A 
CASE OF ANEURISM 
OF THE 
EIGHT FEMORAL ARTERY, 
CURED BY DIGITAL COMPRESSION, 
WITH 
REMARKS AND A STATISTICAL REPORT OF TWENTY-TWO OTHER 
CASES TREATED BY THIS METHOD. 
BY 
SAMUEL W. GROSS, M.D., 
CHIEF OF THE SURGICAL CLINIC OF THE JEFFERSON MEDICAL COLLEGE, PHILADELPHIA. 
[Republished from the North American Medico-Chirurgical Review.] 
PHILADELPHIA: 
J. B. LIPPINCOTT & CO. 
1859. A 
CASE OF ANEURISM 
OF THE 
RIGHT FEMORAL ARTERY, 
CURED BY DIGITAL COMPRESSION. 
On the Ist of June, 1858, Sarah, a negress, thirty-two years of age, a 
native of Delaware, consulted Professor Gross on account of a pulsating 
tumor, seated at the upper and inner portion of the right thigh. She had 
always enjoyed good health. Her first symptoms appeared about ten months 
previously, when she experienced sharp shooting pains radiating through 
the hip, down the thigh to the knee, and extending as far as the ankle. 
These pains, which were not of long duration, were intermittent, occurring 
sometimes only once every two weeks, at other times every two or three 
days, being dependent, in some degree, upon* the amount of exercise she 
took. She had been in the habit of rubbing her limb with vinegar and 
Cayenne pepper for these rheumatic pains, as she supposed them to be, 
when, in the latter part of March, she felt a small, hard lump at the spot 
adverted to, about the size of a walnut without its hull. This rapidly in- 
creased, and, about five and a half weeks ago, the pains in the tumor be- 
came so severe as to interfere with walking. On this account, and, inas- 
much as the pain was relieved by the recumbent posture, she took to her 
bed. 
Upon examination, a globular tumor was found at the upper and inner 
portion of the thigh, in Scarpa’s triangle, about one inch and a half below 
Poupart’s ligament. Its length was inches and its width 5f inches. 
The circumference of the thigh was 26| inches; while the sound one 
measured only 23 inches. The tumor presented very distinct locomotion 
and a thrill at its superior portion. The bruit de souffle was well marked, 
and the pulsation was strong over the whole tumor, being distinctly felt 4 
Aneurism of the Right Femoral Artery, 
by the patient, and 84 a minute. The sac could readily be emptied. Pres- 
sure on the artery above diminished the volume of the tumor and caused 
the sounds and impulse to cease. The arterial system was in other respects 
in a perfectly healthy condition, the heart’s sounds being normal and the 
pulse perfectly regular. 
The question in this case arose what plan of treatment should be em- 
ployed. Although the woman was in good health, the operation of cast- 
ing a ligature around the external iliac appeared too formidable, when 
compared with the safer mode afforded by compression. An instrument 
with a single pad, resembling Carte’s circular compressor, was ordered to 
be made, the patient in the mean while being placed upon the use of purga- 
tives, with low diet, and rest in the recumbent posture. The instrument, 
when finished, was found to be too small for the patient’s thigh, and was 
therefore cast aside without the pad having been made to bear upon the 
artery at all. Not wishing to delay the treatment any longer, Prof. 
Gross placed the patient under my charge, compression by means of the 
fingers having been determined upon. Having obtained a suitable num- 
ber of intelligent assistants, on Thursday morning, the 10th of June, at 
ten minutes after ten o’clock, a grain of sulphate of morphia having 
been administered, I began the treatment by applying the thumb over the 
artery as it passes over the pubic bone. At the end of an hour the tem- 
perature of the limb was somewhat diminished. At one o’clock the pa- 
tient complained of sickness at the stomach, which was relieved by half a 
grain of morphia, and in an hour and a half she fell asleep. During the 
afternoon she felt drowsy and did not complain of pain. 
11 p.m.—She has been complaining of pain for the last hour at the 
point of pressure, whenever the assistants relieved each other; in other 
words, when the pressure was relaxed. The knee is the seat of tingling 
pain, which extends to the toes, and the whole limb is painful when touched. 
Friday, 10 a.m.—The tumor feels very solid and cannot be emptied of 
its contents. There is no bruit; but slight pulsation and thrill. The 
point of pressure has begun to be painful, and, to prevent any irritation of 
the skin, moistened flour was spread over it. 
