Percussion should be prohibited over any muscle that is abnormally contracted, over any sensitive area, over any paralysed muscle until its contractility has been restored, or in neurasthenia during any but its latest stages, and probably even then.

It will be surmised from the above account, and from the frequent advocacy during the preceding pages of gentleness, that the author is anxious to impress the essential desirability of exercising care and gentleness throughout all massage treatment, and not only when dealing with acute cases. During a six months' training in which there is so much to be learnt, and during which clinical experience cannot be other than limited, it is impossible to give adequate instruction for the treatment of every class of case which may be encountered, or to indicate how different may be the treatment that should be given to two apparently similar cases, when due regard is paid to all the circumstances.

Every case that is recommended for massage treatment invariably presents one or more structures in which the general vitality is lowered, and, having been taught that certain massage movements are "stimulating," the masseur (not unnaturally) forthwith applies them. Ask that masseur why he does so, and the only answer we get is: "I thought the part required stimulating." Inquire further what he is trying to stimulate, how the movement he is performing is calculated to attain his end, or even perhaps why he thinks stimulation will prove beneficial, and it is rare to receive any satisfactory reply. It is necessary, therefore, to consider exactly what is meant by the word "stimulating" in its application to massage, and to utter a word of warning as to the dangers of over-stimulation.

In routine medical and surgical work the efforts of the physician or surgeon are frequently confined, in the first instance, to ensuring relief for the patient, and sedatives frequently replace stimulants with remarkably beneficent effect.

Thus, considering "accident cases" as a whole, it is safe to say the patients will suffer to a greater or less degree from shock to the central nervous system, and that this element in the case is by no means negligible. Often enough it is overlooked, but it should be the surgeon's first care to reduce the effect of shock to a minimum. After fracture the intense spasm of all the muscles which control the movements of a limb is a source of most acute physical suffering, which greatly augments the general "shock."

Few of those who practise massage have the opportunity of realising how profound may be the "general" effect of such purely "local" suffering. Yet it is the daily experience of every surgeon to note the rapid general improvement of all - save only the most severe - "accident cases" the moment the patient is placed under the influence of an anaesthetic. This improvement is due essentially to the complete sedative effect. If ether is given it acts as a powerful cardiac stimulant in addition; but the primary cause of the improvement is relief from the perpetuation, as it were, of the shock. This can be proved by watching the progress of a case of a severe comminuted fracture of the hip when amputation is performed. The patient arrives in the theatre, apparently moribund. The seriousness of his condition is the result of shock, since there may have been but little loss of blood and sepsis has had no time to play its part. Improvement is noticed directly anaesthesia has been induced, the heart-beat becomes slower and stronger, the pulse increases in volume and tension, while the colour improves and the cold, clammy sweating ceases. Moreover, the improvement is continuous, in spite, it may be, of the infliction of further "injury" by the surgeon, simply because the torn and otherwise damaged tissues - especially nerves and skin - can no longer send up their inimical impulses to the cord and brain from the mangled site of injury.

After the anaesthetic, saline may be given - perhaps alone, perhaps with stimulant in the form of brandy, pituitary extract, adrenalin or ergot, or perhaps with food in the form of dextrose. All these help to tide over the immediate emergency; but last, to minimise the shock as much as possible, most surgeons rely on morphia. The whole of Crile's theory of anoci-association is based on the prevention of stimuli reaching the brain from the site of operation, or, in other words, the prevention of shock due to local injury.

If surgeons, then, note and utilise the beneficial effect of sedatives - and note also the too frequent inimical effect of stimulants, such as strychnine - in the treatment of the result of injury upon the central nervous system, the masseur should follow suit, no matter what the cause of the injury may be, whether physical or psychical.

Again, consider the patient with advanced heart disease who is rapidly failing. A small dose of heroin will often produce a. markedly beneficial effect when every stimulant in the pharmacopoeia has been tried and found wanting. The masseur should, therefore, try equally to soothe the voluntary muscle when "fagged out," not to stimulate it.

If we consider the action of a "stimulating" electrical current on the ordinary muscle-nerve preparation from a frog, the first effect we notice is contraction of the muscle. Surprisingly soon, however, we note the signs of fatigue. When this has advanced so far that the muscle fails to respond, response can still be elicited by application of the electrode direct to the muscle. This indicates that the fatigue is in the nerve - not in the muscle. In using the movements of massage as a means of stimulation we must remember that fatigue and stimulation go hand in hand. Moreover, no muscular response will be obtained from massage unless we are treating a case of advanced nerve disorder, or dealing with an area where it is possible to excite one of the skin-muscle reflexes, or unless we use some form of massage which excites a protective contraction. But we have seen that fatigue of a nerve precedes muscle fatigue, and it is possible to stimulate a nervous system to exhaustion without any visible sign at all. Many a longdistance runner, for instance, is able to sprint the last few hundred yards of a race under the stimulus of sheer will power, without showing evidence that his whole central nervous system is so "done in" that complete unconsciousness will follow a few seconds later. Even when insensible the muscles respond readily and easily to faradism, showing that the fatigue is of the central nervous system rather than of the muscles.