The First Stage of the History of Orthopaedics in Norway : the Therapy of " Self-correction "

The Fi s S age o he His o y o O hopaedics in No way: The The apy o JAN FROESTAD (*) SUMMARY 1.-In oduc ion. 2.-The o hopaedis Gunde Nielsen Kjols ad. 3.-The essen ial ea u es o he he apy. 4.-The heo e ical ounda ion o he he apy. 5.-The sp ead o he he apy. 6.-The alua ion o he me hod o sel -co ec ion: om scep icism o app o al. 6.1.-The e alua ions o he medical p o ession. 6.2.-The assessmen s o he No wegian go e nmen . 6.3.-The app ecia ions o he clien s and he public. 7.-P e ailing ideological ends. 8.-A me aphysical heo y in a me aphysical milieu. 9.-The new impo ance a ached o physical educa ion. 10.-The muscula heo y. 11.-The enewed in e es o he physicians in he o hopaedic ield. 12.-The p e en a i e quali ies o he he apy. 13.-The e icacy o he he apy. 14.-The social composi ion o he clien ele. 15.-The ela ion o he clien s. 16.-Concluding ema ks. RESUMEN En es e a ículo se in es iga el p ime es adio de la his o ia de la o opedia en No uega, que anscu e desde 1838 a 1880 y que se ca ac e izó po un peculia mé odo de educción de las cu a u as de columna, la llamada e apia de «au oco ección». Se indagan, en pa icula , las posibles causas de la ele ada es ima que es a e apia o opédica ecibió en No uega. Fecha de acep ación: 6 de mayo de 1992. (*) Depa men o Adminis a ion and O ganiza ion Theo y. Uni e si y o Be gen. No uega. DYNAMIS Ac a Hispanica ad Medicinae Scien ia umque His o iam Illus andam. Vol. 13, 1993, pp. 73-1 15. ISSN: 0211-9536 74 JA.N FROESTAD 1. INTRODUCTION I seems easonable o di ide he No wegian his o y o o hopaedics, be o e he second wo ld wa , in o h ee ime pe iods. The i s uns om 1838 up o abou 1880 and is cha ac e ized by a peculia me hod o he s aigh ening ou o spine cu a u es, he so-called he apy o «selL ~o ec ion». The nex uns om 1880 o 1916 and is ma ked by he in oduc ion in No way o a new o m o ea men , he Swedish physio he apy. The las ime pe iod uns om he beginning o Wo ld Wa 1 o he beginning o Wo ld Wa 11. This phase is dis inguished by he de elopmen o a much igh e link be ween o hopaedics and he o ganized ca e o c ipples, which o igina ed in 1892 as a philan h opic ac i i y gea ed o he needs o c a aining. In his con ibu ion, howe e , 1 will limi mys :l o accoun o he eai lies s age, and in pa icula indica e some possible causes o he high deg ee o ecogni ion his o hopaedic he apy ecei ed in No way. 2. THE ORTHOPAEDIST GUNDER NIELSEN KJgLSTAD The i s medical o hopaedis in No way, Gunde Nielse i Kjols ad, was bo n in 1794 in Modum, a municipali y in he eas e n pa o No way. His pa en s we e ai ly well o a me s wi h an educa ional le e1 some abo e a e age. By a small inhe i ance and he assis ance o wo pa sons he managed in 1820 o pass he p elimina y deg ee and se o s udy medicine. Se en yea s la e he passed his medical deg ee. A en a ds Kjols ad hold di e en o ices as a my su geon un il he in 1836 was appoin ed medical o ice o heal h o he dis ic o Gudb andsdalen. Al eady du ing his pe iod o s udy Gunde Kjals ad began o de elop his peculia o hopaedic he apy. La e in li e he s a ed: e... as a medical s uden 1 go he idea ha gy nnas ics had o be he p ope emedy which eally had he abili y o s aigh en c ooked peoples. I had only o be sui ed o he pa icula aim and de eloped as an exe cise in sel -co ec ion ... )) (1). The s a ing inciden was ha a young gi l, a close ela ion o Kjals ad (1) Fo handlinge ed De Skandina iske Na u o ske es 7. Me e i Ch is iania 1856 (1857). Ch is iania, Ca l C. We ne & Comp., p. 445; KER, F. C. (1887). No ges Lage i de Ni ande Aa hund ede, Ch is iania, Alb. Ca me meye , p. 609. The Fi s S age o he His o y o O hopaedics in No way 75 who his amily had aken daily ca e o , de eloped a se ious cu a u e o he spine. Kjals ad ied o each he gi l o co ec he cu a u e he sel , by physical exe cises. Acco ding o his own s a emen she was comple ely cu ed. Ha ing passed his medical deg ee Kjals ad only spo adic go he oppo uni y o de elop u he he new he apy. I ook en yea s be o e he chose o appea in public as o hopaedis . In 1838, howe e , he used he i s mon hs o he yea o in ensi e sel - ui ion o a ailable o hopaedic li e a u e. The six h o june he ad e ised o pa ien s and opened, as he i s ,physician in Non ay, an o hopaedic ins i u e loca ed in he small own Lillehamme . The announcemen caused qui e a sensa ion and he esponses we e no al oge he posi i e. Kjals ad was accused o immodes y, ool- ha diness, cha la anism, e c. (2). 3. THE ESSENTIAL FEATURES OF THE THEñAPY On he Con inen specialized o hopaedic ins i u es we e es ablished in he las decades o he eigh een h cen u y. The ins i u es ocused hei a en ion on he di e en echniques o he s aigh ening ou o spine cu a u es. The eason ha his disease seemed p ima ily o s ike women, especially eenage gi ls, was much discussed in o hopaedic and medical ci cles. The epo s om he Non egian ins i u es con i m ha hey we e no excep ion, hey mainly ecei ed gi ls and women wi h spine-diseases, su e ing o he mos pa om scoliosis. The pa ien s dis ibu ion on age indica e a g adual shi owa ds an inc easingly ma ked accumula ion o eenage s (3). This may ha e been due o a common assump ion a he ime ha among he pa ien s su e ing om scoliosis, he eenage s had he bes p ognosis. In con as wi h mos o eign ins i u es whe e mechanical p essu e- and ac ionde ices we e he mos domina ing elemen s in he he apy, Kjals ad de eloped a o m o ea men whe e he pa ien s by pa icula physical and muscula exe cises should s aigh en ou he c ooked spine hemsel es. (2) KJaLSTAD, G. (1849). O hopadiske epheme ide , n.* 1, Ch is iania, Ca l C. We ne & Comp., p. 29. (3) Zbidem; TIDEMAND, A. (1876). Dis ik slege Kjels ads Sel e ningso hopadi, Ch is iania Ch . Schibs ed, p. 46; SALVESEN, J. M. (1855). De o hopzdiske Ins i u i Be gen. No sk Magazin o Lage idenskapen, Fo handlingene, pp. 157-172, 301-318. 76 JAN FROESTAD A o al cu e consis ed o six hou s o daily exe cise, h ee hou s in he mo ning and h ee in he a e noon. The he apy s a ed no mally wi h en minu es o s anding mechanical ac ion in a de ice so cons uc :ed, acco ding o Kjals ad, ha he deg ee o ex ension depended on he pla ien s abili y o sel -co ec ion. E e y day wo such ac ions in a s anding; posi ion was ca ied ou . The essen ial elemen o he he apy, howe e , was he so- called « oo -walk-. I consis ed o a e y slow walk, whe e he weigh o he body was g adually mo ed om one oo o he o he , whilje a he same ime he pa ien ied by image o keep he body in a so s e ched ou posi ion as possible. A e en minu es o walk, he pa ien s we e allowed en minu es o es on a bed, lying on hei back. In addi ian, du ing he h ee hou s o exe cise wo sho mechanical ac ions in bed es was unde aken. Acco ding o Kjals ad only o aid he me hod o sel -co ec ion. 4. THE THEORETICAL FOUAÍDATION OF THE THERAPY The o hopaedis Gunde Kjals ad ega ded he spine (cu a u e as a bodily collapse caused by he weigh o he uppe pa o he body on he spine. This weigh had in his opinion won o e he o ces which no mally kep he body s e ched ou . The ask o he o hopaedis was hus o awake hese dozing o ces. The igh me hod o his was he he apy o sel - co ec ion, also called he he apy o men al gymnas ics. Usi ig his me hod implied, acco ding o Kjals ad, ha «... he Mind and Ma e lows oge he in he sel s Consciousness o One and Uni y ...