Sir William Arbuthnot Lane, 1st Baronet

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"William Arbuthnot Lane" redirects here. For the policeman, see
Sir William Arbuthnot Lane, 2nd Baronet
.

Sir William Arbuthnot Lane, 1st Baronet
Fort George
DiedJanuary 16, 1943(1943-01-16) (aged 86)
Paddington
Occupation(s)Surgeon, naturopath

Sir William Arbuthnot Lane, 1st Baronet,

ear, nose and throat surgery, while designing new surgical instruments toward maximal asepsis
. He thus introduced the "no-touch technique", and some of his designed instruments remain in use.

Lane pioneered

Edwardian periods' preeminent surgeon, Lane operated on socialites, politicians, and royalty. Lane thus attained baronetcy
in 1913.

In the early 1920s, as an early advocate of dietary prevention of cancer, Lane met medical opposition, resigned from

whole foods
, fruits and vegetables, sunshine and exercise: his plan to foster health and longevity via three bowel movements daily. Tracing diverse diseases to modern civilization, he urged the people to return to farmland.

For his New Health, Lane eventually became viewed as a crank. Lane's explanation of the association between constipation and illness as due to

gastroenterologists as wholly fictitious, and Lane's earlier surgeries for chronic constipation have been depicted as baseless. Yet constipation
remains a major health problem associating with diverse signs and symptoms, including psychological—sometimes still explained as Lane's disease—and total colectomy has been revived since the 1980s as a mainstream treatment, although dietary intervention is now the first line of action.

Life and career

Childhood

William Arbuthnot Lane was born in 1856 in

Inverness, Scotland, as the eldest of the eight children of Benjamin Lane,[1][2] a military surgeon enlisted to the British Empire.[3] William attended schools in eight countries on four continents—Ireland, India, Corfu, Malta, Canada, South Africa, and others—while his family followed the army regiment.[1][3] Amid his mother's bearing seven children in rapid succession after him, William was often left in the care of military personnel.[3] At age 12, he was sent to boarding school at Stanley House School, Bridge of Allan in Scotland.[4]

Education

In 1872, his father arranged for him, age 16, to study medicine at Guy's Hospital.[1][2] Apparently shy and appearing young even for his age, William initially had some troubles with fellow students, but they rapidly recognized his exceptional abilities.[2][4] Soon, he was persuaded to switch to surgery, however, a surer career than medicine.[1][4] Later, he received the degrees bachelor of medicine and master of surgery from the University of London.[2][4]

Career

In 1877, at age 21, he qualified as a member of the Royal College of Surgeons,[2] and began to practise in Chelsea, London, at the Victoria Hospital for Children.[1][5] In 1883, Lane became a Fellow of Royal College of Surgeons and joined Great Ormond Street Hospital,[2] where he was consultant until 1916.[1] In 1888,[6] at age 32, Lane returned to Guy's Hospital as anatomy demonstrator and assistant surgeon, and remained with Guy's for most of his career.[1][2]

Lane became especially known for

cleft palate, and developing colectomy,[2] which, although highly controversial and opposed by most surgical peers, notably advanced abdominal surgery.[7] Lane collaborated with Down Brothers to design a number of surgical instruments, including screw driver, periosteal elevator, tissue forceps, intestinal anastomosis clamp, bone-holding forceps, and osteotome.[8] For his surgery on British royalty, he was awarded baronetcy in 1913.[1]

Lane became an officer in

Companion of The Most Honourable Order of the Bath.[1] In 1920, rather soon after returning from wartime service, Lane retired from Guy's Hospital, yet continued private practice out his home office.[2]

Sir William Arbuthnot Lane, 1st Baronet

Writing

He first published in 1883, seven years after starting his surgery career.

cleft palate, many others on other subjects, and, after year 1903, 89 articles directly on chronic intestinal stasis—which, like many Victorians, Lane experienced.[10] He wrote several books, including one on cleft palate, one on surgery for chronic intestinal stasis, and one on New Health.[10] Not for print, his autobiography—manuscript dated March 1936, soon before his 80th birthday—was written for family at the urging of his children.[8][11]

Family

William's first wife, Charlotte Jane Briscoe—daughter of John Briscoe, himself son of Major Briscoe—bore Irene Briscoe in 1890 and Eileen Caroline in 1893, both in St Olave parish.[12] At age 78, Charlotte Jane died in 1935. Sir Lane's daughter Eileen was married to Nathan Mutch, whose sister was Jane Mutch. In 1935, Sir Lane married Jane Mutch (who died in 1966 at age 82).

