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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![I cannot find it there. This child came before me again when she was about twenty-two months old. I happened to see her in a farm-house, and thought it most extraordinary to meet with two such cases within two years; but it turned out to be the same child. There were no patella? at that time—not a rudiment to be felt; and I saw the child walking about the room, bearing its weight upon the condyles of the thigh-bones, with the legs turned forwards, the feet in the air, the soles of the feet present- ing directly upwards, and the child hugging one foot, and sucking one of its own great toes. The mother assured me that the child used to go to sleep in that way. She could not stand upright by herself on her feet, but moved about upon the posterior surface of the condyles of the thigh- bones. I advised the parents to place forms around the room, so that she might rest her hands upon them, and in that way begin to employ the legs as organs of support and progression. This plan was carried out, and the child was not allowed to walk as hitherto, nor to pull her legs directly upwards towards the face, which she was very fond of doing. The legs were from this time kept quite straight when in bed or lying down. When three and a half years old she had no patellae, but at about four years very small ones, like peas, manifested themselves, resting in a rudi- mentary ligamentum patellae, which Mr. Owen, of Finchinfield, then or soon afterwards recognized.* From that time she began to be safer on her legs, and when she was about five years old she could walk, support- ing herself by two short walking-sticks. Afterwards she walked increas- ingly well, but not safely; for the legs used frequently to give way under her, and she would fall down. At between six and seven years of age I examined the patient. She could walk uprightly, but not with perfect steadiness. Each patella was about the size of the rounded end of an adult's little finger, and both joints were very loose, and yielded to lateral displacement much more than they should have done naturally. She re- mained at home until she was sixteen, and it was not until she was ten or eleven years old that she appeared firm upon her legs. I saw her in Jan- uary, 1862. She is short in stature, capable of walking any reasonable distance, and is upon her feet the greater part of the day. The patellae are small, but well shaped and in good position; indeed, on looking at the knees, nothing peculiar presents itself, but she says that if she suddenly comes down upon her feet a little on one side, she is apt to fall. I saw nothing peculiar in her manner of walking when in my room. Here is a case, then, where mechanical rest was the starting-point of the freedom of a patient from ulterior deformity. If she had been allowed to go on walking upon the condyles of the femur, it would have necessarily followed that the strong crucial and lateral ligaments, em- ployed to maintain the bones in their normal relation to each other, and to oppose inordinate muscular force, must have been so stretched that it would have been a matter of impossibility to render the joint serviceable in maintaining the erect posture, or in aiding progression. It is worthy of remark how long a time is required for the repair by anchylosis of serious or severe disease of the knee-joint; but we cannot be surprised at that circumstance when we recollect the large number of soft tissues which have first to be destroyed by disease, then absorbed by * A rudimentary patella has been noticed at the third month ; it remains cartila- ginous up to about the third year, when ossification commences usually by a single nucleus. To meet the increasing strain upon the bone, ossification should be complete about puberty.—[Ed.]](https://iiif.wellcomecollection.org/image/b2102005x_0270.jp2/full/800%2C/0/default.jpg)
