A'CUPRESS1TRE, a mode of arresting hemorrhage from cut arteries. It is based on the principle of temporary metallic compression, and was first suggested to the scientific world by Sir James V. Simpson, bart., in a paper read before the royal society of Edinburgh, Dec., 1839. The simplest mode of practicing it may be thus tteseribed: The needle is passed through the flaps or sides of the wound, so as to cross over and compress the orifice of the bleeding artery, just as in putting a flower in the lapel of one's coat, one crosses over and compresses the flower-stalk with a pin pushed twice through the lapel. The middle portion of the needle—the only part of it which is in immediate contact with the fresh surface of the wound—bridges over and compresses the artery at its bleeding orifice, or perhaps a line or two more on its cardiac side. The head and point of the needle are exposed externally on the cutaneous surface of the flap or side of the wound. " When the needle in this method," says Sir J. Y. Simpson, " the surgeon usually places the point of his left forefinger or of his thumb upon the mouth of the bleeding vessel, and with his right hand introduces the needle from the cutaneous surface, and passes it right through the whole thickness of the flap till its point projects for a couple of lines or so from the surface of the wound, a little to the right side of the tube of the vessel. Then. by forcibly inclining the head of the needle towards his right, he brings the pro jecting portion of its point firmly down upon the site of the vessel; and after seeing that it thus quite shuts the artery, he makes it re-enter the flap as near as possible to the left side of the vessel, and pushes on the needle till its point comes out again at the cutaneous surface. In this mode, we use the cutaneous walls and component substance of the flap as a resisting medium, against which we compress and close the arterial tube. But in some wounds, a neighboring bone or other firm unyielding texture forms the best and readiest point of resistance against which to pin and compress the artery by the acupres sure needle." This is the first and simplest mode of applying A. Six other methods, however, have been suggested; and as each of them has its peculiar appropriateness as a haemos tatic agent, it will be proper to enumerate and describe them. The appliances which these other methods require are—a pin with a glass head, to admit of sufficient pressure for introduction; a needle threaded with iron wire; and a loop of inelastic iron wire, 5 or 6 in. in length. The pins and needles should be of various sizes, and they should also be bayonet-pointed; the latter form being superior to the spear-pointed, as facilitating introduction, and as being less apt to cut the tissues.
Second mode: The needle is inserted iu the fresh surface at a little distance from the vessel; it is pushed on, causing its point to rise up as near the artery as possible; it then bridges over and compresses the artery; then its point is made to dip into the raw surface of the wound on the other side of the vessel; finally, it is forced on until it emerges a second time on the wound. The passive or elastic iron wire with which it is threaded enables it to be easily withdrawn. Third mode: The needle is entered on one side of the artery; is pushed behind so that its point emerges on the opposite side of the vessel; a loop of inelastic wire is then passed over its point, so as to bring the wire over the track of the artery and behind the stem of the eye-end of the needle; finally, the wire is drawn sufficiently to close the vessel, and is fixed by a twist or half a twist round the needle. The needle may again be withdrawn by the wire which threads it. Fourth mode: This differs from the third only in substituting a pin with a glass head for the A. needle threaded with iron wire. The pin is preferred to the wire-threaded needle, as avoiding entanglement with the wire, and consequent pain in withdrawing the needle. Fifth mode: This, which, from its inventor, Dr. Knowles, formerly house-surgeon of the Aberdeen hospital, is also called the Aberdeen mode, has two varieties, which differ from each other only in the extent of the rotation given to the instrument by which the twist is effected. In the former variety, the instrument undergoes a half; in the latter, it
undergoes a quarter, rotation of a circle. In either case, a threaded needle only, or a long pin only, is required. In the former, the instrument is inserted some lines to one side of the bleeding artery, and passed behind it; its point is then made to emerge on the surface of the wound a few lines on the other side of the vessel. Then the needle•(or pin) is twisted half a rotation, so as to bring its head to the side where its point was before making the twist—the Instrument being now above instead of below the artery, and pressed well down upon it. Finally, the point of the instrument is pushed into the tissues beyond the artery, so as to secure it in the proper position, and retain the twist. The latter (and preferable) variety requires only a quarter-rotation to be given to the acupressing instrument. First, the needle (or pin) is entered on one side of the bleeding artery; then pressed onward a few lines in the same direction as the length of the vessel, so that its point emerges on the surface of the wound. Secondly, a quarter-rotation is given to it, so as to place it above the artery: and it is well pressed down against the small portion of tissues between the instrument and the vessel. Thirdly, the instrument is secured and the twist retained by sending the point into the tissues beyond the artery. Sixth mode: This was devised by Dr. Keith of Aberdeen, and requires a long pin with a duplicature of passive iron wire. The point of the pin is inserted a few lines from the artery; passed below or by the side of it; and afterwards pushed on so as to make the point emerge a few lines beyond the bleeding mouth. The duplicature of iron wire is then thrown over the point of the pin; then the two ends are crossed behind the stem of the pin, so as to take the bleeding mouth between them. The ends of the wire are then pulled tightly enough to stop the hemorrhage; then brought forward by the sides of the pin (one on each side), and finally fixed by a half-twist in front of the pin, and close down upon it. Seventh mode: In this, a long needle is passed through the cutaneous surface pretty deep into the soft tissues, at some distance from the vessel to be compressed; then it is made to emerge near the vessel; thee it bridges over and compresses the artery; then it is dipped into the soft parts on the opposite side of the vessel; and finally, its point As brought out a second time through the common integument.
The advantages of A.. as a liremostatie agent (though not universally recognized, and indeed strongly denied by sonic practitioners) have seemed to many eminent surgeons to be these: first, it is not only the easiest of application, but it is the quickest mode yet devised for arresting hemorrhage; second, this abridgment of the time required for arresting hemorrhage lessens the risk of suppuration, and other effects of the higher grades of inflammation in the stump; third, it causes no condition which must be followed by suppuration, whereas the use of the ligature has never been known to obtain imme diate union, or union by primary adhesion, without the formation of pus; fourth, it has never been followed by pymmta—a constant and distressing result in the case of the ligature; fifth, the presence of a foreign body in the wound—always a source of irritatiOn of much shorter duration in the case of the needle than of the ligature, while the former does not divide and strangle the arterial coats, like the latter; sixth, the patient on whom A. has been practiced is comforted by the assurance that in a very few hours after the operation all foreign matter will be removed from the wound—a con solation which he never enjoyed with the ligature.—Proceedings of the Royal Society of Edinburgh, vol. iv. p. 249; Edinburgh 'Medical Journal, Jan., 1860; Medical Times and Oazette, Feb. 11, 1860; Acupressure, 1 vol. 8vo, by Sir J. Y. Simpson, 1865; and A Practical Treatise on. Acupressure, by Mr. Pirrie and Dr. Keith, 1867. [Few surgeons now use A.]