Affections of the Bones and Joints
The bones are subject to a vide variety of affections, but we shall here consider only the most important ones. In those rare varieties not mentioned the same care described here will suffice.
Bones are living functioning tissue and are affected by the same toxic, malnutritional and septic states as the other tissues of the body. The causes of their affections are the same as the causes of the affections of the heart, liver, lungs, muscles, nerves, etc.
Actinomycosis (lumpy jaw), Arthritis Deformans, Osteomalacia, and Rickets are considered elsewhere in this volume. Spinal curvature and bow legs are considered in Volume IV of this series. These conditions will be omitted from the present chapter.
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ATROPHY OF THE BONE
Definition: This is a process of wasting of the bone seen chiefly in aged persons. The condition may be stayed by eliminating toxemia and improving the general nutrition.
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BREAKS AND FRACTURES OF BONES
These are largely surgical cases and cannot be covered here. Suffice it to say that rest, fasting, proper diet and sunshine will hasten healing in old and young alike.
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CARIES OF THE BONE
Definition: This is death and decay of bone.
Symptoms: The pain is usually deep-seated and intense. There may be swelling of the overlying tissue. In many cases suppuration takes place and the abscess points on the surface. Often particles of bone will be expelled along with the pus.
Etiology: The most common form is seen in caries of the teeth resulting in abscess. Perhaps the next most common form is seen in tuberculosis of the bone. Caries may develop in any of the bones of the body. Dr. Howe produced caries of the skull, ribs, femur, etc., in monkeys by feeding them on a greatly deficient diet. Toxemia, septic infection and nutritive deficiencies cause caries in the teeth or elsewhere.
Care of the Patient: The elimination of toxemia by physical and physiological rest, followed by a diet of fresh fruits and green vegetables and regular sunbathing will restore bone health in all early cases.
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EXOSTOSIS
Definition: This is an abnormal bony growth (a tumor) from the surface of a bone.
Unless located where it interferes with the function of the part, by being pressed upon, it presents no symptoms. It is probably induced by prolonged local irritation. Surgical removal is probably the only way to get rid of such growths.
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INFLAMMATION OF BONE
Due to the hardness and density of the bone structure, swelling of the bone cannot take place, but bone inflammation is similar in all other respects to inflammation in the soft structures of the body. The blood supply to the bones is more readily cut off resulting more easily in necrosis or death of the tissue.
Myelitis is inflammation in the medullary cavity of a long bone.
Osteitis is inflammation of the bone structure.
Periostitis is inflammation of the membrane (periosteum) covering the bone.
Symptoms: It is characterized by deep-seated and intense pain. There may or may not be fever and other constitutional symptoms.
Other symptoms will be in keeping with the nature of the trouble.
Etiology: Injury and infection (sepsis) are the chief causes.
Care of the Patient: Rest, fasting, fruit and vegetable diet and sunbathing are the needs.
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OSTEOMYELITIS
Definition: This is inflammation of the bone marrow or of the bone and marrow. Several forms are described as Garre’s osteomyelitis, hemorrhagic osteomyelitis, hunger osteomyelitis, malignant osteomyelitis, osteomyelitis variolosa, and tubercular osteomyelitis. We shall deal only with the tubercular form, as the others are extremely rare.
Symptoms: Tubercular osteomyelitis first manifests itself by extreme pain, then by wasting or atrophy of the muscles above and below the seat of the inflammation. There is often spasm aid rigidity of the muscles. Suppuration occurs with the formation of sinuses through which the pus drains. The bones adjacent to the joints of the hip (hip joint “disease”), knee, ankle, elbow and wrist are most commonly affected. Ankylosis and deformity frequently result. The constitutional symptoms of tuberculosis are present.
Prognosis: This is guardedly favorable in early cases.
Care of the Patient: Care for as directed under tuberculosis.
Sunbathing is decidedly beneficial in these cases and often means the difference between life and death.
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POTT’S “DISEASE”
Definition: This is caries of the spinal column; it is usually tubercular.
