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Bier's hyperemic treatment in surgery, medicine, and the specialties; a manual of its practical application online

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Bier's Hyper emic Treatment in
Surgery, Medicine, and the ...

Willy Meyer, Victor Schmieden

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Hyperemic Treatment




Professor of Surgery at the New Y()rk Post-GraJuate MeJical School and

Hospital ; Attending Surgeon to the German Hospital ; Consulting

Surgeon to the New York Skin and Cancer Hospital, and

to the New York Infirmary



Assistant to Professor Bier, University of Berlin, Germany






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Copyright, 1909, by W. B. Saunders Company

First print ino March, 190S
Second printing June, 1908
Third printinq September, 1908
Fourth printing Januari/, 1909
Second revised edition June, lf>09

• ••••••I . •••••••



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J "

This Volume is Dedicated



The Authors

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The fact that four large prmts have been required to
supply the demand for the book since it was launched some
ten months ago, is gratifying proof of the interest that Bier's
hyperemic treatment has aroused among the English-
speaking profession.

The authors are convinced that the physician who has
given the treatment a fair and careful test, no matter in
what specialty, and has thus had an opportunity of per-
sonally obsening the often remarkable successes that can
be obtained, will be so much pleased that he will be eager to
give the method a permanent place in his therapeutic
armamentarium. He will have learned and seen with his
owTi eyes what a powerful weapon to {)revent and combat
disease we possess in the patient's o\\ii blood. The fact
that the method requires much time and personal care will
not be a deterrent to him. He will consider the results
obtainable, and these will goad him on to further effort.
And this is the way Bier's hyperemic treatment will go
on gaining disciples until there will be none left to withhold
the recognition it so richly deserves.

The authors of the book have revised the text, made such
additions as seemed necessary, and have tried to enhance
the value of the book by interspersing brief histories of
interesting cases. They have also furnished an index to the
world literature, as promised in the first edition. A\Tiile
they believe it is fairly thorough, they are aware that it



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is not complete. Perhaps the authors whose articles have
been inadvertently overlooked, will be good enough to
inform either of the writers of the omission, so that it can
be made good in a third edition.

May the second edition of our book on Bier's hyperemic
treatment make as many friends as did its predecessor and
thus help to swell the ranks of those to be benefited by
this gentle, but nevertheless most potent therapeutic agent.

Willy Meyer
Victor Schmieden

New York and Berlix

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The decision to write and publish in the United States
a manual of the practical uses of Bier^s hyjxjremic treat-
ment in surgery, medicine, and the specialties needs no

Bier's teachings are of such far-reaching nnportance
and great practical value, that there can be no doubt that
they will be generally introduced in the United States
sooner or later.

Nevertheless, it might be of interest to mention the cir-
cumstances that impelled the authors to write this book :

One of them has used Bier's hyperemic treatment in
New York since it was first published, fifteen years ago;
he was probably one of the first in this country to employ
the method. The results he obtained have been so remark-
able from the outset that he has greeted with increasing
interest every new phase in its evolution, becoming more
and more convinced of the value of the treatment as an
important addition to our therapeutic resources. Often
he has presented patients thus treated in clinics and before
medical meetings. Of late he has begun extending its
application to the treatment of acute inflammatory troubles,
always closely following the rules laid down by Bier. He
embodied his experiences in a paper read in the Section on
Surgery and Anatomy of the American Medical Association,
at its Fifty-eighth Annual Session, held at Atlantic City,
June, 1907 (Journal Am. Med. Assoc, August 17, 1907).


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The other author came to the United States in May,
1907, as representative of his chief, Dr. August Bier,
Professor of Surgery at the University of Berlin, to read,
on invitation, a paper on "The Treatment of Bone and
Joint Tuberculosis by ' Stauungs-Hyperaemie ' " before
the Surgical Section of the National Association for
the Study and Prevention of Tuberculosis, at its third
annual meeting, held at Washington (New York Medical
Record, August 17, 1907). Afterward he traveled ex-
tensively through the eastern part of the United States,
lecturing on, and demonstrating, the procedure, by request,
in numerous places, and everywhere he was impressed
with the great interest generally shown by the profession.
No less was he impressed with the extent to which Bier's
treatment is already being employed in America, as well
as the unprejudiced and liberal manner in which the new
teachings were received where still comparatively unknown.

But one and the same great need so often recognized
and complained of by others became apparent to him,
wherever he went; namely, that of a brief and compre-
hensive manual on the hyperemic treatment, that would
enable not only the surgeon and specialist in the other
branches of medicine, but also the general practitioner
to become familiar with the method.

