834: EPITOME OP MODEEN TREATMENT OF 



in which it has been used. Bier's treatment depends upon 

 hyperemia produced artificially. Active hyperemia is brought about 

 by heat, as hot air, etc. Passive hyperemia is secured by suction, 

 as cupping and the >ise of other suction apparatus, and also by 

 placing an elastic ligature about a part sufficiently tight to prevent 

 the return of venous blood, but not so tight as to obstruct the 

 arterial inflow. This latter method is the one which has recently 

 been employed in veterinary surgery and is the method we wUl 

 describe. 



Bier finds that passive hyperemia is useful in infections and 

 inflammations — particularly of limbs and joints — because of the 

 following actions: 1. Bactericidal effect. 2. Relief of pain. 

 3. Resolution of inflammatory deposits and relief of stiffness in 

 joints. 4. Arrest of absorption of toxins into circulation. 5. Short- 

 ening or aborting infections. 



Methods of application. — A rubber Esmarch bandage, about 3 

 inches wide and 5 feet long, is wound about the limb of a horse tight 

 enough to produce a warm edema below the bandage. The bandage 

 is kept in place 20 hours out of the 24, in severe cases; or 10 hours 

 in the 24, in milder infections. Just how tight to apply the bandage 

 is not possible to describe. In the human, relief of pain and a red 

 edema is the desideratum. In the horse the chief point is to avoid 

 producing a cold limb because of too great constriction. Some 

 animals v^ill bite or paw and so displace the bandage. The rubber 

 bandage should have tapes sewn on each end, and is wrapped about 

 the limb and kept sufficiently tight by tying the two tapes together. 

 The bandage is placed in the fore limb on the forearm above the 

 chestnut one day, and the next below the knee (on the metacarpus), 

 and so shifted from day to day. In the hind limb the bandage is 

 placed one day about the middle of the tibia, and the next day 

 below the hock. It should always be placed as far distally from 

 the lesion as possible, but in the horse it can not be affixed at groin 

 and axilla, as in man. The position of the bandage is shifted from 

 day to day to avoid necrosis ol the skin. It is well to protect the 

 rubber by a cloth bandage over it. If the infection is of the knee 

 or hock, the constriction must be above these points. 



The bandage should be applied at the earliest stage of infection 

 to secure the best results. Then' edema may be expected from the 

 bandage, but, in later stages, edema may not occur, and if this is 

 the case the treatment is of little service. If the treatment is suc- 

 cessful either pus will not form and resolution occur, or else it will 

 be necessary to make but small incisions to liberate pus, and the 

 course of the condition should be much shortened. The treatment 

 is only applicable to cases which can be under frequent observation 



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