HISTORY of RSD/CRPS
"Perhaps few persons who are not physicians can realize the influence of which
long-continued and unendurable pain pain can have upon both body and mind".
Silas Weir Mitchell "Nerve Injuries" 1864.
The first descriptions of CRPS were documented during the America Civil War (1861-65) by Silas Weir Mitchell MD, a young US Army contract physician, who treated soldiers with gunshot wounds. In his book "Gunshots Wounds and Other Injuries", he described pain which persisted long after the bullets were removed from the bodies of soldiers. He noted that the pain was characteristically of a burning nature, and named it "causalgia"(Greek for burning pain)which he attributed to the consequences of nerve injury. He observes:
"...a painful swelling of the joints....may attack any or all articulations of a member. It is distinct from the early swelling due to the inflammation about the wound itself, although it may be masked by it for a time:nor is it merely a part of the general edema....Once fully established, it keeps the joint stiff and sore for weeks or months. When the acute stage has departed, the tissues become hard and partial anklyosis results."
Mitchell et al 1864
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The following is excerpted from a story which appeared in the Johns Hopkins Medical Institutions' publication, Brainwaves, and was written by Janet Worthington. It's an account of causalgia, a type of neuropathic pain, as described by Dr Mitchell:
"Under such torments, the temper changes, the most amiable grow irritable,
the soldier becomes a coward, and the strongest man is scarcely less nervous than the most hysterical girl."
Silas Weir Mitchell, M.D., a 19th century neurologist, was as perplexed by the phenomenon of sympathetically maintained pain (he called it causalgia), as his modern counterparts. In his 1872 book, "Injuries of Nerves and Their Consequences," he carefully documented case after case in which injuries resulted in:
"the most terrible of all the tortures which a nerve wound may inflict."
Most of his patients were Civil War veterans, otherwise healthy men whose lives had been forever changed by this peculiar, burning pain, described by one as a
"red-hot file rasping the skin."
In many, pain was associated with a mysterious glossiness in the skin.
"The burning comes first, the visible skin-change afterwards,"
Mitchell reported.
"Of the special cause which provokes it, we know nothing, except that it has sometimes followed the transfer of pathological changes from a wounded nerve to unwounded nerves, and has then been felt in their distribution, so that we do not need a direct wound to bring it about."
The pain's location varied from patient to patient, but:
"its favorite site is the foot or hand...the palm of the hand or palmar face of the fingers, and on the dorsum of the foot; scarcely ever on the sole of the foot or the back of the hand. When it first existed in the whole foot or hand, it always remained last in the parts referred to...if it lasted long it was finally referred to the skin alone. The part itself is not alone subject to an intense burning sensation, but becomes exquisitely hyperaesthetic, so that a touch or a tap of the finger increases the pain."
Patients took obsessive lengths to avoid exposing the area to the air, Mitchell wrote.
"Most of the bad cases keep the hand constantly wet, finding relief in the moisture rather than in the coolness of the application."
The pain took its toll.
"As the pain increases, the general sympathy becomes more marked. The temper changes and grows irritable, the face becomes anxious, and has a look of weariness and suffering. The sleep is restless, and the constitutional condition, reacting on the wounded limb, exasperates the hyperaesthetic state, so that the rattling of a newspaper, a breath of air...the vibrations caused by a military band, or the shock of the feet in walking, gives rise to increase of pain. At last...the patient walks carefully, carries the limb with the sound hand, is tremulous, nervous, and has all kinds of expedients for lessening his pain."
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