Image

Lane was tall, rather thin, seemingly aged slowly, his reactions were often difficult to discern,[1] and yet he often exhibited strong opinions.[2] It was often said that Lane was George Bernard Shaw's model for the scurrilous surgeon, Cutler Walpole—obsessed with excising the "nuciform sac", said to be nickname for the colon—in Shaw's play The Doctor's Dilemma.[13][14] Yet the play was nearly surely about Sir Almroth Wright, whom Lane knew well.[13] After Lane's death, Shaw stated that the play was published long before he had ever heard of Lane, but still regarded Lane's bowel surgeries as "monstrous".[13] And the play well suggests the view of Lane as held by many of Lane's contemporaries.[13]

After 1924, abandoning his private medical practice as well as surgery, Lane's public devotion was

Sir James Mackenzie, William Worrall Mayo and sons William James Mayo and Charles Horace Mayo of Mayo Clinic fame.[8]

Quotes of Lane by his Guy's Hospital house surgeon and biographer, William E Tanner:[16]

  • The man whose first question, after what he considers to be a right course of action has presented itself, is What will people say? is not the man to do anything at all.
  • If you get a rude letter, always send a polite one back. It's much better.
  • If everyone believes a thing, it is probably untrue!

Death

He died at his home,[17] 46 Westbourne Terrace, Paddington, London, W2.[18]

Medical spotlight

Surgery master

By 1886, Lane authored a surgery textbook.

aseptic surgery, an advance beyond antiseptic surgery, Lane enabled new surgeries previously too dangerous.[21]

Widely renowned, Lane's surgical skill exhibited imperturbable calm at difficulties encountered during the operations.[1] A contemporary noted "the originality of his procedures and the smoothness, ease, and perfection of technic that proclaimed a real master, a master who dared where others quailed and who succeeded where others would have failed without his skill, his precision, and the confidence with which he planned and executed his operations".[2] Although most of Lane's surgical career was attended by controversy, it could not be denied that—with but the possible exception of Sir Frederick Treves—Lane was London's best surgeon as to technique.[7]

Internal fixation

Only

aseptic
, surgical techniques, previously unheard of, Lane forged ahead.

In the meantime, other surgeons' poor results, such as sepsis causing failed union, were sometimes erroneously associated with Lane.[2] The British Medical Association appointed a committee to investigate Lane's practise—and ruled in Lane's favour.[22] Whereas other surgeons would attempt asepsis but lapse, perhaps touching an unsterilized surface, Lane's utterly fastidious protocol was unrelenting.[22] His 1905 book The Operative Treatment of Fractures reported good results.[2] And in 1907, Lane introduced plates, made of steel.[2] (Stainless steel, discovered the next decade, was not widely used in medicine or surgery until much later.)[2] And later, Lane's assertion of frequent disunion via nonsurgical intervention was vindicated by radiography.[2] Altogether, Lane's influence introducing internal fixation rivals and may exceed that of other, early pioneers like Albin Lambotte and later William O'Neill Sherman.[2]

Intestinal stasis

Backdrop

At 1886, Russian emigrant

vestigial.[26] Metchnikoff's book La Vie Humaine foresaw a courageous surgeon removing the colon.[27] Lane and Metchnikoff met in Lane's home.[28]

The pioneer British psychiatrist

focal infection",[30] whose theory converged with the autointoxication principle.[25][31][32]

