The kind reception of the first edition to this work has obliged me to decide whether to be content with a reprint, or whether rather to undertake a complete revision. It was with reluctance that I chose the harder course. I felt I could" not leave altogether unfilled the many gaps disclosed, when comparing the daily routine of practice with what I had deemed would suffice. Even now I am painfully conscious of a number of matters of detail still omitted, but trust that the additions made justify my attempt to render the book less incomplete and more generally serviceable. My hope is that what has been added, despite admitted incompleteness and imperfections, may act as a further stimulant of thought and reflection in my readers. Otherwise the revision fails to attain the only justifiable object the book itself can have, namely, the advancement of the cause of physical therapy and the consequent advantage of the ever-increasing number of its beneficiaries. The day has passed when it was enough to "try a little massage" upon those unrelieved by more "orthodox" remedies. More and more is physical treatment being invoked in the earlier stages of illness or after recent injury: more and more is its general usefulness gaining recognition. Reasoned justification of this more general faith that is gradually being placed in "massage" - and in all that the term implies - must not be lacking; it can be supplied effectively only by those who are convinced and taught by practice. To such I specially appeal to investigate some of the fresh paths which I have now tried to indicate. These particularly are the chapters on "The Reeducation of Muscle," "The Combination of Massage and Splintage in Orthopaedic Surgery," and "The Re-education of Amputation Cases." Some passages, again, have been added in the hope that, in them, any medical readers I may have will find confirmation of the view that so far from massage constituting physical treatment it is no more than an auxiliary. This is set forth in the chapters already enumerated, and also in those dealing with "Massage in Obstetrics and Gynaecology," the treatment of "Sacro-iliac Strain," and the chapter on "Forced Movement."

For their unstinted help in the preparation of this edition I have again to thank several of those who had previously earned my gratitude. Miss J. H. Wicksteed has laboured indefatig-ably; Miss M. Randall too has helped me much, and the proofreading has been in the same able hands as before. Mr. George Bethell has again, I am glad to say, been responsible for the Index. I owe several new illustrations and the second Appendix to the kindness of Miss F. Simpson, who until recently has had charge of the elementary class-work at Shepherd's Bush. Her services in this branch of the Massage Department have been invaluable. Figs. 154 to 157 inclusive were kindly provided by Captain James Patterson, of Vancouver. The remainder of the new illustrations were taken for me in the Shepherd's Bush Hospital, with the kind permission of the Medical Superintendent, Major Picton Phillips. All were specially taken, with the exception of Fig. 166, which was lent to me from the photographic records of the hospital.

This book is not intended to serve as a Text-book for the massage student. For such many books are already on the market, and there is no need to add to their number. Moreover, it will be recognised by the experienced masseur that many of the views herein expressed are unorthodox and are therefore dangerous diet for one whose main object in the immediate future is to satisfy examiners.

I have undertaken the heavy task of writing a book in wartime, at the request of my publishers, with two main objects in view. The first is to try to point out, as far as I can, to the practising masseurs and masseuses, what I consider to be the rationale of massage treatment, and to endeavour to introduce into their technique more generally than is at present the case the care and gentleness which appear to me as the key to the riddle of the exact nature of the massage which will most speedily yield a successful result. The six months' training at present in vogue is totally inadequate for efficiency or thorough teaching. My aim is to supplement both as far as can be done by the study of a book.

The second object I had in mind - which, I fear, is less likely to be realised - was that I might be able to place in the hands of my professional brethren a book to which they can refer when issuing instructions to their masseurs. A medical man who fails to issue adequate instructions may often be responsible for the failure for which his masseur is blamed. Another fertile source of disappointment is found in the lack of experience inseparable from a course of training limited to six months.

When a medical man orders massage he should not try to hand over his responsibility to the masseur. He should consider the prescription of massage treatment in the same light as he would consider that of a potent drug and watch its effects no less closely, varying the dose and the nature of the dose from time to time according to indications. If he leaves the details of the prescription to the masseur, he can only expect to encounter the effect of an overdose with considerable frequency, and, less often, fail to note the improvement anticipated owing to insufficiency of dosage. But if he is to prescribe and intelligently to watch the effect of his prescription, it is essential that he should render his instructions intelligible to his masseur, should know what effect he hopes to see and of what danger signals he must beware.