* (4). By hiis peculia spi i ual-physical me hod he o ces which had he abili y o s aigh en ou he c ooked spine should be ac i a ed. Tl~e o hopaedics o sel -co ec ion was a me hod whe e he physician u ged he pa ien o s aigh en himsel ou as much as possible, and o keep himsel in his ex ended posi ion. Se e a1 sou ces ha e s essed Kjals ad's own abili y in his ield, igu a i ely speaking he has been desc ibed as being able o «elec i y his pa ien s du ing he exe cises (5). Acco ding o Kjals ad, howe e , he s eng h o will was no in i sel su icien o s aigh en ou he pa ien s. A sui able me hod was necessa y, (4) KJDLSTAD (1849), op. ci . (n. 2), p. 6. (5) LUCHE, S. (191 1). No sk Medicin i Hund ede Aa , Ch is iania, S eenske Bog ykke i, p. 133. The Fi s S age o he His o y o O hopaedics in No way 77 he so-called cpoin ua ion)). This essen ial me hod consis ed o imagining di e en poin s, especially he e ex-poin , he heel-poin and he oe- poin s. Du ing he physical exe cises he pa ien had o s i e o assume a posi ion whe e an imagina y e ical line d awn h ough he e ex-poin and he na el ouched he so-called bow-poin be ween he heel-poin and he oe-poin s. Gunde Kjals ad ied o make his heo ies and me hod mo e scien i ic wi h some peculia ma hema ical and geome ic a gumen s. Fo ins ance he insis ed on he signi icance o he so-called sgeome ic elemen » as a .six h human sense, posi ioned in he na el, and he «ideal p incipie» comp ehended as a line d awn om he zeni h o hea en h ough he human axis o he cen e o he ea h, and he impo ance o he indi i- dual human being's speci ic weigh in i s ela ion o he cen ipe al o ce, as he qins inc o sel -p ese a ionx (6). In his manne Kjols ad's own heo e ical in e p e a ion o his he apy indica e a clea ben owa ds na u e-philosophical e lec ions. 5. THE SPREAD OF THE THERAPY Kjals ad's ac i i y go o shoo s in Ch is iania and Be gen. The ollowing ins i u es, al1 p ac ising Kj~ls ad's me hod o sei -co ec ion, we e in ope a ion in sho e o longe pe iods om 1838 owa ds he u n o he cen u y (7). Pe iod: Numbe o ins i u es: Di ec ed by: 1838-1847 1 D . Kjols ad 1847-1 850 3 D . Kjols ad, D . Tidemand, D . Sal esen 1850-1 855 2 D . Kjols ad, D . Sal esen 1855-1 860 1 D . Kjols ad 1860-1862 1 D . Tidemand (Miss Dina B own*) 1863-1865 O 1866-1 869 1 D . Tidemand 1869-1883 2 D . Tidemand, eache S oks ad 1883-1 897 3 Teache S oks ad, examinee Kjols ad, Miss Tidemand and Miss Gunde sen (*) Miss B own did no ha e he own ins i u e. She was a o me assis an o Sal esen who p ac ised in Be gen in he 60s. (6) KJ0LSTAD (1849), op. ci . (n. 2), pp. 1-25. (7) Tidssknp o pak isk medzcin (1888), pp. 345-350. 78 JAN FROESTAD The oi hopaedics o sel -co ec ion had i s lou ishing pe iod in he yea s be ween 1847 and 1850, wi h h ee ins i u es in ope a ion, al1 di ec ed by ully quali ied physicians. Bo h D . Sal esen and D . Tidemand had lea ned he me hod as assis an s o Kjols ad a his ins i u e, D . Sal esen had also unde gone a ea men o his c ooked spine by him. Fi e yea s la e only Kjols ad's ins i u e was s ill in ope a ion. A e his dea h in 1860 he o hopaedic en e p ise was ied con inued by D . Augus Tidemand, un il also his ins i u e was closed in he a11 o 1862. Th ee yea s la e Tidemand esumed his o hopaedic wo k and was able o keep i up un il his dea h in 1883, he i s six yea s by means o public g an s. In 1869 a new ins i u e was es ablished in Be gen, by he eache C is ian S ocks ad, an ea lie pa ien o Kjols ad and assis an o Tidemand. A ei- he dea h o Tidemand he he apy o sel -co ec ion was main ained o some yea s, bu now en i ely by o hopaedics wi hou o mal medical educa ion. S ocks ad con inued his en e p ise in Be gen, assis ed by some o he physicians in he own, D . Tidemands ins i u e was main ained by his wo assis an s, one o hem his daugh e . A he same ime he examinee Tho ald Kjols ad, he oldes son o he ounde o he me hod, opened an o hopaedic ins i u e iii he capi al. Du ing he 70s and especially a e 1880, howe e , o he o ms o ea men s, no ably he a ious o ms o physio he apy, became he ashion (8). 6. THE VALUATION OF THE METHOD OF SELF-C0RREC:TION: FROM SCEP3 ICISM TO APPROVAL The success o new medical he apies is usually con ingeni on he social alua ion o hem. As he ollowing accoun indica e he app o al o he he apy o Kjols ad was in pa icula dependen on he assessmen s o he medical p o ession, he s a e and he public. 6.1. The e alua ions o he medical p o ssion The i s h ee yea s o his o hopaedics he a i udes owa ds Kjols ad's (8) Tidsskn o Den No ske Lcege o ening (1897), p. 41 and (1903), pp. 743-744; PIENE, R. D. (1979). Mellom beskje igelse og p o esjon. U ikling a sykegynznas y ke am i1 o en lig au o isasjon, Uni e si e e i T oms0, pp. 4447. The Fi s S age o he His o y o O hopaedics in No way 79 en e p ise was nega i e, bo h wi h he public and wi h he medical p o ession. One eason o he p o essional scep icism migh ha e been due o he me hod's dis inc i e new and o iginal ea u es. Se e a1 condi ions indica e, howe e , ha his was no a e y de e mining ac o . The eason ha Kjols ad in he beginning o his o qopaedic ca ee was me wi h suspicion seems o be ha he iola ed a s anda d o medical wo k which a ha ime was ac i e in he medical p o ession, a leas in he leading medical milieus. The ac is ha JSjols ad ins uc ed his pa ien s no o exp ess hemsel es abou he cu e and i s e ec , and kep sec e his own expe iences. This p ac ice seems o ha e iola ed some ideals abou ankness and he impo an e a ached o a sys ema ic alua ion o he e ec s o new he apies. The ac i i y o Kjols ad was discussed in he medical associa ion in he capi al in 1841 and mo e in o ma ion abou his me hod and i s e ec s was exp essed o be equi ed. In july his yea he edi o o he Weekly e iezu o medicin and pha macy called a en ion o Kjols ad's en e p ise and cha ac e ized his p ac ice as edecidedly unwo hy. a medical p ac i ione . The edi o indica ed ha he public medical au ho i ies ough o ake an ini ia i e o ge hold o he long wan ed in o ma ion (9). Kjols ad's own jus i ica ion o his concealmen was e asi e and pecu- lia . Al1 he same he s a ed: C.. no deadly powe will o ce me o speak whe e 1 can and ough o keep silen ... 9 (10). The eason o he whole episode seem o ha e been ha Kjols ad was s ill unce ain as o he e ec s o he cu e and wan ed o keep he esul s sec e un il he wi h g ea e con iden e could a gue o i s sui abili y. G adually, howe e , Kjols ad mus ha e el he p essu e pu on him by his p o ession. A sho ime a e he c i icism o his p ac ice by he edi o he decla ed in a capi al newspape s ha he exemp ed his pa ien s om hei p omise o sec ecy. The e a e indica ions ha he p o essional a i udes owa ds Kjols ad's he apy a ha ime was changing. One physician s a ed in he e iew, wi h ega d o he cu e: e he e ec s seems, al1 conside ed, o be posi i e ... many pa ien s shall ha e become conside ably be e and some e en ully cu ed .. .» (1 1). Ano he physician accoun ed o eb illian e ec s» wi h ega d o isola ed cases (12). Ha ing gi en up o keep sec e his expe iences, in he (9) Ugeskni jo Medicin og Pha macie (1842), n."8, p. 256. (10) KJaLSTAD, C., quo ed in: Ugeskn? jo Medicin og Pha macie (1842), n." 28, p. 256. (11) Ugeskni jo Medicin og Pha macie (1842), n."9, p. 380. (12) Ugeskni o Medicin og Pha macie (1842), n." 50, p. 405. 