169 



the diet of tlie patient was restricted, and digitalis was adminis- 

 tered to him. 



By the 12th day the tumour was reduced to about half its original 

 size; had become solid, and was free from pulsation. Notwith- 

 standing these circumstances, Dr. Mutter did not consider it safe to 

 allow his patient to move about, or even to relax the treatment, but 

 continued to pursue the same course, with slight modifications, for 

 six weeks longer. At the expiration of this period, the tumour had 

 nearly disappeared, the collateral circulation was fully established, 

 and the disease radically cured. 



Dr. Knight's case, which is peculiarly interesting, from the novel 

 manner in which the pressure was made, and quickly effected a cure, 

 was that of a mulatto man, aged 48, in whom a popliteal aneurism 

 had existed for several months. The aneurismal tumour, which was 

 well marked, filled up the whole popliteal space. The leg was very 

 painful and oedematous. After the oedema was removed by rest, 

 and other appropriate treatment, pressure on the artery, by means 

 of the hoop tourniquet, the calliper shaped instrument, the common 

 tourniquet, guarding the limb against pressure of the strap by en- 

 casing it with thick sole-leather, and by a variety of other mechanical 

 contrivances, was fairly tried. By whatever instrument, however, 

 the pressure was made, and however carefully it was guarded, whe- 

 ther continued on one point only, or shifted from one part of the artery 

 to another, the pain became in a short time so severe that it could 

 not be endured. The pain complained of was not in the part pressed 

 upon by the instruments, but was felt equally in the thigh and 

 below the knee, and occurred whether the limb was left uncovered 

 or was enveloped in a roller. It usually began in twenty-five or 

 thirty minutes after the pressure was made, and became intolerable 

 in fifteen or twenty minutes longer, and could be continued in no 

 instance beyond one hour. These efforts were persisted in for eight 

 or ten days, and as nothing had been gained at the end of that time, 

 were abandoned. Before resorting, says Dr. Knight, to the ligature 

 of the artery, I concluded, with the concurrence of his physician, 

 Dr. Tyler, to try manual pressure upon the vessel. " To accomplish 

 this, a sufficient number of assistants were procured from the mem- 

 bers of the medical class, who cheerfully offered their services. 

 They were divided into relays, two keeping up the pressure for five 

 or six hours, relieving each other every hour or half hour, and these 

 succeeded by two others. Sufficient pressure to arrest the pulsation 

 in the tumour was found to be most easilv made with the thumb or 

 12 



