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  A TREATISE

  ON

  ACUPUNCTURATION, &c.


  DEDICATED, BY PERMISSION,

  TO

  ASTLEY COOPER, ESQ. F. R. S.


  Plummer and Brewis, Printers, Love Lane, Eastcheap.


[Illustration: ACUPUNCTURATION NEEDLES.]




  A TREATISE

  ON

  ACUPUNCTURATION;


  BEING

  A DESCRIPTION OF A SURGICAL OPERATION ORIGINALLY PECULIAR
  TO THE JAPONESE AND CHINESE, AND BY THEM
  DENOMINATED

  ZIN-KING,

  _Now introduced into European Practice_,

  WITH

  DIRECTIONS FOR ITS PERFORMANCE,

  AND

  CASES ILLUSTRATING ITS SUCCESS.


  BY

  _JAMES MORSS CHURCHILL_,

  MEMBER OF THE ROYAL COLLEGE OF SURGEONS IN LONDON.


  _LONDON_:

  PUBLISHED BY SIMPKIN AND MARSHALL,

  STATIONER’S COURT;

  SOLD BY E. COX AND SON, ST. THOMAS’S STREET; J. CALLOW,
  PRINCE’S STREET, SOHO; MESSRS. UNDERWOOD, FLEET STREET;
  BURGESS AND HILL, WINDMILL STREET; AND J. COX, BERNERS STREET,
  OXFORD STREET.


  TO

  ASTLEY COOPER, ESQ.


  THE STEADY FRIEND AND PATRON OF HUMBLE MERIT,

  THE AUTHOR RESPECTFULLY INSCRIBES

  THIS LITTLE TREATISE;

  LESS FROM PRESUMPTION OF ITS DESERVING

  HIS APPROBATION,

  THAN

  AS A MARK OF RESPECT

  FOR SPLENDID ACQUIREMENTS,

  AND OF

  GRATITUDE,

  TOWARDS A GREAT MASTER.




TREATISE

ON

ACUPUNCTURATION.




_Preliminary Remarks._


If the medical profession merit the reproach, of being easily deluded
into an admiration of novelty, then I need use no apology for
introducing the following pages to notice, nor will my subject stand in
need of prefatory allurements to obtain attention; but if on the other
hand, a rational theory, built on sound logical reasoning, be the only
evidence to which any value can be attached, then will my efforts have
been unavailing and fruitless. Under the impression, however, that
there exists a desire for speculation and discovery on the one hand,
regulated and qualified by a moderate and proper degree of scepticism
on the other, I shall presume a medium of the two extremes, and
proceed without apology or preface to my subject, trusting, that the
interesting facts which I have to relate, will elicit such attention
and investigation, as will kindle a desire in some men, at least, to
become acquainted with a process, which appears to rival the most
successful operations for the relief of human sufferings.

I should not have taken the tales which are told of the wonderful cures
effected by this operation amongst the original founders of it, as
sufficient authority for recommending it, nor would I admit the fables
which are promulgated by these people, as evidence of its efficacy, had
not this efficacy been witnessed by European spectators on its native
soil, and at length experienced in our hemisphere; and even, latterly,
in our own country.

The operation of acupuncturation has been seen by so few Europeans,
that our books have made us acquainted with little more than its
name. It is of Asiatic origin, and China and Japan peculiarly claim
it as their own. A writer in the year 1802, mentions a discovery of
its having been practised by the natives of America, and refers to
Dampier’s voyages for an account of it; but I have in vain followed
Capt. Dampier’s relation of his adventures, in crossing from the
South to the North Sea, over the Isthmus of Darien, for any account
of the operation, for he does not so much as name it. He speaks of a
work intended to be published by his surgeon, Mr. Lionel Wafer, who
accompanied the expedition, and to which he refers his readers for an
account of the manners and customs of the interior of the country. Mr.
Wafer was detained, from an accident, a considerable time amongst
the Darien Indians, and did, on his return to England, publish this
book, which I have therefore been at the trouble of perusing, but do
not learn from it, that the operation of acupuncturation was practised
in that part of America: it is true, Mr. Wafer describes a method of
blood-letting employed by the natives, which is somewhat correspondent
to acupuncturation, but both the intention and the effect are widely
different. This operation is effected in the following manner: the
patient is taken to a river, and seated upon a stone in the middle of
it. A native, dexterous in the use of the bow, now shoots a number of
small arrows into various parts of the body. These arrows are prepared
purposely for this operation, and are so constructed, that they
cannot penetrate beyond the skin, the veins of which, opened by the
puncturation, furnish numerous streams of blood, which flow down the
body of the patient. If this be the operation which has given rise to
the idea, that acupuncturation is practised by the American natives,
the conclusion is evidently erroneous, as it is simply a method of
blood-letting, and is generally resorted to for the cure of fever.
Now, acupuncturation has no reference whatever to bleeding, and it
is rare, that even a drop of blood follows either the introduction
or withdrawing of the needle; nor does it appear, that the Chinese
and Japanese, with whom it originated, intended it as a method of
abstracting blood, which is proved, not only by the consequences of
the operation, but by the manner in which it is performed, and the
nature of the diseases to which it is applied. If it could have been
established, that the natives of the American Isthmus were acquainted
with it, it would have been a curious, as well as an interesting
enquiry, to ascertain whence they derived it.