80 JAN FROESTAD decade om 1842 Kjols ad ook a lo o ini ia i es o ge he he apy app o ed by he medical p o ession. In he a11 o 1842 he go ~wo colleagues o e alua e he he apy. The physicians o e saw he cu e o hal a yea , and s a ed subsequen ly in he newspape s ha one hi d o 34 cases had been comlple ely s aigh ened and ha al1 he pa ien s, wi h one possible excep ion, had imp o ed hei la ge and o en e y old cu a u es (13). In 1844 Kjols ad held a lec u e abou his o hopaedic me hod a he ~Fi h mee ing o he Scandina ian na u e-scien is ss. On his occasion, howe e , he did no succeed. The lec u e was cha ac e ized as e i mbling wi h philosophiical and ma hema ical ph ases .... (14). This expe ience seems only o ha e led Kjols ad o in ensi y his campaign o he he apy o sel -co ec ion. In he ollowing yea s he a se e a1 occasions ied o demons a e o he medical associa ion iin he capi al, wi h he uise o plas e cas s, he e ec s o his cu e. He also go in ouch wi h he medical associa ion o ha e a commi ee o physicians appoin ed o e alua e he he apy. The delibe a e in en ion was o a ain a s a emen om he commi ee o be used a he six h mee ing o he scandina ian na u e-sci zn is s in 1847, whe e he once mo e ied o gi e an accoun o his he apy. On his mee ing Kjols ad dis ibu ed he commi ee's s a emen , which was posi i e bu no e y conc e e ega ding he e ec s o he cu e. Two o he physicians o he commi ee ga e an addi ionial s a emen , decla ing ha hey had wi nessed he s aigh ening ou o se e e cases o cu a u es,. in a deg ee hey had no hough was possible (15). I was p obably mo e impo an , howe e , wi h ega d o he ecogni ion o Kjols ad, ha i was some o he mos dis inguished physicians in Non ay ha made hese s a emen s. A he mee ing Kjols ad also dis ibu ed decla a ions om he o he medical o hopaedis s in Non ay, D . Tidennand and D . Sal esen, which s a ed ha he he apy was supe io o o he o hopaedic echniques. In addi ion he demons a ed he e ec s o he cu e wi h he help o plas e cas s. Acco ding o Kjols ad's own s a emen his lec u e and exhibi ions a he mee ing was highly accep ed and he a las ob ained he ecogni ion he had long hoped o (16). In he nex yea s Kjols ad was able o con ibu e o some mo e posi i e (13) KJ0LSTAD (1849), op. ci . (n. 2), p. 49. (14) LAACHE (1911), op. ci . (n. 5), p. 132. (15) KJ@L,STAD (1849), op. ci . (n. 2), p. 59. (16) Zbidem, p. 53. The Fi s S age o he ~is o y o O hopaedics in No way 81 s a emen s abou his he apy and in 1849 he published a book abou his o hopaedic me hod and heo y, wi h al1 he ad an ageous s a emen s om o he physicians included. He also go in ouch wi h he medical associa ion in he capi al o see ha i con inued i s e alua ion o he he apy. The commi ee's inal s a emen was made in 1852. I decla ed ha he pa ien s had been ex ended abou one inch lying down and a li le mo e han one and a hal inch in a s anding posi ion. Rega ding he e ec o he he apy on he pa ien s gene al heal h he commi ee s a ed ha i see ned o be e y ad an ageous (1 7). When Gunde Kjols ad opened his o hopaedic ins i u e in 1838 he was me in he su oundings by scep icism and suspicion. G adually he a i udes changed and his me hod achie ed conside able ame as a well sui ed he apy o he ea men o ~c ookedn. Many o his colleagues and some o he mos c edi ed physicians in Non ay also decla ed hemsel es in a ou o he me hod. The p o essional a i udes owa ds Kjols ad's he apy seem o ha e al e ed ch onological in he ollowing manne : Pe iod: A i ude: 1838-1842 Scep icism, ejec ion 1843-1 846 Some accep ance 1847-1 85 1 App o al 1852-1860 Rega ded as a supe io he apy A e he dea h o Kjols ad in 1860 Augus Tidemand was ega ded as he mos compe en o hopaedis in No way. O o Lund, he chai man o he medical associa ion in he capi al, spoke o Tidemand as e... he pe son ha wi h us is he g ea es au ho i y in his ma e ... » (18). The o hopaedic ac i i y o Tidemand was discussed se e a1 imes a he mee ings o he medical associa ion du ing he 60s. I is e iden om he epo s ha his o hopaedics was gene ally app o ed. On one occasion, howe e , he physician Joachim A. Voss d ew a en ion o he ac ha he acknowledged Danish o hopaedis A. G. D achman had decla ed ha he he apy o sel xo ec ion was a igmen . D achman had s a ed in a Danish medical jou nal: (17) No sk Magazin o Legeuidenskapen, Fo handlingene (1852), p. 265. (18) LUND, O. quo ed in: No sk Magazin o Lege idenskapen, Fo handlingene (1867), p. 176. 88 JALN FROESTAD 1850-1857: The a angemen o ((con iden ial p incipal» was ex ended o an ad iso y commi ee wi h some oom o independen ini ia i es - p o esso Con adi was appoin ed chai man o hie commi ee, appoin ed as addi ional membe s we e F ans Ch is ian Faye, p o esso o medicine and Hen ich S e ens, chie physician. 1858-18'74: An o ice o depu y sec e a y wi h medical kniowledge was ounded in he depa nen o in e na1 a ai s, as head o he heal h se ice - appoin ed was he physician Ch is ian Kie ul , he o me sec e a y o he ad iso y commi ee. In his con ex i is no he g adual s eng hening o he medical p o essional elemen in he cen al s a e bu eauc acy ha is he mos in e es ing ea u e, bu he ac i is possible o ela e al1 he physicians ha was appoin ed o hese o ices o s a emen s o ini ia i es in a ou o Kjals ad o Tidemand. The p o esso Ca l Wilhelm Boeck pa icipa ed in he commi ee appoin ed by he medical associa ion o e aluai e he he apy o Kjols ad, and wi h he physician O o Lund he ga e a e y ad an ageous supplemen a y s a emen o i s quali ies a he mee ing o he Scandina ian na u e-scien is s in 1847 (31). The chie physician Hein ich S e ens assis ed Kj0ls ad a he mee ing so ha he was able o show a big case o plas e cas s o illus a e he e ec s o he cu e (32). The p o esso Fi ans Ch is ian Faye also in ol ed himsel in a ou o Kj~ls ad a his mee ing. He pe sonally eques ed he acknowledged Danish o hopaedisa Johann Ch is ian A. Bock o ca y ou expe imen s o documen he alue o he he apy o Kj0ls ad (33). P o esso Con adi was among hose physicians exp essing hemsel es mos in a ou o he o hopaedics o Tidemand in he 60s. As men ioned i was Con adi who sugges ed o use he au ho i y o he medical associa ion o ob ain public g an s o he en e p ise o Tidemand (34). The physician Ch is ian Kie ul also in ol ed himsel in his ini ia i e. Kie ul had himsel a s ong p o essional in e es in o hopaedics. In 1852 he published a pape on he causes and ea men o he spine cu a u es. As will be (31) KJ0LSTAD (1849), op. ci . (n. 2), p. 59. (32) Zbidem, pp. 52-53. . (33) FAYE, F. C. quo ed in: Fo handlinge ed De Skandina iske Na u o skiwes 5. M@ e i 1847 (1849). Kabenha n, Gyldendalske Boghandling, p. 917. (34) CONRADI, A. C. quo ed in: No sk Magazin o Lcegeuidenskapen, Fo handlingene. (1863), p. 101. The Fi s S age o he His o y o O hopaedics in No way 89 elabo a ed la e he in his wo k pic u ed he o hopaedics o Kjols ad as a supe io he apy (35). I ollows ha he s a e's inancia1 suppo o he o hopaedics o sel - co ec ion bo h was ela ed o he ac ha his he apy ob ained he app o al o he cen al medical milieu in No way and o he ci cums ance ha leading membe s o his milieu, al1 posi i e in hei a i ude o he he apy, occupied he posi ions as medical expe s o he cen al bu eauc acy in his ime pe iod. I seems likely ha he a i udes and in ol emen s o hese p o essionals wi h ega d o he o hopaedic en e p ises o Kjols ad and Tidemand in a la ge measu e we e conduci e o he ecommenda ion o he depa men o mee he eques s o public g an s. 6.3.' The app ecia ions o he clien s and he public How did he clien s iew he he apy? Reg e able, he e is less in o ma ion le o h ow ligh on his issue. I has been claimed, howe e , ha he he apy o sel -co ec ion go a epu a ion among people as a sui able he apy o he ea men o ~c ookedn (36). The app o al o he cu e mus be assessed in ela ion o he a ian he apies a ailable o he pa ien s a he ime. I seems easonable o assume ha he p o ac ed mechanical p essu e and ex ension- he apy usually mus ha e in ol ed long and hea y su e ings. I was claimed ha he cu e in many ins ances was inju ious o heal h. As dis inc om his cu e, he he apy o sel -co ec ion en ailed ha he pa ien s we e allowed o mo e abou and hey we e ins uc ed o do physical exe cises ha p obably had a a ou able e ec on hei gene al heal h. The o hopaedics o Kjols ad, howe e , was no bed o oses. The he apy equi ed g ea pa ience and enaci y o he pa ien s. Bo h Kjols ad and his colleagues complained as o how di icul i was o sway he pa ien s o be su icien ly pe sis en du ing he he apy. Rumou s sp ead on how ough he cu e was and how s ic he eache could be. In 1856 Kjols ad ound himsel obliged o make a public p onouncemen s a ing ha he in ended (35) KIERULF, C. T. (1853). En k i isk F ems illing a de o skjellige Meninge om Ryg adsk umningens Aa sage og Behandling. No sk Magazin w Lcege idaskapen, Fo handlingene, p. 87. (36) Zllus e e Nyhedsblad (1857), n." 30, p. 152; (1860), n.", p. 30. 