Tuesday, 10 March 2015

From Orient to Occident Part II: Acupuncture in Victorian England

N.B. This is the second half of a two-part series on acupuncture in Victorian England.  If you haven’t already done so, I’d recommend checking out Part I first.

Just to quickly recap, in the first post I discussed:
1)      acupuncture’s use in Victorian England
2)      acupuncture’s dismissal by reigning medical authorities
3)      Wakley and the Lancet published case studies to prove acupuncture’s efficacy

Wakley and the Lancet’s defense of acupuncture is fascinating – especially when contrasted with their contemporary denunciation of other inexplicable medical treatments like mesmerism, phrenology, and homeopathy.

Mesmerism or animal magnetism was attacked consistently by the Lancet after the infamous Dr. John Elliotson failed to adequately demonstrate the phenomena while in Thomas Wakley’s home.  Phrenology was slowly losing supporters, and homeopathy was almost always attacked as quackery.[1]    
Anonymous pamphlet attributed to Wakley.
Moreover, acupuncture possessed many similar characteristics to both mesmerism and phrenology.  First, all three “cures” were practiced by Dr. Elliotson.  Second, in an age when there was an effort to entrench science within medicine, there was no viable or accepted explanations for how either mesmerism or acupuncture worked. 

Case studies and experiments could take acupuncture only so far  – recorded cures via traditional acupuncture were professed to succeed in less than half of the cases in which it was employed.[2]

So we reach a bit of a conundrum.  Why didn’t Wakley and the Lancet portray acupuncture the way they treated mesmerism or homeopathy?

I would suggest that it’s simply because acupuncture needles were adaptable.

Both mesmerism and phrenology could be disproved as phenomena and thus rejected.  Acupuncture, however, in part because the Europeans were unsure as to how and when it should be used, required both wide and repeated experimentation.  Due to this experimentation, the procedures of, and occasions for acupuncture were widened considerably and changed along with the shifting medical trends of the period.

Perhaps in response to the calls for trials and experimentation, acupuncture began to be used for a wider variety of diseases in the 1830s.  In addition to the traditional cases of rheumatism, sciatica and lumbago, medical practitioners began to use acupuncture to treat cases of dropsy, hydrocele, ascites and ganglions.[3] 

Dropsy (1817)
All four of these ailments involve the accumulation of fluid.  Dropsy or oedema as it is now known commonly occurs in the ankles, hydrocele is an accumulation of liquid in a sac near the testes, ascites cause abdominal swelling due to fluid accumulation, and ganglions, also fluid filled sacs, tend to occur on the top of the wrist or foot. 

The “acupuncture” used in these cases, however, differs considerably from that practiced in the Orient.  Rather than the insertion of needles into the skin to stimulate nerves and relieve pain, acupuncture was now used to puncture cysts and release the accumulated fluid. 

This likely occurred for several reasons: first, the needle was a very visible and material object; the focus on it and its function paralleled the value and focus placed on surgical instruments at the time.  Second, as is still partially true today, they simply did not understand how acupuncture worked and thus tested its efficacy in as many cases as seemed plausible.

A more marked modification involved the coupling of electric therapy with acupuncture. 

Yes, that is as horrific as it sounds.

The treatment was reported by the Lancet as early as the 1820s, but was not recorded in any high numbers until the 1870s.

Electricity had been used in English medicine throughout the eighteenth century.[4]  The Lancet, however, only noted its use coupled with acupuncture in eight articles during the course of the nineteenth century.  The first three of these were published during the 1820s and 1830s.[5]  

Dispensing of medical electricity. Oil painting by Edmund Bristow, 1824.
The first instance was a case study of a physician who used galvano-acupuncture to treat “paralysis of the lower extremities, produced by curvature of the spine.”  The patient, a young girl who had been paralyzed for several months, consented to have acupuncture needles inserted into her back – the article states that they were driven into her spinal cord – and have these “brought into contact with the wire of a voltaic pile.”[6]  

Shockingly, the therapy was a success and the girl was able to walk again. 

The last case was recorded in 1830 and detailed the use of “electro-puncture” that is, acupuncture coupled with a galvanic battery, to treat successfully two cases of dropsy.[7]  Our knowledge of how often this treatment was used is hampered by the lack of articles published on the subject.  While the Lancet did publish one article in 1848 calling for the use of galvano-acupuncture in cases of asphyxia, it was merely a suggestion and did not include either case studies or even claims of successful use.[8]  It was not until 1879 that the periodical began publishing any significant number articles treated by galvano-puncture.

