needling, 1947; acupuncture, 1972

Needling, 1947; acupuncture, 1972

Margaret Sfanley, RN

The first time I saw an acupuncture needle was in 1947. At that time, I was a nurse in the Friends Ambu- lance Unit, and working in a mobile medical team in northwestern China in the war-torn province of Shensi. Our patients were villagers and Chinese civil war casualties. Village cave-dwellings (yao tung) served as temporary hospitals. The operating rooms were caves facing south which received the most sunlight, for there was no electricity in those rural Chinese villages.

Margaret Stanley, RN, CNM, MN, MPH, has most recently been a project nurse for a Parent Child Center Demonstration for the Minnesota Depart- ment of Health. The project included family plan- ning counseling and identification of health and developmental problems in children from birth to school age. She is a certified nurse-midwife. She has a master’s in nursing degree from Western Re- serve University, Cleveland, and a master’s in public health from the University of Michigan, Ann Arbor.

At the end of one day’s work, I sat after dinner in our dining-cave with other members of our international team of volunteers. It was growing dark by the time the cook’s helper had cleared away the dishes and placed a lamp in the middle of the table. The lamp consisted of a twisted wick of cotton lying in a small pot- tery bowl filled with peanut oil. It cast only a little light on the table, leaving the rest of the arch-roofed cave in shadow.

In the post-prandial lull, our New Zealand physician started talking. I can still hear his down-under voice telling about the exploratory laparot- omy he had performed that day in the surgical theater-cave: “I operated to remove foreign bodies from a patient with scar tissue already forming across his abdomen from gunshot wounds. Without x-ray I couldn’t pre- dict the location of the bits and pieces

AORN Journal, October 1973, Vol 18, N o 4 731

The author (right) with interpreter at the

Great Wall which she visited during a month-

long stay in China.

I expected to find. I would not have been surprised to find miliary tuberculosis, also. But I was surprised to get the ‘inside story’ on acupuncture.”

He caught our attention a t once. “Needling,” as our interpreters trans- lated the Chinese word for acupuncture, was known to us as common traditional treatment administered by local healers, but we had never met the acupuncturists nor seen the needles. We often had reports from patients about having pain devils driven out with needles of gold or silver.

The surgeon’s precise voice continued: “Along with some USA-made ammunition in our patient’s fasciae, we removed a five centimeter piece of needle; not a USA-made needle, but a Chinese needle.” We Amer- icans, Canadians, British, and New Zealanders were well aware that we were using medical supplies donated by home countries to help heal wounds inflicted by military supplies from some of the same sources.

“A Chinese needle?” The question invited an explanation.

“Acupuncture!” He delivered his punch line.

An evening-long discussion ensued out of our interest to learn more about acupuncture. One person asked, “What part of the needle?”

He replied, “The point.” He took from his jacket pocket a

box, and out of the box a corked test tube, and out of the test tube a cotton-wrapped two-inch-long piece of needle. It was silver, thin and flex- ible. Its reason for being in the patient’s abdomen would remain an unexplained mystery. I tended to classify needling with cupping, blood- letting, and herbal remedies, though I knew very little about any of these cures for ills which have been used as folk medicine for thousands of years in that part of the world.

We were there to teach Chinese physicians and nurses Western scientific medical and nursing care and to minister to those suffering from disease and injury. Our students were eager to learn. Conditions were prim- itive and resources were few. Wher- ever we went, patients crowded to be seen: children with serous otitis media, trachoma, communicable dis- eases, kala-azar; and both adults and children with malaria, tuberculosis, parasites, infections, tumors, and old

732 AORN Journal, October 1973, Vol 18, N o 4

Practicing on each other, two 72-year-old Shanghai students learn acupuncture.

untreated injuries. Doctors and needles were well accepted by patients, even in the countryside where for- eigners had never been seen before, because of the long-standing experience of the Chinese with acupuncture treatment for various ailments by local practitioners of the healing arts.

