Solving the Mystery of Sir William Osler and Acupuncture: How Knowledge and Prevailing Attitudes Shaped a Physician

INTRODUCTION

In April 1913, before a crowded hall of medical students at Yale University, Sir William Osler (1849–1919) began the first of six lectures on what he described as “an aeroplane flight over the progress of medicine through the ages.” On the first day, he covered the origin of medicine before focusing on the legacy of ancient Greece. He praised Egypt as a “highly civilized state” and complimented the “rationalizing influence of the Persians.” ¹

When he moved on to the topic of Chinese medicine, Osler was not impressed. He said, “Even the briefest sketch of the condition of Chinese medicine leaves the impression of the appalling stagnation and sterility that may afflict a really intelligent people for thousands of years. It is doubtful if they are today in a very much more advanced condition than were the Egyptians at the time when the Ebers Papyrus was written. … [I]t is an interesting experiment, as illustrating the state in which a people may remain who have no knowledge of anatomy, physiology or pathology.” ¹

Osler’s attitude was on par with a late-19th-century Western physician who was sharply forged by the halls of established medicine. This pervasive bias against Chinese medicine continues to be an issue in North American medical institutions today. However, there are two other primary sources related to Osler and Chinese medicine that conflict with Osler’s Silliman Memorial Lectures at Yale. Harvey Cushing’s biography of William Osler and Osler’s landmark medical textbook suggest a more complicated path to Osler’s conclusive remarks.

ACUPUNCTURE APPEARS IN THE INDEX AND BODY OF OSLER’S TEXTBOOK

To the surprise of many in the medical profession, acupuncture is listed in the index and body of a few editions of Osler’s textbook, The Principles and Practice of Medicine, including the first publication in 1892. He listed three indications that include lumbago, dropsy (edema), and sciatica. For example, Osler gave specific instructions on the practice of acupuncture for lumbago:

“For lumbago acupuncture is, in acute cases, the most efficient treatment. Needles of from three to four inches in length (ordinary bonnet-needles, sterilized, will do) are thrust into the lumbar muscles at the seat of the pain, and withdrawn after five or ten minutes. In many instances the relief is immediate, and I can corroborate fully the statements of Ringer, who taught me this practice, as to its extraordinary and prompt efficacy in many instances.” ² The mentor Osler referred to was none other than Sydney Ringer, who was credited with developing the first physiological saline solution.

THE ALLEGED ACUPUNCTURE TREATMENT FAILURE

Only a single piece of evidence connects Osler to the actual practice of acupuncture, which was gathered through a tertiary source. One of Osler’s contemporaries, Harvey Cushing (1869–1939), published a biography of Osler’s life in 1925. In The Life of Sir William Osler, a former medical student recalls a time at McGill when he witnessed Osler treating a wealthy patron, named Peter Redpath (1821–1894), with acupuncture for intractable low back pain. The patient “arrived exhausted after mounting the stairs, and in due course, they went to treat him by acupuncture, a popular procedure of the day, which consists in thrusting a long needle into the muscles of the small of the back. And at each jab, the old gentleman is said to have ripped out a string of oaths [swearing]. And in the end, he hobbled out, no better of his pain, this to Osler’s great distress, for he expected to give him immediate relief.” ³

After the publication of Osler’s biography in 1925, Peter Redpath’s niece and nephew sent vigorous demands to the Dean of McGill Medical School for Cushing to remove this account. They argued that their uncle “did not hobble and he certainly could not swear” as he was a pious man, and this account was “completely false.” ⁴ If, however, Osler did follow his textbook recommendation to use “ordinary hatpins,” it is safe to presume that most patients would have sworn and hobbled after such a treatment. The average gauge of a hatpin in the late 19th century, or Victorian Era, would have been the width of a blood transfusion needle (16–18 gauge).

