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
Catalogue details

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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    cle, and the consequent pressure upon the pneumogastric and auditory nerves on its floor. If the fourth ventricle be filled with fluid, it must for the time exert some pressure upon the auditory nerve, thus explaining the temporary deafness. His pulse was usually extremely weak, irregular, and slow, from 50 to 60 beats per minute. He was thought to be suffering from heart dis- ease. A peculiar restless, uneasy look of the eyes and stare, with dilated pupils, and a muddiness of the conjunctivae, afforded a ready indication of any temporary derangement of his health. For the last year of his life he was gradually losing flesh; he became more feeble, too, and ac- quired a slight stoop in his gait. He also carried his head peculiarly, as if affected with slight stiffness of the neck. [This is the way in which hydrocephalic patients carry their heads.] A few months before his death, while in the country, he had a severe attack of vomiting, with great prostration, without any apparent cause. The last month or two were marked by a morbid activity and restlessness. Amongst other things, he became greatly excited about the preparation for a scientific meeting; and this was followed by great prostration and collapse. On the day of his death he had been to the Crystal Palace. He had had some vomiting in the morning, and again about two hours before he reached home. He walked from the Crystal Palace, and when he entered the room he staggered, and said he felt giddy and oppressed. He was placed on a bed, and cold was applied to his forehead; but he died in a short time with stertorous breathing [indicating pressure upon the medulla oblongata], but was sensible almost to the last moment. If I were to select this opportunity to enlarge upon the apposite cir- cumstances of this case, perhaps I might do so at too great length. I will merely observe that I think it an important and interesting experiment in reference to the circulation through the brain, the administration of food and stimulants, and various other matters. His brain could bear no fulness of blood, no increase of size, because the cerebro-spinal fluid could not escape from the interior of the brain. He could not take wine, beer, or spirits; and could bear no muscular exertion. The congestion of the brain produced vomiting by pressure upon the medulla oblongata, exert- ing its influence upon the pneumogastric nerve. He died from pressure upon the medulla oblongata, with stertorous breathing—that pressure which could not be obviated. I shall dwell no longer either upon this case or this kind of case, but I think that occlusion of the cerebro-spinal opening is a pathological condition which has not received due attention from the profession. Before quitting the subject of the circulation through the brain, let me say that I think it is generally supposed that during sleep the brain is in a state of congestion, or, rather, overcharged with blood; and that it is the pressure of that blood which in some measure induces or sustains the state of repose or cerebral quietude. Mr. Durham, one of our demonstra- tors at Guy's Hospital, has put into my hand this paper, containing the result of some experiments which tend to show that the brain is not in that condition during sleep; that it loses its congested character in order that it may assume what we should call its state of quiescence, or rest. The facts are very few, and they shall be allowed to speak for them- selves. A dog having been chloroformed, a portion of bone, about as large as a sixpence, was removed from the parietal region of the skull by means of the trephine; the subjacent dura mater was cut away, and the surface
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