90 JA,N FROESTAD o ound an associa ion o elde ly ladies o supe ise he iins i u e. The s a emen was concluded by he names o 26 ene able ladies o he bou geois, al1 engaged in social wo k (37). This may indica e ha he me hod o sel -co ec ion ne e became as popula wi h he public as wi h he medical p o ession. The a iguous and s enuous ea u es o he he apy may ha e been a eason o he seemingly dec easing popula i y o he cu e in he 1870s, as o he mo e pleasu able o ms o physio he apy came in o ashion. The gene al imp ession is s ill ha he he apy o sel -co ec ion du ing he wo decades om abou 1840 ob ained a ecogni ion in No way as a well sui ed and e en supe io me hod o he cu ing o c ooked spines. In wha ollows I will emphasize some ci cums ances which may ha e con ibu ed o his app o al. No a emp will be made o weigh he ela i e signi icance o he di e en condi ions e ealed, o o ace he ela ions be ween hem. This would ha e equi ed a mo e heo e ical in o med analysis, which is no he ai n in his ound. 7. PREVAILJNG IDEOLOGICAL TRENDS The e is an enchan ing a ini y be ween he eaching and heo y o Kjols ad and he p e ailing ideological ends in No way in he pe iod om 1840 o 1870. In his ime pe iod pie ism a ained hegemony in i-eligious li e and libe alism beca ne he p e alen economic doc ine. Pie ism emphasized he signi icance o asce icism as a way o pu i ica ion and sal a ia~n. Analogous, Kjols ad ega ded com o , indi e ence and i oli y o be ices o g a e dange o his he apy. He s a ed: <<As in Di ine, Religious and Mo al li e indi e en ism is he mos cunning and dange ous Enemy, as well as he e in he o hopaediic li e ... >> (38). The ideology o libe alism s essed he necessi y o dis inguish be ween he wo hy and he unwo hy in he socie y and 6 es ic he public commi men . Only he wo hy ough o ha e ce ain igh s o public suppo and he elie ough p e e ably o be gi en as a way o help pieople o help hemsel es. The heo e ical basis o he me hod o sel -co ec ion highligh ed (37) Byminne (1982), n . 1, p. 6. (38) KJ0LSTAD (1849),. op. ci . (n. 2), p. 9. The Fi s S age o he His o y o O hopaedics in No way 9 1 he signi icance o he pa ien s own e o and pe sis ence and seems o ha e been well adjus ed o he p e ailing libe al ideas. Tidemand s a ed: ~Sel -help is he claim o ou ime. In he same manne , howe e , as he lack o will o help onesel , i his is possible, make he pe son unwo hy o he suppo o o he s, up igh aspi e o elie e one's own dis ess by wo k and diligence, cons i u e he essen ial condi ions o p og ess in he ele an cause. To b ing his p inciple o bea wi hin a b anch o he p ac ica1 o ien ed medicine, his was he idea o ou compai io , he deceased medical o ice o heal h, Gunde Kjols ad .... (39). I seems easonable o assume ha some o he heo e ical e lec ions o Kjols ad and Tidemand, well adjus ed o he p e ailing ideological ends, mus ha e had a legi ima ing e ec wi h ega d o hei o hopaedic ac i i y. I emains o be examined, howe e , i his accommoda ion is main ained as o he p o essional de elopmen in he same pe iod. 8. A METAPHYSICAL THEORY IN A METAPHYSICAL MILIEU Gunde Kjols ad's philosophical and pa ly eligious e lec ions was no accep ed wi hou es ain by he medical p o ession. His lec u e a he mee ing o na u e-scien is s in 1844 was no ecei ed wi h en husiasm, as men ioned, because o his endency o philosophical and ma hema ical exp essions. The gene al imp ession is s ill ha he na u e-philosophical heo ies o Kjols ad o some ex en was ully accep ed by his colleagues, o hen ise conside ed as a necessa y elemen o his me hod. The chie physician O o Lund, la e chai man o he medical associa ion in he capi al, s a ed in 1842 ha Kjols ad's he apy seemed o be «... based on a mo e accu a e unde s anding abou he p inciples o he ea men o spine cu a u es ... D (40). The co ps physician Tho ald We lesen s a ed a abou he same ime ha he me hod c... seems o be based on a comp ehension o he ac ual cha ac e o he c ooked spine ...n (41). A medical p ize pape on he di e en opinions o he causes and (39) TIDEMAND (1876), op. ci . (n. 3), p. 1. (40) LUND, O. quo ed in: Ugesk i o Medicin og Phamzacie (1842), n.90. (41) We lesen, T. quo ed in: KJ0LSTAD (1849), op. ci . (n. 2), p. 49. 92 JAN FROESTAD ea men o he spine cu a u e was published in No way i 1 1852 by he physician Ch is ian Tho ald Kie ul . I is likely ha he accoun was based o some ex en on he expe iences o Kie ul as a my su geon in he wa be ween Denma k and Ge many in 1848 and as su geon a he' ield hospi al in Augus enbo g du ing he a mis ice. In his desc ip ion Kie ul ep esen ed he o hopaedic me hod o Kjols ad as a supe io he apy. Rega ding Kjds ad's philosophical and eligious e lec ions IKie ul s a ed: «l seems o me ha a lo o his has o be a pa o his me hod and no wi hou ha m can be sepa a ed om i ... al1 his mys ical speech ha he in ensely imp esses his pupils, make hei whole spi i o ien ed on him and as a esul hey keep hei minds on he eachings, emembe he pu pose and ne e o ge he sel -s aigh ening ...a (42). Kie ul ob iously did io ega d Kjds ad's e lec ions as en i ely scien i ic alid, bu conside ed hem al1 he same as an essen ial he apeu ic measu e, and as a well sui ed me hod o e oke he spi i ual o ce o he pa ien . The essen ial ideas o Kj~ls ad, on which he based his o hopaedic me hod, he concep ion o an in ima e link be ween he mind and he body and he idea o he signi icance o ac i a e he spi i ual-physical o ce o he pa ien , seem o he mos pa o ha e been accep ed by he medical p o ession in No way, and by many acknowledged physicians conside ed as he one igh p inciple o he cu e o he spine cu a u e. This app o al is easie o unde s and i i is ealized ha al hough medicine a he middle o he p e ious cen u y had aken a s ep owa ds an empi ical based science, many o he adi ional me :aphysical and na u e-philosophical e lec ions su i ed and con inued o cons i u e he base o many he apies. The new scien i ic o ien a ion did no gi e as p o i s in he o m o new and mo e e icien he apies. The mode n, empi ical based medicin was o a long ime cha ac e ized by biological basic scien i ic esea ch wi hin he ields o ana omy, physiology and pa hology, while mos o he medical cu e was s ill based on he classical, holis ic eachings o he ~iddle Ages, ega ding illness as a esul o an in e mp ion o he liquid balance o he human body. The e a e some enchani ing simila i ies be ween his eaching and Kjols ad's own e lec ions o he spine cu a u e, ega ding i as a esul o an une en di ision o he bending and s aigh ening (42) KIERULF (1853), op. ci . (n. 35), p. 91. The Fi s S age o he His o y o O hopaedics in No way 93 o ces in he human body,' emphasizing he signi icance o he uni y o mind and body in he he apy. One eason ha his heo y and me hod did no mee wi h mo e esis ance may be ela ed o he ac ha i 'ma ched nicely o some undamen al, hough maybe eceding, pe spec i es on heal h, illness and ea men . In he No wegian medical milieu many o he adi ional concep ions was s ill iable, among hem he common assump ion o cons i u io epidemica - he idea ha unknown a mosphe ic o ces had g ea in luence on he sp eading o epidemic diseases -, o he p esump ion ha i was possible o ans e illness om human beings o animals, no o men ion he ai h o many ecognized physicians in a lo o di e en healing emedies like ings and oin men s agains a h i is (43). This indica es ha he dis inc ion be ween o mal medicin and he quacke y was no e y sha p in he middle o he nine een h cen u y. Agains his backg ound i is easie o comp ehend why he heo e ical e lec ions o Kjds ad did no gi e ise o eage objec ions. Fo a medical milieu ha s ill had s ong links o na u e-philosophical concep ions i was no ha d o accep a new he apy based on simila e lec ions. 9. THE NEW IAG'ORTANCIE ATTACHELI TO PHYSICAL EDUCATZON Du ing he nine een h cen u y people's a i udes owa ds he body and he impo ance hey a ached o he heal h o he body expe ienced a ma ked change. As a esul o he in e ac ion o a numbe o social o ces he socie y's p ejudice iewing he body wi h a lo o con emp and suspicion, was shaken. The al e a ion o hese a i udes has been seen in ela ion o such a ious ci cums ances as he new doc ine o man and na u e p opounded by Spence and Da win, he di usion and popula iza ion o he new insigh in o he medical ields o pa hology and physiology, he new inqui es in o he li ing condi ions and physical su e ings o he wo king classes and, in some coun ies, he pa icula in e es o he s a e o ha e mili a y ec ui s o s ong physique (44). (43) GR@N, F. (1933). De no ske medin'nske selskap 1833-1933, Oslo, S eenske Bog ykke i Johannes Bjo ns ad A/S, pp. 60-92. (44) CRUNDEN, C. (1981). The concep o he body. Zn: MCNAIR, D.; PARRY, N. A., Readings in he His o~y o Physical Educa ion, Hambu g, Ve lag Ing id Czwalina. 