Acupuncture Article from the BMJ, 1858
This article gives an account of how acupuncture was being practiced and written about in the year 1858. The account comes from no less a ‘distinguishable’ publication as the British Medical Journal (BMJ)
1858 in the UK
In 1858, Queen Victoria was the monarch and Charles Dickens was touring up and down the country. It was also the year of the ‘Great Stink’ during the summer of 1858 – when the smell of faeces-polluted water and other industrial toxins in the Thames River was so severe, that members of parliament (who for once were directly affected), decided to do something about it. Following this, a proper sewerage system was planned and upon being built, helped clean up the water and reduce the risk of cholera.
Elsewhere, doctors tended to the business of healthcare.
Here is an account of acupuncture recorded in the British Medical Journal (BMJ) in the edition of August 28th, 1858 by the Medical Doctor – T. Ogier Ward, in Kensington (presumably West London). My commentary follows:
by T. Ogier Ward, M.D., Kensington
I have read in the JOURNAL with much interest the lectures of Dr. Brown-Séquard, especially the fifth, which seems to be the most practical, inasmuch as the experiments detailed prove that irritation, etc., of one part, may be transmitted by reflex action to another more distant part, in the following manner. The irritation is conveyed by an afferent nerve to the nervous centres, and thence is reflected to the more distant part through the sympathetic, which, by producing a contraction of the vessels, reduces the hyperaemia of the affected part. In this way Dr. Brown-Séquard explains the benefit derived from the actual cautery in facial neuralgia and affections of the eyes, when applied to the ear of the same side, or even between the shoulders. A completely opposed explanation of the action of the actual cautery has been recently given by Dr. Inman in a paper read to the Lancashire and Cheshire Branch; and certainly Dr. Brown-Séquard’s experiments, though they establish the facts in some cases, do not afford any explanation why this action of the sympathetic nerves is confined to a part in a morbid condition, and does not extend, at least, as far as can be ascertained, to the whole system. But whether Dr. Brown-Séquard or Dr. Inman be right, non est meum tantas componere lites; the object of the present communication is to offer an explanation, deduced from Dr. Brown-Séquard’s experiments of the benefit derived from two operations much less severe than the actual cautery, which, from its formidable appearance, is never likely to be used extensively in this country, at least in private practice.
The operations I allude to are, the injection of opiates beneath the skin over the nerve affected in tie douloureux, and acupuncture; in both of which, the great and immediate benefit, by the cessation of the pain, is to be attributed to the punctures, and not to the opiate injected. I do not deny that the opiate may be absorbed, and produce a certain amount of direct effect on the nerve where this is situated superficially; and the profound sleep produced in some instances must be attributed to the opiate; but in cases where the injection has been successful in deeply seated pains, I believe we may reasonably ascribe the cure to the simple puncture, especially as we meet with the same results from acupuncture. Hitherto the modus operandi of acupuncture has been involved in mystery, but now Dr. Brown-Séquard’s discovery of the reflex action induced by counter-irritation, appears to afford at least a plausible explanation of it.
Acupuncture is a remedy that seems to have its floods and ebbs in public estimation; for we see it much belauded in medical writings every ten years or so, even to its recommendation in neuralgia of the heart, and then it again sinks into neglect or oblivion; and it is not unlikely that its disuse may be occasioned, partly by fear of the pain, and partly by the difficulty the patient finds to believe so trifling an operation can produce such powerful effects. Another reason for its neglect may be that, like every other remedy, it fails occasionally, and the practitioner, disgusted at having persuaded his patient to submit to a pain, which, though slight, has been attended with no benefit, will not again undergo such a disappointment. However this may be, its use is not as frequent as it deserves; and now that we know the rationale of its operation, I venture to bring forward a few cases in illustration of its remedial powers, in order that others may be induced to give it a more extensive trial, and thus ascertain its true value in the treatment of neuralgic or rheumatic pains.
Case I. A middle aged labourer came to me with a chronic rheumatism of the parts about the right shoulder, particularly in the deltoid, which was so painful that he could not raise his arm horizontally. I inserted two needles into the muscle, one just below the head of the humerus, and the other near insertion of the muscle, and in about a quarter of an hour he could lay his hand on his head, and in a few days was quite well, without a second operation.
Case II. An elderly labourer, suffering from rheumatic pain and stiffness of the rectus and other muscles in front of the right thigh, so that he dragged the limb in walking, was enabled to walk without much limping, after the the insertion of three needles down the front of the thigh fo a period of twenty minutes; and he required no further treatment.
Case III. An old clergyman, very liable to sciatica, having been advised to try acupuncture, was in the habit of using daily, previous to dressing himself, two or three needles inserted along the course of the nerve, to enable him to walk down stairs with comfort.