5| p.m.—The tumor is very hard, but not diminished in size. No thrill 
or bruit, and but very feeble pulsation. The compressed spot is quite 
painful. Treatment discontinued after 31 £ hours’ employment. A grain 
of morphia was administered, and pounded ice in a bladder was applied, 
to be continued during the night. 
Saturday, 10 A.M.—The patient slept well last night. The tumor is 
softer, but cannot be emptied. The pulsations are stronger, and there is 
some thrill. The compression was renewed at twenty minutes to eleven 
o’clock, and in an hour she complained of great pain in the knee, which Cured by Digital Compression. 
5 
soon extended to the toes. At half-past twelve the patient took one grain 
of morphia; the pain soon ceased, but occasionally returned. At half- 
past five half a grain of morphia was administered. 
At 8 p.m. the point of pressure gave so much pain that a thin opium 
plaster was interposed between the skin and finger to avoid more irrita- 
tion. This had a good effect in palliating the suffering. 
10 p.m.—The patient complains of much pain throughout the whole ex- 
tent of the tumor. The thrill has disappeared, and the pulsations are be- 
coming feeble. The femoral artery is beating forcibly, and a collateral 
branch, about the size of the ulnar artery, can be felt beating at the inner 
and posterior portion of the tumor. 
At 11 p.m. half a grain of morphia was administered; faintest percep- 
tible pulsations. 
At 12J all pulsation had ceased. The femoral still pulsated pretty 
freely. The compression was continued for another hour, at the end of 
which time the femoral was beating gently. 
At 2| o’clock, being satisfied that nothing more could be done, and that 
the circulation in the tumor was arrested, the patient was left, half a grain 
of morphia having been administered. 
For a few days after this event the patient had slight tingling pains in 
the limb. Dp to the time of her departure her appetite was good, and she 
slept well and was comfortable in every particular. 
In about a week a gum ammoniac and mercurial plaster was placed over 
the tumor, and her diet was restricted. The tumor gradually diminished 
in volume, and she left for home on the 6th of July, not quite a month 
after the commencement of the treatment. At the time of her departure 
the affected limb had diminished to exactly the same size as the sound one. 
The femoral artery was pervious to within an inch above the tumor, and 
she could walk with comfort. 
On the 18th of October, Sarah came to the city to report herself. The 
tumor had diminished to the size of a walnut and was very solid. The lo- 
comotion was perfect and her health was good in every respect. 
Remarks.—This case is an admirable example of the cure of aneurism 
by digital compression, even when this has been interrupted. The total 
amount of time necessary for its cure was forty-five hours and fifty-five 
minutes: at the first sitting, thirty-one hours and twenty minutes ; at the 
second, fourteen hours and thirty-five minutes. 
The compression was almost total, preventing the blood from entering 
the tumor at all; and the whole time in which the blood did traverse the 
sac did not exceed two hours. 
There cannot be a possibility of doubt, judging from the state of the 
tumor, that, had the compression at the first sitting been continued for two 6 
Aneurism oe the Right Femoral Artery, 
or three hours longer, a cure would have been the result. This was pre- 
vented, however, principally on account of the pain at the point of pres- 
sure, and also on account of the fatigue of the assistants and myself. I 
therefore preferred to wait, feeling confident that at the next meet- 
ing we would see the success of the treatment. My mind was also 
biased, when I remembered two cases reported respectively by Mr. Por- 
ter and Mr. Cusack, in both of which mechanical compression had been 
used, but proving irksome to the patients, was discontinued. The sacs 
were hard and incompressible, but pulsation still continued; the patients 
got out of bed and walked about, and yet deposition of fibrine con- 
tinued until a cure was effected. The state of the tumor in the above case 
was exactly in the same condition as in those reported by the Dublin sur- 
geons, and I expected, with the aid of the pounded ice, that a similar re- 
sult would follow. In this, however, I was disappointed, and had to re,- 
commence the treatment. 
The pressure was made mainly over the artery, where it crossed the 
horizontal ramus of the pubes; but when the pain became a source of an- 
noyance, the finger was shifted and pressure was applied over the artery 
in the space between Poupart’s ligament and where the saphenous joins 
the femoral vein. When made upon the former spot it was more easily 
kept up, and with less pain to the patient and to the finger of the operator. 