It is in order to fill this gap, that this book has been
written. It contains in a nutshell the experiences gathered
at Bier's clinic, where the hyperemic treatment had its
birth, together with those made on American soil.

Willy Meyer
Victor Schmieden
New York and Berlin

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Introduction 17



The Advantages of the Hyperemic Treatment Over
Other Methods 21

Methods of Inducing Hyperemia 23


General Rules for the Application of Hyperemia 26
Obstructive hyperemia by means of the elastic ban-
dage ". 26

Obstructive hyperemia by means of suction appa-

ft ratus 44

The induction of hyperemia by means of hot air. . . 64


The Treatment of Special Diseases by Means of Arti-
ficial Hyperemia 78


Hyperemic Treatment in Surgery 79

Traumatisms 79

Inflammations 84

Acute infections 84

Furuncles and carbuncles 84

Abscesses, acute lymphadenitis, infected
wounds, acute infectious inflammations

within the mouth and of the face 90

Puerperal mastitis 96


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Acut€ infectious inflammation of joints

(arthritis gonorrhceica) 101

Felon and phlegmon of the tendon-sheaths 105

Acute osteomyelitis 118

Recurrent osteomyelitis 121

Erysipelas 121

Obstructive hyperemia as a prophylactic 122

Appendix — Compound fractures 128

Chronic infections 131

Tuberculosis 131

Tuberculosis of spine, ilio-sacral joint and

of the OS sacrum 145

Tuberculosis in various localities 151

Syphilis 160

Chronic inflammations not due to specific bac-
teria 161

Chronic arthritis (chronic articular rheuma-
tism); arthritis deformans; arthritis

urica (gout) 161

Appendix — Joint stiffness following inflam-
mation 163

Various surgical diseases benefited by Bier's

treatment 164

Diseases belonging to the domain of ortho-
pedic surgery: inflammatory flat-foot

and scoliosis 164

Varicose veins; ulcerations of the leg. . . . 167
Senile and diabetic gangrene; gangrene due

to embolism of the main artery 168

Burns 170

Frost bites 170

Intra j)erit()noal adhesions 170

Tumors 170

Hyperemic Treatment in Medicine 172


Hyperemic Treatment in Gynecology and Obstetrics 184

Hyperemic Treatment in Genitourinary Surgery 188

Hyperemic Treatment in Otology 194

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Hyperemic Treatment ix Ophthalmology 199


Hyperemic Treatment in Rhinology, Pharyngology,
AND Laryngology 202


Hyperemic Treatment in Neurology, Including
Psychiatry 206

Hyperemic Treatment in Dermatology 210

Conclusion 211

Literature of Bier's Hyperemic Treatment 217

Index to Bibliography 263

General Lndex 269

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1. Application of Bier^s elastic bandage around arm. . . 28

2. Application of Bier's elastic bandage around arm 29

3. Application of Bier's elastic bandage around arm. ... 30

4. Dressing during treatment 32

5. Technique for obstructive hyperemia at shoulder-joint . 38

6. Elastic neck-band 39

7. Rubber bandage used for neck-band 40

8. Neck-band made of black rubber 40

9. Application of elastic bandage for obstructive hyper-

emia of head 41

10. Obstructive hyperemia for testicles 42

11. Rubber tube for testicles 42

12. Rubber tube for testicles 43

13-16. Suction glasses 46

17-20. Suction glasses 47

21-22. Suction pumps 48

23. Suction glass for puerperal mastitis 48

24. Suction glass for puerperal mastitis 49

25-29. Vacuum glasses 50

30-32. Vacuum glasses 51

33. Patients treated with suction cups for suppuration

and fistulous tuberculosis 53

34. Suction apparatus for finger (felon, etc.) 54

35. Suction apparatus for hand 55

36. Medium position for moving wrist in vacuum glass. . 56

37. Dorsal flexion of wrist produced by the vacuum 56

38. Volar flexion of hand 57

39. Strongest volar flexion 57

40. Passive stretching of the fingers 58

41. Fingers pressed into flexion by vacuum 58

42. Foot-piece in place without supports 59

43. Cushion under heel for treatment of talipes calcaneus 59

44. Movable and adaptable support under the fore part

of the foot for treatment of pes equinus 60

45. Large laterally slanting cushion in place 60

46-48. Apparatus for finger-stretching 61

49. Suction apparatus for elbow-joint 62

50. Suction apparatus for knee-joint 62

51. Suction apparatus for knee-stretching 63

52. Contractol knee stretched by suction apparatus. ... 63
5,'^. Hot-air box, open 65

54. Wooden hot-air box for hand 66

55. Hot-air box for elbow — ^ 67


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56. Hot-air box for shoulder 68

