This measure was unknown to the ancient Greeks and Romans, but appears to have been in use from time immemorial in China and Japan, whence it was introduced into Europe. Though noticed so early as 1683 by Koempfer, no practical use of it was made until a comparatively very recent date. in 1816 M. Berlioz, of Lyons, called the attention of the profession to the remedy; and M. Bretonneau afterwards performed a series of experiments which served to fix its value as a remedy. ( Trousseau and Pidoux.)

Acupuncture consists in the introduction of sharply pointed and very smooth needles, through the skin, into the tissues beneath. it is stated, as the result of numerous experiments, that all kinds of structure, muscles, blood-vessels, nerves, parenchymatous tissue, membranes, even the brain, may be thus penetrated without serious injury, if the needle be not allowed to remain too long. The sharp point seems to insinuate itself in such a mode as scarcely to wound, but merely to separate the ultimate components of the tissues. Steel needles are perhaps on the whole preferable, as being the sharpest, and susceptible of a very high polish; but silver, platinum, and gold have been recommended; and the two latter have the advantage that they undergo no chemical change.

The introduction of the needle is, in some instances, apparently painless, in others very painful; but, in most, it produces a moderate uneasiness, which the patient finds readily supportable. Almost always a little redness and heat are perceptible about the place of insertion. if allowed to continue, the needles often produce considerable inflammation in their course.

When the space to be operated on is limited, only a single needle is introduced; when it is extensive, several.

In the introduction of the needle, the skin should be rendered tense, the point gradually insinuated, and the instrument rotated between the fingers.

The length of time, during which the needles should be allowed to remain, varies with the effect desired. in simple neuralgia, they may afford relief in five or six minutes; in more fixed affections, often not before half an hour or an hour; and sometimes days elapse before the end is accomplished : but the rule is to allow them to remain until the pain is relieved. There is, however, some risk of injurious results from inflammation, if they arc suffered to continue too long.

The complaints in which they have been most effectual are those of a neuralgic, rheumatic, and spasmodic character. The needle is introduced into the painful tissue.

How does acupuncture operate? I have no doubt whatever that, in many instances, it acts through the mind, as the cold steel of the dentist will cure the toothache before the tooth has been pulled, or as the metallic tractors, and the homoeopathic globules cure neuralgia and rheumatism. The relief is not the less positive because thus obtained. Perhaps there is still a revulsive action. The excitation of the cerebral nervous centres diminishes irritation elsewhere; and, if the impression has been sufficiently strong, the relief may have a considerable degree of permanence.

But I am quite disposed to believe that there is also a more limited revulsion; the irritation which produces the pain of the disease, being diverted from its original seat towards the course of the instrument.

I shall consider the rubefacients in the two divisions of the simple inflammatory, and the pustulating. it will be seen, hereafter, that there is some difference in their mode of therapeutic operation, which justifies this arrangement.

1. Simple inflammatory Rubefacients.