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

TREATMENT. 259
pain it causes, aud passive motions and electricity must
for the same reason be laid aside.
Often, indeed, the pain from these joints is exquisite,
and in the first few months of treatment defies all
means
of relief except absolute repose ; and this, unhappily,
is
a fatal sentence for the limb. When left to themselves,
adhesions are sure to form, and partial anchyloses occur,
so that it
proved best on the whole to treat them for a
time with small blisters, aud as early as the inflammations
allowed, to ansesthetize the patient and use passive motion
with freedom. This, at all events, was the method found
most productive of good after gunshot injuries of nerves;
and in the rare cases of arthritic trouble from nerve
wounds which I have since seen, I have found it the only
reliable treatment.
Where the joint maladies are of long standing and neglected,
the induced current^ or, still better, that from a
galvanic battery, should be used, and the adhesions at
once broken up under ether or chloroform, the sufferer
being fortunate if the state of the muscles has been such
as not to alter materially the normal relations of the
articular surfaces.
After a year or two has passed, leaving the smaller joints
enlarged and only slightly painful, they may be slowly
reduced by surrounding them with rings of caoutchouc
cut from thin rubber tubes and slipped over the joint.
The pressure
is borne very well for the day or uiglit, and
is pretty sure, in time, to lessen the size of the part most
remarkably, while at this stage the persevering use of galvanism,
of passive motion, and of all the forms of rubbing,
becomes available.
it
Notwithstanding the obstinacy of these arthritic troubles,
is sometimes possible to overcome them when the patient
is sufficiently determined ;
or if,
as in the following
example, the resolute rule of a military hospital can be