Glu teal Region 459 



Practically, Scarpa's triangle occupies the upper third of the thigh, 

 Hunter's canal the middle third, and the popliteal space the lowest 

 third. 



After ligation of the superficial femoral the circulation is carried on 

 by the many unnamed, empty muscular branches of the femoral below 

 the ligature bringing in blood from muscular branches above it ; by 

 the deep part of the anastomotica magna bringing in blood from the 

 descending branches of the external circumflex ; by the superior 

 muscular branches of the popliteal anastomosing with the lower per- 

 forating arteries and with the comes nervi ischiatici (in a dissection 

 which I once made this was the most important collateral route) ; and 

 by superior external articular branches anastomosing with the external 

 circumflex. 



As an anatomical exercise the following question may be 

 answered : What structures are divided in a transverse section 

 across the middle of the thigh ? Ans. : Skin and superficial fascia, 

 and, in the latter, branches of the internal, middle, and external 

 cutaneous nerves, and of the lesser sciatic ; also the long saphenous vein 

 and lymphatics. The fascia lata, which is especially strong in the 

 region of the ilio-tibial band. The sartorius, rectus femoris, vasti 

 and crureus, and branches of the anterior crural nerve. The gracilis, 

 adductors longus and magnus, and the obturator nerve. Hunter's 

 canal, with the superficial femoral vessels and the saphenous nerve. 

 Descending branches of the internal and external circumflex vessels ; 

 the termination of the profunda vessels, and of a perforating artery. 

 The biceps semi-tendinosus and membranosus ; the beginning of the 

 internal and external popliteal nerves of the great sciatic ; perhaps 

 the comes nervi ischiatici, and ascending muscular branches of the 

 popliteal artery ; the femur and its periosteum. 



The gluteal region. Between the ischial tuberosity and the 

 great trochanter a shallow space can be made out by thrusting the 

 fingers into the glutens maximus. In its depth are the small external 

 rotators of the femur, and in the higher part of this space, under cover 

 of the rotators, is the capsule of the hip-joint. In the case of acute 

 effusion into the joint, a deep-seated fulness may be detected here, 

 which may be aspirated through the muscle. 



It is difficult to show by marking on the rounded buttock the 

 position of parts which lie in the flat beneath it, and in attempting to 

 do so the student must work at first with the dry bones beside him. 

 He begins by tracing the iliac crest backwards to the posterior 

 superior spine, which overhangs the side of the sacrum ; descending 

 an inch, his finger is over and upon the sacro-iliac articulation ; in 

 sacro-iliac disease there are a swelling and tenderness at that spot. 

 A little below this is the posterior inferior spine. This spine, which 

 is at the lower part of the sacro-iliac joint, and may be easily made 

 out in a thin person, is to be the starting-point for a bold, sickle-shaped 



