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.