Friday, June 9, 2017

Sprained Ankle Part 2

Below is an excerpt from "Transaction" Volumes 28-29 by the Texas Medical Association ©1896 I share this tidbit not only for the medical information of the time but also for the 6 case histories the author cites. Not because of the unusualness or the significance of these injuries happening in the 19th century but because these same events could happen today, with the exception of jumping down from one's buggy. Enjoy!
PS Tomorrow's post will give more food for thought about sprained ankles and the treatment mentioned below.

My excuse for offering a paper on this subject is because I have found so few physicians who have adopted this method of treatment in sprained ankles.

The treatment of which I am going to speak is by basket strapping, with adhesive plaster. This originated with Mr. Edward Cottrell, of London, as far as I know. Dr. V. P. Gibney, of New York, commenced using this treatment in 1888. One year later I consulted him in a case of this kind, and he advised the basket strapping. The patient, however, rebelled, and would not allow me to try it. I then determined to test its value on some other case when opportunity presented. Speaking of this class of injuries, Dr. Gibney said: "I had learned to look upon a sprain as a kind of mystery involving a laceration of fibrous structures about the joint, a rupture of the ligament or ligaments, sometimes a teno-synovitis, sometimes contusion of the cartilege, and was inclined to look with a certain degree of admiration or pity on the man who was able to say that this ligament or that ligament was torn or detached from the bone; but was never able to say which was which, and I treated my cases as most men do to-day, by fomentation for a little while, then plaster of paris bandage or silicate of sodium, rest on axillary crutches, subsequent rubbing and massage, etc., etc. I confess I was never enamored of this treatment, and I had a grave apprehension always when I took charge of a case, lest I should get a stiffish joint following treatment, an irritable joint—one very much like the joints left after tuberculous disease in children, where suppuration has not been a part of the disease. The external features of a sprain, the signs, were always very well pronounced. One could see the puffiness in the neighborhood of the malleolus or over the dorsum of the foot, the localized swelling with extra heat, and sometimes ecchymosis."

The method adopted by Dr. Gibney, as described in Mr. CottrelPs little book, is as follows: "Cut strips of rubber adhesive plaster about one-half inch in width and long enough to completely encircle the foot. Then, with the foot raised, begin strapping the ankle and lower third of the leg, as I would an ulcer. The first strip came over the outer side of the foot down near the base of the little toe. It was put obliquely so that the next strip should cross this, one end beginning near the heel and terminating under the ball of the great toe. The third strip overlapped the first about one-half and was snugly applied, while the fourth overlapped the second in same direction, and so on until I had completely covered the foot, ankle and lower third of leg."

In the cases I have treated this way, I have generally tried to hold the foot elevated, rubbing it gently to reduce the swelling as as much as possible for half an hour or so before applying the strips. I have treated quite a number of cases in this manner, and must say that it is the most satisfactory way that I have ever treated sprained ankles. I have notes of six cases in particular in which I adopted this method of treatment.

Case 1.—D. L., a colored porter at the depot, sprained his ankle badly by a bale of cotton turning over on it. When I saw him it was swollen badly and quite painful. I had it elevated, after bathing thoroughly and gentle rubbing kept up for about half an hour, while I was cutting my plaster ready to apply. I then applied it as described, and also a cheese-cloth bandage over the plaster to hold it more snugly. I told him to put on his sock and shoe and lace it up around his ankle, which he did, and continued at his work. He wore the plaster for about one week, considered his ankle was well, removed it and had no further trouble.

Case 2. — Mr. ti., a lawyer by profession, jumped out of his buggy one afternoon in the country, lighting on a stone which turned under his foot, causing a very painful sprain. I saw him in about two hours afterwards; his ankle was swollen quite badly and very painful. I followed the same course of treatment, applying the adhesive strips and bandage. He staid in bed until the next morning, got up and put on his shoe and walked about the house some that day; and the next day went to his office, and continued from that time going on and attending to his business. His ankle, however, was somewhat sore in a week's time, and some of the strips had become loose, when I removed them and applied another dressing. He wore that for a week longer, then removed it and had no further trouble.

Case 3.—Mrs. D., a lady about 35- years old, rather tteshy and heavy, applied to me with a sprained ankle, which had been done about a week. She had not been able to walk without suffering a great deal of pain, or going on crutches. I applied the basket strappings as in the other cases. Her relief, however, was not so prompt as in the two former cases, but said it felt more comfortable immediately after the dressing was applied; she could wear her shoe and go with much less pain than before. It continued improving slowly and at the end of two weeks she was able to walk and have the dressing removed.

Case 4.—Miss C, a young lady about 15 years old, clerking in a dry goods store, stepped on a stone one morning while coming to the store, and sprained her right ankle. She called in my office soon afterwards. The ankle was swollen and painful: was hardly able to bear her foot on the floor. I applied the basket dressing, after which she put her shoe on and continued at work in the store. It gave her a little pain for a few days, but she continued goingr and wearing the dressing. I rebandaged the ankle in about a week. She wore the second bandage a week longer, when the ankle was well.

Case 5.—Miss H., a young lady attending school, jumped off the steps one evening; her foot turned, causing a painful sprain of the left ankle. I saw her two hours afterwards; she had been keeping it in hot water for some time before I saw it. I had it elevated for half an hour, having some one to rub it during that time, and then applied adhesive strips and bandage, as in the first case. She remained in bed that night, got up and put on her shoe the next morning. While she felt considerable soreness of the ankle, she could walk without much pain, and continued to do so. All pain and soreness was gone in about three days. She wore the dressing about a week, removed it and had no further trouble.

Case 6.—Mr. H., an attorney, stepped on a stone in his yard at noon and sprained his left ankle. It hurt him for a little while right badly, but he afterwards walked up to his office with the aid of a stick. It was hurting him so badly by night that he was hardly able to get home, and after walking home it became exceedingly painful. I saw it about eight hours after the injury, applied the adhesive plaster and bandages, told him' to get a laced shoe to put on the next morning, and try to walk around the house, which he did, and the next day he went to his office and continued using his ankle every day. He wore the dressing about ten days, then removed it, his ankle being perfectly well. There were no after effects.
I am highly pleased with the results I have had with this method of treating sprained ankles. With the old method of putting them up in plaster paris sometimes for weeks, we often find, upon taking them out, the joints sore and stiff, unable to move it. The modern method has certainly saved much valuable time patients. The old method would have perhaps made larger bills for me, but I feel that we are more than recompensed by gratefulness from our patients when we can save them time and suffering.

Dr. Gibney, in commenting on this treatment, says: ilI have treated sprained ankles in this way at my clinic and in the outpatient department of the hospital. Both at clinic and at hospital we kept pretty full notes of cases, but they have not been tabulated. Suffice it to way that members of my staff and students have been very much impressed with the facility with which patients get about when thus treated, and medical friends who have asked me about sprains, and have adopted the plan here advocated, have reported to me almost uniformly the brilliant results they have obtained. I do not call to mind any adverse opinion."

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