Page:Cyclopaedia, Chambers - Supplement, Volume 2.djvu/636

 T H I

T H I

T*HETES, ©nV, in antiquity, the Weft clafs of people at Athens. Ariftides repealed Solon's law, by which the Thetes were made incapable of bearing any office in the government. Potter, Archffiol. 1. i. c. 4. p. 16.

THE VET, a name of one of the Hebrew months, anfwcriugto our December moon. See the article Tebet.

THEXIS, a word ufed by the old medical writers, fometimes for wounds made by puncture with (mall i nft.ru merits, and fometimes for the operation of the future, or the fowing toge- ther the lips of a wound, to make it heal with a lefs fear.

THIGH (Cycl.) — THiGH-Bone. Wehave an account in the Philofophical Tranfactions of a large piece of a young man's 'Thigh-bane being taken out, and the place fo well fupplied by a callus, that he walked {trait. See N°. 461. Sect. 2.

FracluredTniGn-Bone. The Thigh-bone, though the large ft and ftouteft in the whole body, is yet frequently broken, both near its middle, and towards its ends or articulations 5 but more particularly near that part ufually called its neck, near its articulation with the hip-bone; and when this is thecals, it is very difficult to fet it, and retain it in its place. When the bone is broke in two places at once, which fometimes happens, the danger is yet much greater ; and if the patient, in this cafe, efcapes death, which he feldum does, he is commonly lame, ever afterwards.

Sometimes this bone is broken tranfverfelv, fometimes ob- liquely, and at other times the ends flip a great way over one another, which makes it a very bad cafe ; for the mufcles of this part being very robuft, and itrongly contracted, draw the lower end of the bone with a confiderable force upwards, fo as to make it require great ftrength to extend and replace it.

The oblique fracture of this bone more frequently flips out of its place again than the tranfverfe, and generally leaves the Thigh fomewhat fhortcr than the other, notwithstanding all the caution the furgeon can ufe in the letting it. It is there- fore neceffary, in thefe cafes, befide the means that are com- mon to all the fractures, to u(n a more Uriel and tight ban- dage in this than in the tranfverfe fracture, to prevent the bones from being eafily removed. When a fracture of die Thigh- bone happens near its middle, or towards it lower head; it is to be extended and replaced with the hands like other fractures, except that the extending force required is very great; and where the hands ofaftrong aflutant arc not enough, flings, napkins, or linnen bandages, are to be bound round each head of the Thigh, whereby the fractured bone may be extended both ways, by the ftrength of three or four perfons at once, while the furgeon cautioufly reduces the fracture with his hands, and feeures it with a proper bandage and drcfling ; there are fometimes cafes where the joint ftrength of three or four men, applid in this manner, are not fufficient to make the neceffary extenfion ; in which cafe the furgeon is obliged to- have rccourfe to ropes and pullies, by means of which one man will pull more forcibly and equally than feveral can with- out them. But cafes that require this treatment are not com- mon. ' When the neck of the Thigh-bone is fractured, to which, from its oblique or tranfverfe direction, and fpongy or brittle fub- ftance, it is very fubject ; it makes a fracture not only very difficult to reduce, but fuch a one alto as can feldom be cured without leaving the limb fhortcr than it was before. The rea- fons of which arc, that the fragments cannot but with great difficulty be preflcd into their right places, by reafon of the great thicknefs and ftrength of the mufcles which cover them; and that it feldom happens that the bones can be retained in their natural pofition, after they have been ever fo well re- duced ; becaufe the mufcles which pafs over and are inferted below the neck of this bone, draw its lower part upwards ; and both thefe accidents happen the more naturally and eafily, becaufe of the oblique pofition of the neck of this bone, which is inferted into its head in a direction not perpendicular, nor parallel, but as it were Hoping on one fide ; fo that it is no wonder that lamenefs, and other bad accidents, are the con- fequences of this fort of fracture.

To all thefe reafons we may alfo add, that it is very difficult to difcover when the neck of the Thigh-bone is fractured, this cafe being ufually taken for the head of the bone being flipped out of its fockct or acetabulum ; and this indeed, till of late, lias been almoll a general error. When we can think the external force to have been ftrong enough to have produced a fracture, when the patient cannot bear any ftrefs upon the limb by fetting his foot on the ground, when very acute pains are felt about the articulation itfelf ; and when we find die affected limb fhorter than the found one, it being an eafy matter to turn the foot almoft round from one fide to the other, and any cracking or grating of the bones be perceived in that motion nie may reafonably fuppofe the neck of the Thigh-bone is fra- ctured ; the limb mult then be extended very gently and gra- dually, till it be brought to the fame length with the found one; this may be eafily done, cither by means of a napkin, or the hands uf an affiftant in molt cafes, in fuch a manner, that the furgeon may be able to rejoin, in fame meafure, if not 'perfectly, the neck of the Thigh-bone with its head, ftill firmly remaining in its focket : And though a fhortnefs of the limb, or lamenefs, is generally left behind after this fracture;

