It is, however, better that massage and medical gymnastics should be carried out by some one accustomed to it and with sufficient knowledge in his own line. Such a worker must know a certain amount of anatomy and physiology, studied with special reference to his work. In studying this he has a right to "skip with discrimination." He need not study the deep nerves of the head, but it is important that he should understand the knee-joint; he can safely leave the mechanism of the accommodation of the eyes an open question, but he must know the forces which influence the flow of blood in the veins; he need never hear of acute yellow atrophy of the liver or of acromegaly, but it is of great importance for him to be familiar with inflammation and its various products. He must also be skilled in technique. The uncritical enthusiasm which mechanotherapy, with its often splendid results, is apt to arouse in medically untrained workers renders it necessary that they should learn from the beginning that there are many diseases and conditions which cannot be benefited by massage and gymnastics, and various conditions which render all such treatment dangerous. But there is one item of knowledge which is of the greatest importance both for himself and others, and which his teacher should take great pains to instil. He must be fully aware of the limitations of his own medical training, and that nothing less than a doctor's full training justifies completely independent work as a physical therapeutist. The more he sees of the training required by a doctor, the greater the difference there is in length of study and other things between himself and the latter, the less pretentious the title he himself bears, the easier will it be for him to feel his incapacity for independent work and to submit to supervision by a doctor; the more difficult also will it be for him to convince the general public of his having any just claim to such independent work. To this independence the work of the medical gymnast and masseur offers many temptations.

In Sweden everything possible has been done to create unsuitable conditions for mechano-therapy.

No one is bold enough or narrow-minded enough to defend the fact that in our medical education, especially at the Carolinska Institute, there is no instruction whatever in medical gymnastics and massage, nor even any recognition of the real practical value of a therapeutic method which is both easily learnt and extremely efficacious. And no one can think it reasonable that doctors who must be acquainted with the method of preparation and the appearance of every drug in the pharmacopoeia are for the most part quite unversed in such an effective remedy as this. To supply this omission the Central Gymnastic Institute was founded.

The Institute has, however, been a partial failure because it has tried to combine aims which cannot suitably be combined. It aims at being -

(1) a place for training teachers of military gymnastics;

(2) a place for training teachers of educational gymnastics;

(3) a school for mechano-therapy.

The first two aims may very well be combined. School gymnastics stretches out one hand to military gymnastics and exercises and serves as a preparation for military service, while stretching the other hand to sport, the drama and games.

It is, in spite of the frequently repeated paradoxes from the Institute, as absurd to insist that a medical gymnast and masseur should be familiar with educational gymnastics as to insist that a truss-maker should be a shoe-maker, and as wrong to start an institution which is to be at the same time a (military or other) school for educational gymnastics and a school for physical treatment as it would be to establish something which should be at the same time a shoe factory and a factory for orthopaedic instruments and apparatus.

A school for physical treatment must live within the medical world, otherwise it is like a separate society, which breaks away and artificially separates itself from and becomes hostile to the world to which it belongs. This has happened with the Central Institute. A more antagonistic spirit than that which rules there against medicine and its workers cannot be imagined, and except when there is some external advantage to be gained, the Institute will have as little as possible to do with the medical world. The Institute has therefore no power of attraction for medical students, and least of all for the better equipped among them.

It was, moreover, an unheard-of and calamitous blunder to couple the teaching and practice of two such different things as educational gymnastics and physical treatment, and this was done for no other reason than that a fencer and gymnast won for himself a brilliant name in the latter.

Lastly, the law of 1887 crowned a real work of destruction, and it is chiefly due to the utter lack of wit in "the Centralists" who were the authors of this law that it has failed to do great harm. The law, which was entirely in the interest of "the Gymnastic Directors," and entirely against the interest of the general public, enacted that no one except a doctor or some one trained at "the Central" should have the right to treat by medical gymnastics, and this only according to the written prescription of a doctor.

This law lead to the absurd and mischievous diploma of "Gymnastic Director," which can easily be misrepresented to the public, giving a false idea of its value.

The majority of "Gymnastic Directors" have not troubled themselves in the least about written prescriptions from doctors, and the doctors, who seldom understand medical gymnastics, have not troubled themselves to write prescriptions.

But instead, the "Gymnastic Directors" have granted so many more diplomas, and have persuaded the public and themselves that this diploma has the same meaning in the domain of physical treatment as the doctor's degree has in general medical practice.