ON AMPUTATION 415 



And, in the second place, an inexperienced or nervous surgeon may be tempted 

 to screw down the rigid instrument with needless violence and damage the 

 intestine by so doing. 



Mr. Davy, of the Westminster Hospital, has suggested a very ingenious 

 mode of compressing the common iliac artery by introducing into the rectum 

 one end of a smooth wooden cylinder two feet in length and about an inch in 

 diameter passed in sufficiently far to permit it to be pressed down upon the vessel 

 on the brim of the true pelvis when the other end or handle of the instrument 

 is carried to the thigh of the opposite side, and then raised so that the rod may 

 act as a lever for which the anus serves as a fulcrum.^ In most cases in which 

 Davy's lever has been employed it has answered to admiration.- But it is 

 intelligible that in case of a short mesorectum it might be impossible without 

 undue force to effect compression of the iliac trunk on the right side ; and of 

 course if the coats of the rectum were unsound, the instrument would be wholh' 

 inapplicable. Accordingly, I lately heard of a case in which a gentleman 

 specially conversant with the use of the lever failed to bring it into effective 

 action ; and another case has been mentioned to me where death resulted 

 from mischief done by the end of the rod working in the dark. 



Hence I believe it to be wiser to adopt here also the principle of Esmarch's 

 elastic compression. It may be applied either to the aorta or to the extreme 

 upper part of the limb. For the aorta a pad of sufficient size, such as a pin- 

 cushion, adjusted over the vessel about the level of the iliac crests, is pressed 

 down by elastic bands, which, however, ought not to encircle the body directly 

 and so cause inconvenient constriction of the waist, but should be connected 

 with the ends of a rigid object placed transversely beneath the back and extend- 

 ing laterally sufficiently far to protect the sides of the body from compression. 

 A narrow piece of board with two lateral notches at each end would answer 

 the purpose quite well for an emergency as a substitute for the curved piece 

 of stout iron with rings or hooks at the ends recommended by Esmarch. 



When the elastic band is applied to the limb for amputation at the hip- 

 joint, special arrangements must be adopted to keep it well out of the way of 

 the knife, and also to prevent it from slipping down and becoming useless when 

 the support of the head and neck of the bone is withdrawn b\- disarticulation. 

 The following method will be found to answer perfectly. An elastic band 

 having been provided sufficiently strong to require the full force of the surgeon 

 to stretch it to twice its length,^ and long enough to encircle the upper part of 



' See British Medical Journal, May i8, i878._ 



* See Mr. Pearce Gould, Transactions of Clinical Society of London, 1S79. 



' About three of the ordinary rods of red caoutchouc, jihiccd side by side and tied together at their 

 ends, will be found to answer the jiurpose for an adult. 



