The
originator of what I have named Nesfield’s Treatment was a brilliant English
surgeon, Mr Vincent Nesfield. Among many achievements in his life, he invented
chlorinated water. I have, therefore, taken the liberty of calling the
procedure Nesfield’s Treatment in this book because I believe it accords Mr
Nesfield the recognition he merits. People can also easily remember a
non-medical name instead of the various tongue-twisting medical names it is
known by; e.g. percutaneous neurotomy, percutaneous rhizotomy, rhizolysis and
others. I would like to think that other medical practitioners will begin
calling it Nesfield’s Treatment as well.
Vincent
Nesfield was a Harley Street specialist. He worked in a broad range of medical
fields; from cancer, ophthalmology, deafness, blood pressure, bubonic plague,
tuberculosis, rheumatism and eczema, to diets for infants. Although he was a
qualified surgeon at the tender age of 21, he had to wait until he was 25
before the Royal College of Surgeons would accept him as a fellow – he was too
young.
Those who
knew him described him as a deeply spiritual man and a dreamer, a man who lived
‘out there’ in a figurative sense. By all accounts he was not a personally
ambitious man. He died in 1972 at the age of 92. At the time he was working on
a serum for cancer.
Nesfield,
incidentally, did not believe there was such a thing as a slipped disc
(although I disagree with him). He wrote ‘The agonising pain in the back which
may continue for months and is usually diagnosed as a slipped intervertebral
disc, has never in my experience of very many cases over 30 years, been due to
a slipped disc; but has been due to a sensory nerve caught up in a muscle or
tendon fibres. This not only gives pain in the back, but referred pain in the
hip, thigh and the leg, and indeed in the sciatic nerve itself’.
Nesfield
developed his procedure in 1918. He used it on soldiers returned from the First
World War for what he described as ‘trench back’. He performed it on an average
of six patients a week during his working career.
In December
1959, a prominent London journalist, Horace Hughes, who had suffered
debilitating back pain since 1945 and whose career was threatened by his
affliction, because none of the many treatments he undertook had worked,
noticed an article in the now defunct Daily
Sketch.
THE SLIP THAT ISN’T
Ever had backache? Suffered
agony when you moved, stood, sat or lay down?
And then said to
yourself: “I’ve got a slipped disc”
Well, you’ve had
your worry for nothing. For in a new pamphlet to-day called ‘Backache and
Slipped Disc’ a Harley Street specialist says THERE’S NO SUCH THING AS A
SLIPPED DISC.
‘The slipped disc
theory has been evolved during the last few years,’ he says ‘due perhaps to
post-mortem findings after a crush from buildings falling on people during the
bombing’.
He points out that
in the vertebrae the intervertebral discs are extremely firmly attached.
‘In fact’ he says
‘it is impossible to move a disc without cutting the ligaments and using a
chisel’.
So how could it
slip?
The cause of that
excruciating pain, says the specialist, is damage to a muscle fibre, muscle
sheath or ligament.
It could be in the
thigh, the muscles between the shoulder blades, the shoulder and the neck, or
the muscles of the chest.
The cure? So simple
and uncomplicated it’s almost ridiculous in comparison to the long drawn out
business of plaster casts and painful operations. Just a tiny incision
one-eighth of an inch wide and about half an inch deep. The relief is
immediate, the cure complete.
It’s so quick that
when the specialist treated a daughter while her mother momentarily left the
room, the mother returned to find that her daughter could stoop, sit, lie down
without pain, things the girl hadn’t been able to do as nine months before
she’d got a ‘slipped disc’ when she’d fallen from a horse.
The specialist sums
up:
‘The agonising pain
in the back which may continue for months or years, usually diagnosed as a
slipped intervertebral disc, has never in my experience over a period of 30
years been due to a slipped disc.’
‘It has been due to
a muscle or fibre caught up with a sensory nerve’
‘The recognition of
the simple fact that a so-called slipped disc is NOT A REALITY would release
many thousands of people from plaster jackets and relieve a very great deal of
pain and suffering’.
Hughes
wasted little time in following up on the article but perhaps it is better that
he recount the story in his own words, in a letter he kindly wrote to me on 23
March 1993.
Horace
Hughes
9
Trewithan Parc
Lostwithiel
Cornwall
PL22 OBD
United
Kingdom
I had had fourteen years of unmitigated pain and disability and things
were indeed desperate as there was a real possibility of having to give up
work, leaving my wife to become the breadwinner. My right leg had lost all
feeling; the foot had turned in and dragged. Then, miraculously, appeared the
article in the Daily Sketch. I was
able to obtain the name of the doctor, Mr Vincent Nesfield. (Mr Hughes then
obtained a referral from his doctor and made an appointment with Mr Nesfield).
