face, and mentions dull pain over the left lung, and a spot of burning sharp pain over the right nipple. Upon examination of the chest we note, on palpation, expansion of chest is impaired; on percussion we find dulness at left apex and middle of lung, and at the right apex, posteriorly; and at the right and left apex anteriorly. On auscultation, posteriorly, we note feeble respiration with prolonged expiration at right apex, with bronchial breathing at left apex ; while anteriorly at nipple we perceive a friction-sound.

Diagnosis.-Tubercular phthisis, with a spot of local pleurisy over right upper lobe.

Treatment.-Cod-liver oil, f3ss. (16 cc.); syr. ferri iodid. gtt. xxx (2 gm.) t. d. ; diet plain, concentrated, and nutritious; externally, tr. iodine over the site of diseased structures.

Original Communications.

THE TREATMENT OF FRACTURE OF THE LOWER
END OF THE RADIUS.

BY RICHARD J. LEVIS, M.D., OF PHILADELPHIA,
Surgeon to the Pennsylvania Hospital, etc.

AT the meeting of the State Medical Society of Pennsylvania, in May, 1879, I had the honor of presenting a splint which, in my opinion, fulfilled all the necessary indications in the treatment of fracture of the lower extremity of the radius, and of offering the following remarks, the truth of which has been confirmed by subsequent experience:

The correct nature and mechanism of the ordinary form of fracture of the lower end of the radius is now, after much controversy, generally admitted and properly comprehended. With this proper understanding the indications become rational and decisive.

In the usual and very characteristic fracture of the carpal end of the radius, the primary line of fracture is, with little tendency to deviation, transverse in direction. Associated lines of fracture are generally those of comminution of the lower fragment, and are caused by the upper fragment being driven vertically into it and splitting it, usually in directions towards its articular surface. The displacement of the lower fragment is towards the dorsal aspect of the forearm, and its articular surface is inclined in the same direction, abnormally presenting backwards and upwards.

The mechanism of the fracture is its production by falls upon the palm of the hand, which, with the carpus, undergoes extreme extension, and the fracture is caused by an act of leverage, or transverse strain. This direction of force has also been called cross-breaking strain.

In this fracture actual displacement of the

lower fragment may not exist at all, or it may be to the extent of complete separation from contact of the broken surfaces, varying with the amount of force applied and with the retaining influence of the surrounding dense structures.

The first essential of the treatment of fracture of the lower end of the radius is the complete reduction of the displacement. The action of replacement must be directed to the lower fragment itself. The reduction of the fracture can usually be thoroughly effected, under anæsthesia, by strong extension applied to the hand, associated with forced flexion of the wrist. Unless vertical splitting or comminution of the lower fragment exist, the maintaining of partial flexion of the wrist, with pressure of a pad on the dorsal surface of the fragment, will prevent return of deformity.

With the object of retaining the apposition of the fractured surfaces, by overcoming displacing forces, I have practiced for many years on the principles involved in the splint here illustrated, the application of which will not require much description.

correct position with reference to the radial

curve.

The splint is made of copper, so as to be readily conformable by bending to suit the peculiarities of size and form of forearms. The series of little pointed elevations along the edge is for the purpose of keeping the bandage from slipping. It is tinned to prevent oxidation. The splint will usually fit the forearm so accurately that but little padding will be required, and a piece of woven lint or of cotton or woollen flannel is all that is necessary for its lining. No dorsal splint is needed, but, as before referred to, a small pad will, in most cases, be required over the dorsal surface of the lower fragment. For retention of the splint an ordinary bandage, two inches and a half to three inches wide, is all that is necessary.

This splint has the merits of being applicable to all cases of fracture of the lower end of the radius, and also to many other injuries involving the forearm and wrist; it is almost indestructible, and, as now supplied, is very inexpensive. It may be obtained by addressing any of the leading surgical instrument

makers.

College Reminiscences.

THE FIRST GRADUATE OF THE SCHOOL. In a letter received by the writer of this notice in 1873, from Dr. M. L. Knapp, originally of New York, but at that time a resident of Mexico, the following claim of priority is advanced by him: "You will find my name in the list of graduates of the First Class, year 1826, and although not alphabetically first in order, I am technically the first graduate of the school. My thesis was the first handed in to the Dean ; I was the first examined, and was understood by the Professors and Class to be the first graduate." News has just been received of the death of Dr. Knapp, at Cadereyta, Nuevo Leon, Mexico. The letter announcing his death, written by his daughter, states that "Dr. Knapp was the third in order to receive his diploma in 1826, the first year of the existence of Jefferson Medical College. According to Dr. Knapp's understanding, he was to have been the first graduate, but Dr. McClellan and another professor had each promised a student the same favor, so a compromise was made by accepting Dr. Knapp's thesis first and awarding him his diploma third. All the names and vacancies in the diplomas awarded that year were filled in by Dr. Knapp, and none of the numerous graduates of dear old Jefferson ever cherished a more ardent affection for his Alma Mater than did our loved and honored father. A worthy son of Erin on

