The Use of a Section of the Scapula in Correcting a Nasal Deformity

Oliver A. Lothrop
1914 Boston Medical and Surgical Journal  
she did by writing lengthy epistles, appealing to ' them in various ways, and some of these letters accomplished their purpose. During an oncoming depression of manicdepressive insanity, I believe work is, as a rule, harmful, and these patients should be relieved from the discharge of all duties, and if possible, be made to remain in bed. A manic-depressive formerly under my care told me that for years before her admission to a hospital she had warded off depressions by dropping all her
more » ... ing all her household cares and social obligations when the first symptoms appeared, and going away for a rest. She likewise stated that even to dress herself seemed such a gigantic undertaking thai she would lie awake and wonder how she could accomplish it. A patient who formerly had a depression every few months has been under my care for the past year, and has not had an attack during that time. As soon as I noticed the slightest change in her appearance or demeanor I made her discontinue all work, and ordered rest in bed and hydrotherapy. She herself is confident that at least two depressions have been warded off in this manner. When convalescence is established, interesting and absorbing occupation should be furnished. Dementia precox, like manic-depressive insanity, often shows itself during a period of unusual mental or physical strain, with the difference, however, that as the excitement of a manicdepressive increases he becomes more and more» zealous in his work, oversteps the limit of his authority and over estimates his strength and ability, while the precox gradually loses interest in his work, becomes indifferent, apathetic and often hypochondriacal. These patients, on admission to a hospital, usually give a long history of having drifted from one occupation to another, their failing efficiency being evidenced by a gradual decrease in salary. Tn view of the fact that more than one-half of the permanent population of hospitals for the insane is composed of cases of dementia precox, it would seem that this class of cases offers the best field for operations in ergotherapy. The importance of preventing habit deterioration by early and systematic cultivation of the work habit is evident. Perhaps the first hospital in the United States to make any attempt to progress along this line was the Taunton State Hospital, Massachusetts. Dr. George C. S. Choate, the superintendent, in bis Annual Report of 1854, gave it as his opinion that two-thirds of the patients in his hospital were capable of employment of some sort. Although the work there has been allowed to lapse somewhat from time to time, the report of that hospital for 1912 shows that seventy-four per cent, of the patients are working. In the New York state hospitals considerable work is being done in the re-education of advanced cases of dementia precox, with good results. At the Government Hospital for the Insane, Washington, D, C, a series of ex-pertinents were undertaken by Dr. Helen Grace Kent and Mr. E. G. Boring, to ascertain the extent to which this re-education could be carried. The principle conclusions drawn by Dr. Kent from several months' work were: "(1) Definite practice effects can be obtained by means of a short series of tests from advanced cases of dementia precox. (2) Practice effects are transferable from one kind of work to another, differing in perpetual but not in motor aspect. (3) Energy expended in mischievous performances may be directed into favorable channels." Mr. Boring's experiments, which included the teaching of rug making, showed similar results, with the additional conclusion that, "Patients suffering from dementia precox are capable in simple industrial operations of a quality of work sufficiently good to be of commercial value." These experiments, which consisted of arranging and cancelling digits, identifying geometrical figures, solving maze puzzles, etc., had the disadvantage, with the exception of the rugmaking, of lacking appeal to the patient's esthetic or industrial sense. They could see nothing to be gained by such exercises, and consequently lost interest. To re-educate the vast army of demented patients in our hospitals for the insane, would be a task which would involve an expenditure of time, energy and money which, in all probability, would not be warranted by the results obtained. The new cases of dementia, precox can, however, with comparatively little trouble, be directed into better paths, to the end that the chronic wards in hospitals for the insane will be Idled with patients who, although demented, will be quiet, tidy, industrious and contented. THE The various types of nasal deformity require entirely different operative procedures for their correction. The simplest type is that of the fracture-dislocation of the nasal bones, and the operation required in such cases consists in a re-fracture and then a reduction of the dislocation. A second type is exemplified in the lateral deviation of the cartilaginous portion of the nose. Another type may be noted in the aquiline deformity which requires a special technic for reduction* The irregular humps often
doi:10.1056/nejm191408201710803 fatcat:rdr5t3kswfhbpiclgkba5qs36a