PRIZE ESSAY. 
ACUPRESSURE. 
AlINT ESSAY 
TO "WHICH WAS AWARDED THE 
MERIT H. CASH PRIZE, BY THE MEDICAL SOCIETY OF 
THE STATE OF NEW YORK, February, 1869. 
By JOSEPH C. HUTCHISON, M. D„ 
BROOKLYN, N. Y, 
SURGEON TO THE BROOKLYN CITY HOSPITAL ; VICE PRESIDENT OP THE NEW YORK 
ACADEMY OF MEDICINE ; VICE-PRESIDENT OF THE NEW YORK 
PATHOLOGICAL SOCIETY, ETC., ETC. 
“ Rem acn tetigi." 
ALBANY: 
WEED, PARSONS & CO, PRINTERS AND PUBLISHERS. 
1869. PRIZE ESSAY. 
ACUPRESSURE. 
ATST ESSAY 
TO Wlircil WAS AWARDED THE 
MERIT H. CASH PRIZE, BY THE MEDICAL SOCIETY OF 
THE STATE OF NEW YORK, February, 1869. ’ 
By JOSEPH C. HUTCHISON, M. D., 
BjfoOKl.YN, S. Y., 
BURGEON TO THE BROOKLYN CITY HOSPITAL; VICE PRESIDENT OF THE NEW YORK 
ACADEMY OF MEDICINE ; VICE-PRESIDENT OF THE NEW YORK 
PATHOLOGICAL SOCIETY, ETC., ETC. 
“ Rem acu tetigi." 
WEED, PARSONS & C'O, PRINTERS AND PUBLISHERS. 
1869. ARTICLE IV. 
MERIT II. CASH PRIZE ESSAY. 
A. Practical Treatise on Acupressure, by Joseph C. Hutchison, 
M. I)., Brooklyn, New York. 
Since the time when Ambrose Pare, three hundred years ago, 
proposed that surgeons “ should bid eternally adieu to all hot-irons 
and cauteries,” and substitute the ligature as a hemostatic, nothing 
comparable to it was suggested until December 9, 1859, when Sir 
James Y. Simpson described “Acupressure, an Excellent Method of 
Arresting Surgical Hemorrhage, and of Aceellerating the Healing 
of Wounds,” to the Royal Society of Edinburgh. 
The best means of controlling arterial hermorrhage is a topic of 
such interest to the practical surgeon, that, it is not surprising that 
a new hemostatic process, which claims to excel all others, should 
stand forth as a subject of the foremost importance. 
The object of this article is, primarily, to place on record the 
results of some experiments made on the lower animals, as well as 
observations on the arteries of the human subject, in order to deter- 
mine (1) the pathological mechanism by which arteries are obliter- 
ated when their mouths have been closed by acupressure-needles, 
and (2) to test the reliability of acupressure as a hemostatic agent, 
and (3) to describe the various methods of applying the needle, and 
(4) to give a synopsis of the cases in which I have practiced it upon 
man, and (5) to express my appreciation of the procedure and of its 
advantages over other methods of arresting hemorrhage, with the 
hope of exerting some influence in securing for it an unprejudiced 
trial by the surgeons of this country. 
The masterly and exhaustive work of Sir James Y. Simpson on 
Acupressure (Edin. 1864), like that of Jenner on Vaccination, has 
left but little for others to investigate. He has, however, stated that 
“no sufficiently extensive series of experiments upon the lower 
animals, or of observations upon the human subject, has yet been 
collected together, to show the whole pathological mechanism by 
which arteries are closed when acupressure is used.”* It was for the 
purpose of contributing to supply this deficiency, that, at the sugges- 
tion of Professor Simpson, the experiments recorded in this paper 
were made. 
“ Rem acu tetigi." 
* Simpson on Acupressure, p. 536. 4 
Instrumentn required for Acupressure, and the Methods of 
applying them. 
The various modes of Acupressure lmve been so fully explained 
in the excellent treatise of Drs. Pirric and Keith, that I should deem 
it unnecessary to consider the subject here, if that work were more 
generally distributed in this country. 
The instruments required for the practice of Acupressure are, 
bayonet-pointed pins, varying in length from three to five inches, 
with glass heads to facilitate their introduction, needles threaded 
with iron wire, and loops of slender annealed iron wire, five or six 
inches in length. The pins and needles should be bayonet-pointed, 
because they can be more easily introduced than the round needle, 
and do not cut the tissues like the spear-pointed needle. But, on 
the cut surface of a flap, I have found the ordinary sewing needle to 
answer perfectly. Fig. 1.* 
The principal methods of Acupressure now in use, are as follows, 
viz.: 
The First Method, which requires the use of the pin alone, is 
performed by pressing the left forefinger or thumb upon the mouth 
of the bleeding vessel, pushing the pin from the cutaneous surface 
through the whole thickness of the flap, and causing its point to 
emerge to the right side of, and close to the vessel. The head of 
the pin is then depressed so that the projecting end is carried across 
the artery, when it is made to re-enter the cut surface of the flap 
close to the left side of the vessel, and pressed on until the point 
emerges through the skin. The head and ]>oint of the pin arc 
exposed externally, and the (fig. 2) middle portion bridges over and 
compresses the artery against the flap, to use the expression of 
Professor Simpson, “just in the same way as, in fastening a flower 
in the lapelle of our coat, we cross over and compress the stalk of 
it, with the pin which fixes it, and with this view push the pin twice 
through the laj>elle.” Fig. 3. 
Only a small portion of the pin is exposed upon the cut surface, 
and this mav often be avoided by passing it higher up in the flap. 
Fig. 3. 
The Second Method consists in inserting a needle threaded with 
twisted iron wire (to facilitate its removal) into the soft tissues a 
little to one side of the vessel, making it emerge close to the artery; 
it is then carried across its track, and dropped down again, and 
thrust into the soft tissues on the other side of the vesgel. Fig. 4. 
In bridging over the arterial tube, the end of the needle must be 
* These appliance* may he obtained from Mr*. (Jeo. Tie man 4 Co.. 6? Chatham St., 
Xew York. 5 
well pressed down upon the vessel so as to close it, before the needle 
is tixed in the tissues beyond. Occasionally a pin may be conveni- 
ently used, instead of a needle. This method is not often used, but 
it answers very well for acupressing vessels of moderate size. 
The Third Method consists in passing a needle threaded with iron 
wire, twisted (as seen in fig. 4), behind the bleeding vessel in the 
wound, throwing a loop of the wire over the point of the needle, com- 
pressing the artery between the wire-loop in front and the needle 
behind, and finally fixing the wire by a half twist around the eye 
end of the needle. The appearance of the vessel is shown in fig. 5. 
