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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![dantly. A splint was applied, and the arm was kept quiet for a short time. I saw the patient several times, and with a probe could detect disease of the clavicle at its sternal end, extending into and implicating the whole of the sterno-clavicular joint, where she suffered a great deal of pain. She had subsequently several attacks of bronchitis, with cough and expectoration, which disturbed the joint very much. Ultimately she died, I believe of pyaemia, after a few days' severe illness, but I could not suc- ceed in obtaining a post-mortem examination of the case. Disease between the first and second piece of the Sternum, cured by Best. The case to which I will now briefly allude is one of great interest— namely, disease between the first and second bones of the sternum. This patient, D. J , was formerly a medical student. He was twenty-two years of age when he first consulted me in March, 1853, for pain and un- easiness about the upper and middle part of his chest. He stated that for several months he had been unable to take the least amount of exer- cise without considerable pain and difficulty of breathing; any attempt even at gentle motion, as in walking, full breathing, coughing, or indeed the least movement of the head or arms, was sufficient to increase his suf- fering. He had constant dull pain in the neighborhood of the sternum, extending towards the lower part of the back of his neck and between his shoulders, which during damp weather was of the most severe and gnaw- ing character, accompanied with a sense of oppression and constriction about the air-passages, as though he were being choked. Any attempt to take a deep inspiration produced pain in the same part. Pressure made with the hand upon the front of the chest during expiration was attended with pain of the most severe and lancinating kind. He jumped and started in his sleep, and was disturbed by frightful dreams. His appetite had failed during the last few weeks, but he did not appear to have lost much flesh. He had consulted many eminent physicians and surgeons in town and country, but could not learn from them any distinct cause of his suf- fering. He had been leeched and blistered over the chest and spine, and had passed in succession through the ordeals of boating, cricket, quoits, and gymnastic exercises; indeed, every possible kind of treatment ap- peared to have been pursued, but without benefit, and he was now worse than ever. I might say that he had not been previously examined care- fully with respect to the sternum or spine. The physicians and surgeons who saw him were satisfied to take his indications of pain, as he was a professional man. I suppose they did not think it worth while to exam- ine the sternum, where the real mischief was found. I examined his spine very carefully, but could not discover anything wrong there. His breathing was regular and natural, but limited in its extent by pain in his chest; the heart's action was normal. There was acute pain on percuss- ing the chest; and on approaching the middle line in front, the pain, by pressure upon the sternum, was much increased. On placing my thumb directly over the junction of the first and second bones of the sternum, and exerting slight pressure upon that part, the pain was so intense that he nearly fainted. It was evident that the secret of all his morbid symp- toms lay in this joint,* and indeed there was some enlargement and thick - * The two upper pieces of the sternum are usually described as united by cartil- age, bony union being rare save in late old age. Mr. Rivington, Med. Chr. Trs., vol. lvii., has drawn attention to the fact that two forms of joint are found here, the am- phi arthrodial, and the arthrodial or gliding variety of the diarthrodial joint.— [Ed.]](https://iiif.wellcomecollection.org/image/b2102005x_0294.jp2/full/800%2C/0/default.jpg)