94 JAN FROESTAD Simul aneously o hese changes in he concep ions o heal h and body, a new a i ude owa d he impo ance o physical educa ion de eloped. A clea indica ion o his al e a ion is he in oduc ion o gymnas ics in he schools. In No way, du ing he en i e cen u y, he eache s o physical aining was ec ui ed almos exclusi ely om he non-commissioned o ice s o he mili a y. As ea ly as 1805 he co ps o chasseu s sen an o ice o he mili a y ins i u e o gy nnas ics in Copenhagen. No un il he 1850s, howe e , was physical aining in oduced a he p ima y schools in he owns, wen y o hi y yea s la e a he schools in he coun y. A he colleges o educa ion gymnas ics we e in oduced du ing he 1860s. lle e oo, he eache s we e o ice s o he mili a y. In 1861 he «Cen al associa ion o he sp eading o physical exe cises and he use o a ms» was ounded. This o ganiza ion ook a leading ole in he p omo ion o physical educa ion in No way, bo h a schools and in o he ins i u ions. In 18'70 he «Cen al Public School o Gy nnas ics~ o he educa ion o eache s o physical aining was ounded in he capi al. Kjols ad in oduced his a ian o physio he apy in a ime pe iod dis inguished by a adical al e a ion o he popula a i udes owa ds he body and he heal h o he body. Th oughou he cen u y lie impo ance o physical aining and a hle ics o heal h easons was payed a en ion o an inc easing ex en . I seems likely ha his de elopmen o e ed a ou able condi ions o medical he apies emphasizing he signi icance o mo emen s o he p e en ion and cu e o diseases and de o mi ies. In espec o women's pa icipa ion in spo and phj~sicai aining, objec ions was aised in No way as in o he coun ies ha his would be inju ious o heal h o ha i was he an i hesis o womanhood. The Non egian o hopaedis s claimed, howe e , ha he me hod o sel -co ec ion showed unique quali ies e en in his ield. D . Sal esen, he o me s uden and assis an o Kjols ad, s a ed: «The objec ion ha e been aised o gymnas ics ha i is imp ope o young gi ls, unwomanly and des uc i e o he emale ideal in beau y. This objec ion, howe e , does no a al1 apply o he gymnas ic me hod in en ed by Kjols ad. This me hod ough ;in my opinion, 1:o be in oduced in e e y school o gi ls ... (45). (45) SALVESEN (1855), op. ci . (n. 3), p. 317. The Fi s S age o he His o y o O hopaedics in No way 95 I seems likely ha he new a en ion payed o physical educa ion con ibu ed o he app o al ob ained by Kjols ad. Wi h ega d o he mili a y physical aining, howe e , i is possible o es ablish a mo e speci ic ela ion o his he apy. In his pe iod o s udy Gunde Kjals ad was appoin ed squad on su geon a he co ps in he dis ic o Telema k. This o ice he hold o one and a hal yea pos ed in K is iansand, pa icipa ing also in he camp o Swedish and No wegian oops in Skine in 1824. In 1828 he was appoin ed co ps physician a he muske ee co ps o he dis ic o Hedema k, un il he in 1836 was appoin ed medical o ice o heal h o he sou he n dis ic o Gudb andsdalen. Kjols ad had, as many o his colleagues, a mili a y ca ee be o e he se led o a ci ilian o ice. I is mos likely ha he was in luenced by he mili a y physical educa ion when he began o de elop his o hopaedic me hod, in pa icula by he mili a y keep- i exe cises. This gymnas ics had a Iong adi ion and, acco ding o an ins uc ion book om 1872 he in en ion was «... o de elop and s eng hen he Soldie s limbs and inc ease his con ol o e hem ...» (46). The e a e some allu ing simila i ies be ween he he apy o sel -co ec ion and some o he e lec ions he mili a y gy nnas ics was based on, as indica ed by he ollowing quo a ion om he ins uc ion book: «... by he con ac ion o i he muscle is exe ed, and by epe i ion o . - his exe cise expe ience is gained, he muscle is s eng hened and i is b ough unde he con ol o will ... (47). Wi hin he me hod o Kjals ad i was he oo -walk, he mos essen ial pa o he he apy, ha mos clea ly indica ed he connec ion o he physical d il1 o he mili a y. The oo -walk was a anged as an o ganized o m o exe cise whe e he pa ien s we e di ided in o wo ows and mo ed hemsel es unde he o de s o he he apis . As he o hopaedis sounded he numbe «one» bo h ows o pa ien s aised hei heels as high as possible and s ood ip oe un il he numbe « wo» was sounded. Now he pa ien s mo ed hei igh oo o wa d and down a heel. As he numbe Nonen once mo e was sounded he pa ien s again had o aise hei heels (46) Ins uk ion i Gymnas ik og Bajone eg ning o In an e ie (1872), Ch is iania, p. 1. (47) Ibidem, p. 5. 96 JAN FROESTAD and s and ip oe un il hey now mo ed hei le oo on a d and down a heel as he numbe ~ wo. was sounded, and so on (48). Mili a y backg ound was no , howe e , some hing ha dis inguished he ca ee o Kjols ad. In he i s hal o he nine een h ceil u y mos o he medical p ac i ione s in Non ay we e employed by he mili a y o a sho e o longe pa o hei p o essional ca ee . In he 1830s abou one hi d o he physicians had mili a y appoin men s (49). The e is eason o belie e ha his common expe ience wi h he mili a y physical educa ion cons i u ed an addi ional ac o con ibu ing o he app o al o Kj~ls ad. 10. THE MUSCULAR THEORY In he las decades o he eigh een h cen u y specialize i o hopaedic ins i u es we e es ablished in se e a1 o he con inen al ci ies. In he i s phase o his de elopmen o o hopaedics as a dis inc he apeu ic ield, he assump ion was ha acciden s like alls and blows o , mo e common, poo depo men when walking o si ing, we e he p incipal causes o he spine cu a u es. Pos u a1 aul s, one assumed, could en ail ha some g oups o muscles con ac ed, wi h a w yness o he spine as he ine i able esul . S e ch-bandages, p essu e-co se s, li e- and b eas -bel s we e co espondingly conside ed o be sui able co ec ing emedies. A eae ion o his assump ion de eloped wi hin he nex decade. In some o bopaedic milieus he p esump ion gained con iden e ha i was diseases in he bones and he so ness o he bones ha caused he c ooked spines. Acco ding o his heo y he use o s e ch-bandages and li e bel s could a ec he bone s uc u e and gi e ise o w yness. As a esul he he apy inc easingly ook he o m o uea men by long lasl ing ho izon al bed es , usually combined wi h p essu e and ex ension o he body. G adually his became he dominan cu e a mos o hopaedic ins i il es, a he apy o en u ilized o se e a1 yea s and as he only emedy o s aigh en ou he spine. The cons an use o he bed es , howe e , had a e y bad in luence on he pa ien s gene al heal h. The o hopaedis s ied ol emedy hese de ec s by di e en he apeu ical adap a ions like he supine posi ion on (48) Fo handlinge ed De Skandina iske Na u oo ske es 7. M0 e i Ch is iania i 1856 (1857). Ch is iania, Ca l C. We ne & Comp., p. 466. (49) LARSEN; BERG; HODNE (1986), op. ci . (n. 29), p. 350. The Fi s S age o he His o- o O hopaedics in No way 97 an inclined plane o on a plane ha could be swi ched be ween a ho izon- al and a mo e e ical posi ion. The o hopaedic ield in he eigh een h and nine een h cen u y was cha ac e ized by many di e en heo ies and schools o hough and by an o en bi e and las ing con lic be ween he di e en milieus. The a ious he apies seem, howe e , o ha e been guided by one o wo basic conside a ions. The bed es , combined wi h p essu e and ex ensionde ices, was pa icula ly u ilized by hose who sough he causes o he spine cu a u e in he bones and e eb as