Remarks on the repair of wounds and fractures in aged persons / by G.M. Humphry.

  • Humphry, George Murray, Sir, 1820-1896.
Date:
[1884]
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the repair of wounds and fractures in aged persons / by G.M. Humphry. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    liiivo ( lioughl; tliat, when tin: miti i(;ivL rorcf;.s are generally failing, when strength and weight are (Uniinisliing, when repair is eaeh year less and less able to keep pace with wear, as evinced, among other things, by the fact that exhaustion is more f^uickly induced and less quickly recovered froro ; when the brain is shrinking, and memoiy and other mental powers arc lowering, and when the circulation is becoming weaker,—that, under these circumstances, the nutritive or reparative processes concerned in breach-closing, in the healing of wounds and ulcers, should manifest an increase of energy, at any rate, of rapidity, in carrying on their work. I do not know well how to explain it; but this exceptional phenomenon of nutrition is not peculiar to old age. It may bo ob- served in some other lowered conditions. The wounds in patients exhausted by large losses of blood usually heal quickly, as they also do after operations for cancer, and in many other debilitated condi- tions. I do not mean persons of naturally strumous temperament, but persons who have been weakened by illness or in other ways. So do, commonly, the gaps caused by carbuncles, and bed-sores ; and very remarkable is the quick healing of the stump left by the separation of the parts in senile gangi'ene—that is to say, this e^Hdeuce of vital energy is manifested in the part next above that which was unable to keep alive at all; and, after fracture of the spine, we sometimes see f|uick sloughing and quick healing in closely adjacent ])arts. An exception must be made of certain impaired conditions of the nervous system in which wounds and sores are sometimes very troublesome. The remarks I have made with regard to the repair in woirnds and ulcers in old persons hold good also with regard to fi'actnres. This is sufficiently proved by the cases mentioned below ; and in one of these, given by Dr. Walford, it may be remarked that the limb, in which the fractured tibia and fibula united in three weeks, was partially paralysed and nearly useless, the knee being contracted ; and in Mr. Copley's case, the broken tibia in a most enfeebled helpless woman of 68 was pretty firmly united in two weeks. Professor Gross, in his System of Surgery, observes that age is no barrier to union, and mentions the case of a lady aged 100, in whom union of a fractured humerus took place in the usual time; and that of a woman aged 93, in whom a fracture of the upper third of the thigh was united in seven weeks. The contrary view, however, is prevalent. In Holmes's System of Surgery it is stated that, in old age, the period is greatly protracted in proportion to the want of vigour of the individual. Chelius re- marks that in advanced age the bono heals with difficulty. In the International Encyclopccdia of Surgery, a doubtful opinion is given; and the prevailing impression respecting the time required is probably to be atti-ibuted not so much to observation of the fact as to an a prion feeling that it is likely to be so; for we know how often that which is probable is assxvmed to be that which is real. Moreover, the circumstance that fractures of the neck of the thigh- bone, which may be regarded as the old person's fracture, commonly does not unite at all by bone, the broken ends in many cases remaining quite separate, seems to give support to the view. It is weU known, how- ever, that this failure depends, not upon the age of the patient, or on any peculiarity in the structiu-e of the bone, or upon any changes that take place in it during the later periods of life, though those changes are such as to cause rarefaction of its cancelli and greater liability to fracture, but upon other causes. Such causes, more particularly, are the separation of the broken surfaces, which commonly occurs ; the buried position of the inner fragment in the cavity of the acetabulum, which prevents any overlapping of the fragments and any throw- ing out of uniting matter around it; as well as the comparative absence, and, when the fibrous covering of the neck is torn through