An Account of a Complete Luxation of the Thigh Bone, in an Adult Person, by External Violence; By Mr. Charles White, Surgeon, at Manchester. Communicated by George Lloyd, Esq; F. R. S.

degree necessary to congeal the mercury; which Mr. Zeicher also at length obtained; the degree of cold of the air being the 175th degree of De Lisle's thermometer, or the 30th of that of Fahrenheit. LXV. An Account of a complete Luxation of the Thigh Bone, in an adult Person, by external Violence; by Mr. Charles White, Surgeon, at Manchester. Communicated by George Lloyd, Esq; F. R. S. Read May 1, 1760. As Robert Hogg, (a farmer in Clyfton, about four miles from Manchester) a strong, robust, middle-aged man, was taking a load of wheat from off a horse, on the 20th of March 1759, his foot slipping, he fell backwards; his breech upon the pavement, and the load of wheat upon his belly and thighs. The servants carried him into the house, and laid him upon a bed, where he remained in the most racking torture, when I came to him, which was about two hours after the accident happened. I found his right buttock as large again as the other; the knee and foot of the same side turned inwards; and the thigh much shortened. Upon endeavouring to make the thigh perform its rotatory motion, there was not the least crackling to be heard. This convinced me, that the head of the bone was thrown out of the acetabulum; and, upon examination, I could distinctly feel it under the glutæi muscles: to which situation of it, and not to any bruise, bruise, I was now satisfied that the size of the buttock was owing. I soon reduced it, by the following easy, and very simple method. Some napkins being first lapped round one of the posts at the foot of the bed, to prevent its galling him, I ordered the patient to be laid upon his back, with one leg on each side the post, and then directed three or four assistants to pull at the dislocated limb, the post now placed to his groin being a fixed point to pull against. Whilst they were making this extension, I clapped my left hand upon the head of the bone, to help it into its place; and, at the same instant, with my right hand, turning the knee outwards, threw the bone into the socket, with the greatest facility imaginable, but with such an uncommonly loud noise, as greatly astonished all who were present. He was perfectly easy from that moment; the enlargement of the buttock entirely subsided. In a fortnight, he was able to move about, without assistance; and in two months afterwards walked as far as Manchester, being then quite sound; and the limb, that had been dislocated, of the same length with the other. **Remarks.** Both antients and moderns have fallen into great errors, in regard to the treatment of accidents, that have happened to the hip joint. The antients, who, for want of frequent opportunities of dissecting bodies, were ignorant, that the neck of the femur was often broken, always imagined it to be luxated. Their patients patients were, therefore, sometimes tormented, (in hopes of a reduction) without any advantage; and this want of success made the surgeons, at other times, abandon their patients, when they might have been relieved. The moderns have fallen into a contrary extreme, but attended with as bad consequences. Boerhaave, in particular, was of opinion, that there never was a dislocation of the thigh bone by any external violence, but that the head of it was commonly broken off at its neck, near the great trochanter. The opinion of so learned a man has had such weight with the generality of the profession, that it has been taken for granted, that, in these cases, the neck of the bone was always broken: consequently, the reduction was seldom attempted, and the unfortunate patients remained cripples during the rest of their lives. But the point is now, I think, cleared up, beyond the possibility of a doubt. In the second volume of the memoirs of the royal academy of surgery at Paris, there are two cases related, to shew the resources of nature, where luxations of the thigh bone have not been reduced. Here it appears, (from examination after death) that, in the first case, the bone was thrown out upwards and outwards, the cotyloid cavity greatly diminished in size, and its figure changed from round to oval. The head of the femur was received into another cavity formed upon the os ileum, under the glutæus minimus, which served it as a capfula, to secure it within this preternatural cavity. This accident was occasioned by a fall, when the patient was a child. She was afterwards able to walk about, though she continued a cripple to the time of her death, which happened happened at the age of sixty-eight. In the other case, the bone was luxated downwards and inwards, and the head fixed upon the foramen ovale. There is a case too related, and very well attested, in the Edinburgh essays, philosophical and literary, vol. 2d, of a man at Worcester, who had the head of the bone thrown out of the acetabulum, and lodged in the groin. It was with some difficulty reduced, and the man suffered no other inconvenience, than that of the leg's being about a quarter of an inch longer than the other. To these, let me add, that, about thirty years ago, my father was sent for to a man, who had luxated his thigh bone three or four days before. The head of it lay in the groin, which the surgeon, who was first employed, did not discover. However, it was immediately replaced, and the patient recovered the use of his limb, in a very short time. From what I have said, I would by no means have it concluded, that the neck of the bone is not sometimes broken, or that it is not even oftener broken than luxated: but, from the case, which has fallen directly under my notice, joined to those, which I have above recited, I think it must appear very clear, that it has been frequently luxated, and that two different ways. C. White.