HOPITAL DE LA PITIÉ.
1
154 HOPITAL DE LA PITIÉ. ON THE USE OF PLASTER SPLINTS IN REMEDYING DIS- PLACEMENTS IN FRACTURES IRREDUCIBLE BY OTHER MEANS. (Under the care of Dr. LABBÉ.) ALL surgeons know how difficult it is sometimes to remedy certain cases of oblique fracture of the lower third of the leg, in which the upper fragment projects under the sur- face. Various apparatus have accordingly been devised for the purpose of preventing this displacement. In France, Malgaigne in such cases used to employ his metallic point, which was fixed into the upper fragment so as to exert a certain degree of pressure, and prevent any fresh displace- ment. The fixing of the metallic point was attended with some inconvenience; besides, it is a special instrument and not easily procurable. We were therefore struck with the advantages afforded by an ingenious contrivance which we saw Dr. Labbe employ with success a short time ago in his wards at the H6pital )a Pitie. The patient was a woman aged forty. Whilst i-n a state of intoxication she had been run over by a gig, and was at once conveyed to the hospital. Fracture of the lower third of the leg was found to have occurred, with very marked displacement of the upper fragment, which projected under the skin and threatened to tear through. A splint was immediately applied by one of the house-surgeons. As the woman was labouring under delirium tremens, it was found necessary to use the strait-waistcoat, and strong doses of opium were administered. However, in consequence of the restlessness of the patient the upper fragment of the tibia projected more and more under the skin, so that it be- came necessary to use some means to prevent its issue through the surface. Accordingly the apparatus was modi- fied, and a cushion placed under the heel, but to no effect, and there was imminent danger of the fragment lacerating the skin. It was at this time that Dr. Labbe first saw the case, and with the view of definitively remedying the dis- placement and preventing deformity, he applied a plaster splint’in the following manner:-Reduction was first per- formed with the greatest care. As soon as this was com- pletely effected the plaster splint was applied so as to cover the sole of the foot, the heel, and the whole of the posterior surface of the leg. The assistants were then requested to continue extension, counter-extension, and perfect apposi- tion of the fragments, until the plaster had become hard. At the end of half an hour the apparatus was sufficiently solid. From that moment all anxiety about a breach of surface ceased, and notwithstanding the disorderly move- ments of the patient, which continued two days longer, con- solidatiou took place so perfectly that it was quite impos- sible to make out the seat of the fracture. Reviews and Notices of Books. Twenty, sixth Report of the Commissioners in, Lunacy to the Lord Chancellor. Ordered by the House of Commons to be printed July 4th, 1872. THis Blue-book contains little that is of general or of medical interest beyond the usual tables showing the total number of insane persons now under care, and the number of admissions, discharges, and deaths during the year 1871. In this respect, as in some other respects, it contrasts un- favourably with the Scotch Lunacy Blue-books, which are not only official records, but have a real scientific value. The total number of insane persons under care on the lst January, 1872, was 58,640, being an increase of 1885 during the year 1871. On the 1st January, 1862, the cor- responding number was 41,129, so that there are now 17,511 more registered insane persons than there were ten years ago. The ratio of the total number of persons of unsound mind per 1000 to the population was, in 1862, 202; since then it has gradually increased year by year, and it is now 2-54. This increase has been mainly in patients of the pauper class, who are confined in county and borough asylums and in workhouses. Taken by itself, it would ’ t seem to indicate a decided increase in the production of :. insanity in the country ; and when we consider how steadily the proportion has mounted up, and still mounts up, year by year, it is difficult to resist the conviction that more persons are going insane now, in proportion to the’popula- tion, than in the last generation. However, the matter is in dispute among those who have given most attention to it; and it is certain that we must wait some years yet before we can estimate the amount of the increase which may be actually due to other causes than an increased production - namely, to such causes as a lower mortality and more careful registration. There can be no doubt that many persons are called insane and confined in county asylums now who would not have been confined or registered as insane in the last generation. It does not appear from the tables in this Report that the power of curing insanity is at all on the increase. In the year 1871 the percentage of recoveries on the admis- sions-that is, on the new cases-was only 33’01, whereas in 1859 it was 35’12, which was itself a low proportion when compared with the percentage of recoveries under the old system, before asylums were made such comfort- able institutions as they are now. For