Since 1875, American medical doctor John Harvey Kellogg in Battle Creek, Michigan, at his huge sanitarium—advertised as "University of Health", staffing some 800 to 1 000, and yearly receiving several thousand patients, including US Presidents and celebrities—had battled degeneration and disease by fending off bowel sepsis.[31][33] In the early 20th century, rebuking alleged "health faddists" like Kellogg and Sylvester Graham, American physicians who embraced focal infection theory cast themselves in the German tradition of "scientific medicine".[34] Kellogg argued that German researchers ostensibly repudiated the autointoxication principle, but, by using different terminology, supported it circuitously.[33] Since French pathologist Charles Jacques Bouchard, in his 1887 book,[35] coined the term autointoxication,[26] French researchers had investigated and openly advocated the principle,[33][36] already presaged by multiple researchers in Europe and America.[32] Meanwhile, British surgeons still knife-happy, Hunter warned of "intestinal stasis" impairing mental stability, and called for "surgical bacteriology".[29]

Lane

In 1908, Lane reported a syndrome of severe chronic constipation, often with dysfunction of

pelvic muscles and obstructed defecation—invariably with psychological dysfunction, impairing quality of life, but affecting mostly women—a syndrome soon termed Lane disease, yet now otherwise termed slow transit constipationas well as colonic inertia.[37][38][39][40] That same year, Lane treated it by surgery.[41][42] The following year, Lane's book The Operative Treatment of Chronic Constipation was published in London.[43] Lane began with colon bypass, and then, at insufficient improvements, performed total colectomy.[14][44] Famed for an appendectomy saving England's monarch, Lane warned of "chronic intestinal stasis"—its "flooding of the circulation with filthy material", thus autointoxication—warnings taken seriously by the public.[24]

Such views on the colon, constipation, and autointoxication were standard in the medical profession, yet disagreement raged over the proper explanation and the proper intervention, and so controversy trailed Lane's surgeries.

British Medical Journal and in The Lancet his first articles on chronic intestinal stasis.[10] Some who endorsed the autointoxication principle interpreted constipation to have a role in it, but a role "obscure", as some thought the drying of fecal matter to diminish putrefaction, but the stasis of the small bowel, rather, to be the especial source of autointoxication.[46] In any case, most surgeons opposed Lane's operating on constipation.[7]

The Royal Society of Medicine called a 1913 meeting, but, despite some 60 synonyms circulating for autointoxication from varying perspectives, suggested neutrality by choosing none and introducing a new term, alimentary toxæmia.[27] Several authors, including Lane, presented papers, whereupon some two dozen responded from April to May.[47] There, "chronic intestinal stasis received its deathblow", when a Fellow's severely antagonistic speech, apparently influencing the course of Lane's career, preempted Lane's opening a surgery school.[27] World War I broke out in 1914, diverting the attention of Lane, newly head of army surgery.[9] Returning from war service, Lane retired from Guy's Hospital in 1920, and continued in private practice.[2] From then onward, Lane wrote almost only on chronic intestinal stasis.[10] Meanwhile, focal infection theory—a primary means of interpreting the autointoxication principle—was "coming of age".[48]

In 1916,

controlled clinical trials, finding Cotton's claims false.)[14][49][50][51] In 1923, on his European lecture tour, Cotton arrived in Britain, where he learned from Lane an improved surgical technique[14]—as well as a new, far less radical surgical procedure.[52] In autumn 1923, Lane had performed the first 19 "pericolic membranotomies", putatively releasing intestinal adhesions.[52] Wherever apparently possible, Lane replaced colon bypass and colectomy with pericolic membranotomy.[52]

New Health

In the early 1920s, Lane began advocating cancer prevention through diet,

pounds a year.[24] In 1925, Lane founded the New Health Society, the first organised body for social medicine,[2] which German pathologist and statesman Rudolf Virchow had pioneered in late 19th century to undo disease's sociopolitical causes. The term New Health largely referred to nonsurgical healthcare against constipation.[10] With advertising by physicians being forbidden, Lane averted disciplining by the General Medical Council by having his name deleted from the Medical Register.[2][7] Lane then promoted his views on healthful lifestyle and nutrition, including return to farmland, ample sunlight exposure, ample exercise, greater intake of whole foods, particularly grains, vegetables, and fruits, and nutritional yeast for B vitamins—Lane's plan to foster defecation thrice daily, cancer prevention, general health, and longevity.[1][24][55] Meanwhile, colectomy for constipation was abandoned amid low success rates but high complication rates.[39]

New Health Society sought to transform the "rapidly degenerating community" into a "nation composed of healthy, vigorous members".

