Notes on a Case of Fracture of the Fibula in a Melancholic Patient, with Remarks on Treatment in Fractures Generally

Abstract

The object of this communication is to draw from the members of the Association the modern treatment of fractures as adopted in institutions for the insane. It is obvious that the various plans, as practised in hospitals, must be considerably modified in asylums. For instance, to strap and bandage a case of fractured ribs, secundum artem, taxes any medical officer, unless the patient is quietly disposed and clean in his habits. However, with skill and a fairly docile patient, there should be little difficulty in the management of ordinary fractures of the bones below the elbows and the knees. From time to time one reads of cases of fractures of the ribs occurring in asylums, remarkable autopsies being recorded. It is difficult sometimes to give a correct history of their causation, and, in consequence, much opprobrium has been unjustly cast on asylum officials. It is believed by not a few that there is a peculiar affection of the ribs in the insane causing them to fracture readily. It is said, too, that it is common in general paralysis. Dr. Christian has stated in the Journal of Mental Science, January, 1886, that he is decidedly opposed to the idea that general paralytics are more liable to fracture of the bones. He gives 250 cases, and says, “I can assure you, gentlemen, I have not come across a single case of fracture among them.” But no figures of the kind can be relied upon unless verified by post-mortem examination. It is not uncommon to find in the mortuaries of ordinary hospitals and asylums, and in the dissecting-room, specimens of fractured ribs, the causation of which is unaccounted for. With our present pathological knowledge of the osseous system we must withhold our verdict.