HYl'KK.V.MIA AND AN.T.MIA. 



825 



is preserved in tlie museum of the hospital. 

 Fig. 328. 



Fig. 328. 



Dislocation foumwardi and backward*. 



B, ooturattfr interma ; C , trochantcr major ; D f 

 the. acrtuliulum ; E, obturator eilerma ; V, tciatic 

 nerve j I, shaft of the femur. 



" A maniac who eluded the vigilance of his 

 keepers, leaped from a third story window. 

 Besides dislocating his thigh, he received other 

 injuries, of which he died in about an hour. 



" On examining the dislocated limb, it was 

 found considerably shortened and inverted, 

 forming about half a right angle with the body, 

 the' shaft of the femur crossing the symphysis 

 pubis was fixed immoveably in this situation ; 

 as the patient was sinking, no attempt wan 

 made at reduction. 



" Twelve hours after the death of the patient 

 I commenced the dissection, by reflecting the 

 glutens maximus, when I found some of the 

 fibres of the glutseus medius and minimus rup- 

 tured at their posterior edge. The pyriformis 

 and gemelli were also partially torn, but those 

 portions of the tendon of the obturator internus 

 which pass through the lesser ischiatic notch 

 were drawn out, and separated from their con- 

 nexion with the muscular fibres ; the head of 

 the femur presented itself through a rent of the 

 capsule, opposite to the upper part of the tuber 

 ischii above the quadratus, so that the great 

 sciatic nerve was somewhat displaced and 

 pressed against the tuber ischii. 



" In this case there was no difficulty in de- 

 tecting the nature of the injury, as, besides the 

 symptoms already described, the head of the 

 femur could be felt resting on the tuber ischii, 

 covered by the outer edge of the glutaeus maxi- 

 inus. 



" If this patient had been in a condition to 

 attempt reduction of the dislocation by fixing 

 the pelvis, and employing extension in the 

 direction of the shaft of the bone, at the same 

 time everting the limb, the head of the femur 

 would have been brought opposite the rent in 

 the capsule, and would have been in all pro- 



balnlity replaced in the acetnbiilnm without 

 greater difficulty than is usualK experienced. " 



( Kllllfl't .lllllHHi.) 



HVI'KK.'K.MIA AND AN.T.MIA, (I/TIJ, 

 ni/ii / ; a, negative ; and atpa, siinguis) (in 

 morbid anatomy). These are terms employed 

 to denote opposite conditions of the various 

 membranous or parenchymatous textures of the 

 body as regards the quantity of blood contained 

 in their bloodvessels; the former, as its deriva- 

 tion denotes, indicating a superabundant sup- 

 ply of blood, the latter a deficiency of that 

 fluid. They are useful terms to the anatomist, 

 inasmuch as they express simply the state of a 

 texture, without any theory being involved 

 respecting the cause or origin of that state. 

 It ought always to be the first business of the 

 anatomist to observe carefully the actual con- 

 dition of the parts submitted to his examination; 

 tliis having been done, he should search dili- 

 gently for some cause, mechanical, chemical, or 

 vital, which will satisfactorily account for the 

 phenomena. 



All vascular textures, it is obvious, are liable 

 to these conditions; and it is equally evident 

 that the relative frequency of their occurrence 

 in different textures will coincide with the 

 natural facility of the flow of blood to or from 

 them, as well as the quantity of blood con- 

 tained in them in the normal state. Thus the 

 lung or the spleen is favourable for the forma- 

 tion of hypenemia, as well from the large 

 supply of blood in each as from the free com- 

 munication between their respective arterial and 

 venous systems, and between the nullifications 

 of vessels of the same kind. 



A bleached state of the same organs may be 

 taken as a good example of the opposite con- 

 dition, or anxmia; but the most complete 

 anaemia is, of course, to be found in organs or 

 tissues which, in the natural state, contain but 

 a small quantity of blood. 



It is important to notice that hypenemia may 

 occur independently of disease and altogether 

 as a cadaveric phenomenon, and there is no 

 mistake more frequently committed by the 

 incautious observer than that of attributing to 

 the influence of a morbid process during life 

 appearances which simply result from the 

 ordinary physical laws which death has allowed 

 to exert full sway over the tissues. Indeed, it 

 is only since anatomists have ceased to regard 

 every instance of an unduly injected tissue as 

 a diseased one, that valuable practical conclu- 

 sions have been drawn from post-mortem obser- 

 vations. 



We may pronounce hyperaemia not to be mor- 

 bid, when it is found to occupy only the most 

 dependent parts of organs, the blood having 

 deserted the vessels of the more elevated parts. 

 At every post-mcrtem examination we have 

 abundant examples of hyperamia of this kind ; 

 if the body have been laid on the back, as is 

 usually the case, the whole of the skin of that 

 region is largely injected with blood ; the sub- 

 cutaneous cellular tissue is in a similar condi- 

 tion, and the adjacent muscles more or less so 



