).

The Increasing Prescription and Popularity of Massage and  Founding of the Society of Trained Masseuses

In 1894 the idea of creating a Society of Masseuses first emerged for two important reasons. Firstly, the rapidly increasing popularity: there was a growing upsurge in interest in the value of massage, also known as “medical rubbing”, due to successful treatments provided by a group of experienced and very competent Swedish masseurs and masseuses that were trained in the Central Institute in Stockholm and had come to practise in Great Britain and also a small number of nurses increasingly undertaking training in hospitals such as the London Hospital, Whitechapel, and incorporating “medical rubbing” into their practice. There were also a few massage schools, for example, the London School of Massage where Dr Fletcher Little (Medical Officer of Health for Harrow) was a lecturer and Director. Dr Fletcher Little also accepted blind people to train as masseuses and masseurs at the London School of Massage. He was for many years an advocate for the training of suitable blind people in massage and integrated blind people into the school alongside sighted student practitioners (Jones, 2021). Nurses at Guy’s Hospital were also taught massage from 1888 by Miss Manley and her sister, both London Hospital trained nurses. Their students were nurses who did a course lasting four to six weeks in their spare time, which, in view of the hours worked by nurses at that time, says much for their determination and calibre (Cooper, 1976). At this time, members of the medical profession were increasingly prescribing massage for their patients, and the treatment was also becoming more popular because of this.

The second reason providing the greater impetus for the development of a specific professional organisation for massage, was very “unsavoury”, as massage establishments or parlours began to be established for sexual purposes under the guise of treatment for patients. Young nurses were being lured on the pretext of being required to give massage to patients, but the reality was that these establishments were in fact what could be described as “houses of ill fame”. These scandals taking place in the last decade or so of the nineteenth century are widely discussed in histories, articles and analytical papers about the massage scandals of the time.

The scandals became so prevalent that questions were asked in Parliament about these massage establishments and the medical journals also took up the issue. For example, in July 1894 the British Medical Journal published an article warning against the use of massage because of unscrupulous people practising (British Medical Journal, 1894; Nicholls & Cheek, 2006). As a result of the weight of all this seriously damaging scrutiny and publicity a small number of founders, led by Rosalind Paget and Lucy Robinson, worked hard to protect their growing occupational group resulting in the emergence of the Society of Trained Masseuses which would, over many years, become a fully-fledged profession.

The Idea of a Massage Society Emerges

An initial discussion about the possibility of forming a Massage Society arose in a conversation between two nurses and midwives, Paget and Lucy Robinson, both were also trained masseuses. Jane Wicksteed (1948), a member of Council of the Chartered Society of Physiotherapy (CSP) and the first historian of the CSP in her book “The Growth of a Profession” wrote:

A summer afternoon in the year 1894, two anxious young women in earnest conversation. Rosalind Paget, the elder, tall, slight and distinguished, is dressed in the close-fitting bonnet and dark uniform dress of the Queen’s nurses and Lucy Robinson…the two nurses, so unlike in appearance, so alike in their aspirations, are seated in the club-room of the Midwives Institute and Trained Nurses Club. The air is thick – or so it seems to them – with the breath of noisome rumours; not only the halfpenny press, but also the revered medical journals, are publishing articles on what have come to be known as ‘Massage Scandals’. Unsavoury establishments are cropping up under the guise of nursing homes and to these places unsuspecting nurses are enticed on the pretext of being needed to give massage to patients…both are immersed heart and soul in their work and cannot endure this cloud that is rising. Suddenly, Lucy exclaims ‘Let’s form a Society’.

Rosalind is horrified: ‘A Society of massage at this time! What would people think, what would people.’”

Following on from this, Paget and Robinson (1853-1921), were joined by Elizabeth Annie Manley (1851-1924) and Margaret Dora Palmer (1837-1921), both of whom were also trained masseuses (Barclay, 1994). Manley ran a successful massage training school and held classes, not only in massage, but also in Ling’s Swedish Movement several times a week. These classes took place at the Trained Nurses’ Club and Midwives Institute, Paget was a Founder member of both of these organisations. Palmer was a well-known masseuse and manager of the massage department of the London Hospital and later became the author of the standard textbook: “Lessons in Massage” (Palmer, 1901).