Throughout the whole course of the treatment the pain was not very great, 
owing to the free use of anodynes, which I consider in these cases of para- 
mount importance to lessen arterial action, relieve suffering, and calm 
irritability of the system. An interesting point, in connection with other 
reported cases, is the establishment of the collateral circulation, as it will 
have been seen, from a perusal of the case, that a large arterial trunk pul- 
sated in a very marked manner previous to the obliteration of the sac. At 
no time was the temperature of the limb much below that of the sound one, 
nor was there much oederaatous swelling of the extremity, showing that 
the vein was not compressed. A point in favor of the compression not 
being altogether so forcible as entirely to prevent the blood from passing 
into the sac, is, that when it was total, the patient experienced more of 
that tingling pain than when the reverse was the case. 
To Dr. Wood, and Messrs. Bxnnton, Glenn, McCondichie, Tomlinson, 
Blicke, Dysart, Purefoy, and Murfree, students of medicine in this city, 
much credit is due for their kind assistance and the praiseworthy zeal and 
interest which they manifested in the cure of this case. 
Since the revival of the treatment of anuerism by compression, princi- 
pally through the instrumentality of the Dublin surgeons, this mode of 
treatment has come into more general use, and its success is due to the Cubed by Digital Compbession. 
better knowledge of the rationale of the mode of cure, and consequently 
the more effectual means employed for that purpose. 
Although in the hands of a few eminent surgeons the ligature has been 
attended with results which, strange to say, have not been attained by 
others of apparently equal skill and care,—which good results have natu- 
rally led them to prefer that method to any other,—yet by most surgeons 
it has been discarded, until, at least, the more safe method has been put 
to test. There are still a few, 'who, instead of being guided by the more 
proper feeling of giving additional security and comfort to the patient, 
prefer the notoriety of a brilliant operation, gaining everything from the 
eclat dependent thereon, and occasionally not allowing the result of their 
treatment to be brought to light. The advantages of compression are so 
very obvious, that it is wonderful that it does not supersede all other me- 
thods of treatment. It is true there are cases in which the aneurism 
is so seated that this procedure would be out of the question, and the aneu- 
rism may be in such a condition as imperatively to call for the use of the 
ligature; but in all external aneurisms where pressure can be brought to 
bear upon the artery, it should unquestionably be employed. Conserva- 
tism in surgery is a term unknown in the vocabulary of some men, but 
those who do know it, and freely employ it, lead certainly a more quiet and 
conscientious, if not a more brilliant life. The advantages of compression 
over the ligature may be stated in a few words. It is a more simple, safe, 
and certain procedure, and, if persevered in, will almost always be success- 
ful. It is not followed by secondary hemorrhage. There is but little 
danger of erysipelas, suppuration of the sac, phlebitis, and gangrene. 
Constitutional effects are not so apt to succeed it. • There is no danger of 
neuritis and purulent collections in the common sheath of the vessels.. The 
length of time required for the cure, and the suffering are not so great. 
The mode of cure more closely resembles that effected by nature, and is apt 
to be more permanent, especially if the ligature be not applied at a dis- 
tance from the sac; in cases where the ligature is near the sac, a loose 
coagulum may form and secondary aneurism may ensue. Lastly, and not 
the least reason of all, is that the surgeon does not feel that anxiety for his 
patient, as is always the case after a capital operation. 
It is not necessary to adduce facts in substantiation of the above state- 
ments, for the records of all cases abundantly prove their validity. 
As instrumental compression has such advantages over the ligature, so 
pressure exerted by the fingers possesses some advantages over that made 
by apparatus. Thus, it is quicker and less painful; it can be regulated 
better, and in some situations can be made to act upon the artery alone ; 
it is applicable when apparatus is not; and in cases in which mechanical 8 
Aneurism of the Right Femoral Artery. 
contrivances cannot be borne, it can be used to excite a tolerance of the 
skin previous to their employment. 
