Part 1

A TREATISE

ON

ACUPUNCTURATION, &c.

DEDICATED, BY PERMISSION,

TO

ASTLEY COOPER, ESQ. F. R. S.

Plummer and Brewis, Printers, Love Lane, Eastcheap.

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.