258 CHRONIC ARTICULAR RHEUMATISM 



Warm water in all forms is frequently employed^ from the Priessnitz pack 

 to a hot bath. The latter are used particularly in the form of natural springs, 

 which are of ancient repute. Their effect is to be ascribed more to the tem- 

 perature of the water and the duration of the bath than to the chemical 

 constituents of the water (hydrogen sulphid, alkaline sulphates, calcium, gyp- 

 sum, sodium ehlorid, etc.). In rheumatism, the unaccountable experience is, 

 that natural mineral waters may bring about improvement after the effect 

 of hot water baths in the home has been exhausted. This effect is chiefly due 

 to the cutaneous irritation of mineral waters rich in carbonic acid, such as 

 those of Nauheim and Oeynhausen, or of mud baths combined with the thermic 

 effect of the water. To these must be added the effect of applications of peat- 

 soil, fango, natural sulphur, etc., and heat applied in various ways, sweat 

 procedures, hot air and steam douches (the latter often producing a relaxa- 

 tion of muscle contractures and stiffness), sand baths, local and general hot 

 air baths and, finally, local inflammatory applications ; painting with tincture 

 of iodin or ichthyol, compresses with iodin — ^potassium iodid salve (1 : 10 : 100), 

 vesication, etc. 



All these applications have in common a tendency to produce hyperemia, 

 and August Bier has contributed other original therapeutic methods. The 

 irritating or anodyne effect of derivatives and counterirritants has always 

 been explained on the hypothesis that the blood is drawn from the distant 

 diseased parts to the surface. Bier has shown that this is incorrect; that, on 

 the contrary, the deeper parts partake in the hyperemia, and that this produces 

 the anodyne and absorbent effect. Bier stimulates this action still further by 

 hot air and stasis. The former produces an intense, highly active, i. e., 

 arterial, hyperemia, which is greater the higher the temperature of the agent. 



A simple apparatus, a wooden box with two openings to permit the en- 

 trance and the exit of the hot air, and bandages on which to rest the affected 

 member are sufficient for the purpose; the hot air is produced by a Quincke 

 sweat tube, or a phenix a air cliaud, the tube being introduced into the open- 

 ing of the box. Similar apparatus has been employed by Tallermann, and 

 Lindemann has used electric heat; the effect of the electric light haths now 

 in vogue, in which the electric bulbs radiate not only light but. heat, is the 

 same. For institutions these are very serviceable, as they are not dangerous 

 and are easy to regulate. Bier's apparatus, however, has the enormous advan- 

 tage that it may be constructed by a carpenter, at very slight cost, in the 

 house of the patient, and be employed at the bedside. The effect of this remedy 

 is excellent, as I am able to testify. 



The value of passive hyperemia attracted the attention of Bier on account 

 of the rarity with which tuberculosis of the lungs is found associated with 

 valvular disease of the heart. He attempted artiflcial blood stasis in tubercu- 

 losis of the joints, and was so gratifled with the success attained that he 

 employed this method also in other Joint diseases. Above the diseased area 

 an elastic (rubber) bandage is applied so tightly that the extremity becomes 

 edematous. 



. However, the pressure must not be so great as to compress the arteries; 

 the member must be warm, and the stasis must not produce the slightest pain. 