It is a little strange, that the surprising efficacy, of which so
much has been boasted by its eastern professors, and the safety,
at least, with which acupuncturation may be performed, having been
so fully demonstrated; it is strange I repeat, that it has not met
with an earlier encouragement amongst us. It is probable, that the
hyperbole in which it has been related, has induced the sober minds
of our Northern soil, to treat these relations as the fictions of
Eastern imagination, and to reject them without examination, as
fables calculated only for amusement. There have not, however, been
wanting sensible minds, and men of talent and reputation, to recommend
this operation; and the names of Ten-Rhyne, Bidloo, Kœmpfer, and
Vicq-d’Azyr, stand conspicuous on the list of those who speak in its
favour; but still, neither of them had undertaken to put its merits
to the test, by actual experiment. Several practitioners in France,
however, have now taken up this neglected operation, and their
report verifies the praises which have been bestowed by others upon
it. My attention was lately directed to it by my friend Mr. Scott,
of Westminster, who, as far as my knowledge goes, was the first who
performed it in England, and some successful cases which I witnessed in
his practice, assured me of its efficacy, and led me to its adoption.
The success of my own subsequent practice, warrants a recommendation of
it, in almost any terms I could give it; but I shall content myself in
laying before my readers, the opinion and experience of some physicians
of eminence, accompanied by a relation of some cases of my own, where
the benefit of the operation has been decidedly successful; upon a
better foundation than which it cannot at present rest for public
examination; it remains for the medical profession to ascertain its
claims to attention by the test of experience, and having undergone
the ordeal of experimental enquiry, it will, I have no doubt, so
fully develope its merit, as to obtain a conspicuous rank in medical
estimation, as a valuable curative measure.




ACUPUNCTURATION.


The method of performing the operation of acupuncturation is simple
and easy, requiring neither practice to give dexterity, nor adroitness
that it may be done with propriety. Anatomical knowledge of the human
body is, however, necessary; as an imprudent application of it, by an
operator ignorant of the structure of the part into which he introduces
his needle, might be productive of bad consequences. To a surgeon,
however, properly qualified, (and no other ought to perform this or
any operation) no danger can arise; as the cautions are but few, and no
risk is incurred, if they are attended to. It is only necessary that
the operator, in introducing the needle, should avoid the course of
large vessels, of nervous trunks, and of the tendons of muscles. It is
not, however, proved, that the latter sustain injury from the puncture
of the needle; but it is as well to avoid the possibility of mischief,
by such a cautious mode of introducing the instrument, as shall be
divested of risk. I cannot better familiarize my subject to the reader,
than by a sketch of it in its native state; and as an excellent
description of the operation, as performed by the Japonese natives, is
given in the ninth volume of the “Modern part of an Universal History,
from the Earliest Account of Time,” I shall extract it, as containing
all that is known of its original practice.

“The place made choice of for the puncture, is commonly at a middle
distance between the navel and the pit of the stomach, but often as
much nearer to, or farther from either as the operator, after a due
scrutiny, thinks most proper; and in this, and the judging rightly
how deep the needle must be thrust below the skin, so as to reach the
seat of the morbific matter, and giving it a proper vent, consists the
main skill of the artist, and the success of the operation is said to
depend. Each row hath its particular name, which carries with it a
kind of direction, with regard to the depth of each puncture, and the
distance of the holes from each other, which last, seldom exceeds half
an inch in grown persons, in the perpendicular rows, though something
more in those which are made across the body, thus,


  .   .   .
  .   .   .
  .   .   .


The needles which perform the operation are made, as was hinted at
first, either of the finest gold, or silver, and without the least
dross or alloy. They must be exquisitely slender, finely polished, and
carry a curious point, and with some degree of hardness, which is
given by the maker by tempering, and not by any mixture, in order to
facilitate their entrance, and penetrating the skin. But, though the
country abounds with expert artists, able to make them in the highest
perfection, yet none are allowed, but such as are licensed by the
emperor.

“These needles are of two sorts with respect to their structure, as
well as materials; the one, either of gold or silver indifferently,
and about four inches long, very slender, and ending in a sharp point,
and have at the other end a small twisted handle, which serves to turn
them round with the extremity of the middle finger and thumb, in order
to sink them into the flesh with greater ease and safety; the other
is chiefly of silver, and much like the first in length and shape,
but exceedingly small towards the point, with a short thick handle,
channelled for the same end of turning them about, and to prevent their
going in too deep; and for the same reason, some of them are cased in a
kind of copper tube, of the bigness of a goose quill, which serves as a
sort of guage, and lets the point in, just so far as the operator hath
determined it. The best sort of needles are carefully kept in a case
made of bull’s horn, lined with some soft downy stuff. This case is
shaped somewhat like a hammer, having on the striking side a piece of
lead, to give it a sufficient weight, and on the outside a compressed
round piece of leather to prevent a recoil, and with this they strike
the needle through the thickness of the skin; after which they keep
turning the handle about with the hand, till it is sunk to the depth
they design it, that is, till it is thought to have reached the seat of
the morbific virus, which in grown persons is seldom less than half, or
more than a whole inch: this done, he draws it out, and compresses the
part, in order to force the morbific vapour or spirit out.

“The directions and nice rules for the performing of this curious
operation are many, and require great skill and attention in the
operator; and when duly performed, may be of excellent use, not
only against the excruciating distemper, called Senki, but against
many other topical ones, which are most commonly cured by the Indian
Moxa, and other caustics. On the other hand, these last are often
tried against the distemper above mentioned, by applying the caustic
to the belly, on each side of the navel, and about two inches from
it, but mostly without any success, it being very unlikely that such
an application should reach the seat of the distemper; whereas, the
benefit which has accrued from the _acupuncture_, in that one disease,
hath encouraged others to apply it indifferently to other parts of the
body, where the moxa is used, and by a due care and precaution not to
prick any nerves, tendons, or other considerable blood vessels, have
cured their patients by it, without putting them to the excruciating
torture which attends that of the Moxa, or other caustics.”

