The Hip comes under massage treatment more rarely than any of the other large joints. Before beginning such treatment it is of the first importance to make sure that no tubercular coxitis is present. The differential diagnosis is important. When the joint does come under massage treatment it is generally for the results of fracture of the neck of the femur, but as regards this subject I refer my readers to surgical text-books. The more advanced in years the patient is, the more probable it is, as we all know, that fracture of the neck of the femur is intracapsular, and then often does not unite. Intermediate forms are found in which the fracture is partly intracapsular, partly extracapsular. But I must point out that it is not uncommon to find patients in whom fracture of the neck of the femur has occurred when they were well advanced in years and which has healed nevertheless. In any case one treats such joints with frictions in front just below and internal to the anterior inferior iliac spine, going backward in an arched line which begins about midway between the anterior superior iliac spine and the highest point of the great trochanter, and ends somewhat above a point midway between the small trochanter and the ischial tuberosity. One tries all the time to keep rather nearer the trochanter than the above-mentioned parts of the pelvis.

In giving passive movements to elderly people one must always bear in mind how very brittle the neck of the femur may be, and how very easily it may be fractured.

With effusion in the joint the swelling is best seen from the front external to the femoral artery.

After dislocation {and reduction) of the hip one has always to devote oneself to energetic treatment of the muscles, which are often severely torn and bruised. After dislocation into the obturator foramen, Pectineus and the Adductor muscles, especially Add. Brevis, are severely strained and slightly torn. After dislocation on to the pubis the Adductors have generally fared worst. After dislocation on to the dorsum ilii or on to the ischium, the Gemelli, Obturators, Pyriformis, and Quadratus are torn, Pectineus strained, and the Glutei often bruised; Obliquus Externus, Sartorius, and Ilio-psoas may also be strained and partially torn. As far as one can get at them one must give frictions over the infiltrations in these muscles, and must begin and end each seance with effleurage over the femoral vein, especially over its upper part near the saphenous opening.

An important point before beginning massage treatment is the differential diagnosis from tubercular effusion by the exclusion of hereditary tendency, the tubercular diathesis, rise of temperature, and by extracting fluid from the joint, which in tuberculosis is opaque instead of purely serous.