57. Hot-air box for shoulder 69

58. Hot-air chamber for foot 70

59. Hot-air chamber for knee 71

60. Hot-air chamber for whole leg 72

61. Hot-air chamber for both hips 73

62. Hot-air douche for trigeminal neuralgia 74

63. Hot-air douche for sciatica 75

64. Small size elastic band for the finger 80

65. Klapp's suction cup in case of carbuncle 87

66. 67. Furuncle of lips 89

68. Suction glass applied to breast 97

69. Suction cup applied to breast 98

70. Anatomy of palm of hand 110

71. Klapp's incisions of infected sheath of the flexor

tendons of the hand and forearm Ill

72. Incisions in case of suppuration within tendon-sheaths

of volar flexors 113

73. Phlegmon of hand and forearm 115

74. Deep and large soiled wound of volar aspect of forearm 123

75. Elastic bandage in fistulous tuberculosis of elbow. 136

76. Suction glass in tuberculosis of elbow 137

77. Plaster-oif-paris support in tuberculosis of the knee. . 139

78. Same as Fig. 77 as carried out by instrument-maker 139

79. Combined treatment of contracted tuberculous knee-

joint 140

80. 81. Cured tuberculosis of left knee 141

82. Tuberculous affection of metatarsus 142

8^^. Daily scene at children's ward 143

84. Local hyperemia in tuberculosis of theos sacrum. . . 147

85. Suction cup in use, same case as figure 84 148

86. Elastic tube in position in double tuberculous epididy-

mitis 154

87. 88. Tuberculous epididymitis treated with suction-

glass 155

89. Apparatus for pes varus 164

90. Hot-air box for scoliotic patients 166

91. Kuhn's lung suction mask 176

92. Kuhn's lung suction mask in position 178

93. Hot-air box treatment of lumbago 182

94-96. Suction glasses for cervix uteri. . : 185

97. Suction glass for pars pendula penis in gonorrhea. . . 188

98. Suction apparatus for prostate 189

99. Suction glass for sty 200

100. Suction apparatus for nose 203

101-103. Suction glasses for tonsils 204

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The physician who intends to make use of artificial
hyperemia must first have a clear idea as to what he wishes
to accomplish with it. To employ artificial hyperemia
means to increase the quantity of blood in a given diseased
part of the body, hoping thereby to obtain beneficial

The task of the blood is to circulate through all the differ-
ent tissues of the body, with few exceptions, and to main-
tain therein the various physiologic functions.

But the blood current accomplishes this not only under
normal conditions, but tries to adapt itself also to abnormal
states. As soon as the body is invaded by disease or
disturbing external influences, requiring an increase or
"^crease of the blood current, the circulatory conditions
become changed.

Everyone who gives this matter some reflection, must
come to recognize that the body in such instances, in prop-
erly regulating the blood current, does a definite, deli-
cate work, thereby often preventing, or even curing
serious disease.

Physicians . must learn to recognize in the circulatory
blood one of the most powerful factors in the human and
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18 bier's hyperemic treatment.

animal system in bringing about the so-called " spontaneous

To explain, a burn may be cited as an example: A hot
iron is brought close to the siuiace of the body. Immedi-
ately the skin turns red. We call this the first degree of a
bum. This reddening of the skin represents, according to
Bier, the body's attempt at protecting the injured part,
the accelerated blood current cooling off the heated part
and, at the same time, furnishing increased nutrition in the
hour of danger.

With the cause persisting, the redness becomes more
and more marked, while the sensitive nerves, through the
production of pain, bring the imminent danger to the atten-
tion of the brain. Soon the cooling blood current proves
insufficient. A large accumulation of serum, a blister,
developing between the layers of the skin, is furnished by
the blood as a further protection against the injurious
effect of the heat. To accomplish this, the body has to
give up the external layer of the epidermis. We call this
appearance of a blister the second stage of a bum.

With the appearance of the eschar, the body throws up
the gauntlet, being no longer able to successfully employ
the curative reactive inflammation. Necrosis sets in.
This is the thu*d stage of a burn.
Definition of Analogous work is done by the blood current in infectious
SSnmaSon!^' processes, — ^although with reduced rapidity in the con-
spicuousness of the various phases, — when bacterial
toxins take the place of the red-hot iron, as shown, for
instance, in the inflammatory redness and the edema of a
furimcle, a phlegmon, an insect bite, etc. We have the
same elemental fight of the system against an invading

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foe. The spontaneous disappearance of an inflammation
means no less and no more than the victorious fight of the
increased blood current against the bacteria.

