278 THE INFERIOR EXTREMITY 



fibres of the iliacus obtain direct insertion into the body of 

 the femur, distal to that prominence (Figs. 121, 122). 



The action of the psoas major and the iliacus depend 

 upon the position of the hip joint when the muscles are in 

 action. If the hip joint is extended they flex it, and rotate 

 it medially until it is flexed ; then they rotate it laterally. 



Dissection. Divide the femoral vessels and the femoral 

 nerve, about an inch distal to the inguinal ligament, and having 

 tied them together with twine throw them distally. Now cut 

 through the sartorius and the rectus femoris, about two inches 

 from their origins, and turn them aside. The tendon of the 

 ilio-psoas must next be detached from its insertion and, with 

 the muscle, turned upwards. This will expose the anterior 

 surface of the capsule of the hip joint. An intervening mucous 

 bursa also will be displayed. Open this and ascertain its extent 

 by introducing the finger. It facilitates the play of the ilio- 

 psoas upon the front of the hip joint, and in some cases its cavity 

 will be found to be directly continuous with the cavity of the 

 joint, through an aperture in the capsule. The intimate con- 

 nection which exists between the capsule of the hip joint and 

 the tendon of the glutseus minimus, the reflected head of the 

 rectus femoris, and the deep layer of the ilio-tibial tract, should 

 be noticed. Lastly, turn aside the tensor fasciae latae, and 

 carefully clean the anterior aspect of the capsule of the hip joint. 



At the end of the fifth day the dissector must paint the 

 various parts of the anterior and medial regions of the thigh 

 with preservative solution, replace them in position and fix 

 the skin flaps over them with a few points of suture. 



On the morning of the sixth day, after the dissection of 

 the lower limb has been begun, the subject is placed upon 

 the table with its face downwards and its thorax and pelvis 

 supported by blocks. In that position it is allowed to 

 remain for five days, and during that time the dissector 

 of the lower extremity has a very extensive dissection to 

 perform. He has to dissect (i) the gluteal region; (2) the 

 popliteal fossa ; and (3) the posterior region of the thigh. 

 With so much work before him, and being limited as to the 

 time in which it must be done, it is necessary that he should 

 apportion the five days at his disposal so as to complete the 

 dissection before the body is turned again. The first two 

 days he should devote to the study of the gluteal region ; the 

 third and fourth days may be given to the popliteal fossa ; 

 and on the fifth day he should undertake the dissection of 

 the back of the thigh, and revise the work of the preceding 

 four days. 



