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Old Injuries And So-called Rheumatism

As people advance in years, it is a common experience that tissues
injured years before are the source of no little discomfort and are
particularly prone to be bothersome during changeable seasons and in
rainy weather. A bone broken when the patient was young may twenty or
thirty years later continue to give warnings of the approach of change
in the weather and be a source of annoyance. A dislocation, especially
if complicated in any way by considerable laceration of the tissues in
the neighborhood of the luxated joint, is sure to be a source of
discomfort of this kind. These painful conditions are generally more
noticeable when patients are run down, or when they have been recently
affected by exhausting disease of any kind, during convalescence from
severe ailments or injuries, or when they are undergoing a special
mental strain. These conditions, like nearly all others worse in damp
weather, are sometimes grouped under the term rheumatism and have been
treated by internal medication. Almost needless to say, such treatment
is sure to fail or to be of only temporary anodyne benefit. As
rheumatic remedies are usually coal-tar products they may even be
distinctly harmful, especially for old patients. It has been shown
that the salicylates, for instance, are much less rapidly eliminated
in the elderly than in the young, in those with defective circulation
or kidney insufficiency than in the well. Their accumulation in the
system causes anemic tendencies and disturbs nervous control.

Just what is the underlying pathological condition in these cases is
not easy to say. In the case of luxations with laceration of tissues
there has undoubtedly been such a disturbance of venous and lymphatic
circulation by the break in continuity of tissues and the resultant
scar tissue, that lymphatic if not also venous congestion occurs
whenever there is any circulatory disturbance. For the maintenance of
normal nutrition of nerve endings a constant flow of blood past them
and a proper action of the lymphatic channels to carry off waste
products is essential. It is easy to understand how much these may be
disturbed in the injuries under consideration. When a bone is broken
there is usually laceration of the surrounding tissues. Owing to the
fixation required to procure proper bony union, the circulation to the
part is much more defective than usual and so the repair of torn lymph
and venous vessels is not as complete as would otherwise be the case.

This seems to explain why such injuries are especially called to the
attention of the patients in damp weather. It is not so much during a
rain storm as some hours before it, about the time when the barometer
begins to drop, that these old injuries become sensitive. Indeed, it
is often said that old persons who have suffered one of these injuries
earlier in life carry a barometer around with them.

Not a few of the lesions called sprains, especially those of the
ankles and wrists, though also of other joints, are often really
breaks of small bones, or at least laceration of ligaments and other
structures. These may long afterward prove a source of pain and
discomfort, worse always in unsettled weather, or after the feet have
been wet, and may seem to be due to some constitutional condition,
though they are merely local. These occur more commonly in women than
in men and the condition needs careful investigation and must not be
put under the vague diagnosis of rheumatism, or the patient will
probably not be improved by the treatment suggested. In all these
cases the general condition must be looked to, and it must not be
forgotten that fat may not mean health, and that increased weight may
be a prominent factor in the production of symptoms in these cases,
especially when individuals live a sedentary life.

There is an important therapeutic method for the prophylaxis of these
conditions that has been attracting attention and yet probably not all
the attention it deserves in recent years. Prof. Lucas-Championniere
of the University of Paris has pointed out that when fractures and
dislocations are treated by the open method with easily removable
apparatus and the employment of massage within a few days after the
fracture, the subsequent discomfort of these lesions is much lessened.

It seems worth while to emphasize this treatment by manipulations and
massage, because it represents a psychotherapeutic factor in the
treatment of these injuries. The hiding away of a limb or a joint for
days and perhaps weeks, while they wonder whether it is getting better
or not is most discouraging to patients. To have the physician see it,
to have him declare that it is getting on well, to have the evidence
of their own senses that conditions are gradually improving, is of
itself a valuable factor for that satisfaction of mind which conduces
to the regular functioning of tissues. Repair undoubtedly goes on
better under such circumstances. Besides, the lack of constriction or
at least its rather frequent periodic relaxation, the airing of the
skin, the regulation of the circulation by massage and manipulation,
all react upon the mind and prevent it from inhibiting trophic
impulses and encourage it to stimulate them in every way.

As to the after-effects of fractures and dislocations as with regard
to all this series of vague pains and aches, the patient's attitude of
mind is of great importance. As they get older their aches and pains
grow worse, partly because circulation is more defective and partly
because they are prone to be much more in the house and the nerves of
patients who are much within doors are always more sensitive than
those of people who are much in the open. If their attention becomes
concentrated on their pains and aches, because of lack of diversion of
mind, then the condition may become a source of serious annoyance.
When these painful conditions develop patients are almost sure to keep
much to themselves and to nurse their ills, and consequently to
increase their discomfort. The circulation to the affected parts must
be stimulated by local treatment, by rubbings, by the milder
liniments, by massage and manipulations, and by local hydrotherapy.
Douches, as hot as can be borne, on the limb followed by cold,
especially if patients are otherwise in good health, will do much to
relieve the stagnant circulation.

Active and vigorous movement while the affected part is supported at
skin pressure (there must be no constriction) is even more valuable
than massage, liniments or douches in the treatment of all these
painful conditions of joints in which there is any scar-tissue.
Wonderful results may be obtained in an old sprain of the wrist, knee
and ankle by covering in the part completely (taking care to surround
the limb) with strips of adhesive strapping simply laid on at skin
pressure, but following exactly every fold or angle of the part, and
then with the part completely covered in this way to urge immediate
and constant exercise. The maintained pressure prevents any tendency
to venous congestion or exudation and favors absorption of fibrous
tissue, and exercise, which should be immediate, is now possible
through the support furnished by the strapping. The re-assumption of
normal active movement molds the old scars, strengthens the muscles
and ligaments and improves the patient's general condition. The relief
afforded is immediate, and the cause of relief, a simple mechanical
device, is apparent. Rheumatism is forgotten as the old crutch is
discarded and the patient is able to use the limb with confidence.

Recent sprains or bruises treated in this way recover perfectly and do
not leave old scar tissue to be a future seat of pain.

Next: Muscular Pains And Aches

Previous: Suggestion In Treatment Of So-called Rheumatisms

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