Passive hyperaemia so produced is a very general mode of treatment, not only of diseases of joints, but also of other affections, especially those of bones. Soft indiarubber tubing is used for the hip and shoulder, centrally to the joints; for more distal joints Martin's or some other indiarubber bandage is used. The bandage (or tubing) is applied rather firmly, so that the superficial and to some extent the deep veins are compressed, and so that a distinct hyperaemia with increase of volume is produced. It should not, however, be applied so firmly as to produce haemorrhage (small red spots), pain, or any noticeable lowering of temperature; on the contrary, the static part should feel warm to the touch, and the patient should find the bandage comfortable. Professor Bier at first used this bandage for the greater part of the twenty-four hours (even for twenty-three hours), but now he more often uses it for eleven to thirteen hours, later on for eight, and finally only for one hour in the twenty-four. The treatment may, of course, go on for weeks and months.

It is well known that active hyperaemia promotes nutrition, healing and repair, as well as resolution and absorption.

Passive hyperaemia, on the contrary, has never been very highly thought of, and certainly has never been thought to assist nutrition anil absorption. But these effects depend entirely on its degree, and I for my part, after only short but convincing experience, feel certain that slight passive hyperaemia may be of very great therapeutic value.+

There can be no doubt that passive hyperemia under certain conditions improves the general state of nutrition. It has long been known that it promotes the growth of hair, and, what is of greater importance, it has been observed that it can promote the development of bone during puberty. When, a short time ago, I expressed my astonishment at the therapeutic value of passive hyperaemia to my friend Dr. P. Haglund he told me of a case of his in which a gangrenous process caused by an ulcer of the leg, in consequence of which amputation had been suggested, suddenly changed its character and began to heal immediately after a thrombus was formed in the femoral vein; at the same time the whole leg became swollen, active granulation began, a considerable sequestrum was taken from the tibia, and healing was completed with astonishing rapidity.

* Bier considers hyperemia treatment to be of importance for medico-mechanical institutions, the work of which, apart from this, he, "bei aller Anerkennung der Krfolge,"' considers to be "ein entschiedene ubertriebene Modesachc.

We must not be too hard on this doubting Thomas!

+ I refer my readers to Professor Bier's treatise "Hyperaemie als Heilmittel": Leipzig, 1903. It is possible that the book contains exaggerations, but it is certainly one of the most valuable medical works written during recent years.

There is every reason to believe that passive hyperaemia has considerable antiseptic properties; in fact in this respect it seems more effective than active hyperaemia. It has long been known that anaemia favours the development of phthisis, that living up in mountainous country, with the consequent hyperaemia (certainly active), counteracts the disease, and that it is also counteracted by conditions causing passive hyperaemia in the lungs. If this depends on the fact that during the stasis the white corpuscles have, as it were, more time to eat up the tubercle bacilli, or whether it depends on the antiseptic properties of the increased carbonic acid, must be left undecided for the present. From Professor Bier's undeniably valuable treatise, even though he may exaggerate somewhat, it is probable that his static treatment of joint affections has its greatest value in the treatment of tuberculosis of joints, in which cases it would be a mistake not to make use of it. In hyperplastic affections of joints after metastases and in synovitis crepitans it is of value because, in addition to its other effects, it lessens pain most remarkably. I do not yet know whether it can also produce any considerable improvement in arthritis deformans.

Warmth in the form of flannel bandages is often applied in various joint affections, e.g., in hyperplasia after metastases of the joint and in hydrarthrosis. They have their value, but it is not great, and for my part I gradually abandoned their use after my first few years of practice.

The constricting, preferably elastic, bandages with which forced compression is exercised in hydrarthrosis and hygroma have a quite different object from those previously mentioned. They are used with or without tapping of the joint, most commonly the knee, to promote absorption. They should be made of rubber, and should never be used unless the vessels are protected by a padded groove. I regard this as a poor and rather brutal mode of treatment.