Stage 2: Immediate Smooth Rubbing. - Commence at any time, the sooner the better, after the fracture has been 'set.' The straps fixing the side-splints are unfastened and the splints are allowed to fall away from the limb. The knee is then steadied by one hand of the manipulator, whilst smooth gentle rubbing from the foot upwards is effected by the other hand, which is made to grasp as much of the circumference of the limb as possible. The time required is from five to ten minutes. The objects are the relief of muscular spasm and rapid absorption of effused blood etc. At the end of this stage the side-splints are replaced, leaving the parts in the condition shown in fig. 1.

Fig. 1. - Massage in Recent Fracture oF the Leg

He has come at once to the hospital, and the fracture has been what is commonly called 'set'; and as he has come to a great hospital we will suppose it has been properly set. There is a good deal of swelling about the fracture; there is also a certain amount of muscular spasm. He complains so much of the spasm that unless something is done he can hardly lie quiet, and he certainly cannot sleep or feel comfortable. The ordinary method under such circumstances is to give an hypodermic injection of morphia, or, if the bones are not in precise apposition, to give an anaesthetic if that has not already been done. You will, however, find that unless the bones are out of place - in which case you must at once rectify the defect, under the guidance of the x-rays if these are available - gentle rubbing over the fracture, merely a smooth upward movement of the hand which grasps as much of the circumference of the limb as possible, will in a very few minutes, in the majority of cases, practically relieve all spasm. You will sometimes find people who are suffering from spasm to such an extent that they cry out with the pain, and who are certainly unable to get any peaceful rest, after a few smooth passages of the hand over the damaged part settle down comfortably; in some cases they will actually fall asleep whilst the rubbing is proceeding. This manipulation, however, must be done in the right way - that is to say, with the flat of the palm of the hand grasping the limb very smoothly and uniformly in the way I show you (vide fig. 2). You need not be in the least degree afraid of passing the hand over the fracture if it is done properly. Patients do not resent the pressure at all - in fact, they rather like it, as some of you know already from what you have seen in my practice. The first object, then, that massage effects in these cases is the relief of the pain due to spasm should it be present. The same smooth movement that I am now applying very gently over the swollen parts immediately about the fracture will also bring about absorption of the effused blood with extreme rapidity, so long as the rubbing is smoothly and carefully carried out. The splints used for the treatment of the fracture, you will note, consist of a back-splint with an oblique foot-piece and two straight side-splints, the latter being secured by straps so that they are easily loosened (vide fig. 1).

Fig. 2. - Massage in Recent Fracture of the Leg