The following are condensed reports of all the cases which have been 
treated by digital compression, employed either alone or in conjunction 
with apparatus. They are given in regular succession, in the order of 
the years in which they occurred :—* 
Case I.—ln 1844, Mr. E. Greatrez was the first to employ digital 
compression, in a patient with popliteal aneurism of the right side. The 
compression was total and double; being made by an Italian tourni- 
quet, alternating with the fingers of the patient. The compressor was 
placed over the artery below Poupart’s ligament, and when the pain pro- 
duced by it became unbearable, the patient relaxed the pressure for a few 
moments, at the same time applying his fingers very firmly to the artery 
just above the instrument, so as to allow of no blood passing through the 
tumor. The cure was effected in twenty-four hours. In this case, there- 
fore, the fingers were but accessory to the instrument. 
Case 2.—ln 1846, M. Yanzetti employed digital compression alone, 
in a case of popliteal aneurism, by means of assistants, at the hospital of 
Kharkoff, in Russia. This was maintained for two days, but was inefficient. 
The patient was cured by the ligature. 
Case 3.—ln 1841, Mr. Tuffnell had, in a case of popliteal aneurism, 
been employing double and alternate pressure by apparatus. The upper 
pad giving rise to inflammation of the inguinal glands, the finger of the pa- 
tient was substituted. This pressure was alternated with that of the in- 
strument for twenty-four hours, when the inguinal pad was again used. 
The cure was effected in seven days. 
Case 4.—ln the same year, Prop. J. Knight, of New Haven, had a 
case of popliteal aneurism, in which apparatus could not be borne at all. 
He cured the case in forty hours by digital compression alone, made by 
intelligent assistants, upon the femoral artery over the pubes. 
Case s.—ln 1848, Dr. W. H. Yan Buren employed, for thirty-six 
hours, digital compression over the external iliac, in a case of true ingui- 
nal aneurism. Being unbearable, the artery was ligated and the patient 
cured. 
Case 6.—One month later, in the same year, Dr. George Fox, in a case 
* In an interesting communication made to the Societe de Chirurgie, by Mons. Ar. 
Verneuil, and published in the Gazette Ilebdomadaire, 30th October, 1857, p. 773, 
will be found the statistics of seventeen cases of aneurism, all popliteal but four, 
treated by digital compression. To this paper, which may also be found in the Dublin 
Quar. Journ. of Med. Sci., May, 1858, p. 486, in the Amer. Journ. of Med. Sci., July, 
1858, p. 234, in the New Orleans Med. and Surg. Journal, Nov., 1858, p. 840, as well 
as to the work of M. Broca, I am indebted for many of the facts here presented. 
For further details of these cases, these two sources may be consulted. Cured by Digital Compression. 
9 
of large inguinal aneurism, applied digital pressure to the external iliac for 
ninety-six hours. On account of the fatigue of the assistants, and being 
unable to procure more, the pressure was discontinued, the condition of the 
tumor being much improved. Mechanical compression was then.employed 
for eight days, and the patient was finally cured by ligation of the external 
iliac. 
Case I.—Prop. Willard Parker, in the same year, in a case of dif- 
fuse aneurism of the femoral artery consecutive to ligation, employed digi- 
tal pressure for seventy-two hours with apparent success ; but the pulsa- 
tion having returned, compression was made by a weight in the groin for 
seven days, and a cure was effected. 
Cases 8, 9.—ln 1850, Dr. J. R. Wood treated two cases of popliteal 
aneurism by digital pressure on the pubes, alternating with Dupuytren’s 
compressor about the middle of the thigh. In the first case the cure was 
effected in forty-eight hours, and in the second, in eleven hours and a half. 
Case !().•—ln 1851, Mr. Norgate employed digital compression, in a 
case of popliteal aneurism, for twenty-four hours, having previously used 
bad apparatus for five days. This was inefficient, and the femoral was 
ligated; the operation was followed by gangrene, necessitating amputa- 
tion, but the patient recovered. 
Case 11.—In 1852, Mr. J. Monro had a case of popliteal aneurism in 
which digital compression was kept up for three days by convalescent pa- 
tients in the hospital. Mechanical compression was then substituted and 
a cure resulted in sixteen days. 
Case 12.—1n 1854, Mr. Wm. Jameson employed digital compression 
for a popliteal aneurism for four hours, when it was discontinued on ac- 
count of the patient being irritable and rebellious. Mechanical compres- 
sion was substituted, and a cure was produced in six days. 