The needle is removed by pulling the twisted wire, when, the loop 
being liberated, it is easily withdrawn. Fig. 5. 
The Fourth Method is the same as the third, substituting the pin 
for the needle. The pin can be more easily applied and withdrawn, 
and therefore should be preferred in all cases where the head can be 
kept without the wound, without straining the tissues. The wire 
with which the needle is threaded is apt to kink, and cause pain 
when removed. When the pin is used, this kinking is avoided. The 
mechanism of the third and fourth methods will be made more intel- 
ligible by reference to Fig. 6. 
Nothing can be more efficient than the third and fourth methods 
of acupressure but whenever it is practicable some other should be 
employed, for the reason that even with great care, we are in danger 
of lacerating the coats of the vessel, or injuring the tissues by draw- 
ing the wire tighter than is necessary merely to occlude the artery. 
The Fifth Method is performed with either pin or threaded needle. 
There are two varieties, in one of which (known as “ the Aberdeen 
twist ”) the instrument is caused to rotate over a quarter of a circle, 
and in the other, it makes a rotation of a half circle. In the former, 
or Aberdeen method, the instrument is inserted on one side of the 
bleeding vessel, pushed onward a few lines parallel with the direction 
of the artery, and its point caused to emerge on the surface of the 
wound, as shown in Fig. 7, A. 
The pin <or needle is then made to undergo a quarter-rotation so 
as to place it across the artery, it is then pressed down against the 
vessel so as to close its tube, before the point is fixed, by being 
passed into the tissues beyond. (Fig. 7, B.) This method is an 
admirable one, and I can fully indorse all that is claimed for it, by 
the distinguished Aberdeen surgeons, Messrs. Drs. Pirrie and 
Keith* 
* See their Treatise on Acupressure. 6 
In the second variety of the fifth method, first proposed by Sir J. 
Y. Simpson,* the pin or needle is introduced precisely us in the 
third and fourth modes. 
It is then twisted as in the first variety, but to the extent of half a 
rotation, around the artery, so as to bring its point to the opposite 
side of the vessel, where its head was before making the twist. (Fig. 
8, B.) The point of the instrument is then well pressed down and 
secured in the proper position by being thurst into the tissues be- 
yond. This variety is also eminently satisfactory. A few days since 
I closed the brachial artery by this method, in the most expeditions 
and efficient manner. 
The Sixth Method is accomplished with a [tin and a loop of wire. 
The pin is inserted into the tissues on one side of the artery and 
close to its mouth, and is carried transversely to the vessel through 
the tissues to the opposite side. An end of the wire is held in each 
hand; the loop thrown over the point of the pin; and the ends 
brought back on each side of the artery are crossed behind the body 
of the pin, and drawn in opposite directions sufficiently tight to 
close the vessel. The ends are then brought up on each side of 
the pin, and the wire is fixed by a half twist around its head. 
The end of the wire held in the left hand should l>e crossed in 
front of that in the right, in order to facilitate its removal. If there 
is any difficulty in removing the wire, it may he obviated by twisting 
the front wire from right to left. The arrangement of wire and 
needle is shown in the diagram. Fig. 10. 
I have frequently used a modification of this mode when there 
were several bleeding points close together, by passing a needle 
through the center of the bleeding mass, and surrounding it with a 
wire, as in the above method. 
The Seventh Method is essentially the same as the second, except 
that the pin enters the flap from the cutaneous surface. The middle 
portion of the pin in front of the integument bridges over the (Fig. 11) 
artery and compresses it against the bone. The pin appears as is 
shown in Fig. 11. 
The following plan, which, for convenience, may Ik* called the 
Eighth, or Brooklyn Method of Acupressure, is an excellent plan for 
the closure of arteries in their continuity. It was devised by the 
writer, and practiced in all the experiments on the lower animals 
described in this paper. 
The artery is first exposed by the usual incision; a loop of wire 
about eight inches long is laid in the wound, parallel with and on the 
* See his work on Acnpiwmrt p. 04. 7 
side of the vessel next the head of the pin; the pin is now carried 
through the flesh from its integumentary surface, half an inch, more 
or less (according to the depth of the vessel), back from the edge of 
the incision, so as to bring it down to the plane of the artery, and 
then over the wire, and beneath the vessel, without disturbing the 
vital and organic relations with nerve, vein, or its sheath (Fig. 12, A) ; 
when the pin has emerged from beneath the artery, the wire-noose 
is thrown over the point (Fig. 12, B); the point is then pushed 
through the opposite flap, at a point corresponding to that at which 
it entered (fig. 12, C); the wire-loop is next brought over the track 
of the vessel, which is now compressed between the pin below and 
the wire above, and lastly, the wire is secured by a half-turn around 
the pin, as is shown in Fig. 12, C; the wound is then closed by 
metallic sutures; the removal of the pin, at the end of the twenty- 
four or forty-eight hours, liberates the loop, which can then be easily 
withdrawn.* 
The artery, vein and nerve are left, by this procedure, in their 
normal positions, with their vital connections undisturbed, and there 
is nothing between the lips of the wound to prevent primary adhe- 
sion. We avoid, in this way, the prolonged irritation of the ligature, 
and the danger of local ulceration, sloughing and secondary hemor- 
rhage, which so often occur after deligation of the arteries, for the 
cure of aneurism, etc. 
Observations showing the Pathological Mechanism by which Arteries 
are obliterated when closed by Acupressure. 
The left common carotid artery of a sheep was exposed by dissec- 
tion, and closed by a pin in the manner described on page 6. (Fig. 12.) 
The vessel was then divided on the distal side of the pin, when 
free hemorrhage occurred, as was expected, from its distal extremity. 
This was arrested by another pin applied in the same manner, and the 
wound accurately closed by metallic sutures, there being nothing be- 
tween the lips of the wound to interfere with union by first intention. 
The vital relations of the parts were left undisturbed by this pro- 
cedure. It may be well to state, in order to avoid undue repetition, 
that in all the experiments herein detailed, this same method of 
acupressure was employed; and the writer believes that it will 
prove to be a useful expedient for closing arteries in their continuity, 
for the treatment of aneurism and the like. At the end of forty-one 
Experiment 1. 
