Fractured ribs in the insane / by T. Claye Shaw.

  • Shaw, T. Claye.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: Fractured ribs in the insane / by T. Claye Shaw. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    FRACTURED RIBS IN THE INSANE. BY Dr. T. CLAYE SHAW, M.D. Nothing gives so b;ul an impression of the management of an asylum as the occurrence in patients of fractured ribs. The press calls special attention to it, and the public mind is much exercised on the matter, whilst it passes unnoticed many things of at least equal importance. Considering the way in which excited and restless persons have to be herded together, the wonder is that such casualties are not more frequent. It is no doubt a defect in our asylum system that so many trouble- some and violent cases have to be placed together; but the expense of these buildings is so enormous, the accommodation is already so insufficient, and the numbers to be treated are so vast, that whilst doing what is possible with the present arrange- ments, allowance should be made for the difficulties under which the system is carried on. It often turns out to be very difficult to determine how and when these injuries to the ribs are caused. The attendants naturally enough deny having used violence; the patient is often unable to say anything about it, or at any rate anything reliable; and the absence of external signs of injury, together with the fact that there has been no need to resort to force in the handling of the patient, renders the deter- mination of the time of the injury (which may be only found on post-mortem examination) a very difficult problem. There are occasions, as in the forcible restraint of violent and impulsive epileptics, where considerable force is used on both sides, but it is very rare to find broken ribs under these circumstances; whilst, on the other hand, we may find a large amount of injury when it is very evident that the patient’s power of violence or of resistance was very small. Does this mean that in the latter class the attendant lost his temper and wilfully assaulted the patient? This may occasionally happen, but it is difficult to