Bier's method of causing congestion of the limb is employed in a modified way by Ewart. Ile applies an elastic tourniquet to the limb after stroking and elevation so as to produce local anaemia for about one minute, after which the pressure is suddenly removed so as to cause arterial flushing and suctional drainage.
Movement of the all the local methods of treatment none are, however, so important as passive movements. From first to last during all stages of the disease the joints should not be permitted to rest except for short periods during acute exacerbations of pain, as only in this way can stiffness, rigidity and ankylosis or locking of the articulations by osteophytic growths he prevented. It is a mistake to dread evil results from passive movements. When these are carried out with skill and gentleness, pain is often considerably relieved and not aggravated. The chief obstacle in employing gentle passive motion is the involuntary interference of the patient, who usually anticipates pain from the move ments. If the physician or nurse exercises sufficent patience till all spasm of the muscles has passed away and a complete passive condition of the limb has been obtained by gentle stroking, then the movements can often be carried out without any pain or distress being produced. The patient must be taught to neither attempt resistance nor assistance to the operator's manipulations. The passive movements may be carried out most advantageously after any of the thermal methods of treatment to be afterwards described.
Active voluntary exercises should follow the passive movements, and the patient must be directed to persevere with these even when they cause pain.
Massage is indicated in every case of long standing, and should always be combined with passive movements; at first gentle effleurage or stroking followed by petrissage or kneading and tapotement or tapping. The main manipulation, however, should be friction massage exercised in the immediate neighbourhood of the affected joint and at a later stage vibration massage or mechanical vibration by the Ruk vibrator may be freely resorted to.
Electricity has been employed in every form, but speaking generally this agent may be regarded as useless unless when combined with passive or active movements, massage and other local procedures. The constant
or galvanic current may he employed to improve the tone of the muscles, the stabile or labile kathodal method being the best procedure. The induced or interrupted current is most used, being conveniently obtained from the ordinary cheap induction-coil battery, but it is painful and often of little value. The hydro-electric bath is in repute, and when employed in conjunction with local hydropathic methods—douching, etc.—should be worth a trial. Some electricians prefer static electricity, and the craze for high-frequency and sinusoidal currents has extended to hydro treatment.
The X rays and Radium emanations have also been extensively employed, but with doubtful results.
almost every conceivable form the thermal treatment of rheumatoid arthritis has been elaborated. The late Professor A. Gordon utilised dry heat in its simplest form. The patient was directed to partially undress and expose the joint before a strong coal fire as long as he could comfortably bear the heat, after which the articulation was covered with a layer of brown paper and an ordinary smoothing iron heated to about 200° F. was passed over the joint, the paper intervening; this still proves one of the simplest and best methods of applying dry heat when the hip-joint is affected. Some physicians apply the actual cautery at a black heat.
The sand-bath, Tallermann's cylinder, the various forms of simple hot-air and Turkish baths are all in frequent use. The Dowsing thermo electric apparatus in which luminous radiant heat is applied to the joint or to the entire limb or body without heating the surrounding air is perhaps the best of all forms, since experiments as detailed by Luke demonstrated that luminous radiant heat possesses greater penetrative power than non-luminous heat. A temperature of 23o° C. may safely be applied to the entire body by means of this apparatus, and a heat of C. may be without danger applied to a limb or joint; the last mentioned temperature is equivalent to F. In the Greville electro thermic generator the invisible rays beyond the red in the spectrum are alone employed, and a temperature of to C. is easily procurable from an electric-light main. The heat in the Tallermann cylinder may be safely applied up to 300° F. (148° C.).