* The same thing may be accomplished by carrying a single thread of wire under 
the head end of the pin after it has passed behind the vessel; the two ends are then 
carried across the track of the vessel and secured by a half-turn around the point end 
of the pin before it is pushed through the opposite flap. hours, both needles were removed, with the loss of only two or three 
drops of blood, which arose from the disturbance of the healing sur- 
face by the removal of the wire which had been passed around one 
of the needles. 
Dissection. The animal was killed twenty-five days after the 
operation. The artery, vein and nerve were matted together by 
inflammatory deposits. Two inches of the artery, on both sides of 
the point of division, were removed, and placed under water. An 
effort was made to force air through the vessel, by means of a blow 
pipe, but both ends were found to be perfectly closed, at the seat of 
the acupressure. On opening the vessel no clot was found in either 
distal or cardiac ends, but they were firmly closed, by means of a 
dense fibro-cellular tissue, for the extent of one-third of an inch, as 
is shown by the specimen. (Fig. 13.) 
A careful microscopic examination of the specimen was made by 
Dr. II. Cresson Stiles. lie found that “the artery at the place of 
operation had been cemented to surrounding tissues by organized 
exudation, so that the continuity of the vessel was demonstrated 
only by dissection. Lymph had been effused both within and with- 
out the vessel, at the point of acupressure, and the extremities were 
connected together by firm fibrous tissue,” which may be seen in the 
specimen. (Fig. 13.) 
Experiment, 2. 
This observation was made in the same sheep, after an interval of 
thirteen days. The right common carotid artery was exposed by 
dissection, and closed by two needles, placed half an inch apart. 
The vessel was divided between them without hemorrhage. The 
needles were removed at the end of forty-one hours, without the loss 
of a drop of blood, and the animal suffered no apparent inconven- 
ience from the occlusion of both arteries. The sheep was killed 
twelve days after this operation. Two inches of the vessel on either 
side of the point of acupressure were removed. After placing the 
specimen under water, an attempt to force air through the artery, 
by means of a blow-pipe, was made, but its calibre was firmly closed. 
On opening the vessel, a purplish clot, half an inch in length, was 
found on the distal sides, which was separable from the internal coat 
of the vessel except at its base. The base of the clot was decolorized 
and firmly adherent to the inner surface of the vessel. The same 
condition obtained on the cardiac side, the clot there being three- 
eighths of an inch long. The artery, at the point of operation, had 
Ikjcu converted into a dense fibro-cellular cord, for the distance of 
one-eighth of an inch, its coats were three or four times their usual 
thickness, and its calibre correspondingly diminished. (Fig. 14.) 9 
Experiment 3. 
The left common carotid artery of a very large and strong sheep 
was exposed by dissection, and its calibre closed by an acupressure- 
pin applied in its continuity. The pin was removed at the end of 
fifty hours, and the animal killed ten days after the operation. The 
artery was adherent to the surrounding tissues, and its canal was 
firmly occluded, as shown by trial with the blow-pipe, as before. 
The internal and middle coats of the artery, at the point of acupres- 
sure, were found to have been divided in their entire circumference, 
and the external coat, in one-lialf its circumference, indicating that 
the pressure had been more forcible than necessary. Firm, red, 
conical clots, three-fourths of an inch, and one inch, in length, respect- 
ively, occupied the vessel on either side of the seat of the operation; 
they were but slightly attached except at their bases, where they 
were closely adherent to the inner coat of the artery. The mouths 
of the vessel were perfectly closed by organized lymph. Its coats 
were thickened at and about the point of pressure, but to a less 
degree than in the previous experiments. (Fig. 15.) 
The object of this experiment was to observe the condition of the 
vessel after acupressure in its continuity, but failed in consequence 
of the too great pressure applied in closing it, whereby the coats of 
the artery had been divided. 
Experiment 4. * 
The right common carotid of the same sheep, on which the last 
experiment was performed, was closed by two acupressure pins, 
three-fourths of an inch apart, and the artery divided between them. 
An assistant was directed to remove them in thirty-six hours, but it 
was forgotten, and they were not removed until the end of seventy- 
four hours. The animal was killed four days after the application 
of the pins, and the artery with the vein and nerve was removed. 
By means of the blow-pipe, the vessel being immersed in water, I 
ascertained that both extremities were perfectly closed. Its mouths 
were closed, not firmly, by what appeared to be primary adhesion, 
and the union was strengthened by adhesion of the outer coat to the 
sheath and the adjacent tissues. The cardiac end was distended to 
nearly twice its natural size by a moderately firm, red, conical clot, 
two inches long, attached closely at its base, but slightly beyond 
that point. The distal end was of normal size, and was occupied by 
a tolerably firm, red, conical clot, one and a half inches long, and 
one-lialf the diameter of the clot on the cardiac side. In both the 
distal and cardiac ends the vessel was thinned for the distance of 
one-fourth of an inch from their cut extremities; this, I believe, was 
owing to the prolonged pressure of the pins (T4 hours). (Fig. 16.) 10 
Erjh'riment 5. 
The left common carotid artery of a dog was closed, by an acu- 
pressure pin, in its continuity. At the etid of twenty-five hours the 
pin was removed, and the animal was killed on the seventh day. 
The artery was agglutinated to the surrounding tissues by organized 
exudation, and when it was placed under water, air could not be 
forced through it with the blow-pipe. On the cardiac side of the 
point of acupressure, the vessel was tilled with a elot one inch long; 
on the distal side the clot was one-third of an inch in length. The 
clot was continuous, and, at the point where the pin had been applied, 
it was firmly adherent to the vessel. A careful examination of the 
specimen shows that the anterior half of the external coat is cut 
through at the point of pressure. This may have been caused by 
undue pressure of the wire, but, probably, it was owing to the small 
amount of yellow elastic tissue found in the arterial coats of the 
dog. The diameter of the vessel was diminished at the seat of 
operation, bv the thickening of the internal and middle coats. 
(F%. 17.) 
Experiment t>. 
The left common carotid of a sheep was closed, in its continuity, 
by acupressure. The needle was removed at the end of forty-seven 
hours, and the vessel althe same time was vivisected, together with 
two inches of the par-vagum nerve. The animal, so far as could be 
observed, did not suffer the slightest inconvenience from the opera- 
tion. The vessel, tried by the blow-pipe, was found to be perfectly 
closed. It was occupied by a firm, red clot, three-fourths of an inch 
long, conical at its extremities, its center being, at the point of 
operation, which was indicated by an indentation made by the needle, 
on its posterior surface. The cardiac and distal clots were con- 
tinuous, as in the last experiment. The clot was intimately connected 
with the internal coat of the artery, at the seat of acupressure, and 
the vessel is slightly contracted at this point. (Fig. 18.) 