I crawled into his consulting room. He performed a simple but brilliant
operation under local anaesthetic which took ten minutes. The feeling returned
to the leg, the foot turned back to its normal position and the (sensation of)
blood could be felt rushing down the leg. A period of six further visits, one a
month, dealt with residual (pain) spots ending on the right hip. To this day,
36 years on, there has never been a day’s pain or disability of any kind. At 80
year of age I can walk miles and garden for hours. He had no back pain up until his death in his
late eighties.
A short time after Horace Hughes’ treatment, a woman friend of his told
a Welsh renal surgeon, Mr W. Skyrme Rees, about Hughes’ miraculous recovery at
the hands of Nesfield. Rees was highly sceptical and doubted it was true. At
the insistence of the woman, Mr Rees eventually made an appointment to meet
Nesfield and watch for himself the procedure being performed. To his
astonishment, he witnessed a male patient enter the surgery suffering acute
back pain and walk out afterwards, apparently fully cured. Nesfield seemed to
place no great importance upon the value of his innovation. In fact he did not
even have a name for the procedure; it was merely something he did to alleviate
back pain.
The effect upon Rees, however, was profound; it caught his imagination.
It was to change his life.
As a renal specialist, bad backs were not something he usually
encountered in the course of his work. Nonetheless he set about conducting his
own research, including considerable anatomical research on monkeys and various
birds. Rees, like Nesfield, concluded that the majority of back pain was not
caused by what are called ‘slipped discs’ at the front of the spine but by
derangement of the zygapophyseal* joints at the back of the vertebra. Rees
believe that by cutting the nerve supply to these joints he had discovered a
way of safely switching off back pain.
Rees performed this operation for the first time on a Mrs Sally
Jones-Davis, aged 59, at Llandudno General Hospital, North Wales after the
house physician sent him a request for consultation.
* Apophysis is a protuberance (process) coming
out of a vertebra. Zygapophyses are processes on the side of each vertebra that
move in co-ordination (articulate) with the corresponding process on the next
vertebra. The zygapophyseal joints are the small joints at the back of the
vertebral body and spinal cord.
Mrs
Jones-Davis was described as having right-side severe sciatic pain. By then she
had been bedridden in agony for four weeks.
Dr Rees describes what followed:
On
arriving at the hospital on 16 June 1960, I found a frail lady lying in a high
bed in the general ward. The ward sister explained that Mrs Jones-Davis had
been placed in this high bed because there were problems of nursing.
The patient’s sciatic pain
was triggered off by the slightest movement and the high bed minimised her
discomfort. Her history was of very severe right side sciatica of sudden onset
four weeks previously. She told a long history of minor pain in the back, not
amounting to disability, before the present attack struck her suddenly, making
all movement impossible. She had been in bed at home for one month.
I performed the described
operation at the level of the 4th lumbar vertebra, using a von
Graefe cataract knife.
At the completion of the
operation Mrs Jones-Davis climbed out of her high bed at my behest and took tea
with us and her fellow patients, free from all pain. She walked out of hospital the next day. This
freedom from pain remained for 15 years until her death in 1975 from heart
failure.
Later, in 1960 as consultant surgeon to the
hospitals of Caernarvonshire and Anglesey, which were going through a period of
great difficulty from hospital cross-infection, Rees was given a grant by the
Welsh Hospital Board to travel to the United States to report on methods used
there to control the problem.
He decided to combine this visit with his own
investigation into the treatment of back pain as practised in America. In the
course of his visit, he met with a Dr Hackett in New York and found that he had
been treating lumbago and sciatica by injecting a sclerosing (hardening)
solution into the ligaments of the zygapophyseal joints. Dr Hackett called his
treatment Pro-Lan therapy. Rees concluded that Pro-Lan therapy was, in some
ways, similar to his own work.
Dr Hackett thought that by placing the sclerosing
fluid around the weakened ligaments in the spine, a stronger ligament was
produced by scarring and that after three weeks, when the ligament was firm
again, the pain would be relieved permanently. Dr Hackett did not demonstrate
this treatment to Rees but gave him the address of a Dr Peterson in Boston,
whom Dr Hacket had trained and who was performing Pro-Lan therapy successfully.
