In the treatment of congestion it is of primary importance that its character should be recognized, as the modes of treatment to be employed in the two forms of congestion are essentially different. In active congestion there is excessive activity of the circulation, and consequently, in many cases, of all the tissues of the organ or part affected. A most important indication of treatment then, is to lessen the activity of the blood-vessels, as well as of the other tissues in the congested part. There is no better agent for accomplishing this than cold properly applied. The degree of the intensity of the application will depend upon the violence of the action and the location of the disease. Cold applications may consist of simply tepid bathing or sponging, or the application of cool compresses, the cold pack, cold foot-bath, cold spray or douche, or the application of ice, according to the part affected or the effect desired. Special modes of application in the congestion of different cases will be pointed out in connection with the description of local diseases. Another excellent means of counteracting the effects of active congestion is derivative treatment; that is, artificially producing temporary congestion in other parts of the body, thus drawing the blood away from the affected part. This may be most easily done by means of hot applications in the form of fomentations or local hot baths. Dry heat may also be employed. In some cases, great benefit may also be obtained from the temporary ligation of certain parts, as of the limbs, by which a large amount of blood may be temporarily removed from the circulation. When possible also, the congested part should be placed in such a position that gravitation will aid in relieving it of its surplus blood, as, for example, in congestion of the brain the head should be raised above the level of the other portions of the body. The same may be said of local congestions elsewhere. This remark applies to both active and passive congestion.

In the treatment of passive congestion, the application of cold is less frequently indicated than in active congestion. In these cases, hot applications are generally much more successful, although we have usually obtained the best results in the use of alternate hot and cold applications. Cold applications produce at first a strong contraction of the blood vessels and thus an increased activity; but if long continued, the vitality of the part is lowered, and hence the original difficulty will be increased. So also in the use of hot applications; the effect at first is astringent in character, like that of cold. It should be remarked, however, that applications for this purpose must be hot; that is, of a temperature above that of the body. Applications of a temperature from 106 to 110 F. are best. In extreme cases, a still higher temperature should be used. If too long continued, hot applications result in rather increasing than relieving the local difficulty. By alternating the two, however, it is possible to continue and intensify the good effects of each remedy for some time. As a general rule in the treatment of congestion, hot and cold applications should be made at intervals of from two to six hours, and between the applications the part should be covered with a tepid compress, changed sufficiently often to prevent its becoming warm. Chronic and passive congestion of internal organs, when acessi ble, as in chronic congestion of the mucous membrane of the pharynx, may be benefited by the use of astringents; but by far the most potent remedy is the application of hot water or steam, as hot as can be borne without pain,-a temperature of 103 to 115. When the congested parts are not accessible, as in the case of the liver, spleen, and kidneys, the hot and cold douche applied over the affected part supplies the best known means of relieving the difficulty. Another point of great importance in the treatment of passive congestion, which indeed should be attended to at the outset of treatment, is ascertaining the cause of the disease. If, as is often the case, the congestion is produced by mechanical obstruction of any sort, as by restriction of the clothing, by pressure, or by any other means of a like character, it should be promptly removed. Passive congestion may often be greatly relieved by rubbing. Care should be taken to rub the parts in such a direction as to press the blood forward in the veins, thus aiding the venous circulation, which is chiefly at fault in passive congestion. In cases in which the difficulty is continued until transfusion of the serum into the tissues has occurred, causing puffiness or swelling of the parts, great advantage may often be derived from the use of properly adjusted bandages. The bandage should be applied smoothly and with even pressure over all parts of the organ, in such a manner as not to interrupt the circulation. The rubber bandage is preferable to all others for this purpose.