An interesting point, connected with the two specimens last 
described, is, that the distal and cardiac clots were shown to be 
continuous by dividing the vessels longitudinally. The needle was 
applied with sufficient firmness, I am sure, not onl}' to arrest the 
pulsation in the vessels, but also to place their walls in close contact. 
I can only explain the continuity of the clots, by supposing that 
some thinning of the walls was produced by the pressure of the 
needle, and that, by this thinning, the hold of the instrument was 
sufficiently relaxed to allow the vessel to expand somewhat, and the 
two clots to approximate and unite. 11 
Experiment 7. 
The right common carotid artery of a dog was closed in its con- 
tinuity by acupressure. The pin was removed in twenty-nine hours. 
Twenty-four days after the operation, the dog was killed and the 
artery removed. One-third of an inch of the vessel, at the place of 
operation, was converted into a solid fibrous cord, in which no trace 
of the arterial coats could be found by Dr. It. Cresson Stiles, who 
made a carefnl microscopic examination of the specimen. On both 
the distal and cardiac sides of the solid portion were found the 
remains of a red clot. (Fig. 19.) 
This specimen shows, in the most satisfactory manner, the ultimate 
changes which take place in an artery after successful acupressure. 
A ligature could not have obliterated the canal more thoroughly. 
This completes the account of the experiments upon the arteries 
of the inferior animals, and the following description of two speci- 
mens taken from the human subject, together with the histories of 
the cases, will finish this branch of the subject. 
Case 1.—Amputation at the Knee-joint — Acupressure by the First, 
Third, Fourth and Fifth Methods — Death on the seventh day. 
Anna M , aged 40 years, was brought to the Brooklyn city 
Hospital, December 8th, 1867, suffering from a severe lacerated 
wound, on the outer part of the left foot and ankle, exposing the 
ankle-joint, caused by the wheel of a city railroad car. Being a 
woman of good constitution and habits, it was thought advisable to 
make an effort to save the limb. The wound was dressed by a 
saturated solution of carbolic acid, in water. Five hours after 
admission, free hemorrhage took place from a branch of the anterior 
tibial artery, which was promptly arrested by House Surgeon X. C. 
Scott, who placed two needles under the vessel, one above and the 
other below the bleeding point, securing the artery by the third 
method of acupressure. The needles were removed at the end of 
thirteen hours, without a return of the bleeding. On the fourth 
day, erysipelas attacked the foot, and extended nearly to the knee, 
followed by free suppuration in the cellular tissue. On December 
23d her condition was such, that a consultation of the surgeons of 
the hospital was called ; it was decided to remove the leg at the 
knee-joint. The inflammation in the parts had caused all the smaller 
arteries to enlarge, so that eleven required acupressure. Ten needles 
were used, one needle securing two arteries. The popliteal was 
promptly and easily closed by the fifth method (quarter rotation); the 
other vessels were secured, two by the first, five by the third, one by 
the fourth, and two by the sixth methods. The flaps were accurately 12 
approximated by iron wire sutures. No dressings were applied. 
Seven needles were removed at the end of twenty-two hours, two in 
forty-seven, and the one applied to the popliteal, at the end of forty- 
eight hours, notwithstanding the pulsations communicated from it to 
the needle had not entirely ceased. The writer’s previous experience 
with acupressure, as applied to the arteries of the sheep, convinced 
him that the vessel was sufficiently occluded, ami that the needle 
might safely be removed. No bleeding followed the withdrawal of 
any of the needles. The patient bore the anesthetic (ether) badly ; 
she vomited frequently during the operation, and vomiting j>ersisted 
until a few hours before her death, which took place, from exhaus- 
tion, seven days and nineteen hours after the operation. 
The post-mortem examination was confined to the examination of 
the stump. A mass of lymph surrounded the extremity of the poplit- 
eal artery, agglutinating it with the vein and nerve. A portion of 
the vessel, three inches in length, was separated from the enveloping 
mass, and when placed under water, it was found to be impervious. 
The extremity of the vessel was contracted, and its mouth closed 
with lymph. Its canal was filled by a conical red clot, half an inch 
long, extending upward to the first anastamosing branch. The 
coagulum adhered closely to the vessel near its mouth. (Fig. 20.) 
The stump was in a sloughy condition; there had been no effort, 
whatever, at repair. 
Case 2. — Amputation of the ley— Acupressure by the Third and 
Fourth Methods— Consecutive hemorrhaye from vessels which 
had not been acupressed—Death from exhaustion. 
James Brady, aged 22 years, entered the Brooklyn City Hospital, 
January 2, 18f>8, with a compound, comminuted fracture of the left 
leg, at the junction of the middle and lower thirds. There had been 
considerable hemorrhage from the wound, for which a tourniquet 
was applied to the femoral, and pressure made over the wound, by 
the direction of I)r. Cochrane, surgeon in charge. This failed to 
arrest the bleeding, and on the following morning an effort was made 
to secure the bleeding artery, when it was found that the injury to 
the bones and soft parts was of so grave a nature that amputation 
would be necessary. The operation was made by I)r. Cochrane in 
the most skillful manner, below the tubercle of the tibia, and with 
his consent I closed the arteries by acupressure. The anterior tibial 
and a muscular branch were closed by the third method, the posterior 
tibial, with its vein, which bled freely, was closed with one needle 
bv the fourth method. The wound was closed accurately by iron- 
wire sutures, and no dressings were applied. The patient vomited 13 
frequently from the effects of the ether, and four hours after the 
operation I was summoned to see him, on account of free hemorrhage 
from the stump. Dr. Cochran having placed the case under my 
charge, I at once opened the wound, the patient being again anaes- 
thetized, and found that the bleeding proceeded from the end of the 
tibia, and from two muscular branches, one in the upper, and one in 
the lower flap, which did not bleed at the time of the operation. 
These vessels were closed by acupressure, by the third and fourth 
methods, and the bleeding from the bone was arrested by Squibb’s 
solution of the subsulphate of iron. The vessels which had been 
acupressed at the time of the operation were found, on careful exam- 
ination, to be perfectly closed. The wound was again brought 
together with iron-wire sutures. 
The consecutive hemorrhage was, undoubtedly, due to the violent 
vomiting, which continued after the operation, and forced out the 
coagula which had stopped the smaller vessels. The vomiting per- 
sisting, the patient was unable to retain nourishment or stimulants, 
and he died from exhaustion forty-nine and a half hours after the 
amputation. The needles were removed from the muscular branches 
at the end of thirty hours, and from the anterior and posterior tibial 
arteries in forty-eight hours, without the loss of a drop of blood. 