applying to him for employment was brought to the notice of the professors, who forthwith appointed him janitor, and many years later, in 1857, when in Philadelphia, Dr. Knapp on visiting the college was ushered in by the same faithful servant [the well-known janitor, William Watson.-ED.], who had grown gray in the service, and had married and reared a family on the simple salary allotted him. In 1857, whilst in Philadelphia publishing his work, known as Knapp's Pathology, Dr. Knapp sustained a severe hæmorrhage of the lungs, and was treated by his cherished old friend, Dr. Paul B. Goddard, who told him his time had not yet come, and succeeded in giving him relief. In 1862 he sought this congenial climate, and true to the principles set forth in his Pathology, prolonged his life for twenty-two years by a diet of succulents and fruits (goat's milk, oranges, and sweet potatoes, especially), and paid his last tribute to Nature surrounded by two daughters, three granddaughters and loving friends, from an acute attack of pneumonia, on the 21st of November and the eightieth anniversary of his birth."

His thesis on "Apocynum Cannabinum" was the first ever published by the Jefferson Medical College, and is referred to in the United States Dispensatory and in Pereira's Therapeutics and Materia Medica. He attended a vast number of the outdoor patients of the Free Dispensary opened in the Prune Street building during the summer of 1825. Faithful till death to the interests of my beloved Alma Mater," was the phrase which concluded his letter of 1873.

Our Library Table.

66

PARACENTESIS OF THE PERICARDIUM: A Consideration of the Surgical Treatment of Pericardial Effusions. By JOHN B. ROBERTS, A.M., M.D., Lecturer on Anatomy in the Philadelphia School of Anatomy; Demonstrator of Anatomy in the Philadelphia Dental College; Fellow of the Philadelphia Academy of Surgery. With illustrations. Philadelphia, J. B. Lippincott & Co., 1880. Pp. 100, 8vo., cloth. Price, $1.25.

It is with pleasure and pride that we announce the appearance of this monograph; with pleasure, not only because it will always afford us especial gratification to call attention to the achievements and honors of Jefferson men, but also on account of the delight we have experienced from a perusal of this little work; we announce it with pardonable pride because of its great intrinsic merit and classical character.

Dr. Roberts, having discovered a corner of the field of practical medicine to which but little attention has been directed, and, as he correctly conceived, regarding which some erroneous and injurious opinions had heretofore prevailed, has proceeded systematically to go over the ground, to study the individual cases, collate them, and compare the results of treatment, in order to rescue a legitimate procedure from the domain of doubt and disuse.

In this monograph, which we believe to be the only one in the language upon this subject of practical interest to both surgeon and physician, the author has systematically considered (1) the causes of pericardial effusions, the varieties and quantity of fluid; (2) the symptoms of pericardial effusions, physical signs, diagnosis and prognosis; (3) treatment by paracentesis pericardii, history of the operation, anatomy, cases suitable for operation; (4) methods of operating, the questio vexata of the point of puncture; (5) dangers to be encountered, objections, complications; (6) table of cases, and the results of the opera

tion.

Dr. Roberts prefers Fitch's dome trocar for use, with the aspirator, and selects for the position of tapping the fifth interspace, about five to six centimeters to the left of the middle line of the sternum, in the adult. Of sixty cases, which he has tabulated, twenty-four recovered, or a proportion of 40 per cent. saved by the operation, which is a more favorable showing than would have been expected from an operation that is confessedly a dernier ressort. It is a result that comes as a revelation to many who had previously given the subject but little thought, and rather warrants the moderate burst of enthusiasm with which the author shakes hands with the reader in his concluding paragraph.

We have no adverse criticism to make upon this valuable essay, but only will venture to express the hope that in a succeeding edition Dr. Roberts will be sufficiently patriotic to deDr. Roberts will be sufficiently patriotic to devote a little more space to Dr. J. H. Warren's case, tapped in 1852, which was the first time the operation had been performed in America, and more especially as it was successful (five ounces having been withdrawn, the patient recovered so that he was able to leave the hos pital in a few weeks). It is remarkable in this connection that the first case on record (per formed by Romero prior to 1819) was also successful, although the opening was made by a bistoury and scissors, and presumably without "full antiseptic precautions."

