46 LANDMARKS MEDICAL AND SURGICAL. 



dislocation or fracture is marked by the projection of the 

 trochanter behind and above this line.' 7 



' Nelaton's line,' as it is termed, theoretically holds good. 

 But in stout persons it is not always easy to feel these bony 

 points so as to draw the line with precision. A surgeon must, 

 after all, in many cases trust to measurement by his eyes and 

 his flat hands his best guides. Thus, let the thumbs be 

 placed firmly on the spines of the ilia, while the fingers grasp 

 the trochanters on each side. Having the sound side as a 

 standard of comparison, the hand will easily detect any dis- 

 placement on the injured side. Hippocrates bids us compare 

 the sound parts with the parts affected (in fractures) and 

 observe the inequalities. 



The top of the great trochanter is the guide in an opera- 

 tion recently introduced by Mr. Adams, namely, the ' subcu- 

 taneous section of the neck of the femur.' ' The puncture 

 should be made one inch above and nearly one inch in front 

 of the top of the trochanter. The neck of the bone is to be 

 sawn through at right angles to its axis, the saw working 

 parallel to Poupart's ligament, and about one inch below it.' 



Spine of the ilium. The anterior superior spine of the 

 ilium is the point from which we measure the length of the 

 lower limb. By looking at the spines of opposite sides we 

 can detect any slant in the pelvis. By pressure on both 

 spines simultaneously we examine if there be a fracture of 

 the pelvis, or disease at the sacro-iliac joint. 



IOO. ' In reducing a dislocation of the hip by manipula- 

 tion it is important to bear in mind that, in every position, 

 the head of the femur faces nearly in the direction of the 

 inner aspect of its internal condyle.' 8 



IOI. Compression of femoral artery. About a point 

 midway between the spine of the ilium and the symphysis 

 pubis, the femoral artery can be felt beating, and effectually 

 compressed, against the pubes. How should the pressure be 

 applied when the patient lies on the back ? In accordance 

 with the slope of the bone that is, with a slight inclination 

 upwards. A want of attention to this point is the reason 

 why so many fail when they undertake to command the cir- 



