The Classic: On Rest and Pain: Lecture XIV

This Classic article is a reprint of the original work by John Hilton, On Rest and Pain: Lecture XIV. An accompanying biographical sketch on John Hilton, MD, is available at DOI 10.1007/s11999-009-0927-2. The Classic Article is reprinted with courtesy from Hilton J. On The Influence of Mechanical and Physiological Rest in the Treatment of Accidents and Surgical Diseases, and the Diagnostic Value of Pain. London, England: Bell and Daldy; 1863. The Association of Bone and Joint Surgeons1 2009 Richard A. Brand MD (&) Clinical Orthopaedics and Related Research, 1600 Spruce Street, Philadelphia, PA 19103, USA e-mail: [email protected] Hip-joint disease not necessarily scrofulous— Importance of diagnosing hip-joint disease in an early stage—Distribution of nerves to the hip-joint—Earliest symptoms of hip-joint disease—Disease of shoulder-joint not kept at rest, joint destroyed; hipjoint-disease in the same patient cured by rest— Dwarfed pelvis as a result of hip-joint disease— Diseased hip-joint cured by five months’ rest—Another case of twelve months’ standing cured by seven months’ rest—Hip-disease in a scrofulous patient cured by rest—Diseased hip-joint, limb bent, straightened under influence of chloroform, and cured by rest—Dislocation on dorsum ilii from disease reduced, anchylosis proceeding—Similar case, dislocation twice reduced. It will be the object of this lecture to direct your attention to diseases of the hip-joint, and to demonstrate the value of rest as a therapeutic agent in such cases. I may commence this subject by observing, that in most systematic works on Surgery, whilst diseases of the joints are arranged under one head, there is generally a separate chapter devoted to morbus coxæ, or morbus coxarius as it is termed. We are thus led to entertain the idea that there is some special peculiarity with respect to the diseases and symptoms, or the pathological anatomy of the hip-joint. I believe this to be a mistaken idea. So far as I know there is nothing in any way special or peculiar as regards the structures or the diseases of the hip-joint, when compared with those of other joints. Their physiological and pathological conditions are in no way peculiar, being obedient to the same laws which are observed to prevail in other joints. Nor do I believe that there is anything distinct in the constitutional tendency of hip-joint disease, though it seems to me that professional opinion points to the hip-joint as emphatically the chosen seat, or special locality, for the manifestation of scrofulous disease of joints. This, to my mind, is a great error—an error, also, which has a very bad influence. If we understand by the term scrofula a constitution highly cachectic, tuberculous, or at any rate disposed to the formation of tubercle, or with tubercle already existing in the diseased part, then if we regard a case of hip-joint disease as purely scrofulous in this manner, the prospect of relief to the patient will appear very small (something like that which may be expected by a person who is suffering from pulmonary consumption, with the probability of an early death 123 Clin Orthop Relat Res (2009) 467:2210–2214 DOI 10.1007/s11999-009-0928-1