The stump was examined, post-mortem, by House Surgeon Scott, 
who, unfortunately, preserved only the posterior tibial artery, on 
account of the hurried manner in which the examination was neces- 
sarily made. There was no union of the flaps and no clots in the 
stump. The cut extremity of the posterior tibial was inclosed in a 
mass of lymph, with the vein and nerve. The artery was foun 1 
impervious by trial with the blow-pipe, the specimen having been 
placed under water. A clot, half an inch long, occupied the cavity, 
and, at its base, was firmly adherent to the inner coat of the vessel. 
(Fig. 21.) The condensation and decolorization of the clot were less 
advanced than in the specimen last described. 
Relative pathological mechanism, by which arteries become closed 
spontaneously, by the use of ligatures, and by the action of 
Acupressure needles. 
The results of the above experiments conclusively show that Acu- 
pressure is a perfectly reliable means of arresting surgical hemorrhage. 
Xo fact in surgery is more thoroughly established than that the 
vessels in a stump can be as promptly and firmly secured by Acupres- 
sure needles as by a silk ligature, and without inflicting injury upon 
the living tissues. 14 
The experiments also show that, when the mouths aud tubes of 
arteries are closed by acupressure, the pathological mechanism which 
leads to their temporary as well as their permanent occlusion, is 
similar to that which follows the arrest of hemorrhage spontaneously, 
and by the employment of the ligature. That is to say, in each 
process there is a temporary barrier — the internal blood clot — until 
coagulable lymph is effused, as a result of adhesive inflammation, 
making a permanent barrier, aided by the gradual constriction of the 
calibre of the artery, and its ultimate conversion into a fibro-cellular 
cord. 
Let us examine more particularly the mechanism by which arteries 
become closed spontaneously / by the use of the ligature, and by the 
action of the acupressure needle. 
The following quotation is from the masterly work of Jones on 
u The process employed by Nature for the Suppression of Arterial 
Hemorrhage” (page 54.) “ A coagulum then formed, at the mouth of 
the artery, and within its sheath, and which I have distinguished in 
the experiments by the name of the external coagulum, presents the 
first barrier to the effusion of blood. The coagulum, viewed exter- 
nally, appears like a continuation of the artery, but, on cutting oj>en 
the artery, its termination can be distinctly seen with the coagulum 
complete!}’ shutting its mouth, and inclosed in its sheath. 
“The mouth of the artery being no longer pervious, nor a collate- 
ral branch very near it, the blood just within it is at rest, coagulates 
and forms, in general, a slender conical coagulum, which neither fills 
up the canal of the artery, nor adheres to its sides, except by a small 
portion of the circumference of its base, which lies near the extremity 
of the vessel. This coagulum is distinct from the former, and I have 
called it the internal coagulum. 
“ In the meantime, the cut extremity of the artery inflames, the 
vasa vasorum pour out lymph, which is prevented from escaping by 
the external coagulum. This lymph fills up the extremity of the 
artery, is situated between the external and internal coagula of blood, 
is somewhat intermingled with them, or adheres to them, and is 
firmly united all around to the internal coat of the artery. 
“The ]>ermanent suppression of the hemorrhage chiefly dopends 
on this coagulum of lymph, but, while it is forming within, the 
extremity of the artery is further secured by a gradual contraction 
which it undergoes, and by an effusion of lymph between its tunics, 
and into the cellular membrane surrounding it, in consequence of 
which these parts become thickened, and 60 completely incorporated 
with each other, that it is imp<*ssible to distinguish the one from the 
other; thus, not only is the canal of the artery obliterated, but its 15 
extremity also is completely effaced, and blended with the surround- 
ing parts. * * * From this view of the subject, we can no longer 
consider the suppression of hemorrhage as a simple or mere mechani- 
cal effect, but as a process performed by the concurrent and succes- 
sive operations of many causes. These may be briefly stated to 
consist in the retraction and contraction of the artery, the formation 
of a coagulum at its mouth, the inflammation and solidification of 
its extremity by an effusion of coagulating lymph within its canal, 
between its tunics, and in the cellular substance surrounding it.” 
The pathological changes which occur in an artery when it has 
been secured by a ligature—as deligation is now generally practiced— 
are as follows: 
Mr. Jones, by a series of admirably conducted experiments, has 
shown that the immediate effects of a ligature upon an artery are a 
complete division of its internal and middle coats, and the strangula- 
tion of its outer one. The ligature does the office of the external 
coagulum • i. e., it acts as a temporary barrier until the internal 
coagulum is formed, and while plasma is being effused from the 
lacerated tunics, between the coats of the vessel and into its sheath, 
uniting them firmly together, and also causing adhesion of the clot 
to the internal coat of the artery, thus effecting its permanent occlu- 
sion. The coagulum next becomes vascular, and, finally, with the 
walls of the artery, is converted into a solid fibrous cord, which com- 
monly extends, as the clot did from the seat of the ligature to the 
first principal branch above. That portion of the artery immediately 
embraced by the ligature, and just beyond it, mortifies, and the liga- 
ture is detached when the slough is thrown off. In the words of Sir 
James Simpson — whose opinions, in this department of surgical 
pathology, are entitled to the highest consideration—“ before the 
separation of a ligature can be effected, it requires to cut through a 
strangulated tube by a process of ulceration or molecular disintegra- 
tion and gangrene ; and there are set up, as a necessary consequence, 
in the immediate vicinity of the ligatured and strangulated artery, 
the process of local disjunctive ulceration and suppuration.” 
The experiments which have been detailed by the writer, show 
that the pathological mechanism, by which arteries are obliterated 
when they have been closed by acupressure-needles, does not differ 
in the outset, and in its ultimate results from that which is observed 
when hemorrhage is arrested spontaneously, or by the application of a 
ligature. The needle, like the ligature, does the office of the external 
coagulum, which forms when bleeding ceases spontaneously. The 
blood, between the needle and the first branch above, becomes stag- 
nant, and an internal coagulum is allowed to form. Dr. R. Cresson Stiles, who examined, microscopically, specimens 
one, five, six and nine, expresses the opinion that “the clot certainly 
does not organize, the swollen walls of the vessel grasp it tightly, send 
their blood vessels into it, absorb it, and replace the clot by their 
own hypertrophy and exudation ; the clot serving as an irritant or 
stimulus to keep up the abnormal vascularity until it disappears.” 
