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part of the same line, about half an inch in front of the lesser trochanter. Since Bigelow's remarkable demonstration, less influence is attributed than formerly to muscular power, in determining the course taken by the head of the femur when it leaves the socket, and in affecting its reduction. The internal obturator muscle, however, situated, as it is, partly within the pelvis and partly behind the hip-joint, leaving the pelvis by the sacro-sciatic notch, passing horizontally outward, and being inserted, with the gemelli, into the upper part of the great trochanter, manifestly has important relations to dorsal luxations and to their treatment. I earnestly recommend that the anatomical relations of the Y ligament, and of the obturator internus muscle, be kept in mind by the surgeon when he stands beside a luxated hip, in order that he may know just how the head of the femur is situated with reference to one or both of these, and whether, intact or ruptured, they will hinder or facilitate reduction.
The cases of dislocation of the hip included in this paper were furnished the writer in response to a circular addressed to physicians in different parts of the State of New York, asking for statistics relating to luxations of the hip-joint. The promptness with which the questions were answered, and the minute details accompanying the cases, are hereby thankfully acknowledged. Eighty-two physicians responded to the circular. Twenty-four of these stated that they had never met with an example of dislocated hip, while each of the remaining fifty-eight reported the number of cases he had treated, with their clinical histories. More than one third of those who had never had a case had been in practice for from fourteen to fifty years, and were known as good, practical surgeons in their respective fields of labor. Many of the histories show great accuracy of knowledge regarding the anatomy of the injured structures, a clear comprehension of the principles involved in the treatment, and marked ingenuity in the selection and the modification of remedial measures. This is specially seen in the treatment by manipulation. The cautious surgeon will find, in these carefully detailed cases, a guide more reliable than ordinary text-books.
The histories show particularly the desirability of carefully attending to the surgical anatomy of the hip-joint. A paper which should embrace the histories of all the cases in ques. tion would, however, far transcend the limits of time and space imposed upon writers by our Association ; and I must content myself with presenting a résumé of the results attained, and with appending to my paper a tabulated statement of the salient features in the cases reported. It should be stated, as bearing on the rarity of the lesions under discussion, that, in several instances, injuries of the hip were diagnosticated as dislocations, which in due time proved to be fractures, usually of the neck and the upper part of the shaft. One distinguished surgeon reports that he has been called thirty times to consult in cases of supposed luxation of the hip, but that, in each instance, no dislocation existed. The comparative infrequency of this lesion is further illustrated by the statement, embodied in the report of many practitioners, that the surgeons in their vicinity, many of whom had been in practice for between thirty and fifty years, had never encountered a case of dislocation of the hipjoint.
The value of my statistics is somewhat impaired by the fact that some surgeons failed to report the age and sex of their patients, while many omitted to designate the kind of dislocations observed by them. My tables embrace an analysis of two hundred and seventy-three cases of dislocation of the hip, showing the comparative frequency of the different forms of the luxation, the age and sex of patients, with the various methods of treatment, and the results obtained. With the exceptions above noted, the figures under the respective headings of the table will speak for themselves.