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1725AndryN

 

Nicolas Andry de Bois-Regard (1658-1742 ncbi.nlm.nih.gov), who proposed the term «orthopedics» and its symbol, spoke about the role of ligamentum capitis femoris (LCF). Regarding this structure, the author engaged in a debate with Jean-Louis Petit (1674-1750 link.springer.com), who discussed LCF in his treatise «L'Art de Guérir les Maladies des Os» (1705). Nicolas Andry was the first to draw attention to the interaction of the LCF with the external ligaments of the hip joint. The dispute between the titans of medicine of the 18th century turned out to be vivid and instructive; it remained in history as the second public debate about the meaning of LCF.


Andry N. A study of different views of anatomy, surgery, physics, medicine... (1725)

 

The most significant quotes about LCF: 

Andry N. Examen de divers points d'anatomie, de chirurgie, de physique, de medecine... Paris: N. Lottin & H.D. Chaubert, MDCCXXV.

Quote 1. pp. 15-16

«Dans le onziémet, je prouve que le ligament prétendu rond de la cuisse, que l'Auteur croit s'opposer à la luxation qui se fait en haut, ne s'y oppose point, & qu'il ne fait qu'empêcher un plus grand écartement de la tête de l'os.»

«Dans le douzième, j'expose le véritable usage du ligament pretend rond de la cuisse, ce qu'aucun Anatomiste, que je sçache, n'a encore fait.» 

«Dans le treizième, j'examine les raisons que l'Auteur apporte pour s'excuser d'avoir appelle rond, un ligament que je lui ai fait remarquer être plat, & je montre que c'est en vain qu'il met ici son esperance en la comparaison qu'il fait du ligament rond avec le pont neuf.»

In the eleventh, I prove that the supposedly round ligament of the thigh, which the Author believes to oppose the dislocation which takes place at the top, does not oppose it, and that it only prevents a greater separation of the head from the [pelvic] bone. 

In the twelfth, I explain the true use of the so-called round ligament of the thigh, which no Anatomist, to my knowledge, has yet done. 

In the thirteenth, I examine the reasons why the author apologizes for the round ligament, which I pointed out to him as flat, and show that in vain he pins his hope here on a comparison of the round ligament with the new bridge.

Quote 2. pp. 75-83

«XI. L'AUTEUR pag. 58. vient au ligament prétendu rond de la cuisse, & page 61. il soutient que ce ligament s'oppose à la luxation qui se fait en haut. Erreur toute visible: la luxation dont il s'agit, se fait quand la ête du fémur sort de sa cavité: or amais le ligament prétendu rond, ne peutmettre obstacle à cette sorie. Supposons par exemple, I. Une boule enchaffée dans une cavité. 2. Une corde attachée au bord inférieur de cette cavité, & en même tems, a la face par laquelle la boule touche le fond de la cavité: il est aisé de concevoir que cette corde ne pourra ja mais empêcherla boule le sortir, & que ce qu'elle pourra aire quand la boule sera sortie, se réduira a empêcher, non que cette boule ne monte, mais qu'elle ne monte au dessus de la cavité; or estce là s'opposer à la luxation? ce n'est qu'empêcher un plus grand écartement de la tête de l'os. Ainsi tout ce que dit ce Chirurgien p. 59. 60. & 61. pour faire voir qu'il a prétendu parler de la luxation en haut, & non de la luxation en bas, quand il a dit que son ligament rond empêchoit la luxation, est à pure perte, & ne le met à couvert de rien.»

XI. The author on page 58 comes to what is called the round ligament of the femur, and on page 61 he states that this ligament resists dislocation which occurs upward. A clearly visible error: the dislocation in question occurs when the head of the femur comes out of the cavity [of the joint]: but the so-called round ligament cannot be an obstacle to such an outcome. Suppose, for example, 1. A ball embedded in a cavity. 2. A rope attached to the lower edge of this cavity, and at the same time to the surface [of the ball] with which it touches the bottom of the cavity: it is easy to imagine that this rope will never prevent the exit of the ball, and that what it will be able to do when the ball is out will be reduced to preventing, not that this ball rises, but that it rises above the cavity; but does this prevent dislocation? this is only to prevent the [femoral] head from moving further away from the [pelvic] bone. So, everything this Surgeon says on pages 59, 60, & 61 shows that he claimed that he was talking about upward dislocation and not downward dislocation when he said that the round ligament prevents dislocation, is purely wasted effort, and does not protect him in any way.