Oldham, Lancashire, was "packed by three thousand or more people", and "that many people had to be carried out fainting, while outside mounted policemen were kept busy holding back and controlling the crowd who wished to force their way into the hall".[24]

Legacy

Seven years before his 1943 death, Lane's autobiography explained himself as a man "acting upon the repeated request of his children that I should write for them a rough sketch of my life", although "it can be of no interest to others".[8] Rather, two of his former house surgeons at Guy's Hospital—first W. E. Tanner and later T. B. Layton—would borrow from it to author biographies on Lane.[8][60] By then, however, consensus had formed that Lane's surgeries to treat constipation had been misguided, and perhaps even Lane himself had concluded so.[7] By 1982, colectomy for constipation was declared "clinically futile".[44] And yet, in Lane's lifetime, it was instead his New Health, including his claims that modern society was ruining health, whereby Lane became, at last, viewed as a crank.[24]

Autointoxication

The

gastroenterologists asserted that "no evidence" supports the autointoxication concept that toxins are absorbed from waste in the large intestine.[67]

In

contain or produce toxins exhibiting systemic effects—as by transmigration into circulation and driving systemic inflammation—effects that include the psychological.[36][68][69][70][71][72][73][74][75][76][77][78][79][excessive citations] Apparent instances of autointoxication associate not merely with constipation, however, but principally with alternating constipation and diarrhea,[36] as Lane had noted in his 1908 paper that described constipation as but the earlier, underlying etiological factor whereby autointoxication may incite diarrhea, too.[41][44]

Constipation

There is much disagreement over the meaning of constipation, far overreported by the general public versus conventional medical criteria—under two defecations per week.[80] Despite the general public's remaining prevalence of belief that maintaining good health requires defecation at least daily, many constipated individuals apparently are quite healthy—some even defecating under once a week—whereas others who defecate daily are unhealthy.[80]

Still, constipation remains a "major health problem".

adolescents, too[83]—or to obstructed defecation, which along with slow colon transit have remained incompletely understood.[84] Individuals have varied complaints and try many remedies for signs and symptoms.[84]

Treating constipation, gastroenterologists' first line of intervention is now dietary—

socioeconomic status—have been recognized,[85][86] although some gastroenterologists as recently as 2012 have claimed that there is "no evidence" supporting a role for exercise.[87] Some 15% to 30% of constipation patients exhibit slow colon transit,[38] which laxatives and medical drugs do not amend.[40] Thus, refractory constipation is sometimes treated surgically reportedly successfully,[81][88][89][90][91][92][93] but sometimes successfully,[84] or even worsening abdominal pain.[94]

Lane disease

The syndrome that Lane reported in 1908, "Lane disease" or "Arbuthnot Lane disease", is now usually termed by gastroenterologists either slow transit constipation or slow colon transit or colonic inertia,[39] exhibited by some 15% to 30% of constipation patients.[38] By 1985, Lane's early article on surgical treatment of chronic constipation had become a classic,[95] while physiologic testing and more accurate patient selection renewed interest in total colectomy with ileorectal anastomosis—that is, removing the entire large intestine and joining the small intestine's outlet to the rectum—to treat colonic inertia, Lane disease.[39][96] By now, gastroenterology's accepted view is that, although few patients meet the selection criteria, surgery ought to be offered as a treatment option for severe chronic constipation.[97] Selection criteria ought to be extremely stringent, including multiple confirmation of slow colon transit by physiologic testing, and further medical, psychological, and psychosocial evaluations, with patients understanding that colectomy might not improve the condition and might even worsen abdominal pain.[94]

Relevance

Willie Lane was among the last surgeons of an era where one could master three specialties—

Sir Arthur Keith who claimed him not clever but carried by faith.[27] In any event, Lane can be characterised as "a crusader, a perfectionist, and an extraordinarily talented surgeon".[27]

