To Illustrate Dr. Ruth's Article on "Fracture of the Femoral Neck; FIG. 12. Represents the proper position of the bed, foot raised and the injured side raised so that the patient's body weight will make the counter extension. No other or complicated apparatus is ever needed or indicated. For a robust adult the weight on the foot will need to be, at the first, from 20 to 30 pounds, the lateral pull 10 to 20 pounds, reasonable care in the adjustment of sufficiently extensive, non-irritating, adhesive material so placed as not to cause constriction of the circulation, proper adjustment of the spreaders at the foot, support of the leg to take the weight off the heel, adjustment of the properly padded bindersboard fixed by adhesive to the upper-inner part of the thigh and with spreader to prevent pressure upon the long saphenus, with frequent raising of the patient to the sitting posture, particularly if aged, will meet and prevent nearly all annoying complications. muscles above the fracture line in such manner that they can no longer force soft parts between the fragments. (See Figures 1, 2, 13 and 14.) Plaster casts of whatever form are in the obsese perfectly loose within three or four days and in the feeble are liable to chafe severely and in hot weather are very irksome in all cases. No form of splint can entirely overcome the displacing forces of weight and muscle action. AUTHORSHIP ACKNOWLEDGMENT. Since submitting the foregoing article for publication, my attention was called to a paper on "Fractures of the Neck of the Femur," written by Dr. Gwilym G. Davis of Philadelphia and published in the October number of the Annals of Surgery. In this article the statement is made that a surgeon named Phillips first called attention to the lateral and longitudinal method of treatment of intracapsular fractures of the neck of the femur. I immediately began a search of the literature and find that Dr. G. W. Phillips of Dixon, Illinois, published an article pertaining to this subject in the American Journal of Medical Sciences for October, 1869. In this article Phillips not only reports a case occurring August 10, 1867, as treated by lateral and longitudinal extension and counter extension, but illustrates the method by the use of a wood-cut. He employed, also, a wooden splint which extended from the ankle to the axilla. In the Chicago Medical Journal and Examiner for May, 1876, occurs the first article written by Dr. T. J. Maxwell on the subject of intracapsular fractures of the femur. Maxwell reports his first case which occurred on January 14, 1871, and toward the close of his article makes the statement that the method is not original with him but that he obtained the idea from an article (undoubtedly Phillip's) published in the American Journal of Medical Sciences. Maxwell, however, discarded the use of the side splint since it added nothing to the treatment but only increased the discomfort of the patient and rendered an inclining or sitting posture impossible. In the perusal of Maxwell's subsequent writings I have been unable to find where he has ever given credit for the authorship of the method other than to himself, nor to my knowledge did he ever allude to a priority claim in any of the numerous lectures and discussions which he gave on the subject. So to Dr. Phillips must belong the honor and credit of first describing and using this method of treatment unless Fate in her mysterious manifestations should decree that he too erred, and some student of medicine unearths a claim prior to the one now recorded. I wish to express my appreciation not only to Dr. Davis, whose article made possible at this time the readjustment in the authorship of the method which I have always termed the "Anatomic Method," but to his colleague, Dr. A. P. C. Ashhurst, who so ably brought out some very salient points in his discussion of Dr. Davis's paper which better enabled me to obtain the proper literature on the subject. |