From the little we have learned of the practice of this operation
amongst the Asiatics, it would seem, that it was chiefly diseases of
the abdominal cavity and viscera, which afforded opportunities for its
performance, such as Colic, Tympany, &c. It is not in such diseases,
however, that I have any experience of its use, but it is questionable,
whether it might not be beneficial, particularly in the latter, and I
would beg to recommend it as a matter of interesting experiment, to be
tried in this malady; such an opportunity, should it fall in my own
practice, I shall take advantage of.

The Indians, however, do not confine their practice of Acupuncturation
(or Zin-king, as they call it) to diseases of this kind. They puncture
the head in all cases of Cephalalgia, in Comatose affections,
Ophthalmia, &c. They puncture the chest, back, and abdomen, not only
to relieve pain of those parts, but as a cure for Dysentery, Anorexia,
Hysteria, Cholera Morbus, Iliac Passion, &c. Local diseases of the
muscular and fibrous structures of the body, also often afford them
occasions for its performance; and it is for diseases of this class
only, that I have hitherto practised it, and for which I would
expressly recommend it.

Neither sufficient time has elapsed, nor a proper selection of cases
been made since this operation has been known to me, to have afforded
me, either a large number of experiments, or a great variety of
diseases on which to try the effects of it: it is true I have employed
it on some few, and I have it in contemplation to encrease the list,
by giving my experiments a wider range, but at present I should not
be doing justice to my subject, to form conclusions on such imperfect
evidence; I shall therefore confine myself, merely to the description
of the good effects, which I have witnessed in diseases of a rheumatic
character, and in those injuries of the fibrous structures of the body,
which are often observed to arise, (particularly in labouring persons)
from violent exertion. This circumstance must be ever in view, and if
it be not fully impressed on the mind, I doubt not but many who may
be induced to try the effect of the operation, may be disappointed in
it; viz. that acupuncturation does no good, nor does it produce even
a temporary alleviation, when the disease for which it is used, is of
an inflammatory character. This distinction seems to have regulated
the practice of those, who have experimented on the subject, and to
have decided them in their selection of cases for the operation. Mr.
Berlioz, of Paris, has practised it extensively, and has recently
published an account of the success which it has had in his hands.[1]
He says,

“The eulogia given to acupuncturation by Kœmpfer and Ten-Rhyne, are
just and merited. We have reason to feel surprized, that although an
age or more has elapsed, since this curative measure has been known in
Europe, no physician has made trial of its efficacy. The practice of
the operation is attended with but little pain, and the success of it
is so prompt, that the disease is alleviated or entirely ceases, as
soon as the needle has been introduced the depth of a few lines; most
frequently, however, the pain is not removed by the first introduction
of the instrument, and it is not until after the use of it for a
second, third, or fourth time, that the cure is completed. Simple
nervous affections, especially demonstrate how much acupuncturation
merits the attention of physicians, for there are but few remedies
possessed of such prompt activity, and which produce such wonderful
effects.

“_But acupuncturation does not appertain in any respect to sanguineous
evacuations_,[2] it can only contribute sometimes to establish the
indications for them. This operation is _not indeed followed by any
success_, when the disease _depends upon sanguineous turgescence and
inflammation_.

“In contrary circumstances, Acupuncturation, by dissipating the
symptoms, demonstrates, that disorder of the nervous system only had
given rise to them.”

The only cases of Rheumatism in which I have been successful with
the operation, have been of the Rheumatalgic form, or that which is
divested of external inflammation; characterised by pain upon motion,
stiffness and coldness of the part; the disease having a disposition to
change its place; is aggravated by atmospheric changes, and relieved
often by stimulant Diaphoretics, Narcotics and external warmth: but I
have yet met with success in some cases where the intensity of the pain
would have led me to believe, that considerable inflammatory action
must have given rise to such exquisite nervous sensibility.

Mr. Berlioz in speaking of the diseases to which this remedy is
applicable, says, “vague and wandering Rheumatism sometimes attacks the
external muscles subservient to respiration; the patient is obliged to
remain motionless; every motion of the trunk compels him to cry out; a
deep inspiration is very difficult, and coughing occasions such cruel
pains, that expectoration is impossible. Acupuncturation dissipates
instantly this state of distress, and renders to the muscles their full
liberty of action. In the space of one or two minutes, a patient whose
sufferings drew from him tears, exclaims he is quite cured.”

These observations of Mr. Berlioz are fully substantiated by the
experience of Dr. Haime of Tours, who has devoted much time and
attention to the operation of Acupuncturation, and has lately published
a most interesting paper upon the subject in the 13th volume of the
“Journal Universel des Sciences Medicales,” at Paris.[3]

The doctor declares that his own practice bears evidence of the
fidelity of the preceding remarks of Mr. Berlioz. He accuses the
Japonese and Chinese, (to whom this operation he says is peculiar,)
practising it too extensively, which has been partly the cause of its
being disregarded by Europeans, and acknowledges that it was to Mr.
Berlioz’s cases, which he has related in his “estimable work,” that he
owed the fortunate application which he has made of this measure.

The following cases are given by Dr. Haime, which he says support the
Theory of Mr. Berlioz.

“Antoinette Boulard, 38 years of age, had experienced in April 1818, a
severe attack of Rheumatism, which fixed on the inferior part of the
left side of the chest; it gave way in 48 hours to the use of some
sedatives, the tepid bath, and the application of a blister to the part
in pain.