Footnotes

  1. ^ a b c d e f g h i j k l m "Sir William Arbuthnot Lane (1856–1943)", Historic Hospital Admission Records Project (HHARP), Website access: 1 October 2003.
  2. ^
    PMID 19418106
    .
  3. ^ a b c González-Crussi, Carrying the Heart (Kaplan, 2009), p 73.
  4. ^ a b c d Mostofi, Who's Who in Orthopedics (Springer, 2005).
  5. outpatients' department was treating 1,500 children a week. New buildings were added in 1905 providing 100 beds. It became part of the St George's Hospital group and moved to the main hospital in Tooting
    in 1964. This photograph shows the hospital shortly before its demolition in 1966".
  6. ^ HHARP states 1882, yet R Brand states 1888, a conflict the present author[who?] judges, by synthesizing both recounts of events, to favor 1888.
  7. ^
    Spectator, 1946
    (Website access: 2 October 2013).
  8. ^ a b c d e f g h i Louis K T Fu, Review: "The memoirs of Sir William Arbuthnot Lane", Bone & Joint, British Editorial Society of Bone & Joint Surgery, Website access: 2 October 2013.
  9. ^ a b c Nicolson, Great Silence (Grove/Atlantic, 2009).
  10. ^ a b c d e f Dally, Fantasy Surgery (Rodopi, 1996), p 86.
  11. ^ Dally, Fantasy Surgery (Rodopi, 1996), p 85.
  12. ^ FreeBMD.
  13. ^ a b c d Dally, Fantasy Surgery (Rodopi, 1996), pp 152–53, quotes Shaw's letter dated 13 March 1948: "I never met AL. Cutler Walpole was in print years before I ever heard of Lane. You have been misled by the fact that Lane became known for inventing and practising the operation of shortcircuiting the bowels by cutting out yards of colon: a surgical monstrosity which obsessed him as the nuciform sac obsesses Walpole".
  14. ^
    PMID 19797603
    .
  15. ^
    doi:10.1093/shm/hkm032
    .
  16. ^ Ole D Enersen, "Sir William Arbuthnot Lane", Whonamedit? (A dictionary of medical eponyms), Website access: 2 October 2013.
  17. ^ "Sir Wm. Lane, Surgeon, Dies". The Boston Globe. 18 January 1943. p. 2. Retrieved 16 June 2019 – via Newspapers.com.
  18. ^ "Lane, Sir William Arbuthnot (1856 - 1943)". Plarr's Lives of the Fellows. 30 July 2013. Retrieved 16 June 2019 – via livesonline.rcseng.ac.uk.
  19. ^ W Arbuthnot Lane, Manual of Operative Surgery (London: G Bell and Sons, 1886).
  20. ^
    S2CID 20401107
    .
  21. ^ Martin Pugh, We Danced All Night (Bodley Head, 2008), p 48.
  22. ^ a b c González-Crussi, Carrying the Heart (Kaplan, 2009), p 74–75.
  23. ^ a b c Tauber & Chernyak, Metchnikoff and the Origins of Immunology (Oxford, 1991), pp viii, 11.
  24. ^ a b c d e f Scull, Madhouse (Yale U P, 2005), p 34.
  25. ^
    PMID 2668399
    .
  26. ^ a b c González-Crussi, Carrying the Heart (Kaplan, 2009), pp 76–78.
  27. ^ a b c d e Dally, Fantasy Surgery (Rodopi, 1996), p 88.
  28. ^ Walter Gratzer, The Undergrowth of Science: Delusion, Self-Deception, and Human Frailty (New York: Oxford University Press, 2000), pp 143–147.
  29. ^ a b c Scull, Madhouse (Yale U P, 2005), p 37.
  30. ^ a b c Ingle, PDQ Endodontics, 2nd edn (People's Medical, 2009), p xiv.
  31. ^ a b Scull, Madhouse (Yale U P, 2005), pp 34–36.
  32. ^ a b Noll, American Madness (Harvard U P, 2011), pp 117–21.
