On rest and pain : a course of lectures on the influence of mechanical and physiological rest in the treatment of accidents and surgical diseases, and the diagnostic value of pain / delivered at the Royal College of Surgeons of England in the years 1860, 1861, and 1862 by John Hilton.

  • Hilton, John, 1804-1878.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: On rest and pain : a course of lectures on the influence of mechanical and physiological rest in the treatment of accidents and surgical diseases, and the diagnostic value of pain / delivered at the Royal College of Surgeons of England in the years 1860, 1861, and 1862 by John Hilton. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    plained of pain in the knee six months before he began to be lame. He was under the care of Mr. Stormont, of Cheshunt, eighteen months ago. He used to lie in bed for a week or ten days; then get up, and soon became lame again, taking alternate rest and exercise, but on the whole steadily getting worse until December, 1860, when he could not get up, since which he has been constantly in bed, lying on his right side. Dis- location of the thigh-bone must have occurred when in bed. The left leg was drawn up. He suffered great pain in the knee and hip. The gen- eral health was very bad, and he could scarcely bear being moved by the nurse. This patient was in an hospital in London during the months of April and May, 18G0. He had an issue made over the hip-joint when in that institution without any benefit; no splints were applied; he was more lame when he came out than when he went in; and he was repre- sented as incurable. He came under my care on the 23d of January, 1861. He had then a dislocation of the left femur on to the dorsum of the ilium. The dislocation was reduced three weeks after admission, under the influence of chloroform. The pelvis and lower limb were then carefully (and not too tightly) bandaged to a straight wooden splint placed on the outer side of the limb. The splint had a transverse foot- piece fixed to it in order to prevent any rotation of the hip-joint. There was scarcely any pain in the knee or hip-joint after that time. His health appeared perfectly good, and the limb was in an excellent position. There was no pain, but simply an abscess upon the anterior and inner part of the thigh, which was left alone. Bony union had taken place between the head of the femur and the acetabulum. This appears to be a good case in reference to the influence of rest in the treatment of diseased hip-joint. Dislocation of Thigh-bone upon the Dorsum Ilii from Disease; Dis- location twice reducedy Anchylosis in good position. The third case is a much more curious one. Mr. Stanley, who hap- pened to be at Guy's Hospital in the summer of 1859, saw this little patient. M. P , aged seven, was admitted into Charity ward on March 2d, 1859, under my care. Her mother stated that she had always been a very delicate child. In November, 1858, she first complained of pain in the left knee, and was noticed to walk lamely; her health also began to be seriously damaged. The mother took her as an out-patient to a London hospital, where numerous blisters were applied without apparent benefit. The recumbent position was subsequently in part main- tained, while occasional blisters over the hip were prescribed. This plan was persevered in, but so severe was the pain experienced in moving, that it was not possible for her to continue her attendance as an out-patient. About a fortnight before her admission into Guy's Hospital, the deformity which is peculiar to the dislocation of the thigh-bone on the dorsum of the ilium first distinctly appeared; it occurred at night, accompanied by great aggravation of the patient's symptoms. This led her friends to seek admission for her into Guy's. The report on admission states that she was a feeble, strumous-looking child, with delicate skin, long eye- lashes, and somewhat prominent lips. She had lost her appetite, and was suffering a great deal of pain in the hip, especially at night. She was very restless, and the left leg was much shorter than the other. The thigh was flexed and adducted, the knee bent, the foot turned inwards, resembling the dislocation of the head of the femur upon the dorsum ilii;