Injuries of nerves and their consequences - Reflex Sympathetic ...

170 INJURIES OF NERVES.
We may then Lave one articulation—
assume importance.
and — if only one, a large one involved, or perhaps all the
joints of a finger, or ever}- joint in the hand, or of the
entire limb may suffer. The swelling is never very great,
the redness usually slight,
and the tenderness on touch
or motion exquisite. This condition of things remains
witli little
change during weeks or months, and then
slowly declines, leaving the joints stiff, enlarged, and
somewhat sensitive, especially as to movement. A small
proportion of such cases find ready relief, but in many
of them the resultant anchylosis proves utterly unconquerable,
so that it is vain to break up the adhesions
under ether, or to try to restore mobility by manipulation
or splints. All alike fail, and serve only to add to the
essential tortures of the accompanying neuralgia and hyperpesthetic
states of skin. Since writing my last paper,*
I have met with some of the former patients who suffered
with these troubles, but in no case originally very
severe was there any great gain, — indeed in most of them
the joints had become everj^ year more stiff and useless.
It is then quite clear that injuries of the spine, diseases
of this organ, and of the brain, and wounds, or any form
of lesions of nerves, are capable of developing in the joints
inflammatory conditions, usually subacute, and which
so precisely resemble rheumatic arthritis in their symptoms
and results, that no clinical skill can discriminate
between the two. In this state it were well to leave the
subject. The chemical theories have crumbled, and, in
the growing tendency to believe that rheumatism may
have more forms than one, it may not be amiss to recall
the facts to which we have contributed, and which are
well illustrated by the following case. Other and more
severe examples will be found in the cases appended to
the later chapters of this work.
* Reports of the Sanitary Commission.