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 / by John Hilton ; edited by W.H.A. Jacobson.

Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: 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 / 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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    pains is that which occurs between the shoulders, or over the inferior angles of the scapulas. This pain must he connected with the distribution of some of the spinal nerves, because no other structures could express the pain, and no other nerves occupy the position, except the fourth, fifth, and sixth dorsal nerves, which are distributed over the inferior angles of the scapulas and interscapular space. Hence we must conclude that these nerves are the immediate seat of the pain. If we trace internally the great splanchnic nerve from within the thorax downwards, and find it connected at its abdominal end with the solar plexus, thence trace its distribution to the stomach, duo- denum, liver, and pancreas; and if we follow the other or upper end of the same great splanchnic upwards to the fourth, fifth, and sixth dorsal nerves, which give peripheral sensitive filaments to the integuments, over the angles of the scapulas, to the interscapular spaces and the adjoining skin, we can well imagine (without going into the question of how the transmission is made) that these nerves carry in g the influence upwards and backwards may explain the occurrence of the pains sometimes experienced in those external parts associated with abdominal visceral disturbance. I think it likely, then, that the pain which persons experience in disease of these viscera may be explained by the relative position of the great splanchnic nerve, communicating, on the one hand, with the solar plexus, and thence with these digestive organs, and, on costal space (4th, 5th, 6th) are supplied by the same nerves Now the 4th, 5th, and 6th intercostal nerves are those which give off large lateral cutaneous branches, descending over two ribs before they terminate in the skin over the 6th, 7th, and 8th intercostal spaces.” This is the theory that infra-mammary pain is a reflex neuralgia expressive of some distress in the heart. The sensorium hears of the distress through nerves which enter the cord at the same point as those from the 6th, 7th, and 8th intercostal spaces ; this impression is referred by the mind to the sensitive skin. This distress in the heart may be brought about indirectly by some exhaustion of the medullary and vaso-motor centres which regulate its action through the cervical sympathetic and the vagi, the exhaustion being due to worry or overwork, or from the effects of long-continued irritation of uterine nerves (as in leucorrhoea) extending to the encephalon; nothing being more common than dorso- intercostal pain on exertion in cases of leucorrhoea.—[El'.]
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