yet becaufe there are fome cured without thofe misfortunes, it is always belt to ufe, for that end, fo ftrict or tight a bandage, that it may retain the neck and head of the bone together, fo that they may be in a way of uniting evenly. The bandage called jpica inguinalis is the molt convenient for this purpole, and a large and broad napkin, or other linnen cloth, is, with this, placed between the Thighs, to keep the body of it from fubfiding ; and laftly, ligatures are put about the knee and an- cle, by which the foot is faftcned to the lower part of the bed, to prevent the limb from being contracted upwards. If the fracture of the Thigh-bone be accompanied with a wound, it makes the cafe very difficult and dangerous. And if thefe acci- dents happen to be inflicted on the neighbouring joint, death is generally the confequence, more efpecially when any of the large blood-veflels are alfo wounded, which will be readily enough known by the haemorrhage. In thefe fractures, with a wound, the eighteen-headed bandage is to be ufed for the dreffing ; and if the wound be much contufed, fo that extra- vafated blood be lodged under the fkin, and about its mterfti- ces, it is to be carefully opened by feveral incifions, of a fuffi- cient depth, that the extravafated blood, which would in afhort time putrify, may be difcharged. The injured parts are to be afterwards warned with lime-water, mixed with a fourth part of fpirit of wine camphorated, till the contufed parts are di- gested.

when this kind of fracture is accompanied with no very vio- lent lofs of blood, nor the bone near, the proper dreiling is dry lint folded up, with which the wound is to be filled. If the flux be greater, rectified fpirit of wine, or other aftringent liquors are to be ufed ; but if the hemorrhage be very violent, from an artery, the tournequet is to be ufed, and the vefiel fe- cured by a ligature. After the blood is flopped, and the wound cleanfed, the fragments of the bone are to be replaced, and the limb carefully bound up with comprefies, fplints, and the eigh- teen-headed bandage, and defended by a cafe of ftraw. But it the fracture isattendedwitha violent haemorrhage, and great fplinter- ing of the hone, fromgun-fhot wounds, foasto indicate the great crural artery to be wounded, the belt method is to amputate the Thigh, and tie up the artery in time; for the crural artery is fo large, that it feldom grows together ; and if it does, the lower parts are foon feized with a gangrene. Heifier, 129. We have the defcription and draught of a machine for re- ducing fractures of the Thigh-bone, by Mr. Ettrick, in the Phil. 1 ranf. N°. 459. Sect 4. Luxated Thigh. It has been formerly imagined, that the head of the Thigh-bone being difplaced out of its acetabulum, was a very common cafe ; but more knowledge in anatomy and furgery have convinced us now, that this accident is very rare. The reafon it was before fuppofed common, was, that a fra- cture of the neck of the Thigh-bone was generally miftaken for this luxation.

It will eafily be conceived, that this is the true ftate of the cafe, and that a real diflocation of the Thigh-bone is very rare, if we confider how very deep the finus or acetabulum is, into which the head of this bone is received, with what a broad concave cartilage the head of this bone is covered, how extremely ftrong the ligaments are with which it is faftened, how greatly it is defended with thick and ftrong mufcles, and at the fame time reflect how very weak and brittle the neck of the Thigh- bone is, in companion of any other part thereof; and from all thefe confiderations, how vaftly more eafy it muft be for the fame force to break the bone off juft under its head, than to difplace it out of its focket. And, indeed, when luxations of the Thigh-bone do happen, it is much more frequently from internal than from external caufes. For phyficians have ob- ferved, that the ligaments of the Thigh-bone, though naturally of extreme ftrength, may be, by various caufes, and particu- larly by a flux of humours, fo relaxed and weakened as to let the head of that bone flip fpontaneoufly out of its acetabulum or focket ; fo that the Thigh, though not eafily luxated by ex- ternal violence, may eafily happen to be fo without any exter- nal violence, and while the patient lies in his bed. This is an accident, however, that happens much more rarely to adults than to infants.

Whenever the head of the Tlngh-bone is thruft out, it is almoft always wholly difplaced ; fo as to make a perfect luxation ; the exact roundnefs of this head, with the great ftrength of the circumjacent mufcles, and the narrownets of the fides of the acetabulum, will not admit the bone to be partially diflo- cated or thruft out of its place a little way only ; for as foon as the head of the bone is thruft up to the edge of the acetabulum, it muft unavoidably either turn quite out, or fall back again into its right place.

The thigh is found to be capable of luxation four ways, upward and downward, and backward and forward ; but it is moft frequently diflocated downward and inward, toward the large foramen in the os pubis. For befide, that the cartilaginous defence, on the lower part of the acetabulum, is not fo high as in the reft, the ligamentum rotundum is ever found to give way more readily in that part than in any other-; and laftly, the adjacent mufcles are fouiid to be weakeft in their refiftance on this part. And there is, befide all thefe, a certain eminence in this edge of the acetabulum, which prevents the head of the bone from falling back again eafily into its right place,

when