18thC French use of medical electricity.
During the late nineteenth century, physicians expanded their use of electricity as a medical treatment.   Both those on the medical fringe and regular hospital practitioners were extolling the virtues of electricity in curing a wide variety of ailments. 

It could be said that acupuncture, due to its coupling with electricity, underwent a renaissance in the latter decades of the nineteenth century.  While cures via traditional acupuncture left much to be explained and could not be professed to succeed in a half, or even a third, of the cases in which it was employed, the “advances of science” at least ensured that these electrical practitioners understood the basics of what they practiced.

In addition to the adaptation of acupuncture needles in electric therapy, it is also plausible that the continuing success of acupuncture could be linked with Victorian ideas on pain and need to control the body; the infliction of pain was seen in a positive light.[9]  As one article noted in a rather matter of fact manner, patients “watch with interest the insertion of the needles into their muscles and the transfixing of their limbs; welcoming the return of sensibility, even in the shape of pain, as a longed for boon.”[10] 

Another, in relation to sciatica, criticized traditional methods of acupuncture that only pierced the skin.  The practitioner stated that it was far more effective to pierce the nerve and that “the patient can always tell when the nerve has been pierced by pain shooting down the leg.”[11] 

From the 1820s to the 1890s, acupuncture in Britain had come a long way.  From the relatively painless therapy so extolled in the 1820s and 1830s, there emerged two far more painful treatments that better suited the scientific and medical environment.

To sum up the two blog posts: 
1) The changing representations of acupuncture in the Lancet have revealed a treatment that first served the periodical’s purpose in professionalizing medical practice.  The manner in which the ancient “cure” worked was a mystery to the Victorian medical practitioners.  The Lancet fully encouraged experimentation with this mystery treatment and included successful case studies in its defence.   
2) Acupuncture even became one of the many issues involved in the verbal sparring between the College of Physicians and professionalizing radicals such as Thomas Wakley.   
3) Perhaps in response to the periodical’s encouragement, and in part reflective of the push to entrench science within medicine, acupuncture was soon used for an even greater variety of ailments.  Despite its widened scope, it was never (in the Lancet at least) placed on the same level as many other baffling treatments such as mesmerism. 

Two possible reasons have been forwarded to explain this: First, in the 1830s, while acupuncture was used to treat ailments such as hydrocele, dropsy and ascites, it is evident that this was merely a logical extension of the needle’s form and function.  After all, if the acupuncture needle could be used to pierce the skin, why should it not be used to pierce cysts? 

Second, during the latter half of the nineteenth century, acupuncture was transformed to fit the needs and trends of the current medical marketplace.  It was first coupled with electricity and may had its life further extended by the burgeoning need to discipline the Victorian body. 

By the end of the century, acupuncture had transformed from a little known Oriental treatment to one with an Occidental – or rather a decidedly Victorian – veneer.

Let me know what you think here or on Twitter - I'm @medhistorian.

[1] For more on this, see John Epps, The Rejected Cases; With A Letter to Thomas Wakley on the Scientific Character of Homeopathy, London, Sherwood and Co. (1845); Lancet 58, 1464 (1851), 285.
[2] The words “cure” and “succeed” have to be viewed critically.  What did it mean to be “cured” of lumbago?  Was acupuncture a “success” for treating immediate pains?  Or did it dismiss entirely chronic pains? Lancet 97,2487 (1872), 567.
[3] See for example: Lancet 27, 703 (1837), 750; 28,713 (1837), 194-196; 28,721 (1837), 486-487; 29,743 (1837), 313; 115,2947 (1881), 285; 134,3436 (1889), 13-14.
[4] This was not just an English fad, other periodicals shared French and Italian experiments with electro-acupuncture i.e. Popular Science Review 10,38 (Jan 1871), 329.
[5] There are references to both galvanic and faradaic acupuncture.  Multiple articles, however, suggest the superiority of galvanic acupuncture i.e. Lancet  114,2926 (1879), 455; 114,2927 (1879), 499-502.  Iwan Rhys Morus writes more about this in Shocking Bodies: Life, Death & Electricity in Victorian England (2011).
[6] Lancet 6,157 (1826), 719.
[7] Lancet 13,335 (1830), 614-616.
[8] Lancet 51,1293 (1848), 636-637.
[9] See Iwan Rhys Morus, “Bodily Disciplines and Disciplined Bodies: Instruments, Skills and Victorian Electrotherapeutics,” Social History of Medicine 19,2 (2006), 241-259.
[10] Lancet 114,2927 (1879), 502.
[11] Lancet 141,3633 (1893), 860-861.


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