o he body. Ri al milieus ook o a g ea e ex en he muscula sys em o he body as hei basis. I had been no iced ha mos o he c ooked spines was ben on a d o he igh . This obse a ion led o he de elopmen o a heo y ha he spine was easily a ec ed i an une en muscula o ce ac ed on i . I was known ha he muscles on he igh side o he body usually a e suonge and mo e ad anced. I was hus supposed ha he muscles on he conca e side o he cu a u e had de ea ed i s le ad e sa ies and con ac ed. The muscles on he con ex side o he cu a u e had been ex ended co espondingly and had los much o hei o ce. This heo y legi imized he de elopmen o he apies ha emphasized he signi icance o es o ing he muscula balan- ce o he body. l In 1828 he acknowledged F ench o hopaedis Jaques Ma hieu Delpech published a wo k whe e he ejec ed he long and con inuous bed es and in oduced gymnas ics and ba h as means o s eng hen he weakened muscles o he pa ien s. In sho ime physical exe cises we e in oduced as a p e en a i e emedy a mos o hopaedic ins i u es. G adually his led o he de elopmen o mo e specialized o hopaedic gy nnas ics, o which he physio he apy o Phe Hen ik Ling in Sweden became he mos amous. The in ension o his he apy was, by he execu ion o accu a e physical exe cises, o s eng hen speci ic g oups o muscles in such a way ha hey could coun e ac he o ce o he opposi e muscles and d aw he spine in o a na u al posi ion. When he physicians in Non ay du ing he second o hi d decade o he nine een h cen u y began o ake an in e es in he o hopaedics, i was he muscula heo y ha had caugh he wind. Gymnas ics had al eady been in oduced as a he apeu ic o p e en i e emedy a mos o hopaedic ins i u es. One o he i s medical p ac i ione s in Non ay ha ook an in e es in he spine cu a u e and i s ea men was Ch is en Heibe g. Heibe g 104 JAN FROESTAD died ha d, bu had g adcially o gi e way o ano he pe spec i e which in i s di e en a ian s emphasized he congeni al weakliness o gi ls and hei un a ou able upb inging. Kjols ad himsel seldom exp essed his opinion ega ding he speci ic causes o he c ooked spine. A s a emen he made in 1856, howe e , indica e ha he wen a owa ds accep ing he heo y o€ he emale weakliness. Wi h ega d o he weakening o he spine he s a ed ha i o en seemed o be he e ec o eyoung gi ls long and unsc upulous si ing a school, imposed bo h he e and a home wi h oo much in ellec ual wo k and needlewo k in p opo ion o hei age and sex ...* (64). Kjols ad's assis an , D . Sal esen, exp essed himsel in a simila manne : .. . how easy he one-sided s i e o he ende gi ls in ellec ual educa ion is done a he expense o he physical heal h and due o his b eak down he igu e ... » (65). The heo y o he emale weakliness combined wi h o much seden a y wo k as a main cause o he c ooked spine seems g adiially o ha e been accep ed by mos o hopaedic and medical milieus. Rega ding he mos p e alen cu a u es o he spine Ch is ian Kie ul s a ed i,n 1852, wi h e e ence o he expe iences a he o hopaedic ins i u e a Tubo g in Denma k: N,.. no mally, in ac almos wi hou excep ion, i has a deepe cause and ha is weakliness ... » (66). Rega ding he e olu ion o scoliosis in hese ende gi ls he claimed ha i mos o en could be obse ed ha « he cu a u e e ol es a he ime when hei schooling is mos exhaus ing ... >> (67). A decade la e he acknowledged Danish medical o hopaedis A. D achmamn exp essed a simila opinion as he s a ed wi h egai d o scoliosis: «... i inju es almos exclusi ely sligh , pale, lean and weak gi ls and mos o en du ing he phase o as physical g ow h ...» (68). In espec o he social dis ibu ion o scoliosis he o hopaedis claimed: (64) KJQLSTAD, G. (1857). En nze me e Fo kla ing .o e Sel e ningsme hoden, end hid il e gi e gjennem de sk i lige og yk e O d. In: Fo handlinge ed De Skandina iske Na u o ske es 7. M0 e i Ch is iania 1856, Ch is iania, Ca l C. We ne ,Se Comp., p. 450. (65) SALVESEN (1855), op. ci . (n. 3), p. 317. (66) KIERULF (1853), op. ci . (n. 35), p. 781. (67) Ibidem, p. 11. (68) DRACHMANN, A. quo ed in: Biblio hek o Lczge (1861), p. ,95. The Fi s S age o he His o y o O hopaedics in No way 1 O5 «I exis s p incipally as a cul u al disease in la ge places and among he well- o-do classes ha educa e hei child en in a so manne and keep hem o eaching and long seden a y wo k a an ea ly age .... (69). This e iew indica es a a ou able ela ion be ween he heo y o he emale weakliness, he he apy o sel -co ec ion and he g owing ambi ions o he medical p o ession a he middle o he nine een h cen u y. The o hopaedics o Gunde Kjols ad became a ac i e no only because o i s sui abili y o p e alen ideological and heo e ical ends bu as well owing o he ac ha he me hod, in a pe iod whe e he medical p o ession had he ambi ion o asse i sel in new ields, could be used as a p ophylac ic, as con as wi h he mechanical he apy. Kjols ad had he ision ha he he apy o sel -co ec ion ough be made gene al, i ough in his opinion o become an essen ial pa o educa ion, bo h in he amily and a school. In ha case Kjols ad had he con ic ion ha .al1 cu a u es like al1 powe lessness, weakliness, sickliness and a lo o speci ic diseases will anish om ea h ...w (70). Wi hin he medical associa ion ques ions ela ing o school hygiene we e subjec s o discussion, pa icula ly in he 1830s and 1860s. In 1835 he No wegian p o esso F ede ik Hols claimed ha he schools o gi ls had an inju ing e ec on he pupils heal h and pu o wa d as e idence he ac ha he pupils we e less o g ow h han gi ls ha did no a end school. He a gued ha he physicians ough o in ol e hemsel es in his ma e (71). The he apy o sel co ec ion did no only ha e a po en ial as a p ophylac ic, he No wegian o hopaedis s ook conc e e ini ia i es in ha di ec ion. In 1849 he o me assis an o Kjols ad, D . Sal esen, in oduced a p e en a i e physio he apy o young gi ls a his ins i u e in Be gen. Mos o he gi ls, bu no al1 o hem, su e ed om small cu a u es. In coope a ion wi h he heologian Dahl he also succeeded o b ing in physical exe cises o sel - co ec ion a he la ges school o gi ls in he own (72). Kjols ad, on his side, ga e o hopaedic cu e by he hou , chie ly wi h a p e en a i e adap a ion, designed o pa ien wi h small o incipien cu a u es (73). (69) Zbidem. (70) KJ0LSTAD (1849), op. ci . (n. 2), p. 9. (71) GR0N (1933), op. ci . (n. 43), p. 54. (72) SALVESEN (1855), op. ci . (n. 3), pp. 316-318. (73) KJDLSTAD (1849), op. ci . (n. 2), p. 11. 106 JAN FROESTAD The g owing in e es o he physicians in Non ay in school hygiene, he ocus o he heo y o emale weakliness on he un a ou able e ec s o p o ac ed school a endance and he appa en p e en a i e quali ies o he me hod o sel -co ec ion, i seems likely ha he combina ion o hese ci cums ances con ibu ed o he acknowledgemen ha Gunde Kjols ad ob ained. I ollows ha he a ac ion o his o hopaedics maly be ela ed bo h o he wish o he physicians o ein o ce hei con ol o his he apeu ic ield and o he g owing ambi ions o he medical p o ession o expand he ield o ac i i y and socie al in luence o he occupa ion. 13. THE EFFICACY OF THE THEWY In 1897 he acknowledged Ge man o hopaedic su geon Albe Ho a s a ed: «In my opinion, he p oblem o he ea men o scoliosis is he main p oblem o he o hopaedics o he u u e ... » (74). He seems o ha e been igh . Mo e han i y yea s la e he English o hopaedis Osmund- Cla k s a ed: ~Scoliosis is ema kable o he s ubbo nness wi h which h oughou he ages his de o mi y has de ied explana ion ... D (75). In 1981 he h ee ecognised A ne ican o hopaedis s T. Taylo , P. Gosh and G. Bushell, decla ed: «I is eg e able ha he las wo decades ha e no seen a single majo ad ance in he ea men o scoliosis based on a scien i ic unde s anding o he ae iology and mechanisms o cu e p og ession ... (76). The ea men o scoliosis seem o he bulk o he wen ie h cen u y o ha e been cha ac enzed by a sho age o scien i ic knowledge and a non-a ailabili y o a ai ly eliable he apy. The e is no eason o belie e ha his si ua ion was any mo e ad