Much of the success which is attending orthopaedic surgery in its applications to the necessities of our wounded could not be attained without the concomitant of massage. Manipulation and exercises must often precede, should frequently accompany, and must almost invariably follow effective work by the surgeon. Without them his task in many cases would be either impossible or futile.

Massage is a dual agency, of prime value in either aspect. It may disclose (and aggravate, if we are not careful) latent mischief, as well as alleviate the danger which is apparent; and it can expedite, confirm, and finally give effect to the amelioration made possible by surgery. In either case the primary reason is the fact that massage can be made to originate passive movement, movement not simulated, though it may be unconscious, nor even, perhaps, the result of the patient's volition, though executed by him. At times we must gain our ends, as it were, by stealth. If movement of this kind be the first objective, the method by which it is to be induced can have little in common with the strenuous procedure in which alone some masseurs still indulge. For the present purpose, at any rate, no great aid would be expected of such an auxiliary. Methods may bear small resemblance to one another save in name; and I have endeavoured to point out the vast difference that exists between what I have called "relaxed" and all other forms of mobilisation.

Whether massage, manipulation, and mobilisation are to be for or against us to-day, when we cannot afford to ignore them is a question first of principle and then of method. I have therefore endeavoured to set forth both how and why the various kinds and degrees of each - as a persuasive, and rarely as a coercive, agency - should be severally applied. One thing I have felt we have long needed, namely, a considered study of principles such as underlie treatment by relaxation as well as that by contraction. The foundation of success in the restoration of function after disease or injury is the appreciation of the nature of true passive movement, and the skilful gradation to active movement, which must be successively partial, universal, and simultaneous. The prescribed processes and exercises, to justify their performance, so draw out or educate the degenerate but dormant abilities of injured muscles and tissues as to enable them to complete the recuperative course by their revived power of spontaneous action.

One word is necessary on the subject of the "exercises" so constantly referred to in the text. Certain exercises are described in detail. It must not be supposed, however, that this is done with the least idea that these can in any way replace or supplant the system of exercises we know as "Swedish." For all time these must remain as a pattern and guide. Whenever reference is made to exercises, the additional word "Swedish" should therefore be understood. The exercises described in detail, and which are not to be found in any Swedish table, are recorded only on this account. I have found them of service as an auxiliary to Swedish exercises; my hope is that others will share my experience. Moreover, treatment by Swedish exercises requires trained teachers, of whom, in the present emergency, the supply is inadequate. Some substitute has to be found, and I have tried to suggest one.

The final stage of convalescence may be long and tedious, perhaps a year's or two years' journey. The problem of the treatment to be given in such cases, and of its administration, has to be faced and solved, if men who have suffered in the nation's cause are not to lose the chance of regaining the greatest measure of physical ability that still is possible to them. It is one of the many questions which will demand solution and will get it, but not without much thought and labour.

The list of those who have helped me to prepare this book is a long one.

To Sir Robert Jones I am indebted for the valuable opportunity of working for him at the Special Military Surgical Hospital, Shepherd's Bush; and he has now added to his many kindnesses that of writing the Introduction which follows.

Miss Randell, Sister in charge of the Massage Department at St. Thomas' Hospital, has laboured indefatigably with my manuscript from beginning to end, and her help and advice have been most valuable. Miss J. H. Wicksteed, my Head Masseuse at the Shepherd's Bush Hospital, has done the same, and has also spared many hours of her small leisure to aid me in preparing the illustrations.

These I owe to the admirable skill, care, and patience of Mr. F. Howard Lewis, Photographer of the Military Orthopaedic Hospital. Most of the photographs were taken in this hospital by kind permission of the then officer in command, Major J. J. Jenkins. All but seven are original. Five of these are illustrations of the use of slings, borrowed from my former book, The Treatment of Fractures by Mobilisation and Massage, the sixth I have modified from Sir Robert Jones, while the seventh, Fig. 75, is the photograph of a patient under the care of Major Bristow, which he has published in his recent Treatment of Joint and Muscle Injuries.

The thankless and laborious task of correcting proofs has most kindly been undertaken by Mr. H. C. Streatfeild, Cle., his wife and daughter, the two latter being most valued members of my staff at the Orthopaedic Hospital. My readers, no less than myself, owe them a debt of gratitude. Other members of this staff who have helped me are Miss G. D. Innocent and Miss J. Milne.

My relief was great when Mr. George Bethell, Registrar of the Medical Society of London, kindly undertook to prepare the Index, without which any value the book may have would be very materially less.

J. B. M.

London, W.