“Six weeks afterwards I was called to see this woman, who had fallen
again into the same state. I found her with the trunk in a state of
inability of action, the motion of the respiratory muscles extremely
difficult, and the plaintive tone of voice indicated the violence of
the pain, which drew from her cries on the least motion. The pulse was
small and concentrated, but without sensible acceleration; the body was
covered with cold sweats; and the unhappy patient, altogether, was in
a state of inexpressible anguish. I thought it right to have recourse
to the same remedies which had been successful on former occasions;
but my hopes were deceived. Three days were passed in this state, and
Antoinette obtained no relief: I determined therefore to practice
acupunctuation. I introduced a needle[4] at the inferior margin of the
cartilages of the false ribs. The instrument had hardly passed to
the depth of a few lines, when the patient said the pain had changed
its seat, and was descended into the abdomen, at the same time that
it had lost much of its violence. I continued the introduction to the
depth of an inch; by this means the pain was driven from the abdomen,
and permitted the patient to breathe freely: however I maintained the
needle in its place for five minutes, and then made a second puncture,
and successively a third, in the place where the disease had taken
refuge. This third puncture made the pain totally disappear, and the
patient cried out that I had restored her to life. Sleep of eight hours
duration and a state of perfect calmness succeeded this operation.

“However Antoinette sent for me on the following day, saying her
sufferings had returned, but with less violence, and entreated me with
much earnestness that I would repeat the operation “seeing” she said,
“that it was only the sound,” (for so she named the needle) “which gave
her relief.” The operation was this time still more successful. The
treatment was now continued for four days, and the last puncture so
entirely relieved the pain, that it has not since returned.”

In addition to the above successful case the doctor adds another not
less so.

“A woman had suffered for several days with wandering Rheumatic pains,
which continued daily to encrease in violence; there were however at
all times fixed pains in the shoulder and in the right arm, which
acquired such a degree of intensity by intervals, that the patient
could not refrain from crying out. She was in this state when she came
to consult me: finding, however, neither alteration in the pulse, nor
encrease of heat, nor redness of the skin, nor tension, nor swelling
in the part affected, I considered the case to be simple Rheumatalgia,
and passed the needle to the middle of the arm, between the fibres of
the Triceps Brachialis muscle; the place designated by the patient as
the seat of the pain. The pain was driven into the fore arm, and the
second puncture caused it to descend into the hand, and a third being
made in this part, caused it totally to disappear, and the patient said
with delight and astonishment, she was cured; and was so satisfied with
this treatment, that she spoke of it to every body. I have not since
seen her, although I requested her (and she promised) to return in the
event of a relapse.” But the most remarkable case which has occurred
to exemplify the triumphant effects of acupuncturation, was that of a
girl of 24 years of age. She was naturally healthy and robust, and had
enjoyed good health till she was 15 years old, at which time the signs
of puberty were manifested. At this period the system became much
disturbed, menstruation was established with difficulty, and continued
with irregularity; she lost her cheerfulness, and symptoms of the
nervous temperament became predominant.--Various nervous symptoms now
evinced themselves, and amongst others an obstinate vomiting occurred,
which subsided only during very short intervals. She continued in this
state for two years[5]. From this time she gradually got worse, and
in addition to the habitual vomiting which she had endured from the
age of 16, she suffered extremely from violent general convulsions.
Some medicines were now given which relieved the sickness, and the
use of the cold bath suspended the convulsions. After the treatment
had been continued two months, she was visited by Dr. Haime, (to
whose description of this interesting case, I am indebted for these
particulars,) who found her labouring under partial convulsions, with
a disposition to vomit occasionally. The means which had been before
employed were still continued, but the symptoms became more aggravated,
but were a little subdued by blood-letting from the saphena vein.
The convulsions were almost wholly removed, at least had become only
partial; the spasmodic efforts being concentrated on the diaphragm and
stomach; but a nervous hiccup supervened which acquired such a degree
of intensity, that the unhappy patient experienced no intervals of
ease. All the known anti-spasmodic remedies were now tried during the
space of six months without any benefit. Blisters to the pit of the
stomach afforded no sort of relief, and the cold bath gave but a short
and temporary alleviation. Scarifications followed by the application
of a cupping glass were made on the side of the Dorsal Vertebræ, and
the situations corresponding to the pillars of the Diaphragm, which
suspended the symptoms but for a few days: relief was only partially
obtained by the cautery, and the hiccup returned with its original
force accompanied with such a convulsive affection of the stomach,
that this organ appeared to act like a pair of bellows, alternately
receiving and expelling large quantities of air. At length when the
hiccup ceased, it was replaced by partial convulsions or some other
symptoms, and vice versa.

Seeing the want of success of all attempts to cure this obstinate
disease, and reduced to the necessity of remaining a mere spectator of
its dreadful effects, Dr. Haime consulted every book which he conceived
might give him some information by which some other curative measure
might be suggested; but his researches were totally unsatisfactory,
until he met with Dr. Berlioz’s observations upon Acupuncturation,
when, not less struck with the curious facts which Dr. Berlioz
relates, than with the efficacy which it was reported to possess in
nervous diseases, he resolved to try it as a sort of forlorn hope,
upon his present patient: he accordingly proposed it to her, and
readily obtained her consent to its performance. He communicated his
intention to Doctor Bretonneau, Physician to the general hospital, who
had seen the case with him, and had often spoken of it; and in his
presence he performed the operation for the first time. A needle was
introduced perpendicularly at the centre of the Epigastrium, and the
two physicians soon became convinced of the astonishing promptitude of
the remedy; for the instrument had hardly passed to the depth of a
few lines, when the symptoms vanished as it were by enchantment. The
operation not appearing to be painful to the patient, the introduction
of the needle was continued to half its length, in depth from twelve to
fifteen lines, where it was suffered to remain for five minutes. The
result was a perfect calmness, and a total suspension of the hiccup
for three days, when the same symptoms returning, the needle again was
had recourse to, and with the same efficacious effect as at first;
and the operation was performed again and again, at longer or shorter
intervals, according as the symptoms re-appeared, and always with the
same advantages. Dr. Bretonneau became convinced of its efficacy by
himself performing it several times. The treatment of the case was
thus continued, selecting the part for the introduction of the needle,
according to the situation of the symptoms which each operation was
intended to alleviate; and Dr. Haime asserts, it never once failed
of success; for the convulsive motions of the head, the instrument
was passed into the muscles of the neck; into the masseter muscle, to
relieve constant gaping; and into the fore arm when these muscles were
affected; and thus, by pursuing the disease as it were, the convulsive
disposition was entirely removed, and the patient restored to health.