Case 13.—1n the same year, a patient, under the charge of Mr. Colles, 
cured himself, without assistance, of a diffuse popliteal aneurism, by inter- 
mittent digital compression, in seven days. 
Case 14.—During the same year, and under the same surgeon, a femo- 
ral aneurism was cured in about six days, by partial, irregular, alternating 
digital and mechanical compression. 
Case 15.—M. Yanzetti, in the same year, cured a popliteal aneurism, 
by digital compression, in forty-eight hours, various apparatus having 
been previously applied. 
Case 16.—1n 1855, M. Yelaton, in a case of popliteal aneurism, tried 
mechanical pressure for sixteen days. This not succeeding, he substi- 
tuted digital compression, which was maintained for ninety-four hours. 
The cure was not permanent. The limb was amputated, and the patient 
died of purulent infection. Aneurism op the Right Femoral Artery, 
o 
a 
& 
525 
Operators. 
M 
U1 
§) 
<1 
Date. 
Variety 
of 
Aneurism. 
Style of 
Compression. 
Duration. 
Result. 
Remarks. 
Authorities. 
1 
Edw. Greatrez.. 
Male 
27 
1844 
Popliteal 
Total digital 
24 hours 
Cure 
The patient regulated the 
Medico-Chirurgical Trans- 
and instru- 
pressure. 
actions, vol.xxviii. p. 39, 
1 
mental. 
1845. 
2 
Yanzetti 
9 
9 
1846 
Popliteal 
Dig;., primary 
2 days 
Inefficient 
Ligature of the femoral. 
M. Verneuil’s paper. 
and alone. 
Cure. 
0 
TnfiWIl 
\1t1p 
07 
1847 
7 rlftirn 
Cure 
17; „ x? x; 1 „ i x 
TV ..1.11 V T . 4 ! . . 1 TV 1 
and instru- 
ting with apparatus. 
xxi. p.305,1849; Broca. 
mental. 
op. cit. p. 808. 
4 
Male 
48 
1847 
Digital, total, 
and alone. 
40 hours 
Cure 
17;,,„x i xi,;_ xu - 
assisted by other means; 
apparatus having proved 
' intolerable. 
Boston Med. & Suig. Jour- 
nal, May, 1848; Trans. 
Am. Med. Assoc., vol. i. 
p. 169, 1848. 
5 
Van Buren 
Male 
25 
1848 
Inguinal 
Dig., primary 
36 hours 
Unbearable 
Ligature of external iliac. 
New York Journal Med., 
and alone. 
Cure. 
vol. ii., new series, p. 
168, 1849. 
6 
Fox 
Male 
24 
1848 
Inguinal 
Digital. 
96 hours 
Failure 
Mechanical pressure for 8 
days. Ligature of exter- 
nal iliac. Cure. 
Am. Jour. Med. Sci., 1849, 
new series, vol. xviii. p. 
377. 
7 
9 
? 
1848 
Digital pri- 
mary. 
72 hours 
Inefficient 
femoral. 
gature of femoral for pop- 
vol. ii., p. 228, 1849. 
liteal aneurism. Com- 
pression by weight in 
groin for 7 days. Cure. 
8 
Wood 
Male 
30 
1850 
Popliteal 
Digital and 
instrumental. 
2 days 
Cure f 
Digital compression on pu- 
bis alternating with Du- 
New York Journal Med., 
vol. vi., new series, p. 
9 
Wood 
Male 
33 
1850 
Popliteal 
11J hrs. 
Cure 
puytren’s compressor on 
304, 1851. 
instrumental. 
I 
thigh. 
10 
Male 
34 
1851 
Popliteal 
Digital. 
24 hours 
Failure 
Previously bad apparatus 
for five days. Ligation 
of femoral; gangrene; 
amputation. Cure. 
Dublin Medical Press, vol. 
xxvii. p. 247, 1852. 
11 
Male 
23 
1852 
Popliteal 
Dig. primary. 
3 days 
Failure 
Made by patients for six- 
teen days; subsequently 
mechanical compression. 
Cure. 
London Lancet, vol. i. p. 
117, 1858. Cured by Digital Compression. 
11 
12 
Jameson 
Male 
45 
1854 
Popliteal 
Dig. primary. 
4 hours 
Failure 
Subsequent mechanical 
compression and in six 
days a cure. 
