THE THIGH. 



45 



In performing the operation for the relief of the stricture 

 in femoral hernia the incision through the skin should be 

 about an inch and a half external to the spine of the pubes. 

 Its direction should be vertical, and its middle should be just 

 over the femoral ring. 



97. Lymphatic glands in the groin. The cluster of 

 inguinal and femoral lymphatic glands can sometimes be felt 

 in thin persons. The inguinal lie for the most part along the 

 line of Poupart's ligament : they receive the absorbents from 

 the wall of the abdomen, the urethra, the penis, the scrotum, 

 and the anus. The femoral glands lie chiefly over the 

 saphenous opening and along the outer side of the saphena 

 vein : they receive the absorbents of the lower extremity ; 

 they receive some also from the scrotum of which we have 

 practical evidence in cases of chimney-sweepers' cancer. 



98. Trochanter major. The trochanter major is a most 

 valuable landmark, to which we are continually appealing in 

 injuries and diseases of the lower extremity. There is a 

 natural depression over the hip (in fat persons) where it lies 

 very near the surface, and can be plainly felt, especially when 

 the thigh is rotated. Nothing intervenes between the bone 

 and the skin except the strong fascia of the gluteus maximus 

 and the great bursa underneath it. 



The top of the trochanter lies pretty nearly on a level 

 with the spine of the pubes, and is about three-fourths of an 

 inch lower than the top of the head of the femur. A careful 

 examination of the bearing of the great trochanter to the 

 other bony prominences of the pelvis, and a comparison of its 

 relative position with that of the opposite side, are the best 

 guides in the diagnosis of injuries about the hip, and the 

 position of the head of the femur. 



99. Nelaton's line.' If in the normal state you examine 

 the relations of the great trochanter to the other bony pro- 

 minences of the pelvis, you will find that the top of the 

 trochanter corresponds to a line drawn from the anterior 

 superior spine of the ilium to the most prominent part of the 

 tuberosity of the ischium. This line also runs through the 

 centre of the acetabulum. The extent of displacement in 