WHAT THE THREE PRIMARY SOURCES REVEAL AT FACE VALUE

Soon after the great wave of interest in acupuncture in the early 1970s, some physicians disputed that Osler was an acupuncturist based on the “imperfect acupuncture” treatment mentioned in the biography. “Osler’s apparent unawareness of the oriental origin of acupuncture may have been due to the assumption that his tutor, Dr. Sydney Ringer, was merely following a well-established English therapeutic procedure.”^5,6 At face value, one could assume that Osler tried acupuncture, it did not go so well, and he dismissed the practice. Case closed. For the medical acupuncturist and medical anthropologist, however, there is an obligation to look further back in history to Osler’s acupuncture training and at the cultural context during his time.

As with Chinese medicine’s goal to find the root cause, a detective searches to discover the key motives, which are necessary to clarify the reasons why Osler would make such remarks about Chinese medicine late in his illustrious career. By the time Osler spoke at Yale in 1913, he was already a household name in the English-speaking world. His professional status was so elevated that he had little to lose as Regius Professor of Medicine at Oxford and as one of the four founders of Johns Hopkins Medical School. One can only imagine how medical training might have changed if Osler promoted the practice of acupuncture to future physicians. He might have had an even stronger opposition to the Flexner Report (1910), which espoused a reductionist approach and used Johns Hopkins as the model for a top-rated medical school.^7,8

REOPENING THE OSLER AND ACUPUNCTURE “COLD CASE”

Why would a truly great physician like Osler, with his love for books and his insatiable curiosity for the history of medicine, not find acupuncture and Chinese medicine so amazing and intellectually satisfying that he missed the opportunity to integrate them into his practice and teaching?

Historical research, unlike medical research, is grounded in the use of primary sources, or material written during the period in question. The following deconstruction, with the support of both primary and secondary sources, demonstrates compelling evidence that Osler was not an acupuncturist. However, the question that should garner more attention from medical acupuncturists is not whether Osler was an acupuncturist. The key question should be: Why was Osler not an acupuncturist?

Osler championed equanimity and humanism in his teaching and mentorship throughout his career. Another famous physician, Sun Simiao (581–682) from the Sui and Tan dynasty period, wrote, “Wherever a physician treats an illness, he must quiet his spirit and settle his will, he must be free of wants and desires, and he must first develop a heart full of great compassion and empathy.” ⁹ Both physicians shared key core values in the practice of medicine. The challenge that Osler would have faced, as do physicians today in the Western world, is how to cross from one paradigm of medicine into another without disrupting the bounded rationality of their original training.

The readers of Medical Acupuncture may appreciate the opportunity to deepen one’s understanding of a profound medical system like Chinese medicine, but the challenge lies with casting aside the presentist viewpoint, or the tendency to interpret past events in terms of a person’s modern values and concepts. The root of Osler’s dismissal of acupuncture exists in the analysis of the three primary sources mentioned: a medical textbook, a lecture, and a biography. They hold the clues to solve the Osler and acupuncture cold case.

Finding resolution begins with tracing two key aspects in William Osler’s life:

Knowledge: Training for Chinese medicine and references that were available in Osler’s time.

OSLER’S LEGACY AND CAREER

Western medicine acknowledges William Osler as the Father of Modern Medicine and as one of the most influential physicians in the world. He pioneered the reformation of medical education in the early 20th century, and he promoted the study of the history of medicine in all three phases of his career in Canada, the United States, and the United Kingdom.

Osler graduated from McGill and spent two years in Europe for his postgraduate studies. He began the first phase of his medical career in Montreal at McGill University (1874–1884), where he advanced quickly from lecturer to full professor. He moved on to the University of Pennsylvania (1884–1888) where he spent the next four years until he was invited to be one of the four founding physicians of Johns Hopkins Medical School. In 1904, he was invited to serve as Regius Professor of Medicine at Oxford, which was at the request of King Edward VII.

