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.
- John Hilton
- Date:
- 1879
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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![most simple mechanical apparatus should be used, so as not to confine or make pressure upon the muscles. Walking exercise short of fatigue should, as far as is possible, be daily persevered in.* Typhus Fever followed by Paralysis of the Left Leg ; Recovery much aided by rubbing the Limb icith Sperm Oil, and subsequently with Sperm Oil and Liquor Ammonia?. A little girl, aged six, having previously had good health, was seized with severe fever (with brain disturbance during about a fortnight), from which she recovered gradually. The left leg and foot, however, remained shrunken, with greatly diminished power, and inability on the part of the patient to direct the foot with precision. The limb was always cold except when made warm with artificial heat; various kinds of friction and electricity had been tried during many months, but without any improve- ment. When I was consulted in this case I advised that sperm oil (liquor ammoime was added afterwards) should be well rubbed into the limb night and morning, and lamb's-wool stockings worn. By these means the limb was made warm, and maintained so. Nothing else was done. I have seen this patient since several times, the last occa- sion being April, 1876. She can now walk and run with precision, the muscularity of the limb is much increased, and its warmth well sustained. Hip-joint Symptoms / Joint Disease suspected, the real Cause being Cerebral. Here is a case where the indications were more precise. A young lady aged seven, in August, 1861, being then and previously in good health, was residing at the sea-side, and, after playing and amusing her- self during several hours upon the beach on a bright sunny day, had a sudden chill, then became hot and feverish, had violent headache accom- panied by great heat of head, and for a day or two was delirious. She was confined to her bed from ten to fourteen days, when, on attempting to walk, it was discovered that she was lame in the right leg, and that she could neither bear any great weight upon it, nor control and direct its movements with force or precision. I will not go over the long particu- lars of this case. I was desired to examine it in reference to the question of hip-joint disease. There was no indication of it as far as I could detect; no local heat at all; no pain upon carefully manipulating the hip-joint; no special local tenderness upon applying pressure below Poupart's liga- ment over the hip-joint, where there is always a degree of more or less tenderness, especially in children, this being a rather sensitive part. There was no indication of anything wrong in the hip. This child was treated by tonics. On January 6th, 1862, the patient walked into my room, in every respect improved—less lame, the limb being increased in size, and * Cases (akin to those of which Mr. Hilton is speaking) where a lower extremity i3 affected with infantile paralysis are occasionally thought to be due to hip-joint disease. On the diagnosis between the two, Mr. Holmes (System of Surgery, vol. v. p. 848) speaks as follows :—'' The hip-joint is less easily under observation, and the morbid sensibility which accompanies some of these cases of paralysis gives more resemblance to hip disease on first handling the limb; but the distinction is usually easy to make. Par- alysis generally affects a great part or the whole of the lower limb ; hip disease only causes loss of movement of the part affected. In the former, passive motion is easy and causes no pain, or not more than any other motion; in the latter, the joint is stiff, and an attempt to move it causes acute suffering ; finally, in paralysis there is no wast- ing of the buttock unless the whole limb is wasted, nor is the position of the trochanter ever altered.—[Ed.]](https://iiif.wellcomecollection.org/image/b2102005x_0251.jp2/full/800%2C/0/default.jpg)
