ly be felt,
but to the expert may even become audible. This external manifestation
is, however, not always sufficient in itself, and should invariably be
associated with the rectal taxis for corroboration. It is true that this
may fail to add to the evidence of fracture, but till then the simple
testimony afforded by the detection of crepitation from the surface,
though a strong confirmatory point, is scarcely sufficiently absolute to
establish more than a reasonable probability or strong suspicion in the
case.

In addition to the fact that the rectal examination brings the exploring
hand of the surgeon into near proximity to the desired point of search,
and to an accurate knowledge of the situation of parts, both pro and con
as respects his own views, there is another advantage attendant upon it
which is well entitled to appreciation. This is the facility with which
he can avail himself of the help of an assistant, who can aid him by
manipulating the implicated limb and placing it in various positions, so
far as the patient will permit, while the surgeon himself is making
explorations and studying the effect from within. By this method he can
hardly fail to ascertain the character of the fracture and the condition
of the bony ends. By the rectal taxis, as if with eyes in the finger
ends, he will "see" what is the extent of the fracture of the ilium or
of the neck of that bone; to what part of the central portion of the
bone (the acetabulum) it reaches; whether this is free from disease or
not, and in what location on the floor of the pelvis the lesion is
situated. By this method we have frequently been able to detect a
fracture at the symphysis, which, from its history and symptoms and an
external examination, could only have been guessed at. Yet, with all its
advantages, the rectal examination is not always necessary, as, for
example, when the fracture is at the posterior and external angle of the
ischium, when by friction of the bony ends the surgeon may discern the
crepitation without it.

Every variety of complication, including muscular lacerations with the
formation of deep abscesses and injuries to the organs of the pelvic
cavity, the bladder, the rectum, and the uterus, may be associated with
fractures of the hip bone.

_Prognosis._--The prognosis of these lesions will necessarily vary
considerably. A fracture of the most superficial part of the bone of the
ilium or of the ischium, especially if there is lit