For the fidelity with which I have reported this case, I refer the
reader to Dr. Haime’s own record in the 13th volume of the “Journal
Universel des Sciences Medicales,” and should further evidence of the
efficacy of this remedy be necessary from other authority, I have but
to mention the experience of Dr. Demours of Paris, who has recently
confirmed[6] the report of Messrs. Berlioz and Haime. He dwells with
particular force upon its good effects in Ophthalmia, for which he
directs five or six needles to be passed between the fibres of the
supraspinatus muscle. His method of performing the operation I shall
presently notice when describing this part of my subject. The following
cases which have occurred in my own practice, I shall now lay before
my readers, and I doubt not but I shall make it appear that the
beneficial effects of the remedy employed, are sufficiently flattering
to deserve the esteem I hold it in, and to justify me in bringing the
subject into general notice.


CASE I.

GEORGE MC’LAUGHLAN, about 30 years of age, a Bricklayer by employment,
came to my house in November last, supporting himself by a stick in one
hand, and resting the other against the wall, as he proceeded. The body
was bent at nearly right angles with the thighs, and his countenance
indicated acute suffering. He had been attacked, he said, three days
before, with darting excruciating pains in the loins and hips; every
motion of the body produced an acute spasmodic pain, resembling
an electric shock; and the attempt to raise the body to an upright
position was attended by such insupportable agony, as obliged him to
continue in this state of flexion rather than encounter it by altering
his position. There was no more constitutional disturbance than was
to be expected from three days and nights of constant pain; the pulse
was a little quickened, and the tongue white, but I attributed this
derangement to the irritation set up by the pain and loss of rest. I
directed him to place himself across a chair for support during the
operation, and I immediately introduced a needle of an inch and a half
in length into the lumbar mass on the right side of the spine; in two
minutes time I observed that he seemed to rest the weight of his body
more on his limbs, and in the next instant, without any enquiry being
made, he observed, that he felt his limbs stronger from the “pain
having left his hips.” He next plainly indicated that the disease was
lessened, by raising his body; from which he only desisted, by being
desired to remain at rest, through fear of the needle being broken.
The instrument having remained in its place about six minutes, the
patient declared he felt no pain, and could, if he were permitted,
raise himself upright; it was then withdrawn; the man arose, adjusted
his dress, expressed his astonishment and delight at the sudden removal
of his disease, and having made the most grateful acknowledgements,
left the house with a facility as though he had never been afflicted.
The relief was no doubt permanent, as he did not return, which he would
most probably have done, had he suffered a relapse.


CASE II.

WILLIAM MORGAN, a young man in the employment of a timber merchant,
felt a violent pain suddenly attack the loins whilst in the act of
lifting a very heavy piece of mahogany. The weight fell from his hands,
and he found he was incapable of raising himself. He was immediately
cupped and blistered on the part; but two days had passed and he
was still labouring under considerable pain, augmented violently
by every motion of the body. On the third day the operation of
Acupuncturation[7] was performed upon the part of the loins pointed out
as the seat of the injury, which, as in the former case, dissipated the
pains in five or six minutes, and restored the motions of the back. He
returned, however, the next day, with the same symptoms as at first,
but in a mitigated degree. A needle was now passed to the depth of an
inch on each side of the spine, which, as I expected, terminated the
disease in a few minutes, and it was with pleasure that I understood
the next morning, that the man had gone to his usual employment.

This case illustrates the observations of the French physicians
before cited, as to the efficacy of the remedy in injuries of this
description: it is true that in my own practice it is a solitary
example; but so decisive was the benefit derived from it, that the
case proves a powerful corroboration of both Mr. Berlioz’s theory and
practice.


CASE III.

ELIZABETH JACKS, a married woman, aged 44 years, was admitted into
one of the public hospitals of London, in the year 1817, for an
enlarged Bursa situated under the Rectus Femoris muscle. Soon after
her admission she was attacked with violent pains in the limbs, which
continued to affect her with greater or less violence, till the month
of October, 1820, when a severe rheumatic state of the back of the
head and of the loins supervened; the one preventing flexion of the
neck, the other of the back. Her digestion continued unimpaired, the
pulse about its natural standard, without hardness or acceleration.
Her nights were passed without sleep, and every motion of the body was
performed with pain and reluctance. In this state she applied to me,
and I gave her antimonials combined with opium, keeping the bowels
open with gentle aperients. Under this treatment, she was in some
degree relieved, but as she laboured under the impression that nothing
could be done to eradicate the disease, she discontinued it after a
short time, but in a few days afterwards (Nov. 4th,) Mr. Carpue was
requested to see her; he prescribed ten grains of Dover’s powder, to
be taken every night at bed time: this dose she took twice without
any benefit. The pains had now entirely left the parts they at first
occupied, and had fixed on the intercostal muscles above and below the
seventh and eighth ribs on each side of the chest; whence, to avoid
the insupportable anguish occasioned by the action of these muscles in
the process of respiration, this function was (or at least appeared
to be) wholly supported by the Diaphragm, the abdominal muscles, and
the large external muscles of the neck, chest and back. No other
force but that of pressure upon the situation corresponding with the
interstices of the ribs gave any uneasiness, but on these parts, the
slightest pressure produced intolerable pain: this plainly proved
that the disease affected the intercostal muscles alone. Peritonœal
inflammation ensued, and the suffering which this occasioned, banished
for the time, all attention to the original disease; but no sooner was
this removed, (which was effected by the most active means) than the
patient found that she was still the victim of an unrelenting malady,
which had now pursued her upwards of three years. Acupuncturation now
recurred to me as a probable mean of relieving her from her sufferings.
I accordingly introduced a needle between the sixth and seventh ribs,
and another between the seventh and eighth of the right side; in two
minutes the patient became sensible of relief, and in two or three
minutes more, that side of the chest was emancipated from the disease.