William Osler was dedicated to preserving his writing and library collection by launching a project known as Bibliotheca Osleriana. It was a bibliographic catalog that not only represented his love for books in medicine and science but also left an imprint of his identity and legacy. ¹⁰ The comprehensive catalog was completed and published 10 years after his death in 1929.

The library collection was impressive not only for its selection but also for the nearly 8,000 items on the topics of the history of medicine, medical literature, science, and his own authorship of books, articles, speeches, and sketches.

POSTGRADUATE ACUPUNCTURE TRAINING

Osler’s acupuncture training most likely took place during his postgraduate travels in Europe between 1872 and 1874. Early editions of Osler’s textbook attribute his knowledge of acupuncture to one of his mentors, Sydney Ringer, while studying histology and physiology at the University Hospital in London.^2,3 Ringer was not just the inventor of the Lactated Ringer’s solution; he was also considered a “natural polymath, drawn to other fields and curiosities. He was an early enthusiast of acupuncture in England. He had family contacts in the Far East and may have heard of the practice ‘needling’ from a stay in Paris, where it was already known.” ¹¹

Ringer’s Handbook of Therapeutics was considered a classic textbook during Osler’s mentorship, and 13 editions were published from 1869 to 1897. Ringer devoted an entire chapter to acupuncture in later editions, which discussed the treatment of lumbago, dropsy, and sciatica with acupuncture by the eighth edition (1880). Osler’s selection of the same three indications for acupuncture was, therefore, taken directly from Ringer’s recommendations, such as the case with Ringer’s commentary on lumbago:

THE EARLY CASE DETECTIVES

Two astute physician scholars made initial progress in exploring Osler’s knowledge of acupuncture, notably Richard Golden (1929–2016) and Ilza Veith (1912–2013). Richard Golden was a prolific contributor to the examination of Osler’s written legacy from a practicing internist and library curator standpoint, while Ilza Veith offered a nuanced perspective as both a trained physician and a medical historian. Both scholars offered the deepest insight into the possible connection between Osler and Chinese medicine. Although they agreed that he was not an acupuncturist, they disagreed on the reasoning behind their conclusions.

THE QUINTESSENTIAL OSLERIAN

Dr. Golden was initially trained as a pharmacist and later as a physician in internal medicine. He was known by fellow Osler scholars as the “quintessential Oslerian” with his prolific research spanning 36 years, and he had expert knowledge of Osler’s bequeathed book collection at McGill University. ¹³

One of Golden’s most notable works, A History of William Osler’s The Principles and Practice of Medicine, analyzes the history of Osler’s textbook. He laid out the process and changes made to the textbook over its 16 editions and explored foreign translations that included the Chinese language. Golden used the term “surprisingly” when commenting on Osler’s recommendation to use acupuncture for the treatment of sciatica and low back pain. ¹⁴ Although Golden did not elaborate on his opinion, his intention becomes clear in a separate article on the Chinese translations. He stated that China flourished in antiquity but was plagued with “centuries of stagnation” in medicine and a “lack of progress, particularly in anatomy, physiology and pathology.” ¹⁵ Interestingly, Golden’s statements are nearly identical to Osler’s remarks to the Yale students from almost a century earlier, but the speech from The Evolution of Modern Medicine was not included in his references.^1,15

Golden also published a lesser-known monograph called Osler and Oriental Medicine: A Discursive Review (1982). The title is misleading to the medical acupuncturist because it is not about Osler’s connection with Chinese medicine. Rather, it represents Osler’s connection with the promotion of Western medicine in China. The monograph was about Golden’s research on the Chinese editions of Osler’s textbook through an analysis of Osler’s correspondence with the editions’ translator, Philip Cousland. The translation of Osler’s textbook into Chinese had a tremendous impact on the imperial efforts to Westernize medicine in China. ¹⁶

