Relapse is sometimes not entirely the fault of the patient; it is sometimes due, once more, to disregard of an important principle in treatment. This is that the use of the splint must not be abandoned too rapidly. For instance, it is an error to suppose that it is always within the patient's power to retain the full flexion of his fingers, if the splint which has secured it is discarded suddenly. In a certain percentage of cases, fingers which have been flexed by the aid of splintage will steadily stiffen again into full extension. So, too, I have seen a typical ulnar deformity corrected by splintage and relapse in spite, I believe, of strenuous effort on the part of the patient to prevent it. The secret of success is to reduce the time that the splint is worn day by day. Thus finger-tapes may be left undone half an hour the first day, two periods of half an hour the second, and three the third day. Then a quarter of an hour is added every day to each period of freedom till, finally, the splint is worn only at night. Then, too, the nature of the splintage can be changed by substituting strapping over felt, and finally by tying up the fist in a handkerchief.

But whatever splint is worn the patient should receive treatment daily, and this for two reasons. First, it is essential that, as far as possible, movement should be maintained intact in the direction opposed to that in which the splintage is working; and, second, the muscles which control this movement should be given their full chance of voluntary exercise. Failing these things, function is almost sure to deteriorate greatly while the splint is worn, even though, as is far from likely, mobility has increased. But the masseur must use every care to ensure that the fixation after treatment is at least identical with that before he loosened the apparatus; and he must realise that any day on which he fails to secure some advance - no matter how slight - indicates a day's treatment to no purpose. On the other hand, there is a limit to human endurance, and if the tension or pressure is too great, few patients will endure undue pain when relief follows the easing of a knot! Moreover, if we exert sufficient force to give a sleepless night, the chances are that there will be a reaction next day which will inhibit rather than further progress. At the same time, he who never overdoes it, rarely does enough!

Two final points. Whenever splintage is being used as a means for coercion, it is inevitable that there should be pressure. It is the masseur's duty to see that the pressure is as evenly distributed as possible, and that all points where the main pressure falls are adequately protected. Second, pressure always interferes with circulation to a greater or less degree. The masseur must see to it that circulation is at least adequate after he has refixed the appliance. In all these things, what may be quite satisfactory now, may be the very reverse in a few hours' time.

Occasionally a surgeon moves a joint forcibly from a bad position to a good one, tearing down all impediments, and fixes it in plaster. The reaction is usually great, and physico-therapeutical treatment is impracticable till the splint is released. Then, unless indeed treatment is withheld until the joint becomes more or less fixed in its new position, recurrence is almost certain unless the splintage is released by gradual stages. Day by day the mobility of the joint is restored by a combination of relaxed movement and muscle training, and the splint is replaced in position. Then the splint is discarded for slowly increasing periods each day in the manner already indicated. The same treatment should be supplied whenever an increase in mobility has been secured by means of any of the splints that depend for their efficiency on the use of screws, e.g., the Turner knee-splint. To screw up a joint in a plaster splint to a certain point, discard the splint altogether during a period devoted to physico-therapy, and then replace the splint for further screwing represents a faulty principle. If, for any reason, the screw-splint has to be removed for a time, the interim should, of course, be occupied by physico-therapy, but a temporary removable splint should be worn which prevents as far as possible all tendency to relapse.