Case IV. A lady of middle age, suffering so much from lumbago and sciatica, that she could not rise from her chair without assistance, after trying hip baths and mustard poultices in vain, was induced to apply the needles to the most painful parts, when, to her astonishment, the pain was much relieved, and after three applications, was entirely removed.
Case V. A lady advanced in pregnancy, similarly affected to the last case, and who had failed in obtaining relief from baths and mustard plaisters, used a single needle with complete success, but not without considerable disappointment from the extreme pain produced by the operation. This is the only instance of a complaint I have met with, as, after the immediate pricking sensation during the passage of the needle through the skin, the feeling is usually like that produced by the strong pressure of the point of the finger on the part.
In none of the above cases was there any constitutional affection, each patient stating that his health was perfect; nor was there any appearance of local inflammation. Indeed my use of acupuncture has always been confined to such cases as the above, as I should not expect that acute rheumatism or neuralgia would be benefited by such means.
In conclusion, I would remark that, though the benefit of acupuncture has been attributed by some writers to a quivering of the affected muscles, which is indicated by a vibratory motion of the needle while inverted, such an appearance has never presented itself in any of my experiments upon myself or others.
This is a fascinating case, because I think it gives us a good insight and account of the type of acupuncture that precedes the use of the modern thin filiform needles, which today are manufactured by machines, and are almost painless to insert.
Pain of inserting needles
In this article, the author states that one of the downsides to acupuncture is the pain that a patient feels when acupuncture is bing applied:
Another reason for its neglect may be that, like every other remedy, it fails occasionally, and the practitioner, disgusted at having persuaded his patient to submit to a pain, which, though slight, has been attended with no benefit, will not again undergo such a disappointment
A lady advanced in pregnancy, similarly affected to the last case, and who had failed in obtaining relief from baths and mustard plaisters, used a single needle with complete success, but not without considerable disappointment from the extreme pain produced by the operation.
There is no description of the type of needles he uses. However, from other sources in that century, we know that hat pins or bonnet pins were being used to treat back pain with acupuncture. The famous physician William Osler learned acupuncture in 1873 was one such example.
If we compare this type of pin to the modern day filiform needle, the width is a lot thinner in modern needles, and hence less painful.
Another curiosity is the use of an opiate injected beneath the skin, when the author is discussing the acupuncture experiments carried out by Dr. Brown-Séquard:
the injection of opiates beneath the skin over the nerve affected in tie douloureux, and acupuncture; in both of which, the great and immediate benefit, by the cessation of the pain, is to be attributed to the punctures, and not to the opiate injected.
The use of an opiate may possibly be used to reduce the pain of these large hat pins being inserted, though this is speculation on my part. The author did not attribute the overall result, that is, the removal of the pain down to the opiate. Though, I can assume, it may produce a reduction of pain in the short term
This is an acceptable hypothesis, as opiates will wear off and the symptoms (e.g. back pain) would simply return if it was the opiate in question, alone, that improved the symptoms.
The author Ward, does not appear to use opiates in his own acupuncture treatments (or at least he doesn’t state he does), so we can assume he practices more authentically or “dry” needling.
Reference to acupuncture
It appears that acupuncture had been known for many years at the time. The author mentions that we hear about it in the medical literature every ten years or so and then it seems to fall out of popularity:
Acupuncture is a remedy that seems to have its floods and ebbs in public estimation; for we see it much belauded in medical writings every ten years or so, even to its recommendation in neuralgia of the heart, and then it again sinks into neglect or oblivion…
Acupuncture was known in France in 1816, when a physician Berlioz (father of the famous composer) carried out clinical trials on it. In world events, we know that the 19th century is the height of Empire, and Western imperialism. The Western countries, particularly France and Britain made colonies throughout the world, including the far East, where it is likely they would have encountered organic acupuncture.
The author gives a few brief accounts of cases, where he achieved a successful outcome. All the cases appear to be related to back pain rheumatic pain or sciatica. The use of acupuncture for back pain is still just as common today. Though it strikes me that this form of acupuncture as described in this article is a basic form of acupuncture – e.g. insert the needle into wherever it hurts. There is no mention of Chinese theories or of the use of distal points.
We are left with some questions. Who was T Ogier Ward, M.D.? Where did he learn acupuncture? Also Ward mentions a Dr. Brown-Séquard, which sounds like a French name, and there is evidence of acupuncture being known to the French in 1816. (Source – When did Acupuncture come to the West?). There are likely many records still around of acupuncturists in the 19th century around, which all shows, that acupuncture has been used in the West a relatively long time.
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