166 



As to the instruments used in applying pressure, their shape and 

 construction are matters of comparatively little importance. The 

 essential points in an instrument for compression are : that it should 

 admit of being readily applied ; that its principle should be so simple 

 as to be understood by the patient, and that it should effect the 

 object intended with as little inconvenience as possible. A broad 

 soft pad, Mr. Bellingham thinks, will generally be found to answer 

 best, and the counter-pressure ought to be distributed over a large 

 surface. As to the sites at which the pressure may be applied on 

 the lower limb, either the point where the artery crosses the hori- 

 zontal ramus of the pubis ; between Poupart's ligament and the 

 point at which the saphena joins the femoral vein ; from the middle 

 third of the thigh, down to the opening through which the artery 

 passes to the back of the limb, are any of them eligible situations 

 for it. In regard to the degree of compression, it at first ought 

 always to be light; after a time, when tolerance is established, it may 

 be increased to the degree we consider necessary; but, as before 

 observed, Mr. Bellingham thinks it need never be so great as to 

 interrupt completely the circulation in the artery at the point upon 

 which it is applied. 



In this country true external aneurisms are not common. Your 

 committee are cognizant of but five instances in which the treat- 

 ment by pressure, as now recommended, has been made use of in 

 the lower extremity. All but one of these have occurred within the 

 past year, and the details of them have been kindly furnished by 

 the operators for this Report. 



These cases have been treated by Drs. Buck, Rodgers, and Wat- 

 son, of New York, Knight of New Haven, and Mutter of Phila- 

 delphia. 



The first case was one of femoral aneurism, in which pressure was 

 fairly tried and did not succeed, and it became necessary at last to 

 resort to the operation by ligature. 



The instance which occurred to Dr. Rodgers was that of a negro 

 seaman, aged 47, who, two months before, observed a swelling in 

 the popliteal region, which arose after a fall. The tumour was of 

 the size of a duck's egg, and the symptoms of aneurism were well 

 marked. He entered the New York Hospital, and on the 15th of 

 January, 1847, pressure was made upon the artery near the groin 

 by means of an arterial compressor. This was continued till the 

 12th of February, but it being found impossible to effect the desired 

 object with it, Dr. Rodgers substituted another, consisting essen- 