The same operation was now performed on the other side, though the
good effect was not equally extensive on this as on the right; yet
the patient respired now with so much comparative freedom and ease,
that she exclaimed, she should “soon be quite well.”--The following
day but one, there was a little augmentation of the pain on both sides
of the chest, but a single needle introduced into each part, entirely
removed it. No return of pain after this time visited the right side,
but the left, still continued to be attacked; until at length the
third introduction of the needle, dissipated it permanently, and the
patient has since remained free from the disorder. The needles in every
instance were suffered to remain in the part about five or six minutes.


CASE IV.

HANNAH HOWARD (a female servant in my house) aged 25 years, became in
September last the subject of Rheumatalgia. The shoulders, arms, back
and hips, were the parts selected by the disease for its wandering
peregrinations. Antimonials, Opium, Guaiacum, Hyosciamus, &c. relieved
her occasionally, but at the end of three months, metastasis to the
heart suddenly took place. I was called hastily to her at this time;
she had fainted, and when recovered from the syncope, complained of
violent pain about the region of the heart, which she informed me had
troubled her more or less for several hours. Her pulse was hard, and
beat somewhat about 106 in a minute; but from its extreme irregularity,
it could not be measured with exactness; nor if it might, would it
have been found, I believe, to have preserved an uniformity within
any two given periods; as both its intermissions and its actions of
rapid velocity were produced at uncertain and variable intervals.
Copious bleeding, blistering, cupping, with the use of digitalis and
colchicum, at length removed the disease; and in three weeks she was
able to leave London, to try the effect of country air in restoring
her health and strength. She returned to town after a short time,
perfectly recovered; and continued so, until an exposure to wet brought
on another attack of rheumatalgia; which, after variously shifting its
seat for several days, now fixed itself on the left side. The remedies
which had formerly been of service, were now taken without relief; and
the colchicum[8] (which in most cases of rheumatism will be found,
after bleeding, more valuable than any other article of the materia
medica) was totally inert. The pain had now acquired such a degree of
violence, that the slightest motion of the body gave the most exquisite
agony; and so intense was this state of suffering, that the patient
could not be urged to speak in a tone loud enough to be conveniently
heard, through the fear of exciting an exacerbation of pain, which even
such slight motions occasioned. I now had recourse to acupuncturation;
having introduced a needle through the integuments covering the
interstice of the 8th and 9th ribs, at the part corresponding to the
junction, with their cartilaginous epiphises. I continued to press it
gently forward, by rolling it freely between my fingers. When it had
penetrated to about two thirds, its whole depth (an inch) I enquired
if she experienced either pain from the puncture, or relief from the
disease; she replied, “she scarcely felt the instrument, but that her
rheumatism had suddenly abated of its violence;” and to my surprise,
this reply was expressed in her natural tone of voice. She added,
“that she could now speak and breathe freely,” so that I now found her
former taciturnity, which I had attributed to moroseness, was banished.
I continued the introduction of the needle, and in a few minutes the
disease was dislodged, and fled to the back of the chest, near the
angle of the ribs. The motions of the shoulder were now restored to
their utmost freedom, and I withdrew the needle, and inserted it into
the part which had become the seat of the pain, about two inches from
the spinal column. The disease soon began to dissipate itself totally;
the patient said she was free from uneasiness, and could make a deep
inspiration without pain. The instrument having been retained in its
place five or six minutes, was withdrawn; the chest had regained its
full liberty of action, and the utmost variety of flexion of the body
could be used, not the slightest inconvenience ensuing. The next
day, however, the pain again visited the anterior part of the chest,
and I again had recourse to the needle. The operation was completely
successful; for excepting a slight darting pain, which occasionally
troubled her for a few days afterwards, no symptoms of the disorder
remained, and she continues at this time to attend to the duties of her
station in my family.

Whilst occupied with the preceding pages, I received the following
communication from my friend, Mr. Jukes; which I subjoin as the
strongest corroborative evidence of the efficacy of the practice under
our consideration.

  “Great Peter-Street, Westminster,
      February 27, 1821.


  MY DEAR SIR,

  In compliance with your request, I send you an account of
  the effect of Acupuncturation on our friend Mr.Scott.[9] I
  received an urgent message on the morning of the 18th inst.
  from that gentleman, requesting I would visit him instantly.
  I found him in bed; and, with a countenance expressive of
  much anguish, he informed me, that for three days he had
  been suffering severely from pain in the loins, which he
  attributed to leaving a warm room during one of the late
  foggy nights. Within the last 12 hours it had acquired such a
  degree of violence that even respiration was insupportable,
  except the body were fixed in such positions as permitted
  the least possible motion. An attempt to resume the erect
  posture, produced violent spasmodic action of the muscles of
  the back, which appeared to be communicated by sympathy to
  those of the abdomen and chest, impeding respiration with a
  convulsive effort; nor could any motion of the body be made
  without producing this distressing effect. Neither fever
  nor general derangement was present; the secreting organs
  of the body properly performing their function, proved the
  external locality of the disease. In this state of things,
  Acupuncturation presented itself to us as likely to afford
  relief, and it was therefore immediately resorted to.

