Massage and Physical Exercises have formed a branch of medical and surgical treatment from time immemorial and in all countries, a fact demonstrated by Dr. Kleen in his historical introduction ; and Dr. Kleen's work is a classic upon the subject which deserves the widest possible circulation throughout the world. Its translation into English may therefore be welcomed as a very real step in the diffusion of scientific knowledge upon these methods of treatment. Naturally the author's views will receive criticism when they come to be read by English-speaking people. Swedish methods of massage and gymnastics are not universally accepted as gospel. Sound and considered criticism is healthy, and Dr. Kleen would himself be the last to raise objection to it. But the great scientific work that has been done by the Swedish schools during the last hundred years has undoubtedly done more to place this branch of treatment upon an acknowledged footing than has that of any other group of workers.

The necessity for the general study of physical methods of treatment has been demonstrated afresh in the work of war surgery. Too often have we seen the wonderful work done for the wounded by surgeons at military hospitals robbed of its final success by failure to secure the eventual functional utility of the damaged member by the use of appropriate physical methods. And of all the methods of physiotherapy the use of natural movements introduced in scientifically conducted physical exercises must always remain the foremost. The treatment of these late results of wounds and injuries has aroused an interest in orthopaedic surgery that is unprecedented. Orthopaedic surgery includes something much more than the simple prevention and correction of deformities. The orthopaedic surgeon should think in terms of "Function," and his endeavour should be to restore the affected part to its full normal functional activity, or if this is impossible to secure the very best possible return of functional utility. In this final restoration physical exercise must necessarily take a leading part.

There is without question a large field for a class of worker trained in massage, physical exercises, and other methods of physical treatment, with a limited knowledge of anatomy, physiology, and pathology. These masseurs and masseuses become specially skilled in physical treatment, but their necessary lack of knowledge of general medicine and surgery and of other methods of treatment must limit their outlook to some extent. How frequently must the masseur inquire of the surgeon whether there is any pathological obstruction to a particular movement, or whether there is any pathological change taking place that contra-indicates the forcing of movement. So that in the work of these therapeutists, skilled, but only in one particular branch of treatment, adequate and intelligent direction by the physician or surgeon is essential. Unfortunately the latter too often knows so little of the methods and effects of massage, of the range and mechanism of movements, that he is unable even to guide the masseur by informing him of the end that he desires to attain, much less to instruct him in the means to be employed. Too often the patient is handed over with the general instruction that he is to have "Massage," and any inquiry as to the object of treatment or the actual methods to be used is met by an evasive reply. Two things are necessary : first, the education of the medical profession in the elements of rational physical treatment in all its branches, and second, the inculcation in the masseur of the knowledge that he is a skilled worker in a particular branch of therapeutics and that he is not omniscient in all branches of medicine and surgery.

Dr. Kleen has much criticism to offer of the methods of training adopted in the official schools of massage and physical exercises in Sweden. This will amply repay study in this country, particularly at the present time, when the training and status of the masseur and of the instructor in educational and remedial gymnastics is much under discussion. In the Central Institute in Stockholm the training of instructors in military and educational gymnastics is combined with a school of physiotherapy. One result has been that the trained instructors have too often abandoned the educational side of their work to take up remedial work entirely, because they find that the latter offers a better pecuniary reward. In this way there has been a real loss to physical education. But perhaps the more serious aspect has been the setting up of a class of gymnasts, possessed of an official diploma, who consider themselves qualified to carry out treatment by massage and remedial gymnastics without medical consultation or supervision. And it is evident that in Sweden, as in this country, the average medical man is so ignorant of physical methods of treatment that he is unable to give adequate directions to the masseur. The knowledge that this is so has led to a request by the Carolinska Institute for the inclusion of a course in remedial gymnastics in the curriculum for medical students. It is perhaps too much to expect that a similar view will be taken by the medical educational authorities in this country without at least a preliminary campaign; but it must be evident that a knowledge of the principles of educational as well as of remedial gymnastics by the younger generation of medical men of the country would be an enormous asset to the public health and to the physical well-being of the nation.

R. C. Elmslie.

Translator's Preface. First Edition

The translation of Dr. Kleen's book on "Massage and Medical Gymnastics" has been a gigantic task, since it has been carried out in scanty leisure time. I was impelled to undertake it by the knowledge that there was no book in English offering such a store of information and research on the uses to which this treatment can be put in Medical, Surgical, and Gynaecological cases, as well as in certain diseases of the Eye, Throat, and Ear.

The earlier part of the book and Dr. Arvedson's chapter will, I trust, be useful to students of Massage and Gymnastics. I hope the book as a whole, and especially the later chapters, may induce members of the medical profession to take more interest in the application of a widely used method of treatment which they have so far left too much in the hands of Swedish Medical Gymnasts. If the book fulfils these aims I shall feel that my labour has not been in vain.

Mina L. Dobbie.

Second Edition

The reception given to the First English Edition of Kleen's "Massage and Medical Gynmastics" has shown that an increasing interest is being taken in the subject. It has therefore become necessary to produce a second edition, and this has been carefully revised throughout.

Mina L. Dobbie.