These four dedicated and insightful women had decided that they would, together with committed colleagues of similar backgrounds, form a Society of Massage for the treatment of patients who were injured or sick, and by doing this ensure a safe, clean and respectable profession for women. Before the end of 1894 they consulted some of their colleagues to bring their proposal to fruition and the date of a further meeting was set.

The handwritten notes of this meeting recorded the content of the discussion as follows:

“1894: Midwives Institute ‘le Massage’”

“A preliminary meeting was held in December at the Midwives Institute to consider the subject of massage. Present, Miss Manley, Miss R. Paget in the Chair, Mrs. Palmer and Miss Robinson where it was proposed by Miss R. Paget seconded by Miss Robinson that a Sub-Committee be formed to consider the question of massage in all its bearings especially as to the granting of certificates by the Institute. Sub-Committee to consist of a representative of the Institute (Miss Wilson or Miss R. Paget), Miss Robinson, Mrs. Palmer, Miss A. Manley, Miss G. Manley, Mrs. Arthur (Hon. Secretary)

“ It was also proposed to form rules for masseuses belonging to the Club”.

“That first opinions on the subject be collected by those present.

“That a meeting be called early in the year. The following rules were suggested and an early form of certificate designed. 

Rules:

No massage to be undertaken except under medical direction.

No general massage for men to be undertaken exceptions may be made for urgent and nursing cases at a doctor’s special request.

No advertising in any but strictly professional papers.

It was anticipated that the masseuse would sign a declaration:

“I agree to the foregoing rules and will return the certificate if at any time the Council of the Institute consider I have been guilty of unprofessional conduct.

Signed…………

A further suggestion for wording to be included on the certificate was:

“This is to certify that……….

Has been trained in Practical Massage with Swedish Movement, and we consider her fully qualified to carry out massage treatment under the orders of a medical practitioner. She has been instructed in elementary anatomy and in the use of the battery.”

………..

……………..

…………….

Institute Examiners

For the Institution………

NB.……..has been entered on the role of masseuses at the Institute, further particulars can be obtained from the Secretary ………..

Signed, R. Paget” (Wellcome Foundation)

These early drafted documents were worked upon, greatly expanded and quickly modified as the Society steadily developed and Paget’s strong links with the medical profession were invaluable in currying support and obtaining advice.

Further meetings were held on 4th January,11th January and 1st February.

The handwritten notes of these meetings indicate that Rosalind Paget was in the chair:

4th January 1895. It was decided to adopt amended wording for the Certificate suggested by Dr Cooper Perry (later Sir Cooper Perry). Dr. Cooper Perry was one of the early medical friends of the Society. His name appears as one who gave help, support and advice on many occasions and he suggested wording for the Certificate.

“This is to certify that……

Has been instructed in the theory and practice of massage and that we consider her to be fully qualified to carry out treatment by massage under the direction of a medical practitioner.

Signed…….

……….

……….

Examiners.” (Wellcome Foundation).

It was proposed that the following be the wording with respect to the inclusion on the role.

“………… has been enrolled on the Register of Masseuses at the Institute and any enquiry concerning her should be made to the Secretary at the above address” (Wellcome Foundation). 

The proposed rules were considered. It was agreed in accordance with the doctor’s opinion that the first and second rule be amalgamated as follows:

Rule 1. No massage to be undertaken except under medical direction, no general massage for men to be undertaken except for occasional urgent cases as part of the nurses’ work.

Rule 2. No advertising in any but strictly professional papers. (Wellcome Foundation)

It was decided to get solicitors opinion upon the suggested wording.

11th January 1895 – Discussion about a Constitution and first Council meeting.

1st February 1895 – Decision that the Society’s Certificate should be printed on parchment and fifty certificates were ordered. There were further suggestions relating to masseuses that:

The dress of the masseuse should be appropriate.
Avoidance of gossip.
To refuse any offers of stimulants.
Not to recommend any drugs to the patients or to make a profit from procuring them.
Take precautions against conveying infections.
Fees in accordance with professional rules.