Symptoms: It is characterized by softening and degeneration of the bony tissue of the spinal column. The vertebrae fails to support the weight above them and great deformity results. In its advanced stages the deformity will indicate the affection; but in its early stages tenderness upon pressure and a general sense of weakness are its chief symptoms. Due to the disinclination to use the muscles of the back a peculiar rigidity of the back develops. The patient will prefer to turn the entire body rather than turn the head in looking around. He will bend at the knees and hips and hold the back rigid in picking up objects. A sense of constriction about the chest and stomach is often present. Pus may form around the affected part and, sinking by gravity to lower parts, be discharged as a “cold abscess.”
This condition begins as osteitis and as the vertebra become soft and vascular; the bone corpuscles undergoing fatty degeneration, they waste away even to the point of liquification. The extent of the ensuing deformity is determined by the vertebra affected. The spine above the affected part sinks down, the body is bent forward and the spinous processes project backward. The deformity is more marked when the affection is in the dorsal region of the spine.
Etiology: This condition is more common among undernourished children of the poor and among children who have or have had rickets. Malnutrition breaks down the resistance of the bones; chronic sepsis results in infection of these. The condition is rarely seen in adults and is attributed to “syphilis.” It is here due also to septic poisoning.
Prognosis: As regards life this is favorable. There will almost always be some deformity.
Care of the Patient: The spine should be fixed so that perfect rest is secured. The same care described for tuberculosis should be given. Sunbaths are especially beneficial in this condition.
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AFFECTIONS OF THE JOINTS
ANKYLOSIS
Definition: True ankylosis is immobility and consolidation of a movable joint due to the union of the parts by the formation of bone in the joint. False ankylosis is stiffness and rigidity of the joint produced by rigidity of the parts outside the joints (extracapsular ankylosis); or from rigidity of structures within the joints (intracapsular ankylosis) or by rigidity of the surrounding parts. We are here concerned with true ankylosis.
Symptoms: Rigidity of the joint is the only symptom of ankylosis. An X-ray will show that the bones forming the joint have grown together making one bone of the two.
Etiology: A few cases result from injury, but most cases are due to the destruction of the structures in the joint by inflammatory processes, as in tuberculosis of the joint and rheumatic arthritis.
Care of the Patient: Nothing can be done for true ankylosis. It should be prevented. False ankylosis may be overcome by detoxication and by manipulation of the joint.
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BURSITIS
Definition: This is inflammation of the bursal sacs between joints or other parts that move against each other.
Symptoms: Often deep-seated pain, dull, nagging, or sharp and severe, is the only symptom. The pain is in the joint and is made worse by movement.
Etiology: It is often caused by strains. In such cases, if there is no toxemia, healing is rapid. The chief cause is toxemia.
Care of the Patient: Rest and toxin elimination is the only care needed.
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CRACKING OF THE JOINTS
If no pain or inflammation accompanies this symptom it should be no cause for alarm. It commonly results from a lack of synovial fluid, a lubricating fluid secreted to “oil” the joints and make them work smoothly. It is chiefly a matter of nutrition and circulation and will disappear with improvement of the general health.
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SYNOVITIS
Definition: This is inflammation of the synovial membrane, a serous membrane which covers the articular extremities and the ligaments entering into the formation of joints.
Simple inflammation of the synovial membrane may follow a bruise or injury. In this form there is swelling, pain and an effusion of serum into the joint.
Dry synovitis presents pain, perhaps swelling, but no effusion of serum. In this form ankylosis of the bones may follow rapidly.
Purulent synovitis follows simple synovitis when the effusion increases gradually and changes to a most purulent character. Pus will be discharged from the joint in this form.
Gouty synovitis is seen in gouty or rheumatic subjects.
Gonorrheal synovitis is claimed to follow as a complication of gonorrhea. Since it never develops under hygienic care, perhaps it were better named Medical Synovitis.
Care of the Patient: Rest of the affected joint is most important. Movement increases the pain and aggravates the inflammation. Fasting is very important in all save those cases due to injury or bruises and should be employed in these if the pain is great. |
