A prolonged experience of the use of the combined methods of massage, early movements, and rational posture in the treatment of ordinary fractures coming under notice almost daily in hospital work, confirms the writer in the favourable estimate formed by him as reported in his first communication upon the subject in the 'Lancet' of 1897, and leads to the following conclusions:

1. When managed with ordinary discretion and with average dexterity the result of the method is undoubtedly advantageous, inasmuch as the time elapsing before the patient is able to resume his ordinary vocation is diminished by at least one-third, partly by the increased rapidity of union which ensues and to a great extent by the avoidance of the waste of time which occurs in correcting the stiffness and pain which so often follow upon the discontinuance of splints, in the majority of cases treated by means of the classical method of prolonged splinting etc.

2. The advantages resulting from early passive and voluntary movements - an essential precursor of which is massage - are especially noteworthy, a fact which was fully elicited in an inquiry made by the present writer in connection with a communication 1 read at the meeting of the British Medical Association at Ipswich in 1900, the evidence obtained proving conclusively that early movement is followed by a corresponding early return to the ordinary vocation of the patient.

3. The benefit of the method is remarkably demonstrated in fractures in which the chances of union without operation are practically nil - e.g. intracapsular fracture of the neck of the thigh-bone - the indications being to obtain the best use in the damaged limb by insuring free movement and by preventing the wasting of the muscles concerned; in such cases massage and movements are indicated at once.

1 ' The Present Practice in the Treatment of Simple Fractures.'

4. The danger of thrombosis and embolism feared by some surgeons does not exist more than in fractures treated by prolonged splinting. Cases of embolism may have occurred in the course of treatment upon the lines under consideration, but the writer, whose experience of the method is probably larger than that of any other surgeon in this country, has met with no such case, although he has seen five instances of embolism (two fatal) in cases of fractures managed by prolonged splinting. Thrombosis and embolism will from time to time occur in fractures however treated, a fact of which any surgeon of large experience must be painfully aware.

5. The method is not suited to those who lack discretion or who are defective in dexterity - a remark which applies with equal force to the majority of surgical methods; to such the classical treatment by prolonged splinting, whatever its disadvantages may be, is better adapted.

6. The principal disabilities attaching to the union of fractures in faulty positions, unless the displacement be gross or of the rotatory kind, are avoidable by the use of massage and early movements, by which adhesions around the fracture are avoided.

7. The method is not to be regarded as a substitute for treatment by splints on the one hand or by operative measures on the other, but should be used as a rational adjunct to each.