Dr. Thurnam, in his work on the "Statistics of Insanity," which was published in 1845, says that "a proportion of much less than forty per cent. of the admissions is, under ordinary circum- stances, to be regarded as a low proportion, and one much exceeding forty-five per cent. as a high proportion." In the annual reports of asylums, which are commonly not wanting in self-gratulations, we have failed to observe any notice of this low percentage of recoveries, although it is a matter well deserving attention and calling for explana- tion. Excellent as are our asylums a’3 institutions for the care of the insane, it would be comforting to know that they afford the best conditions of recovery for all the patients who are curable. This Report contains the usual story of deficient accom- modation for pauper lunatics. Old asylums are being en- larged, new asylums are being planned or built, and more asylums are required. Notwithstanding the experience of Scotland, the English Commissioners seem to contemplate no other provision for the insane than the increase of asylums, for they make no reference to the measures for. relieving asylums which receive so much careful discussion in the reports of the Scotch Commissioners. This may perhaps be ascribed to the fact that half the English Com- missioners are lawyers, who cannot be expected to have much scientific interest in their work, while the Scotch Commissioners are medical men of high scientific standing, who evince a deep interest in their work, and bring an ° originality of mind to bear on the problems with which they have to deal. The condition of asylums, public and private, the Com- missioners describe as, on the whole, satisfactory. They, however, urge the desirability of increasing the wages of attendants, so as, if possible, to secure a higher class of men and women for the laborious and anxious duties which they have to perform. There have been some fatal injuries and fatal accidents to patients during the year, but not more, we think, than may be fairly looked for among 58,640 insane patients, many of whom are suicidal, violent, dangerous, or completely helpless, and require by day and night the most anxious vigilance and attention. To guard completely against the possibility of accidents under such circumstances would demand more than human foresight and energy ; and we think some of the comments which the f Commissioners make on these unfortunate events betray a little of that wisdom which is wise after the event. ’
Transcript of HOPITAL DE LA PITIÉ.
154
HOPITAL DE LA PITIÉ.ON THE USE OF PLASTER SPLINTS IN REMEDYING DIS-
PLACEMENTS IN FRACTURES IRREDUCIBLE BY
OTHER MEANS.
(Under the care of Dr. LABBÉ.)ALL surgeons know how difficult it is sometimes to remedy
certain cases of oblique fracture of the lower third of theleg, in which the upper fragment projects under the sur-face. Various apparatus have accordingly been devised forthe purpose of preventing this displacement. In France,Malgaigne in such cases used to employ his metallic point,which was fixed into the upper fragment so as to exert acertain degree of pressure, and prevent any fresh displace-ment. The fixing of the metallic point was attended withsome inconvenience; besides, it is a special instrument andnot easily procurable. We were therefore struck with the advantages afforded by an ingenious contrivance which wesaw Dr. Labbe employ with success a short time ago in hiswards at the H6pital )a Pitie.The patient was a woman aged forty. Whilst i-n a state
of intoxication she had been run over by a gig, and was atonce conveyed to the hospital. Fracture of the lower thirdof the leg was found to have occurred, with very markeddisplacement of the upper fragment, which projected underthe skin and threatened to tear through. A splint wasimmediately applied by one of the house-surgeons.As the woman was labouring under delirium tremens, it
was found necessary to use the strait-waistcoat, and strongdoses of opium were administered. However, in consequenceof the restlessness of the patient the upper fragment of thetibia projected more and more under the skin, so that it be-came necessary to use some means to prevent its issuethrough the surface. Accordingly the apparatus was modi-fied, and a cushion placed under the heel, but to no effect,and there was imminent danger of the fragment laceratingthe skin. It was at this time that Dr. Labbe first saw thecase, and with the view of definitively remedying the dis-placement and preventing deformity, he applied a plastersplint’in the following manner:-Reduction was first per-formed with the greatest care. As soon as this was com-pletely effected the plaster splint was applied so as to coverthe sole of the foot, the heel, and the whole of the posteriorsurface of the leg. The assistants were then requested tocontinue extension, counter-extension, and perfect apposi-tion of the fragments, until the plaster had become hard.At the end of half an hour the apparatus was sufficientlysolid. From that moment all anxiety about a breach ofsurface ceased, and notwithstanding the disorderly move-ments of the patient, which continued two days longer, con-solidatiou took place so perfectly that it was quite impos-sible to make out the seat of the fracture.
