This book reviews the history of acupuncture in Britain from the seventeenth century to the twentieth. It is a scholarly monograph, evidently written originally as a PhD dissertation. Bivins began her research under the impression that she would have to go back only as far as 1971, but she soon was undeceived. In fact, the first knowledge of acupuncture came to the West at the end of the seventeenth century, via the writings of a Dutchman called Wilhelm ten Rhyne (or Rhijn), a physician employed by the Dutch East India Company and stationed in Japan. He wrote in Latin; his account had the title De Acupunctura.
Although Western doctors were interested in acupuncture at this time, they made little attempt to understand its theoretical basis in Chinese thought, of which indeed they generally had a poor opinion. Although Bivins never makes her view of Chinese medicine explicit, I gained the impression that she is a strong believer in cultural relativism and thinks that Western neglect of the Chinese origins of acupuncture led to a failure to make use of its full potentiality: 'The history of acupuncture in the West has been shaped by the casual imposition of [the] European distinction between physic and metaphysic.' However, she does not discuss the traditional version of acupuncture in any detail, and for me the book is somewhat out of focus generally because of this.
Ten Rhyne wrote that the purpose of inserting the needles was to allow wind to escape from the body. Bivins thinks that this was a misunderstanding on his part, but in fact the misunderstanding is hers; ten Rhyne was right. Wind was indeed at the root of all disease according to the original source of our knowledge of Chinese medicine, the Nei Jing, and acupuncture was intended to let it out of the body. (On the importance of wind in the traditional medical scheme in ancient China, see S. Kuriyama, The Expressiveness of the Body and the Divergence of Greek and Chinese Medicine.)
One of the criticisms of the Chinese approach voiced by seventeenth-century Western physicians was that the Chinese physicians treated all their patients' ills through the use of general tables in ancient books. Western physicians, in contrast, made a point of particularizing the features of individual cases. This is a curious and somewhat ironic reversal of the modern situation, in which Western doctors are accused of not paying enough attention to the individual while alternative practitioners, including acupuncturists, are praised for doing so.
Some commentators in the eighteenth century strike a surprisingly modern note. Writing in 1755, a physician called von Sweiten postulated a neurophysiological explanation for acupuncture: 'It would be an extraordinarily useful enterprise if someone would take the trouble to note and investigate the marvellous communion which the nerves have with one another, and at what point certain nerves lie which when stimulated can calm the pain at different points.' This is esswentially what practioners of modern acupuncture believe today.
Although this book focuses on acupuncture in Britain, there are some side glances at acupuncture in France. L.V.J. Berlioz, the father of the composer, was an enthusiast for the treatment. He made the interesting observation that acupuncture worked best when it caused little or no pain; this predilection for using minimal stimulation has been rediscovered by a number of modern practitioners. Berlioz also speculated that electrical stimulation of the needles might be helpful though he apparently did not try this himself.
The part of the book that deals with acupuncture in the nineteenth century is, I think, the most successful. The first English monograph on 'acupuncturation', as it was generally called at this time, was written by a young surgeon named James Morss Churchill. He was principally concerned with the practical aspects of the technique and was at pains to present it in a modern or Western form, unrelated to its Eastern antecedents. It should be judged, he insisted, by its practical success and not by its dubious origins. He attached great importance to case studies, which was the accepted scientific position at the time. Many of Churchill's cases concerned the treatment of 'rheumatic' diseases and 'injuries of the fibrous structure of the body'; this description seems to correspond with what we would now call myofascial pain disorders, still the field in which acupuncture finds its greatest application today.
Churchill's monograph excited a lot of interest in the 1820s, much of it favourable. There were reservations, however, principally on the grounds that it was difficult to explain the observed effects. There was also a tendency to confuse acupuncture with surgical procedures involving needles, such as oedema fluid drainage and venepuncture. Nevertheless, by the end of the decade acupuncture was familiar enough to doctors not to need definition or explanation, and acupuncture was being fairly widely used both in private practice and in the great London hospitals. In spite of this promising beginning, acupuncture went into decline after about 1828. Churchill published an 'Appendix' to his monograph, describing a number of new cases, but this attracted less attention than had his first book.
The reasons for this loss of interest are not entirely clear; there was little medical hostility to acupuncture but it ceased to attract many doctors. Bivins implies that the causes were sociological and cultural as much as medical or scientific. But acupuncture did continue to be used and taught at some centres: these included the Leeds General Infirmary and University College Hospital in London. (It is interesting to recollect that in the 1930s a physician at UCH, J.H. Kellgren, did research which later led to the discovery of trigger points; is it possible that he was influenced by the acupuncture tradition at his hospital?) The treatments advocated generally sound quite modern, although success in sciatica was held to require direct needling of the sciatic nerve, a practice usually discouraged today. The rationale for this was the discovery that at postmortem the sciatic nerve in patients with sciatica was swollen and red, so that puncturing its sheath ought to promote drainage. Acupuncture was said to be safe, although patients were sometimes reluctant to have it; a rather surprising attitude in view of the traumatic nature of much of the conventional treatment in vogue at the time.
Between 1890 and 1970 popular and professional interest in acupuncture almost disappeared in Britain. When it revived in the twentieth century it was in the context of a more general interest in Eastern ideas, and was part of a more widespread enthusiasm for 'complementary' therapies. Bivin's discussion of the modern scene is limited and focuses mainly on the Complementary Therapy and Research Unit in Lewisham. I felt the book began to lose its way somewhat at this point. It will certainly be of interest to readers who already know a fair amount about acupuncture and its history in the West and who are able to fill in the gaps for themselves. It is good on 19th-century British acupuncture, for which it provides plentiful citations, but its treatment of what went before this and what came after it is sketchy and at times unconvincing.