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Updated: May 24, 2025
The induction of passive hyperæmia, by Bier's or by Klapp's apparatus, should also be used, either alone or supplementary to other measures.
There is pain in raising the heel from the ground, and creaking can be felt on palpation. The treatment consists in putting the affected tendon at rest, and with this object a splint may be helpful; the usual remedies for inflammation are indicated: Bier's hyperæmia, lead and opium fomentations, and ichthyol and glycerine.
The primary source of infection is dealt with on the usual lines. If the lymphangitis affects an extremity, Bier's elastic bandage is applied, and if suppuration occurs, the pus is let out through one or more small incisions; in other parts of the body Klapp's suction bells are employed. An autogenous vaccine may be prepared and injected.
A priest was at a little altar by the bier's head, other cowled figures crouched about it. There was a low murmur of praying, even, whining, and mechanical. On the bier Prosper saw the comely Abbot Richard Dieudonne, in cope and mitre, holding in his hand the staff of his high office.
The finger should be immobilised in a splint, and a Bier's bandage applied to the upper arm. Operative interference is indicated if a cold abscess develops, if there is a persistent sinus, or if a sequestrum has formed, a point upon which information is obtained by examination with the X-rays.
In the more severe variety the skin is red, and the swelling partakes of the characters of a phlegmon with threatening suppuration; it may result in crippling from adhesions. Even if pus forms in the sheath, the tendon rarely sloughs. The treatment consists in inducing hyperæmia by Bier's method; and a vaccine may be employed with satisfactory results.
On the other hand, the formation of new bone may be exaggerated, the osteoblasts being excited to abnormal activity by stimuli of different kinds: for example, the secretion of certain glandular organs, such as the pituitary and thyreoid; the diluted toxins of certain micro-organisms, such as the staphylococcus aureus and the spirochæte of syphilis; a condition of hyperæmia, such as that produced artificially by the application of a Bier's bandage or that which accompanies a chronic leg-ulcer.
Any blood vessel that is punctured should be cut across and tied; and divided muscles, tendons, or nerves must be sutured. After hæmorrhage has been arrested, iodoform and bismuth paste is rubbed into the raw surface, and the wound closed. If there is any reason to doubt the asepticity of the wound, it is better treated by the open method, and a Bier's bandage should be applied.
The most effective treatment is Bier's bandage applied for about six hours twice daily; it can be worn while the patient is following his occupation; in chronic cases this may be supplemented with hot-air baths.
We watched the pomp round him, and the circles of people that came to bring a wreath for him or to look upon his face. I saw a girl come and kneel long at the bier's foot. She rose and went away sobbing, leaving a little circlet of flowers. It was Rosa Holf. I saw women come and go weeping, and men bite their lips as they passed by.
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