  “I applied an exhausted cupping glass upon the integuments,
  opposite to the second lumbar Vertebra, and midway between
  this bone and the edge of the Latissimus Dorsi muscle, which
  was the part referred to as the most concentrated spot of the
  disease. As soon as a needle had penetrated to the depth of
  an inch, a sensation arose, apparently from the point of the
  instrument, which the patient described as resembling that
  which is produced by the passage of the electric aura, when
  elicited to a metallic point, diffusing itself at first to
  some distance around the part, and then extending itself up
  the side to the Axilla. This sensation continued to be felt
  for the space of a minute, when a violent pain struck into the
  right iliac region, immediately above, and corresponding with
  the line of, the Crista of the Ilium. No pain was now felt in
  the back, except a dull aching of about two inches in breadth
  on the right side of the spine, extending from the lower part
  of the neck to the Sacrum; corresponding with the situation
  and course of the Longissimus Dorsi Muscle. The pain above the
  hip now began to subside and in the space of three minutes
  from its commencement, had ceased altogether.


  “The uneasiness along the course of the spine still remaining,
  a needle was introduced about an inch from one of the upper
  Dorsal Vertebræ, and another in a corresponding situation
  to one of the lower Lumbar Vertebræ. The pain in the right
  side was in a few minutes entirely dissipated, and the
  patient arose, declaring, that, excepting a slight degree of
  uneasiness on the posterior part of the chest, near the angles
  of the inferior ribs, he was completely relieved from the
  disease. He, however, requested I would pass a needle in this
  last situation; on effecting which the pain soon left its last
  refuge, and the patient dressed himself, and left his house
  in the most perfect health. 1 have this day seen him, and
  he assures me that he has not experienced any return of the
  affection.

  “I should have stated that the sensation, described as
  resembling somewhat an electrical effect, was experienced from
  two of the needles only; the first and the last of those
  which were introduced.

  “I send you the history of this case without any comment upon
  the mysterious nature of this extraordinary operation; yet
  I am convinced there is something more in it than has been
  hitherto explained. I have, it is true, some notions (not
  however fixed) as to its nature; but I would not at present
  venture to detail them, lest the embers of animal magnetism
  might be rekindled in the discussion, and the operation
  from being associated with an exploded theory, sink into
  undeserved and premature oblivion, from preconceived prejudice.

  I am, dear Sir,

  Your faithful friend,

  EDWARD JUKES.”


Conceiving that the foregoing cases will be as satisfactory as a larger
number would, I shall not trouble my readers with a more minute detail.

I could certainly add many others to the list; but to minds open
to conviction and truth, no stronger impression would be made by
multiplying examples; whilst the sceptical, would “not be persuaded,
though one rose from the dead.”


The OPERATION of ACUPUNCTURATION DESCRIBED.

The first step necessary to the performance of this operation, is the
selection of a proper apparatus. It is not requisite, however, that
our needles be either of gold or silver, as those of the Japonese are;
although it is true that the flexibility of these metals prevents
the risque of their breaking; but I have not heard of, or seen, any
instance of such an accident with the steel needle, which is the
material employed in European practice. It may however be left to the
discretion of the surgeon, whether he uses the former or not; it is
only of consequence, that the extremity should be finely pointed, and
preserved so.

Mr. Berlioz uses a steel needle, three inches in length, which has a
head given to it of melted sealing wax. This needle is introduced to
such a depth as the operator thinks proper, depending on the part in
which it is used, as well as the nature of the disease which it is
intended to remedy. If it be intended to puncture any of the viscera,
such a needle will indeed be wanted; but it will be seen by the
practice of the French physicians, that though they have sometimes
thought it right to penetrate the visceral cavities to the whole depth
of this needle, yet it is but seldom that more than one inch of it has
been sunk into the part. I have not, in my own practice, ventured to
use needles of greater length than one inch, and one inch and a half;
and the instrument which I use is an ingenious adaptation of a common
sewing needle to an ivory handle, constructed by Mr. Edward Jukes,
Surgeon Accoucheur to the Westminster Medical Institution (see plate,
fig. 1 and 2.)

Dr. Haime, and I believe the French surgeons who practice
acupuncturation, use this long needle (three inches) and Mr. Demours,
who appears to be a man of considerable mechanical genius, has lately
invented a new apparatus for this purpose. An exhausting syringe is
fitted to the side of a cupping glass, which can be unscrewed and
removed after the exhaustion has been effected by a few strokes of the
piston, leaving the glass affixed to the part. From the top of the
glass proceeds a hollow staff, in which slides (the tube being air
tight) a handle, armed with a three inch needle, which is inserted to
any depth the operator chuses.

The theory which Mr. Demours gives in defence of this instrument
is, that the sensibility of the part is so much lessened by the
conjestion occasioned by the suction of the pump, that the instrument
passes without producing the least pain, whilst at the same time
it penetrates deeper, and more readily, through the tumefaction
occasioned by the turgescence of the sanguineous capillaries and
lymphatics. These advantages, he says, being only obtained by the
operators ability of passing the needle whilst the surface of the body
remains in the state of tumefaction, he contends they cannot possibly
be derived from the simple process of affixing a common glass by the
flame of a taper, as the tumor subsides the instant the glass is
removed.

I do not think it, however, a matter of any moment, whether a cupping
glass be applied or not; it may, certainly, lessen the sensibility
of the part, and consequently diminish the pain occasioned by the
needle; but this is in general so trifling, that no preparatory steps
are required to mitigate it; in fact, it deserves so little the name
of pain, that the patient is often unconscious of the needle having
penetrated.