Rees met Dr Peterson and watched the procedure being performed. Although he was
impressed at first by the theory of it and its apparent success rate, he was
concerned about the amount of pain it caused patients, so much in some cases
that even morphine failed to alleviate it. Later, before leaving America, Rees
was disturbed to discover that at least two patients who underwent Pro-Lan
therapy had become paraplegics. He immediately excluded it as a treatment.
Upon his return to Britain, Rees decided to continue
his research into treatment of back pain and to modify the treatment he had
learned from Nesfield. In the next five years, Rees says he performed the
operation successfully on 88 patients disabled by lumbago and sciatica.
However, in 1965 Rees attracted national attention
for his views about the hygiene standards of British hospitals. As experts in
cross-infection, he and five other doctors accused British hospitals of being
‘The dirtiest hospitals in the world’. In the ensuing uproar the five others
backed down and withdrew their accusations. Rees refused and was suspended from
duty. As a direct result of that, Rees resigned, sold up his possessions, took
a refresher course in general medicine in order to become a general
practitioner again, and vanished.
He re-appeared a few months later on the other side
of the world in Tocumwal, New South Wales, a small town in the Australian bush.
There, as plain Dr W Rees, GP at the age of 53, he introduced his startling
surgical innovation (which he called rhizolysis), to the back pain sufferers of
the bush. Rees chose to become a general practitioner in Tocumwal with great
deliberateness, because it was a place of sheep shearers and fencers, a great
number of whom suffered bad backs.
Now, as a general practitioner, he was able to gain
direct access to large numbers of them. It was an amazing transition for a
consultant surgeon and highly successful one; he began curing bad backs by the
hundred. As news spread of his extraordinary success, people began flocking to
see him from all over Australia.
Along with a rapidly burgeoning patient base, Dr
Rees attracted national attention from both the media and a somewhat sceptical
medical fraternity. In 1972, Rees was the subject of a (then) Australian
Broadcasting Commission documentary “Four Corners”. The report included
interviews with a number of orthopaedic surgeons who voiced their reservations
about his work after watching the procedure being performed.
Nonetheless Dr Rees’ medical career flourished and
he was soon invited to the United States and other countries to give lecturers
about rhizolysis. At home, he was so much in demand that he opened clinics in
Shepparton, Melbourne, Sydney and Wellington, New Zealand.
For reasons that will become clear, interest in
rhizolysis began to dwindle by the mid-1980’s. By then an old man, Dr Rees
closed the last of his consultancies, in Macquarie Street, Sydney and went into
semi-retirement at his home in Woollahra to look after his ailing wife,
Marjorie. Privately, he was embittered that his remarkable surgical innovation
had not gained the world-wide acceptance from orthodox medicine he had hoped
for it. Nor had he been recognised for his work in this field. Indeed, while he
had been handsomely financially rewarded, he concluded there had been a
‘conspiracy of silence’ - a backlash –
against it.
Dr Rees was only partially right. There was a
backlash, and a powerful one, against rhizolysis but there was one of equal
intensity against Dr Rees himself. I know of cases where orthopaedic surgeons
refused to treat patients any further if they dared to go and see Dr Rees.
Dr Rees was a colourful man with total confidence in
himself and his innovation; an articulate, superior, flamboyant Welsh gent, who
is elegantly disdainful of his Australian medical peers and highly zealous in
promoting the virtues of rhizolysis. He admits to ‘cocking a snook’ at them and
flaunting his financial successes, ‘laughing all the way to the bank’ as he
would put it. His personality, his extroverted ways – a chauffeur-driven white
Rolls Royce with red leather seats, presidential suites at hotels,
silver-knobbed walking canes – went down badly with the conservative medical
mainstream.
They turned their backs on him and successfully
vilified a man of impeccable medical credentials, accomplishments and great
personal charm.
Personally, I consider Dr Rees a gifted physician
and a valued personal friend. I will always be grateful to him for what he has
taught me, just as I will always recognise the great work he carried on from
Vincent Nesfield in the treatment of back pain. Until his retirement in March
1993, he enhanced the lives of many thousands of suffering people, and he has
enhanced my own. I believe he has been unfairly denied the recognition he
surely deserves for his work in this field. He has been badly wronged, although
he is outwardly philosophical about it. ‘It is better to be wronged than to do
wrong’ he says quoting Socrates.
