Philosophical Transactions. For the months of July, August and September, 1716. - Part VIII.

Ⅷ. Observations on the glands in the human spleen; and on a fracture in the upper part of the thigh-bone. By J.Douglass, M.D. and R.S.S.

That anatomy, as well as physick and surgery, has received much improvement from a careful and true observation of what was found in the dissection of morbid bodies, will appear from the two following instances, among many more that might be adduced for that purpose. For it is certain, that nothing has contributed so much towards forming a right notion of nature of the several diseases, and a true knowledge of the structure of many parts of the human body, as their appearance in a preternatural state.
My first observation is of the glands visible to the naked eye, that appear dispersed thro' the fibrous substance of the human spleen. The subject I found them in, was a boy of about 4 or 5 years old, that died of general atrophy, or consumption of all the muscular fleshy parts of the body, occasioned without all doubt from the numerous glandulous swellings scattered up and down the whole mescentery; which by compressing the lymphatick vessels, called in this place vasa lactea, prevented the access and supply of the chyle, so necessary for the continued nourishment and increase of the parts. For without the constant recruit of this whitish balsamick liquor, the mass of blood will in a short time be unfit to perform any of those good offices, which a fresh accession of chyle qualifies it for.
In a piece of this spleen we might see, without the assistance of a glass, several round whitish bodies of a pretty hard consistence, and abundance of small white and softer specks; but both of the same nature. These, to me at least, appear to be so many distinct glands become visible; which in a natural state are only to be seen by a fine glass, as the curious malpighius first observed. Vid. his treatise de Liene, Cap. V. de quibusdam corpribus per lienem dispersis. Minima ha glandula, says he, non aque facile sese produnt in quocunque animalium liene; imsola Lienis laceratione innotescunt in Bove, Ove, &. In homine vero dissicilius emergunt; si tamen ex morbo unlversun glandularum genus turgeat, manifestiores redduntur, auita ipsaraum magnitudine, ut in defuncta puella observavi; in qua lien globulis conspicuis racematim dispersis totus scatebat. Which case was the very same with mine.
The second observation. We had still been in the dark, about the nature of luxation of the head of the thigh bone, had we not carefully examined the part in the dead body. For by that sort of enquiry, the common mistake of surgeons was detected, and what was esteemed and treated by them as a luxation of the head of the femur, was discover'd to be nothing else but a fracture of the same bone, near its neck; the globular head being still retained close in its own socket, called the acetabulum coxendicis.
Amongst all the writers of surgery and anatomy, I know but three that were apprised to this mistake. The first was Ambrose-Parec, the second Dr. Ruysch at Amsterdam, and Mr Cheselden, a member of the Royal-Society; whose obvervations on this subject I intend to communicate at another time, together with an account of the true structure of this joint; all in which I will consider the depth of the articulation; the wonderful strength of the muscles that surround it; the many strong ligaments that bind the head within the socket; the smallness of the neck of the bone; its poreous and spungy substance, which makes it much weaker than the rest; and last of all the disadvantages oblique position of this neck, which exposes it the more to outward accidents. From a review of such like considerations, it will plainly appear that a fracture can much more easily happen, than a dislocation in that part from an external cause.
This os femoris belonged to an old woman turn'd of fourscore, who only fell from her chair whereon she was sitting, and thereby suffered this breach of continuity in the substance of the bone. She lived three weeks after it; and tho' it never was reduc'd ,yet she complained of very little or no pain, which may seem very extraordinary. It is observable that the fracture is not only oblique, near the neck of the bone; but that each trochanter, i.e. the two processes near its cervix, are likewise broke short off; and that they were both drawn up almost as high as the head of the bone itself, by the strong contraction of the glutci and other muscles.

A pdf version of the entire text of the Philosophical Transactions of the Royal Society of London can be found here (this article begins on page 499).

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