It is often said that we have much to learn from war injuries from the purely massage point of view. As a matter of fact, not very many new discoveries have been made in the massage world during the last five years. The chief difference between military and civilian practice is this, that the conditions we used to regard as exceptional we are now called upon to treat in overwhelming numbers.

In pre-war days we were often inclined to think that two or three months of treatment was all that any individual had a right to expect, and that if he did not recover in six months the patient was either incurable or had at least received all the treatment to which he was entitled. Now we know that many of our patients cannot possibly recover in less than eighteen months or two years, or even more; and, knowing our indebtedness to the wounded, we face the prospect of prolonged treatment with equanimity.

In other words, we are learning, more fully than ever before, the one great secret of massage treatment - patience. Let us hope that the lesson thus learnt will incline us to patience with the less fortunate of civilians who also require prolonged treatment.

Another thing that is new to many masseurs is to be brought into such intimate contact with the results of sepsis, and many have been the unpleasant surprises when infection has been lighted up afresh by over-vigorous treatment. Sometimes this is administered without due appreciation of the danger, sometimes merely from lack of patience. No means has yet been discovered of hastening the absorption of the pathological products which cripple the patient for so long a time after sepsis has intervened. Nature alone can repair an injury, and that through the circulation. The whirlpool bath owes its success to the fact that, in its use, no attempt is made to confine treatment to the injured part. Thus, if a hand is stiff and rigid, the whole limb up to a point well above the elbow is immersed in the bath. Had masseurs realised the truth of Lucas-Championniere's teaching, these baths would not have gained their reputation so readily. The secret of their success is that the whole limb is treated. Lucas-Championniere always taught that the important thing to remember when administering massage is to treat the whole limb, and that the injured part is the last that should receive attention. When a patient whose hand and fingers are rigid has received massage treatment for his hand alone, the whirlpool bath will hasten recovery in a remarkable manner. When, however, a patient with similar disability has received systematic massage of arm and forearm as well as of wrist and hand, the addition of the whirlpool bath to his daily treatment makes little or no perceptible difference to progress, except in so far as they impart warmth to the limb. A few cases - particularly those with returning sensation who suffer considerable pain - undoubtedly do better with the bath than with massage. These are, however, exceptional. The baths as a rule require little supervision and no labour, and therein they score. When sensation has been impaired by nerve injury all baths require the closest supervision, or severe burns, most intractable in nature, will be inflicted.

The mechanical can rarely, if ever, equal the human agent in any form of remedial work, and so let us beware lest we ask of the baths more than we can reasonably expect. At the same time, let us take their lesson once more to heart, and remember to treat the whole of every limb that has been injured, and not only just the injured part itself. Thereby we can ensure that the injured part will receive a vascular supply adequate for its repair; without this, local treatment is obviously useless, and may even be detrimental. Of what is "treatment" to consist? Once more, in spite of repetition, it is well to emphasise that normal function can do more to restore nutrition than can massage. Every activity that is possible, therefore, within the limits of safety should invariably be prescribed throughout the whole limb.

Whenever there is tissue to be stretched, the very stretching is synonymous with injury. Efficient blood supply and lymphatic circulation are essential for repair, and, in their absence, any injury, however trifling, cannot be made good. It is thus that so many patients travel steadily down the hill in response to too vigorous local treatment.

A patient who wears a splint attached below the elbow should be taught throughout the day freely to exercise shoulder and elbow. If he is not told to do so he will leave the whole limb lifeless and at rest, and the masseur will have missed one of the greatest opportunities he has of hastening recovery.

Massage in war-time should also bring home to all masseurs the truth that underlies Lucas-Championniere's whole teaching of treatment by mobilisation. "Movement is life" was the axiom underlying all his work, and, if we wish to restore the maimed finger as rapidly as possible, we must exercise shoulder and elbow to the full; if the shoulder is stiff, let us hasten its repair by prescribing the full exercise for hand, wrist, and elbow.

Also we must not lose sight of the fact that sepsis is a very debilitating affair at best. This was forced home by the observation of the progress of two brother officers who were in a big railway "smash" in France. Both were strong and healthy men in the pink of condition, and both suffered comminuted fractures of tibia and fibula in both legs at the junction of the middle and lower thirds. One got pneumonia - only a slight attack; the other had no complication. At one point in the treatment of these two patients, the former was in bed with one leg fairly firm and the other quite "wobbly." The officer who escaped the pneumococcus had been walking about for three weeks. Here, then, is an example of the way in which sepsis can hinder repair.

The moral is plain. It is our duty to do all in our power to build up the general strength of our patients, and to this end we must encourage them to take all the regular exercise that lies in their power. A gymnastic class can well be taken, even though every man has his arm in a sling. Few are injured so severely that they cannot perform some educational exercise with advantage.