On balance, though, I also believe that Dr Rees
‘sold’ the treatment badly. In my opinion, the explanation as to the mechanism
of pain relief was incorrect and his selection criteria for who he treated was
in-precise; he used it as a cure-all. Thus, he stepped away from mainstream
medicine and was perceived badly by conservative practitioners. He compounded
his problems by being seen to have become wealthy as a result of it – and then
flaunting it.
In many ways the backlash against him was fairly
understandable. But the tragedy, so far as back pain sufferers were concerned,
was that mainstream medicine tried to bury the procedure with Rees. To me it
seems they – the specialists – were shooting the messenger because they did not
like him. Nor, of course, did they like his message; it could be performed by
general practitioners in their own surgeries.
By 1988 the demise of this demonstrably viable
option for pain sufferers was virtually a fait accompli. There was every reason
to believe that it might eventually die with Dr Rees.
There was a small of doctors quietly, and
persistently practising the procedure in Australia. But, by and large, no-one in
mainstream medicine spoke of it, and it certainly was not included int eh
curricula of any medical schools in Australia. Opponents had adopted a policy
of silence, like a family refusing to speak of a black sheep or ignoring
something in the hope that it will go away. It was highly effective;
officially, Nesfield’s Treatment had ceased to exist.
In that year, of course, my patient Ken and his
miraculous cure led me to meet Dr Rees and learn the procedure. It has taken me
on a fascinating, privileged medical journey, or quest, and has caught me up in
the lives of hundreds of back pain sufferers. It has taken me so far to two
continents to express my views on, and my knowledge of, the subject of my
international peers. It has been an enlightening experience.
More importantly, Nesfield’s Treatment is alive and
well again. I have been asked whether I have taken up the banner once held by
Dr Rees? My answer is a qualified yes. While I have taken up the banner I have
also changed it because I do not accept the reasons Dr Rees gave for the
treatment’s success. I acknowledge his enormous contribution in enhancing the
lives of many of the 16,000 patients he treated in the course of his
extraordinary career. I applaud his work, and Nesfield’s, in shifting the
emphasis away from the slipped disc theory as the major cause of back pain. Dr
Rees, however, like many practitioners, did not place any great emphasis on
follow-up research after patients left his surgery. This gave his critics
further ammunition, which they used to try to shoot him down, especially his
claim that he cured 99.8 per cent of his patients.
I decided at the outset of my work to carry out
appropriate follow-up with all of my patients and to monitor the long-term
effects of the treatment with a view to determining a statistically reliable
success rate. If Dr Rees had made mistakes, I was going to try to avoid them
where possible.
There is little doubt that, despite my caution, I
will stir up a hornets’ nest among my medical peers as a result of writing a
book like this. Many of the older specialists still remember Dr Rees and it is
likely they will lump me in with him in their opinion of me and the procedure.
In the pecking order of the medical world, it should
be borne in mind that I am a general practitioner, not a specialist who has
passed a multitude of examinations to achieve a higher medical status. Some
specialists look down on general practitioners like myself, especially when we
enter their specialised areas e.g. treatment of back pain.
The specialists are correct in part, but it seems to
make little difference to their former patients who come to me and experience a
great reduction in their back pain.
As you will read in a later chapter, I have tried to
publicise Nesfield’s Treatment or percutaneous neurotomy as it is called
medically, through official channels – medical journals – here in Australia but
have met with stern and, in more than one case, vehement resistance.
By writing a book like this aimed primarily at a
non-medical audience, and hopefully for as many back pain sufferers as
possible, I acknowledge that I run a great risk of backlash from my colleagues.
Although I doubt whether I would make much of a martyr, I sincerely believe the
greater good lies in the opportunity for back pain sufferers to benefit from
this treatment.
I often look back on that moment when Ken hobbled
into my surgery, and wonder what would have happened if he had not returned to
me with his revelation, or how I would have felt if my first patient failed to
improve after the treatment? Quite likely, I would have dismissed the technique
out of hand and carried on with my practice exactly as before. Little doubt, I
too would have been sceptic.
In taking up the banner of Nesfield’s Treatment and
changing it, and acknowledging that I run some of the risks of Dr Rees, I also
decided I would try to minimise these wherever possible. I promised myself that
I would do whatever was required to place the procedure on a better, more
credible medical footing with a view to it gaining greater acceptance among
doctors everywhere – and their patients.
In keeping accurate follow-up records, I believe I
have made some progress in this. If this book provides further assistance in my
quest, then my role as a medical practitioner will offer more relief for back
pain sufferers.