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.
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.