Reviews and Notices of Books.Twenty, sixth Report of the Commissioners in, Lunacy to the
Lord Chancellor. Ordered by the House of Commons tobe printed July 4th, 1872.
THis Blue-book contains little that is of general or ofmedical interest beyond the usual tables showing the totalnumber of insane persons now under care, and the numberof admissions, discharges, and deaths during the year 1871.In this respect, as in some other respects, it contrasts un-favourably with the Scotch Lunacy Blue-books, which arenot only official records, but have a real scientific value.The total number of insane persons under care on the
lst January, 1872, was 58,640, being an increase of 1885during the year 1871. On the 1st January, 1862, the cor-responding number was 41,129, so that there are now
17,511 more registered insane persons than there were tenyears ago. The ratio of the total number of persons ofunsound mind per 1000 to the population was, in 1862, 202;since then it has gradually increased year by year, and itis now 2-54. This increase has been mainly in patients ofthe pauper class, who are confined in county and borough
asylums and in workhouses. Taken by itself, it would ’ tseem to indicate a decided increase in the production of :.insanity in the country ; and when we consider how steadilythe proportion has mounted up, and still mounts up, year
by year, it is difficult to resist the conviction that more
persons are going insane now, in proportion to the’popula-tion, than in the last generation. However, the matter is indispute among those who have given most attention to it;and it is certain that we must wait some years yet beforewe can estimate the amount of the increase which may be
actually due to other causes than an increased production- namely, to such causes as a lower mortality and morecareful registration. There can be no doubt that manypersons are called insane and confined in county asylumsnow who would not have been confined or registered asinsane in the last generation.
It does not appear from the tables in this Report thatthe power of curing insanity is at all on the increase. Inthe year 1871 the percentage of recoveries on the admis-sions-that is, on the new cases-was only 33’01, whereasin 1859 it was 35’12, which was itself a low proportionwhen compared with the percentage of recoveries underthe old system, before asylums were made such comfort-able institutions as they are now. For Dr. Thurnam, inhis work on the "Statistics of Insanity," which was publishedin 1845, says that "a proportion of much less than fortyper cent. of the admissions is, under ordinary circum-
stances, to be regarded as a low proportion, and one muchexceeding forty-five per cent. as a high proportion." Inthe annual reports of asylums, which are commonly notwanting in self-gratulations, we have failed to observe anynotice of this low percentage of recoveries, although it isa matter well deserving attention and calling for explana-tion. Excellent as are our asylums a’3 institutions for thecare of the insane, it would be comforting to know that
they afford the best conditions of recovery for all the
patients who are curable.This Report contains the usual story of deficient accom-
modation for pauper lunatics. Old asylums are being en-larged, new asylums are being planned or built, and moreasylums are required. Notwithstanding the experience ofScotland, the English Commissioners seem to contemplateno other provision for the insane than the increase of
asylums, for they make no reference to the measures for.
relieving asylums which receive so much careful discussionin the reports of the Scotch Commissioners. This mayperhaps be ascribed to the fact that half the English Com-missioners are lawyers, who cannot be expected to havemuch scientific interest in their work, while the ScotchCommissioners are medical men of high scientific standing,who evince a deep interest in their work, and bring an °
originality of mind to bear on the problems with whichthey have to deal.The condition of asylums, public and private, the Com-
missioners describe as, on the whole, satisfactory. They,however, urge the desirability of increasing the wages ofattendants, so as, if possible, to secure a higher class ofmen and women for the laborious and anxious duties which
they have to perform. There have been some fatal injuriesand fatal accidents to patients during the year, but notmore, we think, than may be fairly looked for among58,640 insane patients, many of whom are suicidal, violent,dangerous, or completely helpless, and require by day andnight the most anxious vigilance and attention. To guardcompletely against the possibility of accidents under suchcircumstances would demand more than human foresightand energy ; and we think some of the comments which the f
Commissioners make on these unfortunate events betray alittle of that wisdom which is wise after the event. ’