Dub. Hospital Gaz., vol. i. 
n. 5, p. 72, April 1st, 
1854. 
13 
Colies 
Male 
36 
1854 
Diffuse 
popliteal 
Intermittent 
dig., primary 
and alone. 
7 days 
Cure 
Compression made by pa- 
tient. 
Dub. Hospital Gaz., vol. i, 
p. 97, May 1st, 1854. 
14 
Colles 
Male 
32 
1854 
Femoral 
Irreg., alter., 
dig., and me- 
chanical. 
About 
6 days 
Cure 
Med. Times & Gaz., Dec. 
30th, 1854; Ranking’s 
Abstract, No. xxi. p. 
102, 1855. 
15 
Vanzetti 
Male 
36 
1854 
Popliteal 
Digital. 
48 hours 
Cure 
Various apparatus were 
tried for a long time be- 
fore and given up. 
M. Verneuil’s paper. 
Ifi 
Nelaton 
Male 
32 
1855 
Diffuse 
popliteal 
Digital. 
94 hours 
Inefficient 
Previous mechanical com- 
pression for sixteen days. 
Limb amputated; puru- 
lent infection. Death. 
Broca., op. cit. obs, 45, p. 
766. 
17 
Nelaton 
Male 
70 
1855 
Arterio- 
venous at 
elbow 
Dig. and other 
varieties. 
Several 
days. 
Cure 
Broca., op. cit., p. 293, 
obs. 7. 
18 
Vanzetti 
Male 
27 
1855 
Popliteal 
Digital, total, 
primary, and 
alone. 
4 hours 
Cure 
The patient himself made 
intermittent, imperfect, 
digital compression for 
twenty days. 
M. Verneuil’s paper. 
19 
Michaux 
Male 
50 
1856 
Femoral 
Digital total. 
24 hours 
Cure 
Previously intermittent me- 
chanical pressure for four 
days. 
M. Verneuil’s paper. 
20 
Michaux 
Male 
57 
• 
1856 
■ 
Popliteal 
Intermittent 
digital. 
7 days 
Cure 
Previously mechanical com- 
pression. Signs of seri- 
ous disease of heart. 
Bost. Med. & Surg. Jour., 
July 15th, 1858, p. 484. 
21 
Gherini 
Male 
27 
1857 
Varicose 
at elbow 
Dig., primary 
and alone. 
3J hours 
■ 
Cure 
Med. Times & Gaz., May 
8th, 1858; Omodei An- 
nali, vol. clxiii. p. 99, 
22 
Michaux 
Male 
52 
1857 
Popliteal 
Dig,, primary 
and alone. 
24 hours 
Cure 
Previously bleeding, low 
diet and digitalis. Com- 
pression partial and total. 
Lancet, Sept. 11, 1858, p. 
202; from Jour. deMed. 
et de Chirurg. Prat., 
May, 1858. 
23 
3. W. Gross 
Female 
82 
1858 
Femoral (Dig., tot., pri. 
jand alone. 
45 hours 
55 min. 
Cure 
North Amer. Med.-Chir. 
Rev., Jan. 1859, 12 
Aneurism oe the Right Femoral Artery, 
Case I*7.—ln 1855, M. Nelaton employed digital compression con- 
jointly and alternately with direct compression, with apparatus, in a 
case of arterio-venous aneurism at the bend of the elbow. In several 
days the cure was effected. 
Case 18.—In the same year, M. Yanzetti had an intelligent patient 
with a popliteal aneurism. Understanding the plan of treatment, which 
was deferred for twenty days, he himself, during this time, made pressure 
on the femoral artery, which seemed to have a slight influence upon the 
tumor. The treatment was confided to six intelligent assistants, and in 
four hours the patient was cured. 
Case 19.—1n 1856, M. Michaux employed intermittent mechanical 
pressure, in a femoral aneurism, for four days. Digital compression was 
then substituted, and in twenty-four hours the cure was complete. 
Case 20.—The same surgeon, in the same year, in a case of popliteal 
aneurism, first employed a tourniquet and then substituted digital com- 
pression. A cure was effected in seven days, the compression having been 
several times withheld. 
Case 21.—1n 1851, M. Uherini employed digital compression, primarily 
and alone, in a case of varicose aneurism at the elbow. A cure was effected 
in three hours and a half. 
