A treatise on fractures / By J. F. Malgaigne ... Tr. from the French, with notes and additions, by John H. Packard, M. D.

  • Malgaigne, J.-F. (Joseph-François), 1806-1865.
Date:
1859
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on fractures / By J. F. Malgaigne ... Tr. from the French, with notes and additions, by John H. Packard, M. D. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    the degeneration of the skeleton; and if this last and strongly-marked predisposition to fracture does not increase their number from fifty- five to eighty years, and even if, later in life, that number diminishes, it is because the debility of age exempts from the exciting causes, active labor, quarrels, fights, etc. It may be seen that in this enumeration external causes are pro- minent, and that the fragility of the bones acts only in very early and very late life. Boyer thought that the bones of the old became more fragile by the increase of their earthy salts. According to well-known analyses, it is, on the contrary, proved that where the animal matters predominate the bones are more easily broken; and those which most resist fracture are the compact bones of adults. The fragility of the bones of some old men depends on a different cause: namely, an affection of the osseous tissue, enlarging the canals and thinning the walls of the diaphyses, thus increasing till finally the cells of the spongy tissue are made undistinguishable. These lesions I have described somewhat in detail in my Anatomie Chirur- gicale, and they have led me to the following triple conclusion, since confirmed by my researches at Bicetre:— There are persons whose skeletons undergo hardly any modifica- tion in advanced life; and some even in whom the compact tissue becomes denser, and as it were eburnated; these are as little liable to fracture as adults. In others, the absorption is limited to thinning of the spongy tis- sue ; perhaps this is more commonly the case, and hence the large proportion of fractures of the ribs, cervix femoris, cervix humeri, etc. Finally, in a still smaller number of cases, the absorption affects all parts of the skeleton, reducing the walls of the diaphyses to the thinness of pasteboard, or even less; softening the spongy tissue so that it is crushed by the fingers; and here fractures of every kind occur from the slightest causes. But the rarity of this affection for- bids our considering it as a normal state, and I shall speak hereafter of its nature. (2.) Influence of sex.—Men are more subject to fractures than women; the proportion was as five to two in my cases at the Hotel- Dieu. But this result, true in general, is variously modified by dif- ferences in the period of life. Thus I found, for the age of two to five years, the number of girls affected with fracture to be nearly double that of the boys; the latter, on the contrary, were at least three times as numerous as the girls, between the ages of five and tin ; and the proportion went on increasing in the succeeding periods, till in that between fifteen and twenty years there were 136 males to seventeen females, or about eight to one. Afterwards it diminishes, as up to the age of forty-five there were three, or perhaps four, fractures in men to one in a woman. This period passed, it still goes down, so that from seventy to seventy-five years the numbers are equal for