_Chronic Disease of a Joint_ may be the tailing off of an acute
affection, and under the influence of alternate douchings of hot and
cold water, of counter-irritation by blistering or "firing," and of
massage, it may eventually clear up, especially if the general health
of the individual is looked after. But if chronic disease lingers in
the joint of a child or young person, the probability of its being
under the influence of tuberculous infection must be considered. In
such a case prolonged and absolute rest is the one thing necessary. If
the disease be in the hip, knee, ankle or foot, the patient may be
fitted with an appropriate Thomas's splint and allowed to walk about,
for it is highly important to have these patients out in the fresh
air. If the disease be in the shoulder, elbow, wrist or hand, a
leather or poro-plastic splint should be moulded on, and the arm worn
in a sling. There must be no hurry; convalescence will needs be slow.
And if the child can be sent to a bracing sea-side place it will be
much in his favour.
As the disease clears up, the surface heat, the pains and the
tenderness having disappeared, and the joint having so diminished in
size as to be scarcely larger than its fellow--though the wasting of
the muscles of the limb may cause it still to appear considerably
enlarged--the splint may be gradually left off. This remission may be
for an hour or two every other day; then every other night; then every
other day, and so on, the freedom being gained little by little, and
the surgeon watching the case carefully. On the slightest indication
of return of trouble, the former restrictive measures must be again
resorted to. Massage and gentle exercises may be given day by day, but
there must be no thought of "breaking down the stiffness." Many a
joint has in such circumstances been wrecked by the manipulations of a
"bone-setter."
_Permanent Stiffness._--During the treatment of a case of chronic
disease of a joint, the question naturally arises as to whether the
joint will be left permanently stiff. People have the idea that if an
inflamed joint is kept long on a splint, it may eventually be found
permanently stiff. And this is quite correct. But it should be clearly
understood that it is not the _rest_ of the inflamed joint which
causes the stiffness. The matter should be put thus: in tuberculous
and other forms of chronic disease stiffness may ensue in spite of
long-continued rest. It is the destructive disease, not the enforced
rest which causes it; for inflammation of a joint rest is absolutely
necessary.
Public-domain text, read in full here on John Shaqi.
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