Case 22.—1n the same year, M. Michaux, in a case of popliteal aneu- 
rism, employed digital compression, primarily and alone, first partial and 
then total, and effected a cure in twenty-four hours. 
For further convenience of reference these cases have been drawn up in 
the form of a table, from which it will be seen that fifteen were successful 
and eight unsuccessful. The number of the different varieties and the re- 
sult are shown in the following table : 
Variety. 
No. of Cases. 
Cure. 
Failure. 
Popliteal 
15 
30 
5 
Femoral 
4 
g 
1 
Inguinal 
2 
2 
Artcrio-Yenous 
o 
2 
23 
15 
8 
Cures.—ln five cases the digital compression was employed primarily 
and alone. Nos. 13, 18, 21, 22, 23. 
In four cases digital compression succeeded after apparatus had been 
abandoned. Nos. 4, 15, 19, 20. 
Five times digital compression was alternated with pressui’e by appara- 
tus. Nos. 1, 3, 8, 9, 14. 
Once digital compression succeeded when combined and alternating with 
apparatus and direct compression of the tumor. No. IT. Cured by Digital Compression. 
13 
Failures.—ln six cases digital compression was tried before any other 
means. Nos. 2, 5, 6, I, 11, 12. 
In two cases digital compression had been employed after apparatus 
had been abandoned. Nos. 10, 16. 
After examining these unsuccessful cases, the question naturally arises, 
were they all good tests of this mode of treatment, and would it not have 
been possible to have cured several of them had the treatment been con- 
tinued for a longer time ? 
Of these eight cases, it is probable that in No. 7 the cure would have 
been complete, had the compression been kept up several hours longer; 
in Case 11, the pressure must necessarily have been imperfect, on account of 
its having been applied by convalescent patients in the wards of a hospi- 
tal. In Case 12, it was abandoned after four hours, because the patient 
was rebellious. In Cases 5 and 6, the pressure was in one unbearable, 
and in the other no more assistants could be procured; in both, more- 
over, the aneurism was inguinal, where, on account of its unfavorable situ- 
ation, it is exceedingly difficult to maintain pressure, and consequently a 
favorable result could scarcely be expected. Cases 2, 10, and 16, are the 
only ones which we would regard as perfect failures. In examining the 
ultimate results of these unsuccessful cases, we find that in four the artery 
was subsequently ligated, and all but one were successful, Nos. 2, 5, 6,10; 
two were amputated, Nos. 10,16 ; and one patient died of purulent infec- 
tion. In three cases, subsequent mechanical compression resulted in a cure, 
Nos. 7, 11, 12. In Cases I and 12, the tumor was so modified as to ren- 
der a cure by apparatus effectual. In Case 11, digital compression ren- 
dered apparatus bearable. 
The length of time required for the cure of fourteen of these successful 
cases—No. II has to be rejected, as the period is so indefinite—averaged 
two days and two-thirds. When the compression was primary and em- 
ployed alone, the average was two days and thirty minutes; when double 
and alternate, three days and seven hours ; and when employed after apa- 
ratus had been abandoned, the mean duration was two days and twenty- 
two hours. Let us compare these results with those of aneurism treated by 
mechanical compression alone. Thus, Mr. Hutchinson found in the Lon- 
don hospitals that of twenty-six cases of femoral and popliteal aneurism 
cured by this method, the average duration was nineteen days, while in 
the Dublin cases the mean duration of treatment was twenty-five days.* 
M. Broca has found that in ninety-nine cases the length of time re- 
quired for a cure was a little less than fifteen days.f At the present 
time we may therefore state that digital compression alone has effected 
* See Erichsen’s Surgery, second edition, pp. 522-23; London, 1857. 
f Brocades Aneurysmes, etc., p. 844; Paris, 1856. 14 
Aneurism op the Eight Femoral Artery, 
cures in the shortest time. Next in order comes alternate digital and me- 
chanical compression; and lastly, mechanical compression alone requires 
the longest time for a cure, although the duration of this plan is far 
less than that of the treatment by the ligature. The reason why me- 
chanical compression has not succeeded in a shorter space of time, is on 
account of its mal-application in most cases; and when this point has been 
properly attended to, there can be but little doubt that a cure will result 
in half the time it will by the ligature. 