an ageous in he middle o he p e ious cen u y. A he middle o he nine een h cen u y, howe e , o mal medicine was on he de ensi e no only wi h ega d o he ea men o scoliosis. I has been claimed ha he con idence in he physicians in No way, du ing he i s hal o he p e ious cen u y was impai ed' and ha la ge pa s o he (74) LE VAY, D. (1990). The His o y o O hopaedics, London, The Pa henon Publishing G oup L d., p. 529. (75) Zbidem. (76) ' Zbidem. The Fi s S age o he His o y o O hopaedics in No way 107 popula ion a he consul ed he quacks. A he middle o he cen u y he medical p o ession seems o ha e had zi lowe s a us han e e be o e (77). . . I may be assumed ha he ecogni ion ha Kjols ad and his o hopaedic colleagues ob ained o some ex en was ied up wi h he e ec s o hei he apy. The e alua ion o Kjols ad's ac i i y by o he physicians ga e, as men ioned, a a ou able esul . Bo h his wo colleagues ha alued he me hod in 1842 and he commi ee appoin ed by he medical associa ion in he capi al, which made i s inal s a emen en yea s la e , spoke in a ou o he he apy. Acco ding o he es ima ions o Tidemand, abou 20% o he app oxima e 200 pa ien s su e ing om spine-cu a u es he ea ed in he pe iod om 1866 o 1874 we e cu ed o nea ly cu ed, ano he 60% we e imp o ed, while 5% did no bene i om he he apy. Wi h espec o he emaining 15% he esul s we e unce ain o he pa ien s we e no measu ed (78). This assessmen co espond in he main o he e alua ions o he p ac ices o Kjols ad and Sal esen. I is no easy oday o eckon he alidi y o hese nine een h cen u y e alua ions. I seems, howe e , ha he physicians o en payed se ious a en ion as o he p ope way o accomplish exac measu es. The commi ee o he medical associa ion s a ed: <<We soon ealised how e y di icul i is o ob ain a ixed and accu a e concep ion o , and o con ol he al e a ions, ha he spine unde goes by o hopaedic ea men . Se e a1 me hods we e ied ... We came o he conclusion o use plas e cas s o he spine, and i was decided o ake a cas o each pa ien a he in ake and discha ge ...), (79). Employing his me hod he commi ee concluded, as men ioned, ha he pa ien s had been ex ended an inch o an inch and a hal on he a e age, dependen on we he he measu es we e done while he pa ien s we e s anding o lying down. I hese measu es and e alua ions a e c edi ed i is indica ed ha he e ec o he ea men was a ou able. O no doub , howe e , he medical milieu in Non ay did c edi hese alua ions and g adually came o conside he he apy o be bo h e icien and supe io . (77) REICHBORN-KJENNERUD, 1.; GRaN, F.; KOBRO, R. (1936). Medicinens his mie i No ge, Oslo, G ondahl & S~ns Fo lag, p. 125. (78) TIDEMAND (1876), op. ci . (n. 3), Be e ning om ans al ens i ksomhe a 1-11-1866 i1 31-12-1874, pp. 16-20. (79) No sk Magazin o Lage idenskapen, Fo handlingene (1852), p. 263. 108 JAN FROESTAD The app o al o he me hod o sel -co ec ion, howe e , mus be seen in ela ion o he o he a ailable he apies a he ime. I is indica ed ha he physicians expe ienced ha hey had ew emedies o sugges when aced wi h pa ien s su e ing om spine cu a u es. The physician Wilhelm Boeck s a ed in oc obe 1862: N... we a e in ou p ac ice badly o wi h ega d o he ea men o spine cu a u es, and no many ha e he oppo uni y o send hei child en o he expensi e ins i u es ab oad ... (80). Mo eo e , he con idence in hese ins i u es had been impai ed due o he un a ou able e ec s o he p o ac ed, bed- idden mechanical ex ension he apy. As men ioned, Ch is ian Kie ul claimed in 1852 l-ia he young gi ls o en e u ned o i hese ins i u es wi h a b oken heal h. A leas un il he second hal o he 1870s he medical p o ession, o a any a e he uni e si y eache s and he physicians in he capi al, ega ded he o hopaedics o Kjols ad as supe io no only in compa ison wi h he mechanical cu e, bu also as compa ed wi h o he ea men s like he Swedish physio he apy. The physician Joachim A. Voss exp essed a one o he mee ing o he medical associa ion in 1862 ha he hough i un o una e ha Tidemand had been compelled o close his ins i u e, andl s a ed: N... as a empo a y expedien wle now ha e o e e he pa ien s o ~physio he apy o o he ea men by ellec i ica ion a he hospi al ...,, (81:). An ins i u e o physio he apy was opened in he capi al in 1867 by he physician Tycho D. Lange. The discussions a he mee ings o he medical associa ion indica e, howe e , ha he me hod o sel -s aigh ening had a highe s a us a leas un il he second hal o he 1870s. Lange epea edly complained ha his colleagues did no show an in e es in his wo k and did no e e pa ien s o him ha would bene i om physio he apy. Wi hou doub , he he apy o sel -co ec ion was by a he mos c edi ed o hopaedic he apy i n Non ay in his ime pe iod. The app o al o he he apy mus also be assessed in ela ion o he gene al cu a i e abili y o o mal medicine in he p e ious ce i u y. I ough (80) BOECK, W. quo ed in: No sk Maga in o L egeuidenskapen, Fo handlingene (1863), p. . 100. (81) Zbidem. The Fi s S age o he His o y o O hopaedics in No way 109 o be emembe ed, in his connec ion, ha un il he las decades o he cen u y he physicians had no o e y dubious emedies o sugges agains he mos common su e ings domina ing e e y medical p ac ice, he in ec ious diseases (82). Many o he he apies p esc ibed by he physicians we e s ill o an essen ial deg ee based on he classic, holis ic eachings o he Middle Ages, and he e ec s o hei ea men we e usually sligh . The peasan s did no no mally seek hei se ices. Fo mal medicine was no emp a ion owing o i s e icacy and i igh ened mos people due o he cul u al di e ences be ween he physicians and he public. Ins ead, hey consul ed he local quacks, whom hey us ed. I has been claimed ha he physicians had o be pushed he people by public o ices and laws agains quacke y (83). The peasan s ough his policy and succeeded in 1871 o libe alize he qiiack-law. Agains his backg ound i is easie o comp ehend ha he physicians, especially he uni e si y eache s and he physicians p ac ising in he capi- al who we e leas easonable owa ds he quacks, came o app o e he o hopaedics o Kj0ls ad. In he i s place, i is no wonde ha he physicians app ecia ed an a emp o in oduce a new medical ac i i y, p e iously domina ed by lay nen. In addi ion, i is no unlikely ha he he apy o Kj0ls ad was a hi , compa ed o mos o he medical wo k in he p e ious cen u y. I is qui e plausible ha he me hod o sel co ec ion, a e some p elimina y p oblems, came o be conside ed by he medical p o ession as a g ea success, as one o ew oppo uni ies o imp o e he s a us o he occupa ion. 14. THE SOCIAL COMPOSITION OF THE CLIENTELE In he pe iod om 1847 o 1850 h ee o hopaedic ins i u es we e in ope a ion in No way, al1 p ac ising he me hod o Kjols ad. Thi y o o y pa ien s we e ea ed a he same ime. The ma le o o hopaedic ins i u ional ea men was, howe e , e y es ic ed a leas un il he 1870s. This made i di icul o main ain he ins i u es. D . Sal esen, he o me assis an o Kjols ad, s a ed ha he ea men was o en b oken o oo ea ly, pa ly because o he impa ience o he pa ien s, bu as o en due o he limi ed (82) EVANG, K. (1955). Helses elle s u ikling i No ge i 75 i , i. Tidssknj o da no ske l~gejiiening p. 53. (83) BERG (1973), op. ci . (n. 62), p. 39. 