«XII. IL DIT que quand je remarque dans l'extrait de son Livre, qu'il y a une échancrure à la cavité cotyloide, je donne aux Lecteurs à deviner. Il ajoute qu'on aurait du décrire l'endroit où est cette échancrure, & il trouve cela fort à redire, comme si cet endroit étoit quelque chose de fort inconnu. Puis pour suppléer à cette omission qu'il me reproche, & qu'il croit très-considérable, il avertit que l'échancrure dont il parle est placée au bord inférieur de la cavité cotyloide. Il auroit mieux fait de dire quel est l'usage de son ligament rond ; l'occasion s'en présentoit naturellement: mais cela lui eut été un peu plus difficile que de remarquer comme il fait, que l'échancrure est au bord inférieur de la cavité cotyloide, & que le ligament qu'il appelle rond, est attaché par son extrémité, à la tête du fémur , un peu plus bas que le milieu: ce détail qu'il est surpris que nous n'ayons pas fait, est connu des commençans même; mais la fonction du ligament prétendu rond, est quelque chose d'un peu moins connu. Peut-être ne sera-t'on pas fâché que nous l'expliquionsici. Pour bien faire entendre l'usage de ce ligament, je suppose 1. qu'une boule soit engagée dans une cavité, 2. que cette cavité soit la moitié d'une sphere, 3. que la coupe de cette cavité foit perpendiculaire, 4. que du bord inférieur de la cavité, il parte une corde qui aille s'attache a la boule, vers l'extrémité de l'axe qui répond au fond de la cavité. Cela supposé, il est évident que si l'on vouloir faire rouler la boule de maniéré que le point ou s'attachela corde, roulât en haut, cette corde s'opposeroit à ce roulement; que cependant elle n'empêcheroit pas la boule de se jetter en dehors; mais il est visible en même tems, que si du bord supérieur de la même cavité, il vient une seconde corde qui aille s'attacherau point opposé à celui où tient la première, il sera impossible que cette boule roule en dehors: la tête du fémur est la boule dont je parle; cette tête se trouve retenue par deux forces opposées, l'une, qui est le ligament que notre Auteur appelle rond, empêche que le point de la boule osseuse où il s'attache, ne monte; l'autre, qui est la capsule ligamenteuse, laquelle s'attache au col du fémur, empêche que ce point se auquel elle s'attache, ne descende au de-là d'un certain degré; & c'est ce qui est absolument necessaire lorsque les genoux étant fléchis, on se soutient dans cet état, le trône panché en devant, comme font ceux qui veulent se charger de quelque fardeau; car sans cette méchanique, la tête du fémur se jetteroit en dehors, & seroit en risque de se luxer: voilà en quoi consiste le véritable usage du ligament que notre Auteur appelle rond; usage qui étoit un peu plus difficile à trouver, que la situation de l'échancrure.»

XII. He says that when I remark in the excerpt from his Book that there is a notch in the cotyloid cavity, I leave it to the Readers to guess. He adds that it should have been described where this notch is, and he finds fault with that, as if this place were something very unknown. Then, to make up for this omission which he reproaches me for and which he believes is very significant, he warns that the notch he speaks of is located at the lower edge of the cotyloid cavity. He would have done better to say what the purpose of his round ligament is; the opportunity presented itself naturally: but that would have been a little more difficult for him than noting, as he does, that the notch is at the lower edge of the cotyloid cavity, and that the ligament he calls round is attached its end to the head of the femur, a little lower than the middle: this detail which he is surprised we did not make, is known even to beginners; but the function of the so-called round ligament is something a little less known. Perhaps one will not be upset that we explain it here. To make the use of this ligament understood, I assume 1. that a ball is engaged in a cavity, 2. that this cavity is half of a sphere, 3. that the cut of this cavity is perpendicular, 4. that from the lower edge of the cavity, a rope starts which goes to attach to the ball, towards the end of the axis that intersects the bottom of the cavity. It is assumed that it is obvious that if we wanted to rotate the ball so that the point of attachment of the rope would move upward, then this rope would counteract this rotation; but it is visible at the same time that if from the upper edge of the same cavity there comes a second rope which attaches itself to the point opposite to that where the first holds, it will be impossible for this ball to roll outside: the head of the femur is the ball I am talking about; this head is held by two opposing forces, one, which is the ligament that our Author calls round, prevents the point of the bony ball where it attaches from rising; the other, which is the ligamentous capsule, which attaches to the neck of the femur, prevents this point to which it attaches from descending beyond a certain degree; and this is absolutely necessary when the knees are bent, and one supports oneself in this state, the torso leaning forward, as do those who want to take on some burden; for without this mechanics, the head of the femur would migrate outward, and would be at risk of dislocation: this is the true use of the ligament that our Author calls round; a use which was a little more difficult to find than the location of the notch.

