VOL. LI.} PHILOSOPHICAL TRANSACTIONS. 4Q7 



ward ; and the whole limb, from the head of the femur to the toes end, distorted 

 in proportion. 



Mr. Y. thought it was very evident at first sight, that there must be either a 

 fracture of the femur, or a dislocation of its articulation with the ischium. The 

 former he thinks would have been easily discoverable. But as by laying his 

 hand on the great trochanter, while an assistant turned the foot inward and 

 outward alternately, he could perceive that the motion of the great trochanter 

 corresponded exactly to the motion of the lowest end of the femur, he concluded 

 that had there been a fracture, it must have been between the great trochanter 

 and the head>>f the bone. And had this been the case, he expected to have 

 been able to discover it, by the grating that is always to be felt, when the 2 

 broken ends of a bone are moved against each other. But no such thing being 

 perceivable, and yet the limb so much distorted, and the pain so violent, and 

 confined to the parts about the joint, he took it for granted, and pronounced 

 the case to be a dislocation of the femur; and consequently endeavoured to re- 

 duce it by the usual method of extension. To this end, 2 men extended the 

 limb, by pulling on napkins tied round the ancle, while others counteracted 

 them, by pulling at a sheet passed between his legs, and secured at the bed's 

 head, turning the foot outward as they made the extension. This gave him 

 great pain ; but the limb soon became in every respect parallel to the other. It 

 appeared as long, and on laying it down on the bed, the great toes and heels of 

 lx)th feet lay exactly in the same position ; and the only difference he could per- 

 ceive in the 2 limbs was, that there was a little flatness about the hip of the right 

 side. In short, the difference between the 2 limbs was so little, that he began 

 to think he had been mistaken in his opinion of a dislocation (for it was evident' 

 there was no reduction made by the extension, for that could not but have been 

 perceived both by the patient and himself) and that the distortion of the limb 

 was owing to nothing else than an involuntary contraction of the muscles, occa- 

 sioned by the violence of the blow. He therefore bled him, confined him to lie 

 on his back, and charged him to move as little as possible, imagining that rest 

 would be his most effectual remedy. He continued in much pain for some days; 

 but by degrees grew tolerably easy, except when the limb was moved; and at 

 about 1 2 days after the accident, he could suffer the limb to be lifted to and fro 

 gently, with little or no pain at all. Notwithstanding which, he could no more 

 lift it of itself than at first, when it was much more painful. This embarrassed 

 Mr. Y. good deal. He was convinced there was no fracture of the limb in any 

 part; and thought from the circumstances above related there could hardly be a 

 dislocation. He therefore desired the opinion of 2 other surgeons, who on see- 

 ing the position of the limb, and inquiring into all the circumstances, which did 

 and had attended it, agreed with him in opinion, that it was no fracture, and 



VOL. XI. 3 S 



