Seeking Fundamentals: The Colorado Coal Strike, 1913–1914

This chapter details events in Josephine Roche's life from 1913 to 1914. After a restorative break in the Rockies, Roche returned to Denver and faced hard decisions about what to pursue next. Her goal was to figure out what work was most “fundamental” to achieving social justice. Roche wanted to hit injustice where it would hurt most, but she was not yet sure where the tender spot lay. As she began probing for that spot in fall 1913, coal miners in Colorado provided guidance. They opened what turned out to be the country's “deadliest labor war,” a conflict that eventually confirmed what Roche's experience as Inspector of Amusements had begun to reveal: progressive public policies could not, by themselves, achieve justice. Some additional element was required to make good on them, and the strike told Roche that the element was an aroused and organized citizenry, especially in the form of independent labor unions. By 1914, Roche had layered onto her social science progressivism the commitments of a labor progressive, who believed the self-organization of workers as crucial to achieving social justice as progressive public policies.

Radial Tunnel Syndrome: Diagnosis and Management

This study presents a review of 26 cases of radial tunnel syndrome in 25 patients seen in a single hand consultant’s practice over a period of 2.5 years. The protocol for diagnosis was the reproduction of patient’s symptoms on pressure over a palpable tender spot along the course of the radial tunnel, painful resisted supination or resisted middle finger extension, all of which were abolished on infiltration of the tender area with a local anaesthetic solution. The presence of at least two out of three objective signs was necessary for the diagnosis. Initially all cases were treated conservatively, by steroid injection in 25 and physiotherapy in one, with long-term relief of pain in 16. Nine failures were treated surgically, with complete relief of pain in seven. Radial tunnel syndrome should be considered in the differential diagnosis of pain around the hand and or elbow.

Tennis Elbow: A Combined Approach Using Acupuncture and Local Corticosteroid Injection

In a controlled study, a group of 16 patients in a north of England general practice received acupuncture treatment for tennis elbow, followed by a small dose of corticosteroid with lignocaine to a residual tender spot at the elbow. These patients were compared with a similar group of 19 who received a larger dose to a tender spot at the lateral epicondyle, without any initial acupuncture treatment. In the acupuncture with steroid group: 13 patients had benefited following two treatment sessions, two after three sessions and one was no better at the end of the permitted three treatments. In the steroid alone group: 13 had had benefit after two sessions, three after three and three were unsuccessful. This suggests a trend towards increased and more rapid success in the acupuncture with steroid group, but the small number of patients precluded useful statistical analysis. The physical advantage in using acupuncture before administering local corticosteroid injection is that a lower dose of steroid can be used, with consequent reduction in the risk of tissue necrosis and inflammatory reaction.

Tender Spot Injection Therapy for Ankle and Foot Pain

Pain of the ankle and foot following injury or surgery indicates soft tissue damage to muscle, tendons, periosteum or ligaments. Injection of a long acting corticosteroid such as triamcinolone with lignocaine to tender spots will relieve pain. Softened collagen at the site of injection will stretch, and heal to normal length and strength. However, care must be taken not to inject close to tendon, since softening may induce rupture. There is particular danger of this in the Achilles tendon. Case histories are given showing the tender spot injection sites used, and composite diagrams of all 69 tender spots found in a series of 28 patients with ankle or foot pain are illustrated.

Economic Aspects of Tender Spot Injection Therapy

One partner of a four man general practice in Essex used injection therapy to tender spots for musculo-skeletal pain. In a financial audit it was found that the prescription costs for this doctor were significantly less than the average for the other partners. It is speculated that the savings were due to effective elimination of musculo-skeletal pain by tender spot injection, thus reducing the need for analgesic and non-steroidal anti-inflammatory medication in these patients. If one doctor in every group practice nationwide were to adopt a similar, effective technique for treating musculo-skeletal pain, extrapolation of the savings to this practice suggest a national saving in excess of £95 million per year.