THE THIGH. 45 



aspect of the limb. The surface formed by the vastus externus is often seen to be 

 traversed by a longitudinal groove, due to the pressure exerted by the strong ilio- 

 tibial band of the fascia lata as it descends from the insertions of the gluteus 

 maximus and tensor vaginas femoris muscles to the outer tuberosity of the tibia. 

 Of the adductor muscles, the only parts that are to be separately recognized are the 

 strong tendon of origin of the adductor longus below the pubic crest, and the lower 

 tendon of the adductor magnus which is felt distinctly, when the knee is bent, in 

 the interval between the sartorius and vastus internus muscles, extending down to 

 the adductor tubercle on the internal condyle of the femur. The adductors are not 

 marked off on the surface from the hamstring group on the back of the thigh, nor 

 are the latter muscles to be individually distinguished from one another until they 

 become tendinous near the knee. Along the outer and posterior part of the thigh, 

 however, the hamstring muscles are separated from the vastus externus by a well 

 marked groove, corresponding to the position of the external inter muscular 

 septum. 



The whole of the shaft of the femur is deeply placed, and in fairly muscular 

 subjects is not to be detected through its fleshy covering. It approaches the surface 

 most nearly in the lower third of the thigh on the outer side, where it may be 

 readily exposed in the interval between the vastus externus and biceps muscles. 

 The head of the bone is situated close below Poupart's ligament, immediately 

 external to its mid-point, and is occasionally, in thin subjects, to be felt in this 

 position through the overlying muscles. 



The subcutaneous veins of the thigh all join one trunk, the internal saphenous, 

 which ascends from the hinder part of the inner side of the knee, with a gradual 

 inclination forwards, to the saphenous opening. The extent to which this vein and 

 its branches are to be perceived varies greatly with the amount of subcutaneous 

 fat. 



The position of the femoral artery is indicated by a line drawn from a point 

 midway between the anterior superior iliac spine and the pubic symphysis to the 

 prominent tuberosity on the inner condyle of the femur, the hip having been 

 first slightly flexed and the thigh everted. At the junction of the upper three- 

 fourths with the lower fourth of this line, the artery passes backwards through the 

 opening in the adductor magnus muscle. Pressure is most conveniently applied to 

 the vessel as it enters the thigh below Poupart's ligament, and it should be directed 

 backwards so as to compress the artery against the pubis and the adjacent part of 

 the hip-joint. Lower down, the pressure must be made in a direction backwards 

 and outwards, as the artery lies considerably to the inner side of the shaft of the 

 femur. At Poupart's ligament, the femoral vein is close to the inner side of the 

 artery, and the anterior crural nerve is a little distance (a quarter to half an inch) 

 from its outer side. The profnnda, arising from the main trunk usually between 

 one and two inches (3 5 cm.) below Poupart's ligament, follows a line almost 

 identical with that of the femoral artery. 



The small sciatic (posterior cutaneous) nerve lies immediately beneath the fascia 

 along the middle line of the back of the thigh ; and in the same line, but under 

 cover of the hamstring muscles, is the great sciatic nerve. 



THE KNEE. 



On the inner side of the knee, the internal condyle of the femur and the 

 corresponding tuberosity of the tibia produce a rounded surface, the most 

 prominent point of which is formed by the tuberosity on the internal condyle. The 

 interval between the two bones opposite the knee-joint is seldom to be seen, but is 

 always easily felt. It can usually, however, be readily demonstrated by resting the 