If these standards were not adhered to the masseuse could be accused of unprofessional conduct. (Wellcome Foundation).

The Society Formally comes to Fruition on 1st February 1895

The formation of the Society of Trained Masseuses (STM) was formally announced in a letter to the Editor of “Nursing Notes”:

“Sir, There has been, as your readers are fully aware, a good deal written and spoken lately on the subject of massage, and the position held by masseuses in the professional and nursing world.  For some time, those members of the Trained Nurses Club who taught massage have sought to devise some plan for placing their pupils on a firmer and surer professional footing than the majority of masseuses have hitherto attained. It was also desired that they should be protected from any such suspicions as have recently been rife in regard to a few individuals”.

“Some months ago a committee of trained masseuses was formed (with the addition of some teachers of massage not members of the Club) to consider the subject. This committee henceforth to be known as the Society of Trained Masseuses, has met several times, and has now decided to hold regular examinations of their pupils and to give a certificate stating that they have been examined in the theory and practice of massage. The pupils will be examined by two examiners other than their instructors” (Wicksteed, 1948).

With the publication of this letter the Society of Trained Masseuses (STM) was formally launched, it was run by an unpaid Secretary from a small room and a Council of nine under the Chairmanship of Paget. In March 1895, the handwritten documentation shows that the new Council  comprised nine members including Paget as chair and a Augusta Arthur as Hon Secretary (Wellcome Foundation).

Paget chaired the Council of the STM from 1895 and continued as chair when it became the Incorporated Society of Trained Masseuses (ISTM) in 1900, until 1905 (Wellcome Foundation). She was also Director of Examinations from 1895 until 1917. Regarding examinations, it is remarkable that one of the first actions taken by the Founder members of STM was to examine each other under the same strict examination conditions as new recruits to the Society in order to ensure that their own level of knowledge, competence, and skills were at the highest level possible. Following this, the first examinations date for membership of STM was set for February 16th 1895 from which seven candidates were awarded certificates of the Society on 23rd February, as shown on the report of the awards ceremony (Wellcome Foundation). Also a year later, an outside examiner, Mrs Piercy Evans who was the Senior Demonstrator at the London School of Medicine for Women was appointed to examine candidates in the anatomy viva examinations; this started a long association with this famous School.

Medical Patronage

At the Society’s first Annual General Meeting held in February 1896, it was decided to ask a number of physicians, who had worked with and supported the Society, publicly giving their support over several years, to allow their names to be put on a list of patrons. Among the eminent doctors approached and appointed were Dr Playfair, Sir Frederick Treves, Sir Francis Lakin, Sir William Bennett and Dr (later Sir) Cooper Perry.

Part 2 to follow.

References

Barclay J. (1994).  In Good Hands. Butterworth-Heinemann: Oxford, pp25-26.

British Medical Journal (1894). 14th July, p88.

Cooper R.J. (1976). A History of the School of Physiotherapy” in Guy’s Hospital – 250 Years. Guy’s Hospital Gazette: London. pp97-104.

Hannam J. (1997). “Rosalind Paget: The Midwife, the Women’s Movement and Reform before 1914”. In Midwives, Society and Childbirth, pp81-101. Routledge: London.

Jones R.J. (2021). “Blind and Partially sighted physiotherapy in the United Kingdom.  A century of Development, success and challenge.  Will it still belong?”. In Physiotherapy Theory and Practice, 37(3), pp401-419.

Jones R.J. (1991). Management in Physiotherapy. Radcliffe Medical Press: Oxford. p15.

Nicholls D & Cheek J. (2006). Physiotherapy and the Shadow of Prostitution; the Society of Trained Masseuses and the Massage Scandals of 1894. Social Science and Medicine, 62, 2236-2348.

Palmer MD. (1901.) Balliere, Tindall and Cox:London.

Rivers J. (1981). Dame Rosalind Paget DBE, ARRC 1855-1948. Nursing Notes: London. pp56, 24,49, 16,17.

Wellcome Foundation, London. Handwritten Official Papers  including Minutes of Meetings, Agendas, Correspondence and Notes of STM.

Wicksteed J.H. (1948). The Growth of a Profession. Arnold & co: London. pp21, 25, 32.