«XIII. POUR S'EXCUSER d'avoir appellé rond, le ligament dont nous venons de parler, l'Auteur commence par avouer que ce ligament est plat comme je l'en ai averti ; mais il demande page 61. si pour l'avoir appellé rond, il s'enfuit qu'il l'ait cru rond: voici ses paroles qui méritent bien d'être rapportées mot à mot! En quel endroit de mon Livre, vous qui l'avez lû, Monsieur, en quel en- droit ai je dit que ce ligament fut rond? Si je l'ai nommé ainsi, c'est parce que tout le monde le nomme de même; si je lut eusse donné un autre nom, j'aurois détourné mon lecteur, comme on détourneroit un passant qui demanderoit le chemin de la Ville, (il a voulu dire, le che, min d'un Quartier) en lui disant de passer sur le vieux pont, au lieu de lui dire de passer sur le pont neuf. Ce pont est vieux, le ligament est plat; le vieux, s'appellera neuf, & leplats'appellera rond, jusqu'à ce que tous les hommes soient convenus de leur donnerd'autres noms. Voilà ce que répond bonnement notre Auteur. Trois réflexions à faire sur cette réponse, 1. Il n'est nullement vrai que le ligament auquel notre Auteur donnele nom de rond, soit ainsi nommé de tout le monde; j'en appelle aux Anatomistes qui ne se bornent pas à dépouiller les muscles de leur graissé. 2. Le pont neufest vieux, & cependant on l'appelle neuf, il est vrai, mais ce pont qui est vieux, a été neuf, au lieu que le ligament plat n'a jamais ete rond, que jesçache. 3. Si quelqu'un étant vers S. Eustache, demandoit le chemin des grands Augustins, & qu'on lui répondît: au bout de telle rue il y a un pont neuf, qui conduit droit où vous voulez aller; ne seroit-ce pas lui dire que ce pont est neuf? Or notre Chirurgien s'explique de même au sujet du ligament en question. * Il dit, en voulant prouver combien la luxation de la cuisse est difficile, 1. que la tête du fémur est tres-grosse. 2. Qu'il n'y a point de partie où les muscles soient plusforts. ** 3. Qu'il y a un rebord cartilagineux qui augmente le creux de la cavité, où est la tête du fémur. 4. Qu'il y a un ligament rond qui s'oppose à la luxation. N'est-ce pas là veritablement dire que ce ligament est rond? je le prie de me répondre si en disant, comme il vient de faire, qu' ilyaun rebord cartilagineux, il n'entendpas que ce rebord est cartilagineux, il répondra sans doute qu'oui. Cela posé, je le prie tout de même, de me répondre, si en disant qu'il y a à la cuisse, un ligament rond, il n'entend pas que ce ligament est rond. Je laisse aux lecteurs à prononcer. Au reste, comme il vient de me faire une demande, il estjuste que j'y satisfasse. En quel endroit de mon livre, vous qui l'avez lû, me demande-t-il, en quel endroit ai-je dit que ce ligament est rond ? Voici ma réponse, c'est à la page 271. ligne 13. du traité des maladies des os, car c'est là qu'on trouve qu'il y a à la cuisse, un ligament rond, qui en empêche la luxation. Il ajoute, comme nousl'avons vu, que s'il a nommé rond, le ligament en question, ç'a été pour ne pas dérouter le lecteur; mais peut, on dérouter davantage un jeune commençant, que de lui dire qu'il y a à la cuisse un ligament rond? car ce commençant cherchant au fémur, un ligament rond qu'on lui dit y être, & n'y en trouvant qu'un plat, ne sçaura plus où il en fera: or c'est pour les commençans & pour eux seuls, que notre Auteur dit avoir composé son traité des maladies des os. On peut voir là-dessus fa préface. Il auroit mieux fait d'avouericyde bonne grâce, son erreur, comme plus bas, il avoue celle dont je l'ay repris au sujet des poulies & de la mouffle, ainsi que nous l'alions voir.»