He who has followed this train of thought will coincide
with Bier, that an inflammation — ^from the physiologic
point of view — does not in itself represent a diseased condi-
tion, but is a phenomenon indicating the body's attempt
to resist a deleterious invasion.

To increase this beneficent inflammatory hyperemia result- Aim of Bier's

ing from the fight of the living body against invoMon, is the Treatment.

aim of Bier^s hyperemic treatment.

By deduction from this simple reasoning we are able
to discern the first and most important principle under-
lying Bier's hyperemic treatment, namely:

The blood must continue to circtdatCj there must never be First Principle

Underljring Hy-
a sta^sis of the blood. This point is of such paramount peremic Treat-
importance that it must be stated ahead of and apart from
the rules that will be given later for the proper applica-
tion of the treatment.

Bier's teachings are of equal importance in explanation Artificial In-
crease of the In-
of inflammatory processes, as they are in the treatment flammation.

of the same. If they be correct, we shall have to part

with a number of time-honored views, up to the present

time accepted as pathologic truths.

Hitherto it was considered the physician's first duty to
fight every kind of inflammation, since inflammations
were looked upon as detrimental.

Bier teaches just the opposite: namely, to artificially
increase the redness, swelling and heat, three of the four
cardinal symptoms of acute inflammation.

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20 bier's hyperemic treatment.

Hence, all means that tend to subdue an inflammation
are to be discarded.

To cite an example: According to Bier, it is a direct
mistake if the physician orders the use of an ice-bag at
the time of a beginning inflammation. By so doing he
resists the healthy reaction of the body; he suppresses
the salubrious effect of the inflammation and favors the
deleterious influence of the bacteria. The fact that the
ice-bag often brings comfort to the patient and reduces
the pain, at least temi)orarily, does not invalidate the
truth of the above dictum any more than the fact that an
ice-cold drhik momentarily comforts a feverish patient.

The same rule obtains here as is generally applied in
the case of infectious disease. There are very few physi-
cians to-day who woukl attempt to reduce the fever in such
cases. We have learned to look upon this fever as one of
the weapons of the organism in its fight against the intruder.

It would lead too far, to consider hero the many theories
advanced in explanation of the (*fTect of hyperemia. This
book is to deal with the practical application of the latter.
Suflfice it to say, that the artificial increase of all the symi>-
toms and attributes of the comphcatecl phenomenon,
which we call inflammation, evidently is nc^cessary, in
order to succeed in conquering the acute inflammation.

The practical results obtaineil with the hyix'n^mic treat-
ment have proved beyond the shadow of a doul)t the al)so-
lute correctness of the theories advanced bv Bier.

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General Part-

chapter I.


These are the following :

1. Suppression of the infection.

2. Avoidance of suppuration in many cases.

3. The possibility of using small instead of large inci-
sions in cases in which suppuration has already set in.

4. Hastening the course of the pathologic process.

5. Favoring absorption.

6. Diminution of pain.

7. Its wide field of usefulness.

Since it has been demonstrated, that by increasing Suppression of
the inflammatory symptoms a beginning infection can
be made to subside, we ought to more generally practise
abortive treatment of incipient troubles of this kind;
for instance, of incipient phlegmons or furimcles.

While it is not possible to suppress every infection Avoidance of
before pus is formed, there is no question that by means many^cases. ^
of artificial hyperemia suppuration can be avoided in
a larger percentage of cases than by any of the other
therapeutic measures at our disposal.


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The Possibili^
of Using Smau
Instead of Large
Incisions in the
Cases in which
has Already Set

Hastening the
Course of the
Pathologic Pro-

Favoring Ab-

Diminution of

Wide Field of

In cases in which suppuration is unavoidable even with
the aid of artificial hyperemia, owing to the intensity of
the infection, Bier's treatment enables us to accomplish
with small incisions, what formerly could be achieved with
large ones only. This has been shown by manifold practi-
cal experiences. The advantage is obvious.

The increased supply of blood hastens markedly the
course of a suppuration, inasmuch as it favors the rapid
development or demarcation and separation of necrosed
portions in soft tissues as well as in bones (rapid formation
of sequestra).

The hyperemic treatment has been foimd most useful
in that it favors the absorption of exudates and pathologic
tissue changes of various kinds.

There is no other method that is superior to hyperemic
treatment in point of gentleness and painlessness of appli-
cation as well as tendency to reduce pain.

Bier's treatment can be employed to advantage in a

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Online LibraryWilly MeyerBier's hyperemic treatment in surgery, medicine, and the specialties; a manual of its practical application → online text (page 1 of 18)