The advantages derivable from shampooing and manipulations in sprains, wrenches, and similar injuries have been recognised for centuries, especially as shown in the rapid removal of extravasated blood, the cure of oedema, the prevention of stiffness, and the checking of muscle waste - the identical complications which are prone to occur in fractures: a fracture being nothing more than an exaggerated form of sprain, the bone, in addition to the soft parts, having been torn. It is presumed that no intelligent surgeon who has had any practical experience would in these days hesitate to use massage and movements in a case of sprain or wrench, however severe, if the bone were intact and the skin sound. The sole reason for avoiding the application of these common-sense methods in fractures seems to be the general belief that any plan of treatment which would entail movement, however slight, between the fragments, must be inimical to union and therefore unsound, if not actually dangerous, in practice. It is, however, quite certain that the very slight amount of movement entailed by this method, if properly applied, not only has no tendency to prevent union, but, on the contrary, may sometimes tend to promote union by the increase of callus so produced. It would be easy to give instances in support of this contention. The perfect manner in which union occurs in fracture of the ribs, or the excellent union which often follows upon fractures in the lower animals, notably the dog, in which immobility is generally quite out of the question, may be taken as examples; on the other hand, the remarkable frequency of non-union in fractures of the skull, specimens of which may be found in every museum, in which of necessity there has been absolute immobility, should be noted. It must not be inferred from what has just been said that the writer advocates intentional movement of the fragments in recent fracture; these remarks are simply intended to emphasise the fact that the amount of movement, if any, which occurs in the proper application of this treatment is not sufficient to interfere in any way with union, and need not, therefore, stand in the way of the application of the common-sense principles which apply, as a matter of course, in ordinary sprains.

In any case of recent simple fracture, unless the local condition of the skin from blistering or other causes is contra-indicative, massage cannot be commenced too soon with a view to the relief of pain and the prevention of spasm. The soothing effect upon irritable muscles in the majority of cases is most remarkable, in some instances rendering an apparently unmanageable fracture quite amenable to ordinary methods of reduction, which could not otherwise be effected without operation - a result the value of which in some subjects can hardly be over-estimated. The ease with which a difficult fracture can be manipulated after it has been subjected to gentle, smooth rubbing is often a revelation to those who have had no experience in the matter.

Massage is, moreover, a useful precursor of truly effectual voluntary movement, and it is an integral factor in the production of the fullest benefit derivable from passive movement, since the latter, although it prevents adhesions, does not prevent muscle waste to any great degree, a defect which is supplied by massage.