XIII. To justify himself for calling the round ligament just mentioned, the Author begins by admitting that this ligament is flat, as I pointed out to him; but he says on page 61, if he called it round, he excludes the fact that it is round, and that he thought it all out: these are the words that deserve to be quoted word for word! «In what part of my book did you read, Monsignor, where I said that this ligament was round? If I called it that, it's because everyone calls it the same; if I had given it another name, I would have deceived my reader, just as a passer-by would be deceived who asked the way into the city (he meant the way to the quarter), by telling him to pass over the old bridge, instead of telling him to pass over the new bridge. This bridge is old, the ligament is flat; the old, will be called new, and the dish will be called round, until all men have agreed to give them other names.» This is what our Author rightly answers. Three thoughts to make on this response, 1. It is in no way true that the ligament to which our Author gives the name round, is thus named by everyone; I appeal to the Anatomists who do not limit themselves to stripping the muscles of their grease. 2. The new bridge is old, and yet it is called new, it is true, but this bridge which is old, was new, whereas the flat ligament was never round, as far as I know. 3. If someone being near S. Eustache, asked the way to the Grands Augustins, and was told: at the end of such street there is a new bridge, which leads straight where you want to go; would it not be telling him that this bridge is new? Now our Surgeon explains the same about the ligament in question. * He said, trying to prove how difficult it is to dislocate the hip, 1. that the head of the femur is very large. 2. That there is no part where the muscles are stronger. ** 3. That there is a cartilaginous rim that increases the depth of the cavity where the head of the femur is. 4. That there is a round ligament that opposes dislocation. Is this not truly saying that this ligament is round? I beg him to answer me if by saying, as he just did, that there is a cartilaginous rim, he does not mean that this rim is cartilaginous, he will undoubtedly answer yes. That being said, I still ask him to answer me, if by saying that there is in the thigh a round ligament, he does not mean that this ligament is round. I leave it to the readers to decide. Furthermore, as he has just made a request to me, it is only fair that I satisfy it. In what part of my book, he asks me, in what part have I said that this ligament is round? Here is my answer, it is on page 271, line 13, of the treatise «On bone diseases», for it is there that one finds that there is in the thigh a round ligament, which prevents dislocation. He adds, as we have seen, that if he named the ligament in question round, it was to not mislead the reader; but can one mislead a young beginner more than by telling him that there is in the thigh a round ligament? for this beginner seeking in the femur a round ligament that he is told is there, and finding only a flat one, will not know what to make of it: now it is for beginners and for them alone, that our Author says he composed his treatise «On bone diseases». You can see his preface on this. He would have done better to admit his error with good grace, just as below, he admits the one I reprimanded him for on the subject of the pulleys and the muffle, as we were about to see.

Quote 3. pp. 144-145

«Une autre réflexion que nous ferons, c'est que quand nous avons dit que l'insertion seule du ligament prétendu rond, suffisoit pour faire voir que ce ligament ne retient point dans la cavité cotyloide, la tête du fémur, nous nous sommes expliquez sans aucune ambiguité quelle qu'elle soit; la chose ne pouvant être obscure qu'à ceux qui n'ont aucune notion d'Anatomie & qui sont ceux là mêmes pour qui nous n'avons nullement prétendu écrire;…»

Another reflection we will make is that when we said that the insertion alone of the so-called round ligament was sufficient to show that this ligament does not retain the head of the femur in the cotyloid cavity, we explained ourselves without any ambiguity whatsoever; the matter can only be unclear to those who have no knowledge of Anatomy, and those are precisely the ones for whom we did not intend to write...

Quote 4. p. 147

«L'article de la creste de coq & de la cervelle de lievre, que j'ay repris encore, est dans la seconde édition comme dans la première. Je dis la même chose des articles qui concernent la dureté des os, le ligament rond, & plusieurs autres points quej'ay relevez.»

The article on the cock's crest and the hare's brain, which I have taken up again, is in the second edition as in the first. I say the same thing about the articles which concern the hardness of the bones, the round ligament, and several other points that I have noted.