Adhesive inflammation is also excited bv the presence of the needle 
pressing the walls of the vessel together, and by the irritation result- 
ing from the division of the artery, causing adhesion of the walls of 
the vessel to each other, and of the outer coat to the sheath or other 
immediately adjacent tissues. Finally the vessel is converted into a 
fibro-ecllular cord (Fig. 19), presenting the same appearances as those 
which follow the use of the ligature. 
But there is a vast difference in the amount of inflammation which 
results from the two procedures. By the use of the acupressure- 
needles placed across the mouths and tubes of arteries, their internal 
surfaces are merely placed in close contact; and the pressure neces- 
sary to arrest arterial hemorrhage by the needle is not sufficient to 
produce strangulation. The exudation of lymph goes on from the 
vasa vasorum into the mouth and sheath of the vessel, and it is per- 
manently closed by adhesive inflammation. The needles can be 
withdrawn with safety from the wound, at the will of the surgeon, 
at periods varying from 13 to 48 hours. This, the experience of the 
writer has shown. 
But when an artery is closed by a ligature, the internal coats are 
lacerated, and the external is strangulated, leading to its destruction 
by ulceration, suppuration and death at the constricted point; dead, 
putrefying sloughs (the ends of the vessels), are left applied to the 
absorbing surface of the recent wound, the ligature, left in the wound 
for an indefinite period, absorbs the secretions, which B|>ecdily decom- 
pose and act as a foci of irritation to the surrounding tissues; all of 
which conditions prevent union by primary adhesion, and expose the 
patient to the danger of septic poisoning. 
Torsion as a substitute for the Ligature. 
The torsion of arteries for the arrest of hemorrhage is an old pro- 
cedure, mentioned by Galen, and reintroduced by Thierry, Amusat 
and Velpeau; at one time strongly condemned, at another highly 
lauded, it has lately been revived by the great Mr. Syme, of Edin- 
burgh, as a substitute for the ligature, and is now practiced to a con- 
siderable extent abroad. It is a well established fact that when 
torsion is applied to a large artery, the effect of the twisting and 
laceration of its coats is to destroy and to deprive them of vitality, 17 
followed by suppuration as marked as that which is caused by the 
application of the ligature. “By the tearing,” says Chelius, “and 
bruising of the arterial coats in torsion, separate fragments of the 
coats die off and suppurate.”* 
“ The advantage that torsion is supposed to possess over the liga- 
ture,” remarks Mr. Ericksen, “ is more fancied than real; the twisted 
end acts as a foreign body, and is as likely to interfere with union as 
the pressure of the ligaturc.”f Professor Miller of Edinburgh, speak- 
ing of the effects of torsion, says that “the twisted portion of the 
vessel must slough and separate ; the noose of a ligature is not more 
truly, or to a greater extent a foreign body.” 
Importance of practicing Acupressure upon the Cadaver, and upon 
the lower animals. 
My first experiment with Acupressure was performed upon the 
dead subject. It was made by amputating the thigh, and afterward 
introducing the nozzle of a Davidson’s syringe into the common iliac 
artery. A strong man then pumped water into the artery with suffi- 
cient force to throw a stream through the severed ends of the femoral 
to the distance of five feet. No difficulty was found in arresting the 
flow by acupressure needles applied in the various methods which 
have been proposed. In order to acquire a facility of manipulating, 
I would strongly urge the necessity of thus practicing the operation. 
Indeed, a mere description of the process, even with the assistance 
of good illustrations, is difficult to comprehend. But it becomes at 
once perfectly simple, when tried experimentally, with the aid of 
diagrams, or still better when we can witness its application by one 
who is expert in the use of the needle. For the purpose of learning, 
from its distinguished author, the most successful modes of applying 
Acupressure, I visited Edinburgh, in the autumn of 18G7, and I 
desire publicly to express my obligations to Sir James Y. Simpson, 
and his accomplished assistants, Drs. Black and Aitken, for their 
valued aid, and to the former for his generous hospitality. 
I have now employed Acupressure on forty-four arteries in man, 
varying in size from muscular branches to the popliteal, and seven in 
the lower animals; and my assistants Drs. Elbrigg, Knox and Scott 
have each practiced it upon one artery, making a total of fifty-four 
arteries on which I have observed its effects. The needles were 
removed at periods varying from thirteen to forty-eight hours. In 
Synopsis of my Experience with Acupressure. 
*See Clielius’ “System of Surgery,” Vol. 1, p. 310. 
f See Ericbseu’s “ System of Surgery,” p. 1£J3. every ease the occlusion of the vessel was thorough and complete. 
Among the operations in which it was employed were three amputa- 
tions of the leg, one at the knee-joint, two of the fore-arm, one of the 
arm, one of the foot, one excision of the testis, and one wound of the 
radial artery. 
A synopsis of the cases is given in the following table: 
Tabular View of Dr. Hutchison's Cases of Acupressure. 
6 
Z 
H 
i 
i 
< 
Disease or Injury. 
Operation. 
Method of 
Acupressure. 
AcuprSMU re 
Discoid tu'd. 
Result. 
1 
F. 
12 
Foot crush ed by R. R. 
car; amputation of leg; 
eml of hones exn<>s<s| 
by sloughing or nap*. 
Re-amputation of 
leg. 
First, Third 
and Fourth. 
After 
47 hours. 
Recovery. 
* 2 
M. 
28 
Bad stump from slough- 
ing of Haps, after disar- 
ticulation of tirst four 
metatarsal bones. 
Disarticulation of 
tarsus anterior to 
scaphoid bone. 
First, Fifth 
and Hlxth. 
22 hour*. 
Recovery. 
3 
F. 
40 
Laceration of leg by R. 
R. car; ankle opened; 
erysipelas and suppu- 
rative cellulitis. 
Disarticulation of 
knee-joint on 14th 
day. 
First, Third, 
Fourth, Fifth. 
22. 47 and 48 
hours. 
Death (Hea 
Case 1 p. 11.; 
4 
M. 
•w 
Compound ' comminut- 
ed fracture of leg. 
Primary amputation 
of leg. 
Third and 
Fourth. 
30 and 48 
hours. 
Death. (Hee 
Case p. It) 
& 
M. 
33 
Wound of radial artery. 
Ac'sure eds. rod. art. 
Third. 
2S hours. 
Recovery. 
6 
M. 
33 
Hemhorrhage from su- 
perficial!* volte; stall- 
ing wound. 
Acupressure of both 
ends of superficial 
Is voUe. 
Third. 
27 hours. 
Recovery. 
7 
M. 
14 
Compound comminut- 
ed fracture of fore-arm. 
