MEDICAL TIMES. 
[May 10, 1873 
500 
The limb was then enveloped in cotton wool, kept 
in place by a loosel/-applied roller, and half a grain 
of morphia was given hypodermically. 
Under the watchful care of Mr. Rowland, the 
patient made a satisfactory recovery, the ligature 
not being detached until the twenty-sixth day. The 
pain was relieved at once, and the tumor slowly 
decreased in size. At this time, two years after the 
operation, the measurement about the knee is fif- 
teen inches, and a small tumor about the size of an 
English walnut occupies the popliteal space. The 
patient enjoys good health, and is able to perform 
his ordinary duties about the farm. 
Remarks.-The very unfavorable condition of 
the patient, exhausted by pain and loss of rest, with 
the character of the aneurism from which he was suf- 
fering, rendered the prognosis in this case doubtful 
under any plan of treatment. The condition of the 
patient was such as to imperatively demand that relief 
by surgical treatment should not be long delayed, 
and at the same time his state, as well as the nature 
and condition of the aneurism, made the question as 
to the selection of the method of treatment one of 
great importance, and one which required most care- 
ful deliberation. Treatment by compression, so 
frequently successful in ordinary cases of popliteal 
aneurism, did not appear to be applicable in this case, 
for these reasons: r. The possibility of failure, and, 
as a consequence, the continuance of the pain and 
other unfavorable symptoms. 2. The danger of 
increasing the oedema and venous congestion, already 
of a threatening character, in reference to the pro- 
duction of gangrene. 
The fact also that there were not at hand proper 
appliances for making compression had its influ- 
ence in the decision to reject a trial of this method 
of treatment,-a matter of importance always; es- 
pecially does it obtain in such a case as the one 
under consideration. • 
Amputation at the middle of the thigh was 
deemed unadvisabie on account of the condition of 
the patient. The shock consequent upon an opera- 
tion of such magnitude would have produced, in 
all probability, a speedily fatal termination. 
Ligation of the femoral artery, therefore, while 
not free from some of the objections properly urged 
against other methods, seemed to be the plan of 
treatment presenting the most favorable prospects 
of success. 
The employmert of a large ligature, and its ap- 
plication to the vessel with moderate force, without 
doubt contributed to the successful issue by pre- 
venting the too ranid separation of the coats of the 
vessel, with the hazard of producing secondary 
hemorrhage. 
LIGATION OF THE FEMORAL ARTERY 
FOR LARGE ANEURISM OF THE PO- 
PLITEAL ARTERY-RECOVERY. 
BY J. EWING MEARS, M.D. 
MAY 14, 1871, I was asked by Dr. J. T. Row- 
land, of Media, Delaware County, to see in 
consultation a patient who was suffering from an 
aneurism of the left popliteal artery. The follow- 
ing history of the case was obtained by his son, Dr. 
F. F. Rowland, then a student of medicine: 
"T. K., set. 66 years, native of Ireland, temperate, 
farmer by occupation. With the exception of several 
attacks of rheumatism, he has enjoyed good health. 
He has never sustained any injury to which he can at- 
tribute the origin of the tumor. The first intimation he 
had of any trouble in his leg was in September, 1870, 
when he noticed that in tying the string in the shoe of 
the left foot a tingling sensation was felt, which ex- 
tended up to the knee. This condition continued until 
January I, 1871, when he discovered a tumor, about the 
size of a small egg, occupying the popliteal space. At 
first the growth of the tumor was slow. Within the past 
two weeks the increase in size has been very rapid, 
measuring at this date twenty-six inches in circumfer- 
ence." 
On examination, a large, irregular-shaped tumor 
was found occupying the left popliteal space, and 
encroaching, to a great extent, upon the external 
surface of the limb. The surface was cold and had 
the livid hue which indicates venous congestion. 
Large veins were distinctly visible coursing over it. 
The leg was flexed at an angle of 6o°, and was 
greatly increased in size by oedema. Pulsation 
could not be detected, and the aneurismal bruit was 
distant and indistinct. 
During the past two weeks the patient had suf- 
fered intense pain from the pressure produced by 
the rapidly enlarging tumor, and was greatly ex- 
hausted by pain and loss of rest. Anodynes in 
large doses failed to alleviate his sufferings, and he 
was extremely anxious that something should be 
done for his relief. A careful examination of the 
heart and superficial arteries was made, in order to 
ascertain their condition. This examination show- 
ing them to be free from disease, I advised ligation 
of the femoral artery according to Hunter's method. 
The plan of treatment being accepted, I cut down 
upon the vessel, and surrounded it with a large 
silk ligature, which was applied with moderate force 
to the artery and was successful in controlling the 
circulation through the vessel and aneurismal sac.