Quote 5. p. 179

«Ligament prétendu rond, son usage. 77-78. 79. 80.»

So-called round ligament, its use. 77-78. 79. 80.

Quote 6. p. 184

«Rond. Ligament rond. Plaisante excuse de l'Auteur des lettres, sur ce qu'il a dit qu'il y a à la cuisse un ligament rond. 79, 80.»

Round. Round Ligament. The amusing excuse of the Author of the letters, regarding his statement that there is a round ligament in the thigh. 79, 80.


External links

Andry N. Examen de divers points d'anatomie, de chirurgie, de physique, de medecine... Paris: N. Lottin & H.D. Chaubert, MDCCXXV [1725].  [gallica.bnf.fr

Authors & Affiliations

Nicolas Andry de Bois-Regard (1658-1742) was a French physician and writer, professor at the French College. [data.bnf.fr , en.wikipedia.org

Nicolas Andry de Bois-Regard, portrait by Jean François de Troy, 18th century (left side); The book"L’orthopedie", 1741, Paris (right side). 
Image from article: Tsoucalas G. Historical Vignette… (2017);
 (Creative Commons Attribution 3.0 License, no changes)

Keywords

ligamentum capitis femoris, ligamentum teres, ligament of head of femur, role, anatomy, function 

                                                                     

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HISTORY OF THE STUDY

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  A fragment of the manuscript of the translation of Josephus Flavius' Antiquities of the Jews ( Ἰουδαϊκὴ ἀρχαιολογία / De antiquitate iudaica) into Latin by Rufinus Aquileiensis. The translator worked approximately between 344 and 411 in the Roman Empire. His work was rewritten between 1150 and 1199 in Northern France. In Josephus's translation of Antiquities of the Jews, ligamentum capitis femoris (LCF) is referred to as «neruum». The selected fragment deals with the LCF of an animal and discusses a biblical episode of its damage in a human. See our commentary at the link: 344-411Rufinus Aquileiensis [Rus]. T he original text: 93-94JosephusF . Quote [ Lat] De antiquitate iudaica. Liber primus (original source: 1150JosephusF, p. 22, fragment) Translation [Eng] Antiquities of the Jews. Book 1. 20.2 When Jacob had made these appointments all the day, and night came on, he moved on with his company; and, as they were gone over a certain river called Jabboc, Jacob was left behi...

1794LoderJC

  Drawings and descriptions from book Loder JC. Tabulae anatomicae (1794). Image of the hip joint, ligamentum capitis femoris (LCF) and peripheral part of the acetabular canal ( hiatus acetabuli ,  see Fig. 2.10) .   External links Loder JC. Tabulae anatomicae quas ad illustrandam humani corporis fabricam colle git et curavit. Vinariae, 1794. [ wellcomecollection.org ] Authors & Affiliations Justus Ferdinand Christian Loder (1753-1832) was a German anatomist and surgeon, professor of surgery and anatomy at the University of Jena. [ wikipedia.org ] Justus Christian Loder (1801?) Engraving by F. Müller after a painting by Fr. A. Tischbein; original in the  wikimedia.org   collection (CC0 – Public Domain, no changes)   Keywords ligamentum capitis femoris, ligamentum teres, ligament of head of femur, anatomy, image                                    ...

150-250Targum Jonathan

  Fragments from the Targum Jonathan on Genesis. Tractate was written between about 150 - 250 in lend of Israel. The text is a combination of a translation and commentary on the book of Bereshit. The unknown compiler mentions ligamentum capitis femoris (LCF) in an animal and an episode of its damage in a human. See our commentary at the link: 150-250Targum Jonathan [Rus]. Quote 1. [Heb] Genesis. 32:33 (original source:  sefaria.org ) Quote 2. [Heb] Genesis. 43:16 (original source:  sefaria.org ) Translation Quote 1. [Eng] Genesis. 32:33 Therefore, the sons of Israel eat not the sinew which shrank, which is in the hollow of the thigh of cattle and of wild animals, until this day; because the Angel touched and laid hold of the hollow of the right thigh of Jakob, in the place of the sinew which shrank. (Transl. by J.W. Etheridge (186 2 ) ; original source: targum.info ) Quote 2. [Eng] Genesis. 43:16 And Joseph saw Benjamin with them: and he said to Menasheh whom he had mad...