Primary amputation 
of fore-arm. 
Fourth and 
Fifth. 
22 hours. 
Recovery. 
8 
M. 
20 
Fracture of condyles of 
humerus, rupture of 
hrachial artery; gan- 
grene. 
Amputation of arm 
on &th day. 
Fourth and 
Fifth. 
19 and 48 
hours. 
Recovery. 
• 
M. 
28 
Hand crushed. 
Prim. amp. fore arm. 
Acu're muse. br. art. 
First, twice 
23 hours. 
Recovery. 
10 
F. 
40 
Laceration of leg .......... 
repeated. 
Third. 
13 hours. 
Recovery. 
11 
M. 
30 
Compound comminut- 
ed fracture of foot. 
logoff* amputation 
oKfoot (primary;. 
Fifth. 
22 hours. 
Recovery. 
12 
M. 
20 
Hero Ai loses carles of 
bones of leg. 
Amputation of leg... 
Fifth, Sixth. 
63 hours. 
Recovery. 
13 
M. 
36 
Excision of testis 
First. 
19 hours. 
Recovery. 
The time for the removal of the needles. 
The answer to the question “ at what time should the needles be 
withdrawn t" is furnished, so far as iny exjierience goes, in the above 
table. The popliteal, the largest artery which I have yet acupressed, 
was found closed in forty-eight hours (Case 1), while the needle was 
removed from the radial, ulnar and tibial arteries in twenty-two 
hours, and from smaller vessels in thirteen hours. I deemed it best, 
while accumulating practical knowledge on this subject, to err on 
the side of safety to the patient; but I now believe that in minor 
amputations and in wounds the needles may be withdrawn much 
earlier than I have hitherto done. Xo one, it is presumed, would 
advocate so early a discontinuance of the pressure as was practiced 
in one of Dr. Keith's cases of amputation of the thigh. The patient, 19 
a boy twelve years old, amusing himself with the pin-heads protrud- 
ing at the angles of the wound,” withdrew the pin compressing the 
femoral artery four hours after it had been applied, and yet no 
hemorrhage resulted.* In a case of excision of the mamma by Dr. 
Coghill, of Shanghae, the needles were removed in two hours, with- 
out there following any hemorrhage.f 
The acupressure should be continued longer than usual, when the 
operation is followed by vomiting, as the straining might cause the 
expulsion of the forming eoagula, and dangerous hemorrhage set in. 
Again, when pulsation is seen at the head of the pin, or when pul- 
sation of the principal arteries can be felt up to the edge of the 
wound, we should be cautions in withdrawing the needles. 
Cases illustrating the simplicity and value of Acupressure. 
Case 3.— Secondary hemorrhage from wound of the Radial and 
Superficialis Voice Arteries —• Needles applied to their distal and 
cardiac ends— Third Method. 
James Mankey, 33 years of age, entered the Brooklyn City Hos- 
pital, December 1, 1867, with an extensive laceration of the left 
forearm and hand. Four days subsequently sloughing took place, 
followed by hemorrhage from the radial artery. It was estimated 
that a pint of blood was lost in a very few minutes. The house sur- 
geon stopped the bleeding, by applying a tourniquet to the arm, 
and Squibb’s solution of the subsulphate of iron to the wound. 
When I reached the hospital, I applied two sewing-needles under 
the artery, one above and the other below the bleeding point, and 
surrounded each by the iron-wire noose (third method), with the 
effect of instantly checking the hemorrhage. The needles were 
removed at the end of twenty-two hours, with no return of the bleed- 
ing. 
On the following day, bleeding occurred from the superficialis 
voice, and a considerable quantity of blood was lost before the house 
surgeon, Dr. Elbrigg, could reach the bedside. lie arrested the 
bleeding by the same method which I had employed the day before. 
At the end of twenty-seven hours the needles were taken away, 
bleeding did not return. These two examples illustrate in a strik- 
ing manner, the usefulness of acupressure in cases of sloughing 
wounds. If ligatures had been used upon arteries in this sloughing 
mass, where their coats had been weakened by the inflammatory 
process, premature separation would have probably ensued, and 
* See Pirrie and Kieth on Acupressure, p. 174. 
f See Simpson on Acupressure, p. 81. 20 
bleeding recurred. If ligatures had been applied to the vessels, in 
sound tissues, nbove and below the bleeding points, a long, tedious 
and unsatisfactory dissection would have been necessary; all of 
which was avoided by the simple and rapid process of acupressure. 
Case 4.— Amputation of the Fore-arm — Acupressure by the First 
Method— Three Arteries secured with one pin. 
James W. Anderson, aged 28, entered the Brooklyn City Hospital, 
October 19, 1868, with a compound, comminuted fracture of the 
metacarpal bones of the left hand, the soft parts being lacerated up 
to the wrist joint, caused by the falling of a trip-hammer. The fore- 
arm was amputated by Dr. Cochrane through its lower third, and, 
with his permission, I closed the radial, ulnar and interosseous arteries 
by one long pin. The pin was thrust through the skin and was 
carried under the radial and out again through the skin ; it was then 
made to re-enter the skin on the radial side of the interosseous and 
ulnar arteries, to pass under those vessels ami then out through the 
skin again. The three vessels were thus effectually compressed. The 
pin was removed at the end of twenty-five hours without the loss of 
a drop of blood. The patient was discharged at the expiration of one 
month. 
The late Dr. Enos found it necessary to perform clitoridectomy on 
a patient aged 30 years. Very free hemorrhage took place from the 
whole cut surface. It was impossible to seize the vessels and apply 
ligatures, he, therefore, applied the actual cautery, but, without suc- 
cess. Acupressure was then used with the effect of promptly control- 
ling it. 
Case 5. 
Appreciation of Acupressure. 
Haviug in the preceding pages explained the principal methods 
of applying Acupressure; illustrated by experiments on the lower 
animals and observations on the arteries of man, the pathology of the 
subject; and given a synopsis of the cases in which I have practiced 
the operation, it only remains to express the opinion of its value, to 
which I have been led by an impartial investigation of the subject. 
It has been demonstrated by an experience of its application to 
arteries that surgical hemorrhage can be arrested by means of Acu- 
pressure. The extensive experience of Messrs. Pirrie and Keith, who 
have aenpressed upward of eight hundred vessels, in two of whose 
cases only did secondary hemorrhage occur on the discontinuance of 
the pressure ;* together with the experience of Mr. Forster,f I)r. A. 
# See Briti*h Med. Journal. No. !MM. 
f See Guy’* Hospital Ki-jiortM, 1H67. 21 
Ilewson and others,* afford conclusive evidence of its efficiency. 