A striking point in these twelve cures is, that five were effected by pres- 
sure with the finger alternating with the use of the apparatus. In two of 
these cases the pressure was regulated and kept up by the patients, Nos. 
1, 3. In the remaining three, Nos. 8, 9, 14, the compression was made 
by assistants. As this plan is so simple, has been attended with the best 
results, affords such relief to the patient and operator, and has always 
effected a cure whenever employed, it should be preferred to all other 
methods. 
The case of Mr. Codes, No. 13, is interesting from the fact that the 
patient cured himself in seven days, by irregular intermittent digital com- 
pression, the treatment being carried on without the knowledge of the 
surgeon. 
In M. Yanzetti’s case, No. 18, the patient had kept up the pressure 
himself for twenty days previous to the interference of the surgeon, so 
modifying the tumor as to render the cure perfect in four hours. 
Thus it will be seen that in a little more than one-fourth of these cases 
the patients had been, in a greater or less degree, instrumental in the cure, 
leaving the surgeon but little to do. 
Another interesting fact is, as M. Broca observes, “that digital com- 
pression is an American procedure, and the principal merit thereof belongs, 
undoubtedly, to Prof. Knight,” who was the first to cure a case by this 
method, unassisted by apparatus. Besides his case, six others have been 
operated on in this country, making seven of the twenty-three cases ; four 
of which were successful. 
Although the first cure was effected in this country, the case was the 
second that had been treated by digital compression alone, the first hav- 
ing been in the hands of M. Yanzetti, Professor of Surgery in the Uni- 
versity of Padua, who did not, however, succeed in curing his patient. 
The priority belongs, therefore, to the latter gentleman, who has, more- 
over, applied this method in four cases of external phlegmonous inflamma- 
tions, with happy results. 
The compression should, in our opinion, in cases of popliteal and fe- 
moral aneurism, when not contra-indicated, be made upon the femoral ar- 
tery as it lies over the pubic bone. At this point it is more easy of appli- Cured by Digital Compression. 
15 
cation, and causes less pain to the patient and fatigue to the operator. If 
made a little lower down, the inguinal glands are apt to become inflamed 
and give rise to great suffering. The vein, moreover, is here on the inside 
of the artery, and if the pressure be made over the course of the artery, it 
alone will be compressed. Throughout the whole extent of the rest of the 
thigh, the vein will be sure to be involved. 
We trust that this plan of treatment may be more generally adopted 
than it has been heretofore. It is always possible to obtain a sufficient 
number of assistants in private and hospital practice, who would be but too 
glad to avail themselves of such rare opportunities for observation, and do 
all in their power to lessen the dangers and sufferings of a fellow-being. 
Its great value certainly calls for repeated trials; let them be made and 
let new facts be added to those already presented, so that we may more 
readily arrive at the comparative value of all the modes of treatment of 
this class of cases. 
From all the data to be found in these cases, we may deduce the follow- 
ing propositions:— 
I. Digital compression, uncombined with apparatus, was first attended 
with success in the hands of Dr. Knight; but to M. Yanzetti is due the 
merit of having first introduced it into practice. 
11. It has never been followed by bad consequences, and when not suc- 
cessful, it so modifies the tumor and the collateral circulation as to render 
a cure by other means almost certain. 
111. It has been employed alone, either previous or subsequent to me- 
chanical compression, in fourteen instances, eight being failures. 
IY. In only seven cases has it been employed primarily and alone, and 
in all but two with perfect success. 
Y- When double and alternating, it has effected cures in every case, 
five in number, and therefore deserves special attention. 
YI. In most of the cases the compression has been total; but this is 
not necessary for a favorable result. 
YII. It has effected cures, whether it was continued, interrupted, or in- 
termittent ; in some cases the patient applying the pressure. 
YIII. When properly employed and continued for a sufficient length of 
time, and the cases are suitable ones, it can scarcely fail to accomplish a 
cure. Inguinal aneurisms are not fit cases for this procedure. 
IX. It is less apt to give rise to inflammation of the integument, and 
has been borne when mechanical pressure has produced an eschar. 
X. It can be used when apparatus has failed or is intolerable. In a 
majority of these cases, cures have been accomplished. 
XI. In certain situations it can be made to bear upon the artery alone. 
It is far less painful and requires a much shorter time for a cure than any 
other method of treatment.