A CLOSER LOOK AT OSLER’S LIBRARY COLLECTION

Where, then, did William Osler base his opinions on Chinese medicine? A closer look at the contents of Osler’s books related to China offers a clearer perspective. According to Golden’s extensive research of Osler’s collection, 16 works focused on the topic of China. Five items were in the Chinese language, of which three were Osler’s translated textbook. One item was related to Tibetan medicine. The remaining eight works were about either Chinese history or Western medically recognized diseases in China. Osler listed only two of these references for the Chinese medicine section of his Yale lecture series, The Evolution of Modern Medicine. ¹⁶

What was missing? There were no classical Chinese medicine texts or primary source material for classical Chinese medicine in Osler’s library. Out of nearly 8,000 items, there was not a single copy of any of the numerous references that included: Huang di Nei Jing (Yellow Emperor’s Classic), Shang Han Lun (Treatise on Cold Damage Diseases), or Nan Jing (The Classic of Difficult Issues).

SIX DEGREES OF SEPARATION: OSLER AND THE NEI JING

The first substantial English translation of the Nei Jing was published in 1949 by Dr. Ilza Veith, the second early detective into the mystery of Osler and acupuncture. ¹⁷ Veith was the first person to receive a doctorate in the history of medicine in the United States in 1947. She studied at Johns Hopkins under the renowned medical historian, Henry Sigerist, who also shared a fascination with the history of Chinese medicine. ¹⁸ Veith translated a large portion of the Nei Jing into English (34 chapters of the Su Wen) as part of her doctoral thesis at Johns Hopkins University.

Sinologists in the early 1950s harshly criticized Veith’s work for lacking accuracy with her translation, and most of the commentary held xenophobic and patronizing undertones. James Ware was one critic who was the first person to receive a PhD at Harvard in the field of Chinese studies. He wrote on Veith’s book, “Chinese medicine draws its deepest inspiration from sympathetic magic. … The origins of the theories and the practices of Chinese medicine are as unknown to us as they are to the Chinese themselves.” ¹⁹ Another Harvard academic, who used only his initials for his book review, wrote, “The only valid idea which her Occidental medical historian could bring from the most careful reading of her translation would be that the Chinese had some peculiar concepts of medicine, an idea he may well have had before beginning to read the book. Surely he has the right to expect something more.” ²⁰

Contrary to what critics mentioned about the quality of this translation, Veith clarified her intent with the work: “It should be realized, therefore, that the translation of this classic represents the approach of a medical historian rather than that of a Chinese philologist. It is hoped that this preliminary study will serve as a starting point for further work on the text, with more specific attention to its many linguistic problems.” ²¹

Veith was the only woman charter member of the American Osler Society, which held its first annual meeting in 1971. She was the first to lecture on Osler’s connection with acupuncture in 1974. She, like Golden, concluded that Osler was not an acupuncturist. However, she went further to suggest that Osler not only lacked adequate training but was also hesitant to promote any medical practice developed outside the biomedical framework. Veith made great contributions to the study of the history of medicine. Her translation of the Nei Jing, although imperfect, made a significant contribution to exposing the world to Chinese medicine.

WHEN A RELIGIOUS HISTORIAN BECOMES THE RESOURCE FOR MEDICAL OPINION

Every detail was preserved in Osler’s library thanks to Osler’s appreciation for knowledge and history, including handwritten annotations and noted references in the margins of subsequent galley proofs from his dictated speech to Yale medical students. ¹ The references used to support Osler’s disparaging view of Chinese medicine came from an early-20th-century sinologist and religious historian, JJM de Groot, who was not a physician or a medical historian. He wrote a six-volume set called Religious System in China, which was published in 1910.