To those who have cases of pericarditis under treatment, and to those who expect to have them, the information contained in this work will be valuable, if not indispensable. F. W.

THE HEART AND ITS DISEASES; WITH THEIR TREATMENT, INCLUDING THE GOUTY HEART. By J. MILNER FOTHERGILL, M.D. Second edition (entirely rewritten), with illustrations. Philadelphia., Lindsay & Blakiston, 1879. Pp. 471, 8vo., cloth. Price, $3.50. The practical character of Dr. Fothergill's works is generally acknowledged and widely appreciated. The success that has met them, however, has been well merited by his phenomenal industry and recognized ability, whose fruits are displayed on every page. The value of the present work is greatly enhanced by the author's clear powers of analysis of what have been considered some of the more obscure general conditions, and the clearness of his explanations of the almost mechanical relationship between these and heart disorders. The great increase in the resources of modern medicine, and in our ability to detect and relieve diseased conditions, is exemplified in no department of clinical medicine to a more marked degree than in cardiac disorders. This subject has been so well tilled as to resemble an oasis when compared with the barren wilderness still unreclaimed, but which in many parts will yet be made to blossom as the rose by just such work as the book before us exemplifies. To those who wish a clear understanding of the pathology of the heart, and the accepted methods of diagnosis and treatment, we confidently recommend the purchase and study of this book. F. W.

NOTES ON FEVER NURSING. BY JAMES W. ALLAN, M.D., Superintendent Glasgow Fever Hospital. Philadelphia, Lindsay & Blakiston, 1880. (From Presley Blakiston.) Price, $0.75.

This useful little work of sixty-four pages is the outcome of instruction prepared for the guidance of the nurses at the hospital named; but the information conveyed in it is applicable as well to private practice. The proper distinction is made throughout between the nurse and the physician, all that concerns the former being made subordinate to the direc

tions of the latter. Mention, for instance, is made of the medical treatment, but only in an outline way to impart to her an intelligent appreciation of her duties.

will be noticed in a succeeding number of the THE following works have been received, and

CLINICAL RECORD.

THE THEORY AND PRACTICE OF MEdicine.

Third American from Fourth London Edition. By F. T. ROBERTS. Lindsay & Blakiston, Philadelphia. Price $5.

TRANSACTIONS OF THE AMERICAN MEDICAL ASSOCIATION, vol. xxx. 1879.

It would seem almost necessary, at the moment of ushering another candidate for professional favor into the already plethoric world of medical journalism, to state the special claims it offers, and the objects it strives to attain. The CLINICAL RECORD has been instituted more particularly for the purpose of conveying to those interested the most reliable intelligence of current affairs at the Jefferson Medical College, and of furnishing a means of intercourse between graduates of the school. Of these there are probably six thousand now engaged in the active and honorable practice of their profession in different parts of the country. It is especially intended to impart to the graduates and students of the College accurate and elaborate reports of the medical, surgical, and gynecological clinics held by the members of the Faculty and Hospital Staff, with notes of peculiarities of treatment of cases in the hospital of the College. The editors are two of its graduates, who are keenly sensible of the desirability of preserving as much as possible of the valuable instruction of the "Old Jeff," as it is familiarly known.

The CLINICAL RECORD has no organic connection with, nor would it presume to represent that institution. It will not be under the control of any clique, nor be used to subserve any private ends, but will be carried on in the interest of the graduates of the school, with the view of supplying them with such items of information in connection with their Alma Mater,

and such facts of general professional concern, as they will be most likely to appreciate.

They feel satisfied that such a journal will meet an existing need, as they are in constant receipt of letters from graduates of the school, in all sections of the country, desiring to be informed of the welfare and progress of the College. They are, therefore, fully convinced that its graduates, students, and friends generally, will gladly second them in their ef forts to preserve in a tangible shape, for convenience of study and future reference, the rich store of valuable material, the benefits of which have heretofore been restricted to those who were in actual attendance upon the lectures.

It is intended in the columns of this journal to give especial prominence to the following departments:

PHONOGRAPHIC Reports of Clinical LecTURES BY PROFESSORS GROSS, DA COSTA, BARTHOLOW, WALLACE, PANCOAST, AND THE MEMBERS OF THE HOSPITAL STAFF.

NOTES OF PECULIARITIES OF TREATMENT IN THE COLLEGE HOSPITAL, AND RECORDS OF SOME OF THE MORE IMPORTANT CASES.

INTRODUCTORY AND VALEDICTORY LECTURES OF THE COURSE.

