The Ihigh. 339 



and about six inches below the tourniquet and is joined by 

 a longitudinal one commencing at the tourniquet. The in- 

 tegument and superfical fascia are dissected up as far as the 

 trochanter minor, at which point the remaining soft parts 

 are divided down to the bone. The vessels are ligated, 

 the soft parts separated up to the joint, and the whole 

 limb, being used as a lever, is forcibly flexed, abducted 

 and adducted, to permit the entrance of air into the joint 

 after the capsule has been opened, and to rupture the liga- 

 rnentum teres, after which the disarticulation is completed. 



Operations on Arteries. Compression. Compression 

 of the femoral is best made immediately below Poupart's 

 ligament, since, at this point", the artery is separated from 

 the pubic bone by the psoas muscle, only. The pressure 

 should be directed backwards against the bone. In the 

 middle third of the thigh the pressure should be directed 

 from within outwards, because of the relation of the vessel 

 to the bone in this portion of the thigh, lying as it does, to 

 the inner side. 



Ligation of the common femoral, is rarely, if ever, 

 done, since there is always an uncertainty as to the height 

 at which this vessel bifurcates. Further, because of the 

 number of branches given off from this artery, it would be 

 unwise to make the attempt, unless extraordinary circum- 

 stances would warrant it, since a clot might not form, and 

 secondary hemorrhage, therefore, result. Again, since the 

 common femoral is the main bloodvessel of the limb, gan- 

 grene might follow if this vessel were ligated. The superfi- 

 cial femoral, therefore, is generally elected, and the best 

 situation at which to apply a ligature to it, is at the apex of 

 Scarpa's triangle. Ligation of this vessel is done for 

 wounds, or for popliteal, or lower femoral aneurism. Oper- 

 ation. An incision is made through the integument and 

 superficial fascia in the line of the vessel and about three 



