THE HIP AND THIGH. 43 



upper part of the glutens raaximus, and its upper border, which is generally on a 

 level with the centre of the hip-joint, is obscured by the tendon of the gluteus 

 medius descending to its insertion on the outer side of the process. Immediately 

 behind the great trochanter is a well-marked depression, where the lower portion of 

 the gluteus maximus, after passing over the ischial tuberosity, becomes tendinous 

 and sinks in to be inserted into the shaft of the femur. 



Beneath the lower border of the gluteus maximus, the tuberosity of the ischium 

 is to be felt, and when the hip is flexed this process is to a great extent uncovered 

 by the muscle. A line drawn over the outer surface of the hip from the anterior 

 superior iliac spine to the most prominent part of the ischial tuberosity is known as 

 Nelatm's line (fig. 20), and will be found to pass over the top of the great trochanter 

 and cross the centre of the acetabulum. It thus forms a guide to the natural 

 position of the upper end of the femur, and is consequently of service in detecting- 

 dislocations of the hip and fracture of the neck of the bone. 



If a line be drawn from the posterior superior iliac spine to the outer part of the 

 ischial tuberosity, it will cross the posterior inferior spine and the ischial spine : the 

 posterior inferior spine is nearly two inches (4 cm.), and the ischial spine about four 

 inches (10 cm.), below the posterior superior spine : the sciatic artery appears in the 

 buttock at the junction of the middle and lower thirds of this line. The gluteal 

 artery leaves the great sacro-sciatic foramen beneath a spot corresponding to the 

 junction of the inner and middle thirds of a line drawn from the posterior superior 

 iliac spine to the great trochanter, when the thigh is rotated inwards. Between 

 the gluteal and sciatic arteries, the great sciatic nerve leaves the pelvis, and it 

 thence pursues a slightly curved course to a point midway between the great 

 trochanter and the ischial tuberosity. 



THE THIGH. 



The thigh is separated from the abdomen in front by the curved inguinal furrotv , 

 at the bottom of which Poupart's ligament may be felt (except in fat people), more 

 plainly in its inner than in its outer half, as it passes from the anterior superior 

 spine of the ilium to the pubic spine : the band is relaxed, and becomes less distinct, 

 on flexing and adducting, or rotating inwards, the thigh. From the pubic spine, 

 the finger may be carried inwards along the pubic crest to the top of the symphysis, 

 in the male passing over the spermatic cord, or downwards and backwards along the 

 inner margin of the united pubic and ischial rami to the tuberosity of the ischium, 

 thus tracing the boundary line between the thigh and the perineum. Externally, 

 the thigh is not definitely marked off from the region of the hip. 



Immediately below Poupart's ligament, a slight hollow is generally seen, 

 corresponding to Scarpa's triangular space (Vol. II, pp. 252 and 487), in which, 

 just internal to the centre, the femoral artery may be felt pulsating. Close below 

 the innermost part of Poupart's ligament is situated the saphenous opening in the 

 fascia lata, the upper end of which is about one inch outside the pubic spine. 

 Through the lower part of this aperture, and about one inch and a half below 

 Poupart's ligament, the internal saphenous vein passes back to join the femoral 

 trunk, and above the vein is the spot where a femoral hernia first makes its 

 appearance on the surface of the thigh. Over the opening, and for a short distance 

 below it, the femoral or lower inguinal lymphatic glands may usually be felt through 

 the skin, surrounding the upper end of the internal saphenous vein. 



From the apex of Scarpa's triangle a depression is continued downwards along 

 the inner part of the thigh, between the masses formed by the quadriceps extensor 

 muscle in front, and the adductor muscles on the inner side. The sartorius muscle 

 lies along this depression, and may be distinctly seen when it is brought into action 

 by raising the leg across the opposite knee. The form of the rectus muscle may be 