BIOGRAPHICAL SKETCHES OF THOSE CONSPICUOUSLY IDENTIFIED WITH THE HISTORY OF THE COLLEGE, AND OF ITS PROMINENT GRADUATES (WITH AN OCCASIONAL PORTRAIT).

NEW REMEDIES, AND THEIR THERAPEUTICAL APPLICATIONS IN THE CLINICS.

PROCEEDINGS OF THE ALUMNI ASSOCIATION. INTERESTING CASES IN THE PRACTICE OF GRADUATES OF THE SCHOOL.

HISTORICAL REMINISCENCES OF THE COL

LEGE.

CURRENT EVENTS AND GOSSIP ABOUT THE COLLEGE.

CORRESPONDENCE.

MATTERS OF GENERAL MEDICAL INTEREST. NOTES AND QUERIES.

STUDENTS' DEPARTMENT.

MISCELLANEOUS AND PERSONAL ITEMS.

MARRIAGES AND DEATHS OF GRADUATES OF

THE SCHOOL.

OBITUARY NOTICES.

REVIEWS OF Books.

BOOKS AND PAPERS RECEived.

dry details of the physical properties of drugs in all their minutiae are only lightly touched upon, in comparison with the more important principles of therapeutics, which receive elaborate discussion and consideration. The large ex

reach.

THE TEACHING OF THERAPEUTICS.

THE mode of teaching Therapeutics and Materia Medica at the Jefferson Medical College has greatly varied, even in the experience of graduates of the school of not very long standing. Some of our readers may possibly recall the earlier teachings of the first professors, which were probably after the routine methods of those and even of later days. Perhaps the first innovation in these methods was that made about forty years ago, at the time of the secession of the professor of those branches by appointment to another school, at a period of the year when it was too late to make a new appointment to fill the vacancy. Professor Dunglison for a whole session lectured on these subjects, in addition to his regular course on Institutes of Medicine, but combined the two chairs in such a way as to impart to his class a knowledge of the physiology of the various organs and at the same time the therapeutic action exerted upon these organs by the different articles of the Materia Medica. Professor Robert M. Huston, who occupied the chair for many years after, gave much time to the physical properties of drugs, in connection with their therapeutical applications, and this plan was followed by Professor John B. Biddle, whose death in 1879 was so sincerely deplored by the students and profession at large. The method pursued by Professor Thomas D. Mitchell, who for several years after the loss of Professor Huston taught these branches, was unique in one respect, in that the whole range of the Materia, Medica was taught in alphabetical order; assuredly an unphilosophical arrangement, because it admitted of but little therapeutic classification of remedies, and gave no clue to the student as to the choice of an article from a group of similar therapeutic efficacy. writer of this article well remembers listening to a lecture delivered by him, which included the following diversified programme: Ferrum, Fennel, Fish, and Flannel.

The method adopted by the new professor of these branches, Dr. Roberts Bartholow, is

1

tioner is made to bear rich fruit as thus imparted to the hundreds of students who are his almost daily listeners. A group of remedies, of similar physical properties, is considered as a whole in their therapeutical actions, rather than elaborated individually. Of course the most important articles, such as quinine, opium, etc., receive separate and distinct notice, but the trivialities of the Materia Medica are left to be learned in the after-experience of student or professional life; in other words, the course is a thoroughly practical one, imparting many a useful lesson which the practitioner of the next or the succeeding year-now the student of to-day-will treasure up for his own guidance.

THE CHAIR OF PHYSIOLOGY AT THE COLLEGE.

By unanimous vote of the Faculty and the concurrence of the Board of Trustees, Dr. Henry C. Chapman, Professor of Physiology at the Pennsylvania Dental College, was invited to continue the course of lectures interrupted by the death of Professor Meigs, who delivered his last lecture November 1st, 1879.

The appointee for two years has been connected with the College as Demonstrator of Experimental Physiology. This position he obtained chiefly through the kind efforts of Professor Meigs, whose friendship and confidence he possessed to an unusual degree. He had also lectured upon the same subject in the spring and summer course with general satisfaction.

In 1864 Dr. Chapman was graduated from the Department of Arts of the University of Pennsylvania; in 1867 he took his degree at the Medical Department, and ten years later he formally passed his examination and received his diploma from the Jefferson.

After a course of study in Europe, where he made the acquaintance of Professor Stricker, Claude Bernard, Mr. Flower, of the London College of Surgeons, and Mr. Owen, of the British Museum, and others, from whom he received complimentary letters, he returned to Philadelphia, where he was Resident Physician at the Pennsylvania Hospital for two years. He then engaged himself in lecturing at the University, and during theprolonged illness of the late Professor F. G. Smith delivered a Smith delivered a course of lectures upon