338 Anatomy Applied to Medicine and Sutgety. 



Operations. Excision of the Hip Joint. Unless 

 contraindicated, the best incision for exposing the hip joint 

 is Barker's, whereby the joint is opened from in front. 

 Operation. The incision, about three inches in length, 

 starts about half an inch below and a little outside of the 

 anterior superior spinous process, and is made downwards 

 and slightly inwards, passing between the sartorius and 

 the tensor vaginae femoris. On separating these muscles 

 the outer edge of the rectus is identified, and the knife 

 passes through a quantity of areolar tissue between this 

 muscle and the glutens minimus, dividing, generally, a 

 small branch of the external circumflex artery. The cap- 

 sule of the joint is opened, by this incision, where it over- 

 lies the middle of the neck of the femur and the diseased 

 portion of the bone is then removed. 



Amputation at the Hip Joint. Of the different 

 methods of haemostasis employed in this operation, none 

 can compare with the simplicity and effectiveness of 

 that of Wyeth's. Amputation by this method is per- 

 formed as follows : Two large mattress needles, each 

 about ten inches in length, are employed ; one, introduced 

 one inch below and slightly to the inner side of the an- 

 terior superior spinous process, traverses the muscles 

 and fasciae on the outer side of the hip, to emerge on a 

 level with, and about three inches from the point of entry. 

 The other is inserted about one inch below Poupart's liga- 

 ment, a little to the inner side of the saphenous opening, 

 and, passing transversely backwards through the adductor 

 muscles, emerges about one inch below the tuberosity of 

 the ischium. The points of the needles are now protected 

 by bits of cork, and a piece of rubber tubing, half an inch 

 in diameter and long enough to go around the thigh five 

 or six times, is wound tightly around the hip above the 

 fixation needles. An incision is then made around the limb 



