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 / by the late John Hilton ; edited by W.H.A. Jacobson.

  • Hilton, John, 1804-1878.
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: 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 / by the late John Hilton ; edited by W.H.A. Jacobson. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    441/540 (page 419)
    or parturition. * Sir Benjamin Brodie said, The only answer I can give is, that this lady had had one child : that is my sole exjjerience in the matter. That, I believe, was considered satisfactory by the mother. The child is reported to me as growing up in perfectly good health, but retaining her remarkable gait. I saw this patient ngain in Jiiiy, 1862. She was in excellent health. The same * An elaborate paper on this subject (Das Becken bei angeborener doppolseiiiger Hiiftgelenksluxation) will be found, by H. Erni^t Sassman, Arch, fiir Gynsekol. Bd. v. The following are amongst the iibnormalities met wi'h in the pelvis of a woman, set. 19, the subject of congenital dislocation of both hips.—Sacrum moie horizontal than usual, and more concave, coccyx united to sacrum almost at a right angle, ilia very steep, cavity of true pelvis not narrowed in any direction, transverse diameter of pelvic outlet enormously enlarged, the antero-i)Osterior much diminished, pubic arch extniordinarily wide, ischial tuberosities widely apart, pelvis supported upon femurs at a marked slope from behind forwards, and from above downwards. Some of the above alterations are thus brought about. As soon as the child begins to stand and walk about, the lumbar lordosis (see Fiirs. above, 83 and 84) increases rapidly, and causes the incliuatioo of the pelvis, tilting the gacrum uo aud the pubes down. By this displacement of the sacrum increased ten-ion is thrown upon the posterior parts of the sacro-iliac ligaments, the hinder portions of the i.ssa innorainata are also drawn together, which would make the anterior jiortious gape widely; but this is prevented by the pubic symphysis; and so the soft bones, fixed behind and in front, curve outwards in the centre. This excessive widening of the pelvic brim would be prevented by the upward and inward pressure of the femurs through thericetHbula; but owingtothe dislocation of these bones this pressure is wanting. The widening of the pelvic outlet is brought abmit by the pressure of the displaced femurs (m tlie false pelvis acting on the ossa innominata as levers, driving the upper part in and the low< r out. A greater agent in widening the outlet is muscidar action ; thus, the femurs not being in the acetabula. the pelvis by its weight sinks and is, as it were, slung upon the heads of the femurs by the muscles around their necks; these being attached to the ischial spines and tuberosities draw these parts outwards and upwards. The abii« rmal inclination forwards and downwards of the pelvis upon the femurs is aided by the excessive tension which is thrown upon iheilio-psosB muscles and the ilio-femoral ligaments, owing to the displacement upwards and backwards of the heads of the femurs. As to pregnancy and delivery, there is greater di8Comfort than usual during the former, owing to the disjilacement forwards of the uterus, and during tids period the peculiaiity of the gait is incri a^ed ; during delivery the chief cause of delay is the horizontal [)Osition of the uterus; but on the whole the prognosis is jxjarcely worse than in normal pelves.—[Ed.] 2 E 2