Human anatomy; Medicine -- Study and teaching; Palpation
97. =Lymphatic glands in the groin.=--The cluster of inguinal and
femoral lymphatic glands can sometimes be felt in thin persons. The
inguinal lie for the most part along the line of Poupart’s ligament:
they receive the absorbents from the wall of the abdomen, the urethra,
the penis, the scrotum, and the anus. The femoral glands lie chiefly
over the saphenous opening and along the outer side of the saphena
vein: they receive the absorbents of the lower extremity; they receive
some also from the scrotum--of which we have practical evidence in
cases of chimney-sweepers’ cancer.
98. =Trochanter major.=--The trochanter major is a most valuable
landmark, to which we are continually appealing in injuries and
diseases of the lower extremity. There is a natural depression over the
hip (in fat persons) where it lies very near the surface, and can be
plainly felt, especially when the thigh is rotated. Nothing intervenes
between the bone and the skin except the strong fascia of the gluteus
maximus and the great bursa underneath it.
The top of the trochanter lies pretty nearly on a level with the spine
of the pubes, and is about three-fourths of an inch lower than the top
of the head of the femur. A careful examination of the bearing of the
great trochanter to the other bony prominences of the pelvis, and a
comparison of its relative position with that of the opposite side, are
the best guides in the diagnosis of injuries about the hip, and the
position of the head of the femur.
99. =Nélaton’s line.=--‘If in the normal state you examine the
relations of the great trochanter to the other bony prominences of the
pelvis, you will find that the top of the trochanter corresponds to a
line drawn from the anterior superior spine of the ilium to the most
prominent part of the tuberosity of the ischium. This line also runs
through the centre of the acetabulum. The extent of displacement in
dislocation or fracture is marked by the projection of the trochanter
behind and above this line.’[7]
‘Nélaton’s line,’ as it is termed, theoretically holds good. But in
stout persons it is not always easy to feel these bony points so as
to draw the line with precision. A surgeon must, after all, in many
cases trust to measurement by his eyes and his flat hands--his best
guides. Thus, let the thumbs be placed firmly on the spines of the
ilia, while the fingers grasp the trochanters on each side. Having the
sound side as a standard of comparison, the hand will easily detect
any displacement on the injured side. Hippocrates bids us compare the
sound parts with the parts affected (in fractures) and observe the
inequalities.
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