De Groot claimed that Chinese medicine was based on superstition with “spectres [ghosts] being the chief causation of disease and plague, their ejection or expulsion was ever a prominent element in the healing art. This art may have grown out in other directions or branches, but the great demonistic element re-appears in it everywhere to this day. This volume will therefore also conduct the reader into the field of medicine and promotion of public health.” ²²

A lack of knowledge and access to adequate references were not the only factors that likely influenced Osler’s opinion. The pervasive attitudes toward China, the culture, and its people played a significant role in dissuading Osler from pursuing Chinese medicine. To not mention this point would largely negate the cultural zeitgeist of Western medicine during Osler’s time. It will, therefore, be summarized.

THE WESTERNIZATION OF MEDICINE IN CHINA

Western trade and missionary travel to China increased during the Qing dynasty from the late 17th into the early 20th century. Missionaries combined medicine with religious conversion, and they were increasing in numbers and influence well into the early 20th century.

It was during this time that opium was introduced to China by foreign traders and smugglers, while the Qing dynasty also succumbed to widespread corruption and degradation. ²³ These influences disrupted the traditional medical systems, including the decline of acupuncture after centuries of advancement during the Ming dynasty. Acupuncture fell out of favor with the elite, and there were multiple attempts by both Chinese and Western officials to ban or restrict acupuncture. ²⁴

As mentioned, Osler was involved with the first translated Chinese edition. Chinese language translations did not include acupuncture or any component of Chinese medicine. Osler’s main focus of interest was to address the prevalent diseases in China related to public health, including beriberi, cholera, and pneumonic plague. ¹⁶

MALTREATMENT OF ASIAN IMMIGRANTS IN THE UNITED STATES AND CANADA

North America hosted a long history of anti-Asian sentiment in the 19th and 20th centuries. This was codified by law through the Chinese Exclusion Act of 1882. “The Chinese were already seen as less than human, which is why the act passed,” according to legal historian, John A Powell. It was “the only time in our history that a law named an ethnicity to not come to the United States. They don’t belong. They are too different than us.” ²⁵

Such attitudes weighed heavily into the fabric of the health care system. In 1900, when the bubonic plague reached San Francisco, the city’s Board of Health enacted racially motivated measures that were both ineffective and harmful. ²⁵

Neither Americans nor Canadians were immune to racism. An influx of over 15,000 Chinese railroad workers arrived in Canada, and they were willing to work for less pay than white laborers. This led to years of racial clashes, riots, exclusionary organizations, and harsh immigration laws. British Columbia Premier, Sir Richard McBride, speaking on Asian immigration, told a Times of London correspondent in 1914, “To admit Orientals in large numbers would mean in the end the extinction of the white people, and we always have in mind the necessity of keeping this a white man’s country.” ²⁶

Why are prevailing attitudes toward Chinese medicine from over a century ago relevant today? They continue to linger in very subtle ways. Consider the Johns Hopkins University web page for Acupuncture. The phrase, “Acupuncturists believe the human body has more than 2,000 acupuncture points,” would not be used for a biomedical discipline like rheumatology or surgery. ²⁷ Although belief is one of the four key components to embrace any medical system (believable, satisfying, digestible, and repeatable), this language demonstrates that there is still more work required to reduce persistent bias against Chinese medicine. ²⁸

CONCLUSION

William Osler was one of the most influential physicians to pave the way for modern medicine. He was instrumental in guiding medical education to how it functions today, but the current state of the health care system requires a deeper introspection into how it developed. The cultural landscape most certainly influenced Osler’s decisions surrounding the knowledge and practice of acupuncture. Had he been as curious about searching for primary sources for Chinese medicine as he was with Western medicine, he might have influenced others to translate the Nei Jing into English during his lifetime.

If Osler had pursued acupuncture, perhaps medical acupuncture would be included in medical education today. Evidence-based approaches are not enough to move the needle to a more integrative model. Attitudes about a medical paradigm matter. Access to the correct knowledge matters. Together they shape the minds of physicians, researchers, and other health care professionals who practice in today’s health care systems. By looking back at the history of acupuncture’s obstacles, medical acupuncturists have a unique role as ambassadors to integrate East Asian medicine into the health care systems of the future.