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The elbows should be kept extended if the triceps is involved and semiflexed if not; the forearm in supination or palm up until the balance between the pronators and supinators is determined and then the weaker should be favored. The wrists should be bent back, or extended, to about 45; the fingers kept in a neutral position of semiflexion.

The thumb is often neglected and serious malformation is invited. It should be abducted from the index finger and carried forward toward the palm. The palmar aspect of the splint should rest only on the ulnar side of the palm and never on the fatty part or eminence of the metacarpal part of the thumb, which would tend to make a flat hand.

The light papier mache hand splints described and recommended by Dr. Jean McNamara in a recent number of the "Physiotherapy Review" are admirable for the purpose. At the Orthopaedic Hospital, in Los Angeles, we have used a light frame of wire covered with light canvas, in the form of aeroplane wings placed crosswise of the bed under the mattress of a Bradford frame, bent forward slightly, (the hands and elbows being controlled by small splints) for cases of shoulder girdle and arm involvement.

These positions must be maintained at all times and when the patient is turned there should never be any alteration in them.

All through the period of convalescence the weakened sets must never be stretched and in muscle training we believe that the joints should never be carried beyond the point of placing the affected muscles on a slight tension to give them a starting point. Even in flail parts these precautions should be maintained.

The same protective care is carried over into the functioning or walking stage of convalescence. When braces take the place of splints these same physiological precautions must be taken. No deformity should ever be allowed to occur, and it will not occur if such physiological rest treatment is instituted early and continued throughout all the stages of treatment.

When deformity has already occurred in later stages, it should at once be corrected and a return to positions of physiological rest may allow the regaining of power lost by atrophy from disuse and the stretch paresis caused by deformity.

Very often there is not so much actual residual paralysis as one had supposed at first glance. It should be stressed to all and sundry, that the occurrence of deformity is a direct index to the kind of care the patient has had and usually means that some one has neglected to properly apply the principles of physiological rest positions for a long enough period.