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 ; edited by W.H.A. Jacobson.

Date:: 1877

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 ; edited by W.H.A. Jacobson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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4«‘3 uneasy look of tke eyes and stare, with dilated pupils, and a muddiness of the conj unctivse, afforded a ready indica- tion of any temporary derangement of his health. For the last year of his life, he was gradually losing flesh ; lie became more feeble, too, and acquired a slight stoop in his gait. He also carried his head peculiarly, as if affected with slight stiffness of the neck.” [This is the way in which hydrocephalic patients carry their heads.] ‘ ‘ A few months before his death, while in the country, he had a severe attack of vomiting, with great prostration, without any apparent cause. The last month or two were marked by a morbid activity and restlessness. Amongst other things, he became greatly excited about the prepara- tion for a scientific meeting; and this was followed by great prostration and collapse. On the day of his death he had been to the Crystal Palace. He had had some vomiting in the morning, and again about two hours before he reached home. He walked from the Crystal Palace, and when he entered the room he staggered, and said he felt giddy and oppressed. He was placed on a bed, and cold was applied to his forehead; but he died in a short time with stertorous breathing [indicating pressure upon the medulla oblongata], but was sensible almost to the last moment.” If I were to select this opportunity to enlarge upon the apposite circumstances of this case, perhaps I might do so at too great length. I will merely observe that I think it an important and interesting experiment in reference to the circulation through the brain, the administration of food and stimulants, and various other matters. His brain could bear no fulness of blood, no increase of size, because the cerebro-spinal fluid could not escape from the interior of the brain. He could not take wine, beer, or spirits ; and could bear no muscular exertion. The con- gestion of the brain produced vomiting by pressure upon the medulla oblongata, exerting its influence upon the pneu- mogastric nerve. He died from pressure upon the medulla oblongata, with stertorous breathing—that pressure which could not be obviated. I shall dwell no longer either upon this case, or this kind of case, but I think that occlusion of the cerebro-spinal opening is a pathological condition which has not received due attention from the profession. Before quitting the subject of the circulation through

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