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.

    34/538
    which local and remote accidents seemed to produce, which induced our forefathers to “let blood” in almost every kind of accident which compelled the patient to keep quiet, or confined him to bed. The spleen has a strong elastic capsule, and also an internal network of highly elastic* tissue, so that the symptoms are rendered latent by the low condition of the patient, or masked by the existence of some severe injury that chiefly attracts the surgeon’s attention. In speaking of the treatment, Mr. Erichsen writes as followsThe supine position should also be occasionally changed for the lateral one, or, if the patient have sufficient strength, he may be seated partly upiight. And the starched bandage may here be of most essential service, by enabling the surgeon to place patients with injuries of the lower limbs in such a position and such an atmosphere as shall remove two of the most active predisposing causes of the form of pneumonia now under consideration, namely, the recumbent position, and the comparatively impure air of a hospital ward or sick-room.” Dr. Milner Fothergill (Joe. supr. cit., p. 140) speaks thus of the value of position in adynamic congestions of the lungs :—“ When the patient lies upon his back, as he does in the typhoid condition, the posterior portions of the lungs are among the most dependent parts of the body. The blood collects in them, from lack of tone in the vessels to prevent such stagnation. It becomes at once apparent that under these circumstances stimulants must be administered, and freely too, in order to maintain the power of the circulation. But more than that, mere position is not without its importance. As long as the patient can turn over on either side, the lung of the other side is to some extent unloaded, and so relieved. Old practitioners are always hopeful of fever patients as long as they can turn over. The same species of hypostatic congestion is found under similar circumstances in the kidneys; and when the power to turn over is lost, it is a good practice to roll the patient first on one side for an hour or two, and then on to the other, in order to mechanically unload the congested viscera of each side alternately, especially in advanced typhoid states.”—[Ed.] * In addition to the elastic fibres spoken of above, the presence of involuntary muscular fibres in the capsule of this orgau, which, from its close relation to the digestive function, is constantly liable to con- siderable variations in size, shows an especial provision for providing the spleen with rest. The existence of these fibres, though disputed in man (W. Muller and Harless affirming, while others, as Gray and Kolliker, deny or doubt their presence), has been demonstrated in tho capsule and trabeculae of the spleen of many of the mammalia, notably the ruminants and the pig. Their abundance in the spleen of these animals may, I think, be explained by the frequent and sudden inter- ruptions to which the digestive function must of necessity, from their mode of life, be subject in these animals.—[Ed.]
    digitised image 1
    digitised image 2
    digitised image 3