110 JAN FROESTAD will o abili y o he ela i es o pay he expenses (84). To cushion hese ci cums ances bo h Sal esen and Kjols ad we e in many ins ances o ced o educe he egula ed ee. Kjols ad s a ed: ((Economic condi ions and o he ci cums ances has made i impossible o many o make use o he o dina y cu e ... in No way he money ha e a oo es aining e ec on he o hopaedics ... a mo e would ha e been s aigh ened i no he lack o money had p e en ed a longe cu e ... >) (85). In spi e o some pilblic g an he main enance o he o hopaedic ins i u es in Non ay was chie ly based on he ees om he loa ien s. Only a ew places a he ins i iu es we e ese ed o pa ien s o limi ed means. In he 60s, a Tidemand's ins i u e he paymen o he boa di was 48 N k ., a mon h, he washing o clo hes no included. The cos o he ea men was 32 N k . a mon h. I dec eased o some ex en , howe e , i he cu e las ed mo e han hal a yea (86). I is highly p obable ha hie he apy was conside ably cheape han he ea lie p ac ice o send hie pa ien s o ecognised ins i u es ab oad. Ne e heless, a cu e a he ins ii u e was bo h long las ing and expensi e. A ha ime he sala y o eache s a he boa d schools in Be gen was abou 1 .O00 N k . annually, a male eleg aph ope a o had an ini ial annual sala y o 1.000 o 1.200 N k ., unskilled wo ke s mos ce ainly we e payed a less (87). I may be assumed, wi hou much doub , ha he cu e a he o hopaedic ins i u es mus ha e been a oo expensi e o mos people. I is likely ha he clien basis was mainly cons i u ed by pa ien s om well- o-do amilies. This es ic ed he ma ke o o hopaedic p ac ice. X is plausible, howe e , ha his in lux o a high s a us clien ele accoun s o some o he acknowledgemen ha he o hopaedic ins i u es ob ained. The p o essional app o al o he he apy o sel -co ec ion has now been assessed bo h wi h ega d o i s appa en he apeu ic quali ies and he social composi ion o he clien ele. I s ill emains, howe e , o conside how he ecogni ion was ied o he shaping o he ela io i be ween he (84) SALVESEN (1855), op. ci . (n. 3), p. 159. (85) KJOLSTAD (1849), 'op. ci . (n. 2), pp. 11, 49-50. (86) Byminne (1982), n.* 1, p. 10. (87) HAGEMANN, G. (1992). Skole olk. Lme nes his o ie i No ge, Oslo, Ad IlJo am Gyldendal a.s., p. 50. The Fi s S age o he His o y o O hopaedics in No way 11 1 he apis and he pa ien , as a consequence o some ema kable ea u es o he me hod. 15. THE RELATION TO THE CLIENTS The physicians had, as men ioned, undoub edly an ambi ion o b ing he o hopaedic ield back unde he con ol o o mal medicine. They had oiced se e e c i icism agains he o hopaedic ins i u es, led by laymen. I may be assumed, howe e , ha i he physicians had engaged hemsel es in his ield wi hou being able o show good esul s, he s a us o he occupa ion could easily ha e been u he educed. Fo una ely, in his espec , he me hod o sel -co ec ion exhibi ed ano he sympa he ic ea u e. I al e ed he ela ion be ween he pa ien and he he apis in a a ou able di ec ion. I is e y much o he poin ha Kpls ad ansla ed he wo d ~o hopaedics~ as ~ igh educa iom (88). Wi h ega d o .he he apy he s a ed: «... i 's whole cu a i e abili y and i s healing o mind and body is based exclusi ely on ins uc ion, eaching, con ic ion and imp o emen , bo h mo ally and in ellec ually ... » (89). Thus Kj~ls ad decla ed: M... he exe cise o my o hopaedics is ied o eaching in an insepa able manne ... » (90). He de ined his medical wo k in a pedagogical, o some ex en also in a heological, di ec ion. The pa ien was assigned an ac i e ole in he he apy. The cu e was desc ibed as a me hod o each he pa ien o heal himsel . The ole o he he apis was depic ed as o each he pa ien he quali y o he cu a u e and how i was sus ained, and wha he pa ien could do o coun e ac i . The e ec s o he cu e, howe e , Kj~ls ad ega ded as di ec ly condi ioned by he pe sis ence, pa ience and s eng h o will o he pa ien . In case o he passi e ea men wi h mechanical p essu e and ex ension de ices he pa ien could ha dly be blamed i he esul s o a long las ing and expensi e cu e e11 sho o he expec a ions. The c i icism was in ha e en le elled a he he apis o he owne o he o hopaedic ins i u e. The me hod o sel -co ec ion al e ed his ci cums ance in a signi ican (88) KJ0LSTAD (1849), o@. ci . (n. 2), p. 10. (89) Ibidem. (90) Ibidem, p. 13. 112 JAN FROESTAD manne . The me hod implica ed ha he pa ien o a la ge exi en could be hold esponsible o he esul s o he cu e. I he e ec s o he ea men did no mee he expec a ions o i , his could be explained as he esul o a weakness o he pa ien s pe sis ence, e o o mo al. Tidemand s a ed: ~The e ec s o he cu e a e essen ially dependen on he e o s o he pa ien , o he ex en ha he ai h ul and ha d-wo king may a ain g ea e p og ess in a ce ain pe iod o ime, han he lazy and ca eless may ne e gain ... (91). , In his manne he ne hod o sel -co ec ion ook he s ing ou o c i icism. Xn a way he he apy was ximmunizedn. Al1 a ou able e ec s could be a ibu ed he quali ies o he he apy, al1 un a ou able esul s asc ibed o he pa ien . Rega ding he need o he medical p o ession o imp o e i s s a us, his mus ha e been a sympa he ic ea u e. My in e es in his s o y was a oused by he obse a ion ha he o hopaedics o sel -co ec ion ob ained a high deg ee o app o al in No way in he ime pe iod om 1840 un il he second hal o he 1870s, in pa icula by he medical p o ession. This acknowledgemen seemed in he i s ound as onishing, bo h in espec o he peculia , almos «impene ablle» heo e ical basis o he cu e and wi h ega d o he p ac ica1 accomplishmen o he he apy, lhe slow, cu ious « oo walk» and he me hod o <cpoin ua ion» being he essen ial elemen s. My in en ion has been mode a e, simply o speci y some possible connec ions be ween he app o al o he o hopaedics o sel -co ec ion and o he cul u al elemen s o he Non egian socie y in he p e ious cen u y. On one hand, an a ini y be ween he he apy and some con empo a y ideological ends and alues has been indica ed. The o hopaedics o sel - co ec ion seem o some ex en o ha e been legi ima ed by a heo e ical accommoda ion bo h o he ideology o pie ism in eligious li e and o he p edominan libe al doc ine o economics. In addi ion, he he apy de i ed (91) TIDEMAND, A. quo ed in: No sk Magazin o Lage idenskapen, Fo handlingene (1869), p. 98. The Fi s S age o he His o y o O hopaedics in No way 113 ad an age om a new comp ehension and alua ion o physical educa ion as a p e equisi e o good heal h. Wi hin a mo e limi ed con ex some speci ic ela ions be ween he o hopaedics o Kjols ad and he scien i ic communi y o medicine has been assessed. I was emphasized ha o mal medicine in his pe iod s ill main ained many o i s adi ionai links o me aphysicai and na u e-philosophical concep ions, and ha he absence o mo e eage esis ance owa d he heo y o sel -co ec ion mus be iewed in his ligh . Fu he , i was a gued ha he g adual accep ance o he idea ha physical exe cises could p e en and cu e diseases and de o mi ies, he de elopmen o he muscula heo y, and, in addi ion, he common expe iences o many physicians in No way wi h mili a y gy nnas ics, o e ed a ou able condi ions o he new o hopaedic en e p ise. The app o al o he o hopaedics o sel -co ec ion has hus been assessed by e e ing o i s accommoda ion o p e ailing ideological ends and main p o essional cu en s o he p e ious cen u y. The a ac ion o he he apy, howe e , has also been assessed in ela ion o social in e es s, pa icula ly wi h ega d o he demands o he medical p o ession in he p e ious cen u y. Ob ious, he de elopmen o o hopaedics was in his ime pe iod a pe iphe al mo emen wi hin medicine. I has s ill been indica ed ha he ecogni ion o he No wegian o hopaedis s was o some ex en ied o he g owing ambi ion o he nedical p o ession o imp o e i s s a us and socie al in luence. The app o al o he he apy o sel -co ec ion seems in he i s place o ha e been ela ed o he wish o he medicai p o ession o b ing o hopaedics back wi hin he subjec o medicine, and o he ac ha Kjals ad epea edly demons a ed ha he accep ed he assessmen o his colleagues as he decisi e c i e ia o alue he sui abili y o he he apy. The o hopaedics o Kjols ad, howe e , also exhibi ed se e al o he sympa he ic ea u es. To some ex en he a ac ion o he he apy seems o ha e been ela ed o i s p e en a i e quali ies. The medical p o ession had a g owing ambi ion o asse i sel in new ields, paying inc easing a en ion o ques ions ela ed o school hygiene and p oblems in connec ion wi h p o ac ed school a endance. In con as wi h he mechanical he apy, he me hod o sel - co ec ion could be used as a p ophylac ic and he No wegian o hopaedis s ook conc e e ini ia i es o make such use o i , no ably i was in oduced a p ima y school. Fu he , he app o al o he he apy seems o ha e been