It is in connection with the treatment of stiffened joints that the method of induced hyperaemia usually associated with the name of Professor Bier, of Bonn, has in my experience proved of the greatest use both as a preventive as well as a curative measure. I am strongly inclined to the view, without being certain about the matter until it has been confirmed by further experience, that the tendency to stiffness and to the formation of adhesions in joint affections is less when obstructive hyperaemic treatment is used as an aid to massage or any other treatment which seems desirable, but it certainly will not take the place altogether of the various other means of treatment in vogue at the present time; it must, in fact, be regarded as an adjunct, and an excessively useful adjunct, to other treatment.

It will, however, I am sure, be found that in acute conditions like gonococcal arthritis, acute rheumatic arthritis, and the like, when the hyperaemic treatment can be borne, as it usually can be, in the arterial, if not in the obstructive form, that the amount of massage and passive movement subsequently required to restore the normal joint functions is considerably less than when the ordinary methods have been alone pursued.

As an aid in the treatment of joints already stiffened by continued immobilisation, or by adhesions in and around the articulation, provided that these have not become too solidly organised, induced hyperaemia is of undoubted value - a fact in which there is nothing new, as I suppose it is the custom of most of us to prepare a stiffened joint for massage by the use of a very hot compress, with a view to what is commonly called 'softening the parts,' that is to say, to induce a flow of blood to them. This end is more perfectly attained by the hyperaemic method of Bier than by any other means, but care is necessary in selecting the form of application, obstructive or arterial, which is to be used. Speaking generally, if the part is painful, as, for example, in certain cases of stiffening after acute 'rheumatic' arthritis, arterial hyperaemia is more comfortable and efficacious than the obstructive form, especially if there is much thickening of the soft parts about the joint. Similar conditions are suitable for obstructive treatment by the somewhat elaborate exhaustion apparatus invented by Bier for the purpose.

Hyperaemia induced by bandage pressure is by far the most simple and convenient method, and answers well in cases of stiffening of joints without pain, especially if the surrounding induration or oedema is not great. Capital examples of the good results thus obtainable are afforded by cases of stiffness of the fingers (phalangeal joints) so frequently met with after injuries, generally called sprains, but often in reality fractures.

The comparative ease with which in such cases a finger can be manipulated and bent after its base has been encircled by an elastic band for a period varying from fifteen minutes to an hour or more, by which hyperaemia is produced,. with the precautions which I have indicated, is often remarkable, although in common fairness it must be admitted that there is no certainty in this result, as in some cases the effect produced seems to be virtually nothing.

The most striking results of this method of hyper-semic induction have been in my experience obtained in stiffness of the knee-joint, a part which is in many ways particularly well adapted for the treatment, in consequence of the ease with which it can be applied and regulated. One of the most inveterate cases of recurrent stiffness of the knee after successive 'breakings down' of the joint which I have seen really showed no hopeful sign of cure until the obstructive hyperaemic method by bandage pressure was adopted, when the tendency to recurrence steadily decreased, and recovery resulted. This case was also remarkable in showing the long period during which obstructive hyperaemia could be tolerated with absolute comfort, five or six hours being a common period, at the end of which general oedema below the bandage was well marked.

Fibro-Lysin in Stiff Joints.

Injections of fibro-lysin have been recommended as a means of softening or loosening the adhesions in stiffened joints. I have not been able up to the present time to satisfy myself that the treatment is of material use.