Procedures in the hospital such as b l d transfusion and sterile tech- nique were not so easily accepted. One day after a demonstration of tech- niques for sterilizing surgical instruments for student nurses, I checked the clean-up after the last operation. A teenage boy nurse was tending the stove, a brick structure in an alcove just outside the surgery-cave. He was plying the bellows to fan the char- coal for maximum heat from scarce fuel. I could hear the water in the iron cooking pot (gwo) boiling on the stove. The hospital’s alarm clock was on the nearby window sill. I asked the nurse, “How many min- utes?” He showed me when boiling had started and when it would be time to stop by pointing to the min- ute marks on the clock’s face. Time was almost up. He lifted the lid off

the pot. I saw instruments covered with several inches of bubbling, boiling water and there, nestled among some forceps, were a dozen eggs.

Just then an ambulatory patient came up with a small basket asking for the eggs for a fellow patient-one who had received a blood transfusion after amputation. He had been given a gift of eggs to “build his blood” by the hospital cook who had little faith in the strange foreign custom of tak- ing blood out of one person to put into another. The nurse, using forceps which he took carefully from a container of sterilizing solution, deftly conveyed the hard-boiled eggs from pot to basket. He replaced the lid and forceps and talked to the ambulatory patient about the trans- fused patient’s disappointment a t not being able to speak English instantly after receiving blood from an Eng- lish speaking donor. The instruments continued to boil another ten min- utes. Then we removed them from the water, dried and oiled them, and put them in their containers to await the next day’s sterilizing before use.

How different was my experience 25 years later. I spent most of the


month of May 1972 in China after a quarter of a century’s absence. This time I was a visitor, one of a group of 11 American Friends Service COm- mittee delegates. In the course of our three weeks’ travels, I learned as much as I could about health care and saw evidence that a revolution in health has taken place. The promo- tion of health has been given priority since 1949 when China became united under the present government. One of the goals of the new society has been to get rid of the sicknesses of the old society. When I asked how it had been possible to change the country’s health picture from one of rampant disease, suffering, and un- hygienic living conditions to that of a healthy population in one genera- tion, I was told that it is due to food, housing, education on an egalitarian basis, and the fact that there is exer- cise and work for all. Health care, provided by salaried health care per- sonnel, is available under a system of inexpensive insurance. It was also pointed out that since 1949 the Peo- ple’s Republic of China has been a t peace with other countries. And another important reason for improved health, I was told, is that there is now a purpose in life, to “serve the people.” “Serve the people” was a theme reiterated on the stage, in the schools, factories, on the farms, and in clinics and hospitals we visited. Its application to health care was evident in the operating rooms I visited in Wuhan and Peking.

In the Second Hospital of Wuhan Colleg?, I observed a lobectomy one May morning. The patient was a young man who had benn identified by a barefoot doctor in the country as having a persistent cough. The doctor took the patient to town for

an x-ray which revealed a spot on one lung. Then, the patient was taken to the Wuhan Medical Center for treatment. He met with the surgical team the day before surgery for discussion of the procedures he would undergo. It was explained to us that as a result of this preoperative meet- ing, the patient would be more under- standing and less apprehensive of his hospital experience and would learn something of the work of the medical team, and the medical team would be more aware of the feelings of the patient. Together, patient and professionals decided that acupuncture would be the anesthesia of choice in his case.

During the three-hour long lobectomy which I witnessed, three attendants were at all times attentive to the patient. They stood at his head where one, the acupuncturist, manip- ulated the one needle used in the left wrist, twirling it at different rates of speed with her fingers at different stages of the operation. The anesthetist administered oxygen when needed. The third person took vital signs at intervals. One gave him fruit juice to sip, and they talked to him periodically. He sometimes opened his eyes when we took flash photos from the observation window above him. He and the three attendants at his head wwe screened off by drapes from the sterile field and the three surgeons and surgical nurses.

