Acupressure

It may surprise some readers to know that acupressure was in use in 19th-century England. The term, which bears little resemblance to that in use today, defined a technique in which bleeding was arrested using needles. Known today primarily for introducing chloroform, ¹ the obstetrician James (later Sir James) Young Simpson (1811–1870) devised the procedure as a means of avoiding the pitfalls of ligatures to tie severed blood vessels. Described by Simpson for the first time to the Royal Society of Edinburgh in 1859, acupressure excited widespread interest. ²

A lexicon of 1881 ³ describes acupressure as a method of arresting haemorrhage by means of the pressure of a needle. Needles should be long with a sharp point at one end and a head at the other, and should be rendered unoxidisable. Positioned so that it presses down at right angles upon the vessel, the needle should first be passed through the tissue at one side of the vessel and then secured by passing it through the tissue on the other side. By compressing the vessel, haemorrhage is stopped and coagulation rapid.

Simpson passionately believed that postoperative mortality from both haemorrhage and infection could be reduced if acupressure were embraced. He argued that strangulation caused by ligatures invariably led to the mortification and sloughing of tissue. In his book, Acupressure, a New Method of Arresting Surgical Haemorrhage, and of Accelerating the Healing Process, ⁴ Simpson insists that union by primary adhesion is unattainable using ligatures made from silk or other organic material. He maintained that organic material ‘rapidly imbibes … animal fluids into its substance’ saying ‘these deadly fluids speedily decompose and render the threads morbidly poisonous’. Simpson also reminded practitioners that experiments conducted 40 years earlier proved metals could be borne by the body with ‘perfect impunity’. ⁵

Some were unconvinced by Simpson's use of needles as a haemostatic agent whereas others expressed vehement opposition. Chief antagonist James Syme (1799–1870) shredded one of Simpson's pamphlets in front of students and tossed it into the sawdust beneath the operating table, saying ‘There, gentlemen, is what acupressure is worth’. ⁶ Disciples ranged from colleagues in Scotland (Pirrie, Keith and Fiddes) to those south of the border and further afield. By the time Simpson had published his book on the subject, he was able to boast devotees in America, Australia and Asia. Dickenson Webster Crompton (1805–1884) had begun using acupressure at The General Hospital in Birmingham before Simpson's book went into print ⁷ and others soon followed. James Fitzjames Fraser West (1833–1883) and Joseph Sampson Gamgee (1828–1886) of Queen's Hospital, Birmingham, were enthusiasts as was Robert Jolly (1814–1894) of both institutions.

West declared, in a paper of 1869, ⁸ that he was using acupressure in almost every case of amputation. He used data collected over 12 months to show how 19 patients responded to acupressure. Two had died postoperatively though he was at pains to proclaim neither haemorrhage nor infection was responsible. The others did well. West used anything between one and three needles and left them in place for an average of about 50 hours. Two individuals did suffer blood loss but it was staunched in one case by manual pressure ⁹ and by the use of a tourniquet in the other.

The French surgeon M Foucher had used acupressure by 1864 according to Simpson ¹⁰ but Gamgee expressed surprise at French ignorance of the technique in 1867 in a series of papers on the state of Parisian surgery. ¹¹

Acupressure was not merely a fad of the 1860s. Papers written by Gamgee show he was still using it in the 1880s. When it was eventually set aside, it was superseded by sterile catgut ligatures introduced by Joseph Lister (1827–1912).