Indeed, the pathological changes which we have seen to take place in 
arteries that have been closed by acupressure would of themselves 
lead to the conclusion that it is a perfectly reliable procedure. So 
strong has become my conviction that, for the past twelve months, I 
have not taken ligatures into the operating room, and for two months 
during a recent service in the Brooklyn City Hospital, which accom- 
modates from one hundred and fifty to two hundred patients, there 
was not a ligature in the institution. 
Considering that the entire reliability of this procedure, for the 
arrest of surgical hemorrhage, has been fully proven, let us inquire 
if it has any advantages over the ligature. 
1. Secondary hemorrhage is not so liable to occur with Acupressure 
as with the ligature. There are certain constitutional states, such as 
the scrofulous diathesis, and other morbid conditions, marked by an 
aplastic state of the blood, which predispose to secondary hemorrhage. 
But this accident takes place far more frequently as the result of local 
causes, (1) from too rapid ulceration, or (2) too extensive sloughing 
of the vessel at the time of the ligature’s separation. On the other 
hand, where acupressure has been employed, the internal surfaces of 
the artery have merely been placed in contact, no ulceration or slough- 
ing ensues. Again, it is often possible to compress several vessels 
with a single needle, as in Case 4, hence, secondary hemorrhage would 
be less likely to occur than if a ligature had been applied to each 
vessel separately. 
2. Acupressure, as was predicted by Sir J. Y. Simpson, has proven 
to be the most expeditious way of restraining hermorrhage; and, 
with a little experience in its practice, the easiest which has yet been 
devised, and the surgeon requires no assistant as in using the ligature. 
3. Acupressure mry sometimes be employed where it would be 
difficult or impossible to seize the vessels with the forceps, and draw 
them out of their sheaths so as to allow of the application of a liga- 
ture. This is demonstrated by the record of the case of clitoridectomy. 
(p. 20.) 
4. Not only can two or more arteries be closed by a single needle, 
but the venous hemorrhage may be controlled at the same time with 
the arterial; thus preventing, it may be, the absorption by the open 
mouths of the veins of noxious fluids from the surface of the wound. 
5. The needle can be removed in a few hours, or in two or three 
days, leaving the interior of the wound free from all foreign bodies; 
while the ligature is separated by a slow process of ulceration 
* See Pennsylvania Hospital Reports, 1867. 22 
and sloughing, with the accompanying suppuration; and hence the 
primary union of wounds must he greatly diminished when acupres- 
sure is employed. 
6. Acupressure can he practiced with safety upon arteries which 
are so much diseased, that they are too brittle and friable to hear the 
strain of a ligature. This was illustrated by a case reported by Dr. 
Ilewson,* where the ossified brachial was closed satisfactorily after 
amputation of the arm. Dr. Ilewson thinks that if the ligature had 
been used, it would have cut through the artery, with the probability 
of secondary hemorrhage. Two cases are reported by Foucher,t 
where the vessels were ossified and broke under the pressure of the 
ligature, one of them breaking twice under two successive trials; 
they were successfully closed by acupressure. In cases of aneurism, 
where the artery is diseased for some distance above the sack, the 
vessel may be closed by an acupressure-needle at a point where it 
would be inexpedient to apply a ligature. Thus, an aneurism of the 
femoral situated at the inferior angle of Scrapa's space may be 
treated by acupressure at the upper portion of the femoral, whereas, 
if treated by deligation, the ligature would have to be placed upon 
the external iliac artery, a much more serious operation. 
* See Pennsylvania Hospital Reports, p. 141-146. 
f See Simpson on Acupressure, p. :W)4-y06. Fig- 1 • 
A . Accupressure pin _ 
B Needle armed with iron wire . 
C Loop of annealed iron wire . Fig. 2 . 
First Method, showing the pin on the cutaneous surface of the flap . Fi g'. 3 . 
Inner* surface of the same flap (Fig.£.) The artery compressed 
by the pin . Fig.4. 
Second Method by a needle threaded with irtm wire to facilitate 
removal > Fig.5. 
Fourth Method, A pin and a loop of iron wire . The Third 
Method is the same substituting a needle threaded with iron 
wire as in Fig.4. for the pin . Diagram, showing mechanism of the Third and Fourth Methods. 
Fig. 6 . Fig. 7 
rI he tilth. Method with a quarter rotation of the pin .A shows 
the first step transfxion. B.the second step quarter rotation of the 
pin across the artery and its ultimate insertion into the tissues 
beyond . Fig. 8. 
The same Method (Fifth) with ahalf rotation of the pin , A. 
shows tlue first step transfixion. B . second step half rotation oi 
the pin and the ultimate insertion of the point into the tissues 
beyond . Fig .9. 
Sixth Method., by a pin and loop of iron wire. Mechanism of Sixth Method, shoving the arrangement of the wire 
AfterPirrie. 
Fig.!0. FisJ. 11 . 
Seventh Method,showing pin on the cutaneous surface oi the 
flap. The artery compressed between the middle portion of the 
needle and the bone . Fig. 12 
Eighth or Brooklyn Method , 
Showing a plan for the closing of arteries in their continuity for the 
treatment of aneurism &• e. A. Artery laid bare, and. a loop of wire beside 
it,with the pin entering a sufficient distance from the edge of the wound 
to bring’ it down to the plan of the vessel . B . the noose thrown over the 
point of the pin. C . the pin carried through the flap opposite the point 
of entrance and the artery compressed between the pin and wire . Tig. ttf. 
Fi4.13. 
12- 
Common Carotid 
of Sheep, 
JZ days after Aci/pressure-. 
Common Carotid 
of Sheep. 
Zfdays after Acupressure. 
Common Carotid 
or Dog. 
7 daa/s afterAcipressure* 
in its (, "onti n1 ■ ’ t r. Fi§ .16 
Fi^.15 
Fi| .18 
Common Carotid 
of Sheep. 
47 hours otftera4£Upressur&. 
in its Continuity■ 
Common Carotid 
of Sheep. 
10 dou/s a/ter^4cupressur&. 
in its Continuity-. 
Common Carotid 
of Sheep. 
4 dm/s after Acupressure,. Pig. 19. 
•Jig .21. 
Fig 20. 
Common Carotid, 
or Dog. 
24-Z>ou/s & 
~in. its Continuity. 
POSTRIOR TlBIAL, 
Human. 
4242 fours after^4ayaressure. 
Popiitial Artery, 
Human. 
2fays after Acupresszcre