The atmosphere of the operating room impressed me as being well or- ganized, modern, extremely efficient, and tension free. Attention was riveted on the patient by all the team members: surgeons; nurses; the doctor who gave intravenous glucose, blood, and serum; anesthetist; acupuncturist; and others. The patient


During a lobectomy under acupuncture, a patient is attended by three persons: an acupuncturist, who twirls a needle in the patient’s wrist at various rates of speed

during the operation; an anesthetist, who administers oxygen when needed; and an attendant, who takes the patienf’s vital signs and gives him fruit juices to drink.

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The lobectomy wound is dressed and the patient is prepared for transfer from surgery.

was included in some of the conver- sation during surgery. He had been a participating member of the discussion of the operation the day before, and the actual surgery was a con- tinuation, in a sense, of that group discussion. At the end of the three hour lobectomy, during which a lobe of his right lung had been removed with little blood loss and a high level of toleration by the patient, the nurses applied bandages and the patient waved to us as he left the operating room. A nurse told me that he might need another acupuncture needle in about two hours’ time, or some other medication. Until that time, however, they expected the effects of the one acupuncture needle to provide enough loss of sensation for him to tolerate the immediate postoperative period.

The patient was a countryman who had never been sick or hospitalized. Perhaps more important to him than the choice of anesthesia or that for- eigners would report about the extra- ordinary experience of watching his lobectomy, was the fact that some-

one cared about him and his health enough to provide the best health care available. And he participated in some of the decision making about what was going to happen to him.

The experience of watching the lobectomy under acupuncture anesthesia was a dramatic one, but it was not the most impressive part of the health picture I saw during my China visit in 1972. I was most impressed with the look of health upon the faces of the men, women, and the children on the streets, in the schools, factories and everywhere we went. It contrasted sharply with the picture of poor health and suffering which had remained in my mind’s eye all the years since my first time in China in the 1940s.

Other surgical procedures which I observed included the removal of an ovarian cyst, a cesarean section, and a tuba1 ligation, all under acupuncture. Procedures I watched in the Peking Maternity Hospital were a normal delivery and a suction abor- tion, both without any anesthesia of any kind. I observed acupuncture


treatments for deafness, arthritis, and headaches in the Peking Pedi- atrics Outpatient Department, in a May Seventh Cadre School clinic, and in farm commune clinics. Herbs were also used. In the farm commune clinic, we saw an herb garden outside the clinic door. In hospitals, research departments are studying the prop- erties and uses of herbs.

The acupuncture needles I saw in use in 1972 were silver, thin, and flex- ible. The style of needles may not have changed since my first glimpse of a piece of one in 1947, but the style in which they are used has gone through significant changes. Now they are not only used by traditional doctors but also by Western scientific trained physicians. Both traditional doctors and Western-trained physicians now work together in the main- stream of health care professionals. The new and the old working together are trying to transform health care into something better than that provided by either one alone.

As the Western scientific trained doctors are studying acupuncture and the traditional doctors are learn- ing about other kinds of medical treatment, a recognition has come for need for research which has resulted in acupuncture anesthesia. Acupunc- ture anesthesia is about seven years old, having been developed after 1965 during the Cultural Revolution when the medical profession made a great effort to “learn from the people.” Traditionally the acupuncture needle was used only to treat a patient‘s ills. Now it has a new use: to produce loss of pain and sensation to the ex- tent that selected surgery can be done without any other anesthesia. However, there is not yet a large body of knowledge from research on

the subject of the use of needling as anesthesia. We were told that acupuncturists practice on themselves before being qualified to use acupuncture on their patients. Those who find and demonstrate better uses of acupuncture do not receive awards, but are held up as “model” health work- ers.

Few nurses have visited modern China or written about nursing care there. It is to be hoped that Amer- ican and Chinese nurses may find ways to overcome the time and dis- tance which separate us. Each would find professional exchanges interest- ing, and could find a common lan- guage in the “caring about health” component of health care which can make the nurse’s unique role a key- stone to health for a patient.

A patient waves to observers offer undergoing surgery for removal of ovarian cyst.


needling, 1947; acupuncture, 1972

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