240 Complicated Fracture of the Trochanters. 



farther examination of the arteries was made. The 

 ends of the lower ribs and their cartilages, were, on 

 both sides, considerably enlarged, and unnaturally pro- 

 jecting. There was a large (Edematous swelling on the 

 depending part of each side of the neck, and on the arms 

 large steatomatous tumours. All these circumstances I 

 have thus minutely detailed, because they manifestly 

 indicated the existence of an extremely depraved state of 

 the patient's system, previous to death. 



Thus have I given you a circumstantial history- of 

 this interesting case, which has already become more 

 prolix than I intended, so that I shall offer but few 

 comments on it. 



From the anatomical structure of the parts surround- 

 ing the upper end and neck of the os femoris, it is not sur- 

 prizing that fractures of these parts in adults are so dif- 

 ficultly ascertained, and that the precise point of disso- 

 lution should almost always be ambiguous. In oblique 

 fractures, particularly of the head and neck of the femur, 

 the tendency of the large muscles in which it is im- 

 planted to take on a powerful and rigid contraction, 

 and the facility with which the exertion of coughing, 

 sneezing, and any alteration in the position of the body, 

 communicate motion to the thigh, are circumsta 

 which render it extremely difficult to retain them in 

 their proper state of reduction. Hence surgeons more 

 frequently find themselves disappointed in effecting a 

 cure of these fractures, without deformity, than in those 

 of any other of the bones of the extremities. Indeed, 

 Mr. John Bell unequivocally asserts, that no ingenuity 



