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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![with the right sacroiliac synchondrosis. Pressure upon the sacrum or ilium in such direction as to disturb the sacro-iliac synchondrosis gave rise to great pain, as did also pressure applied directly over the joint between the sacrum and the os innominatum. On the other hand, the pelvis being steadied, the hip-joint could be moved about and manipulated in any way without producing pain, so long as the movement did not affect the sacro- iliac synchondrosis. At times there was pain about the gluteal region; there was never pain in or about the knee. The patient could not lie on his right side without pain, was unable to stand or to walk without very great pain, and the attempt to stand produced yielding in the lower part of the back; but there was neither shortening nor lengthening of the limb, nor any marked alteration in the contour of the gluteal region. The patient had had neither shivering nor any other symptoms of irritative fever. He was ordered to keep his bed, and remain abso- lutely at rest upon his back. I will not trouble you with the minor details. About two months afterwards, in February, 1858, he was furnished with a strong pelvic belt of leather, provided with buckles and straps, and so contrived and padded as firmly to embrace and steady the pelvic bones, and prevent, as far as possible, movement of the sacro-iliac joint. The patient remained recumbent in bed until the beginning of April (four months), when he was permitted to sit up in bed, which he did without pain. Jn a few days he got up (wearing the belt), walked slowly about with the aid of a stick, and with scarcely any pain at all. From this time he steadily improved, and at the expiration of five months he left the hospital, returning to his occupation three weeks afterwards. The time spent in rest was therefore six months. I requested the patient to call upon me in 1861, and he did so in March. He could then carry two cwt. without difficulty, and had done so during the last two years, but he still laid great store by the pelvic leather belt, which gave him more comfort and a greater sense of security than anything else, and the tighter it was strapped the more comfortable it was to him. This man presented clear evidence that he had disease between the sacrum and the ilium, from which he had suffered during six months pre- viously to my seeing him. He was perfectly cured by six months' rest. The whole of the good effected was by keeping the pelvis in repose—not interfering with the natural efforts towards repair, which were ultimately made with success. The advantage of the circular belt no doubt con- sisted in its maintaining the diseased parts in forced coaptation, for I be- lieve the man has now anchylosis between the sacrum and the ilium. Sacro-iliac Disease in the Left Side after Parturition;* Suppuration within the Pelvis; Abscess absorbed; cured by Mechanical Rest. In 1853 I saw a lady, aged twenty-four. After a tedious and severe, but natural labor, she had been delivered on April 17th, 1853, of a healthy and strong child. She remained in bed, and everything went on well for two or three weeks, when, on moving abruptly in bed and turning quickly on her side, she felt pain for the first time in her left hip. It was not then *A somewhat similar case of sacro-iliac disease, where the patient had been de- livered with great difficulty of a very large child, is mentioned by Professor Esmarch in his monograph on Cold, translated in the series of the New Syd. Soc. for 1861.—■ [Ed.]](https://iiif.wellcomecollection.org/image/b2102005x_0264.jp2/full/800%2C/0/default.jpg)