The Japonese and Chinese drive in the needle by the stroke of a mallet.
This instrument, in use amongst the former, is made of ivory, with
holes, sunk on its surface in the same manner as a lady’s thimble,
which prevent the hammer from sliding off when the stroke is given.
Such a method is however objectionable, as well from the danger there
would be of breaking a needle not possessing flexibility, as from its
being more painful to the patient.

The method to be employed is the following:

The handle of the needle being held between the thumb and fore finger,
and its point brought into contact with the skin, it is pressed gently,
whilst a rotatory motion is given it by the finger and thumb, which
gradually insinuates it into the part, and by continuing this rolling,
the needle penetrates to any depth with facility and ease. The operator
should now and then stop to ask if the patient be relieved; and the
needle should always be allowed to remain five or six minutes before
it is withdrawn. This mode of introducing the needle, neither produces
pain (or at least very little) to the patient; nor is productive of
Hœmorrhiage, which Dr. Haime says arises from the fibres being
separated, rather than divided by the passing of the needle; the former
of which (the absence of pain) is a point in its favor, which few
surgical operations possess.

It is but rare that I introduce more than one needle at the same time,
as a greater number does not appear to be more efficacious than a
single one. I, however, depart from this rule (as will be seen from
some of the cases) when the pain becomes fugitive from the effects
of the instrument; which is a most encouraging symptom. In such
circumstances, following the disease by introducing the needles where
the pain has removed to, has always proved ultimately successful.

Where also the disease is seated in such several parts, which from
their anatomical situation, are known to receive their nerves from
distinct or opposite departments of nervous origin; or if the disease
pervades more organs or muscles than one, which are but little
connected as to their nervous relations; then I regulate the number of
needles, accordingly as I suppose the several parts may be more or less
connected with each other.

The perforation made by a sharp smooth instrument like a needle, is
of such a simple nature, that there is little danger of doing any
mischief with one of this kind. Dr. Bretonneau, Physician to the
“_Hospital Général_” of Paris, has made a number of experiments on
puppies, the result of which is, that the Cerebrum, the Cerebellum,
the Heart, the Lungs, the Stomach, &c. may be penetrated without
occasioning the least pain or inconvenience.

In one case, where the heart had been punctured, he afterwards
discovered an extravasation of blood into the Pericardium; and Dr.
Haime asserts, that his experiments prove the doctrine of Mons.
Beclard, respecting the elasticity of the arterial tunics, which may
be punctured with impunity. One case of this nature occurred to Dr.
Bretonneau, where a jet of blood followed the puncture of an artery.
The hœmorrhage was immediately stopped, simply by pressure upon
the opening. Dr. Haime says, that he has often, when performing this
operation upon the human subject, thrust the needle to such a depth
into the Epigastrium, that the stomach must have been pierced; but that
it was productive of no more inconvenience than the same operation upon
the more simple parts of the body. I should, however, contrary to such
high testimony, hesitate much to puncture an artery, as an aneurism
has been known to result from a small puncture made by an awl, which
required the division of the vessel for the cure.

I shall here close my subject, not without exciting, perhaps, in the
minds of some of my readers, surprise that I have not attempted an
hypothesis of the operation. I have by no means made up my mind as to
the nature of its action, and rather than venture into speculative
reasoning, which may be received as doubtful by some, and visionary
by others, I prefer preserving a profound silence. The authors whom
I have before referred to, have attempted such an explanation; and
should opinions of this kind be considered as deserving attention, the
enquirers may find them in the paper upon acupuncturation, in the 13th
volume of the “Journal Universel Des Sciences Medicales,” published at
Paris in 1819.


  The needles may be obtained at Mr. Blackwell’s Bedford-Court,
  and Mr. Laundy’s, St. Thomas’s Street, Borough.




FOOTNOTES:

[1] “Mémoire sur les Maladies Chroniques, les evacuationes
sanguines et l’acupuncture; pur L. V. J. Berlioz, D.M.
Paris, 1816.”

[2] Dr. Haime, whose practice will be presently noticed,
observes,

“Lorsque l’aiguille a été introduite avec les précautions
requises, il n’y a pas émission de la plus petite
gouttelette de sang. A ce sujet, le docteur Fréteau est du
mème avis que M. Berlioz, puis qu’il dit, dans son Traité
des emissions sanguines, que l’acupuncture doit être rayée
de la liste des agens propres à provoquer ces evacuations.”

[3] Notice sur l’Acupuncture et observations médicales sur
ses effets thérapeuticques.

[4] Une Aiguille d’Acier, conique, aigue, longue d’environ
trois pouces, et garnie de cire d’Espagne vers son œil,
pour tenir lieu de téte.

[5] “Ou” says Dr. Haime “la malade contracta l’habitude de
l’onanisme et s’y livra sans réserve.”

[6] See the 66th volume of the “Journal Général de
Médicine.”

[7] By a needle of an inch and a half in length.

[8] I have every reason to believe, the wine impregnated
with this plant, is of the most medicinal value, when the
infusion has been made with the seeds, rather than the
roots, as lately recommended by Dr. Williams, of Ipswich.
It is the preparation which I have found most beneficial,
and upon which 1 could place the greatest reliance.

[9] Mr. Scott first introduced the operation into England.


FINIS.




Errata.


  Page 30, line 8, after the word _peculiar_, add, of _practising_.
       44,      2, for _univerel_ read _universal_.
       62,      2, from the bottom, a comma after the word
                   Epipheses, instead of a period.
       68,      3, after the word _muscle_, add, _of the right side_.
       70,      5, after the word _ribs_, add, _of the left side_.


  Plummer and Brewis, Printers, Love Lane, Eastcheap.