  33. ^ a b c John H Kellogg, Autointoxication Or Intestinal Toxemia, 2nd edn (Battle Creek MI: Modern Medicine Publishing, 1919), "Preface", pp 3–11.
  34. ^ Scull, Madhouse (Yale U P, 2005), p 33.
  35. ^ Charles J Bouchard, Leçons sur les auto-intoxications dans les maladies (Paris: Librairie F Savy, 1887), which translates as Lectures on Auto-Intoxication in Disease.
  36. ^
    PMID 23506618
    .
  37. PMID 3545042. INIST 8052319
    .
  38. ^
    PMID 20011411
    .
  39. ^ a b c d Jorge, "Constipation" in Diseases of the Colon (Informa, 2007), pp 118–19.
  40. ^
    Retrograde colonic irrigation
    has limited value".
  41. ^
    PMID 20763645
    .
  42. PMID 20764531
    .
  43. ^ W Arbuthnot Lane, The Operative Treatment of Chronic Constipation (London: James Nisbet & Co, 1909).
    W Arburthnot Lane, The Operative Treatment of Chronic Intestinal Stasis, 3rd edn (London: James Nisbet & Co, 1915).
    W Arbuthnot Lane, The Operative Treatment of Chronic Intestinal Stasis, 4th edn (London: Frowde, Hodder and Stoughton, 1918).
  44. ^
    PMID 7036818
    .
  45. ^ Dally, Fantasy Surgery (Rodopi, 1996), p 154.
  46. ^ Adolphe Combe & Albert Fournier, Intestinal Auto-Intoxication, English trans by William G States (London: Rebman, 1908), pp 72, 107–08, 110, 415.
  47. PMID 19976752
    .
  48. PMID 20770334
    .
  49. PMID 21507275
    .
  50. doi:10.1176/ajp.79.2.139
    .
  51. doi:10.1176/ajp.80.2.149
    .
  52. ^ a b c Scull, Madhouse (Yale U P, 2005), pp 126 & 259.
  53. ^ Martin Pugh, We Danced All Night (Bodley Head, 2008), p 43: "In the early 1920s Sir Arbuthnot Lane started campaigning about poor diet which he saw as a cause of cancer".
  54. PMID 20771328
    .
  55. CB", Ottawa Citizen
    , 19 Sep 1928, p 15.
  56. ^ Rut C Engs, The Progressive Era's Health Reform Movement: A Historical Dictionary (Westport CT: Praeger Publishers, 2003), p 74.
  57. PMID 9366633
    .
  58. PMC 1044197
    .
  59. ^ Reiner Grundmann & Nico Stehr, The Power of Scientific Knowledge: From Research to Public Policy (New York: Cambridge University Press, 2012), p 77–80.
  60. ^ William E Tanner, Sir Arbuthnot Lane, Bart., C.B., M.S., F.R.C.S.: His Life and Work (London: Balliere, Tyndall and Cox, 1946).
    T B Layton, Sir William Arbuthnot Lane, Bt.: An Enquiry into the Mind and Influence of a Great Surgeon (London & Edinburgh: E & S Livingstone, 1956).
  61. PMID 7665877
    .
  62. ^
    PMID 9252839
    .
  63. S2CID 21126594
    .
  64. ^ a b Stephen Barrett, "Gastrointestinal quackery: Colonics, laxatives, and more", Quackwatch, 4 August 2010 (last revised), Website access: 2 October 2013.
  65. ^ a b González-Crussi, Carrying the Heart (Kaplan, 2009), p 77–82.
  66. S2CID 71131710
    .
  67. ^
    S2CID 8060335
    .
  68. PMID 23497633
    .
  69. PMID 23497650
    .
  70. PMID 3760291
    .
  71. PMID 20377338
    .
  72. PMID 21807932
    .
  73. S2CID 24465750
    .
  74. PMID 21984290
    .
  75. PMID 21281494
    .
  76. PMID 22683238
    .
  77. PMID 23886975
    .
  78. PMID 24004817
    .
  79. S2CID 22798964
    .
  80. ^ a b Whorton, Inner Hygiene (Oxford U P, 2000), pp 7–8.
  81. ^
    PMID 23449085
    .
  82. S2CID 24897167
    .
  83. S2CID 38066435
    .
  84. ^
    PMID 20011385
    .
  85. ^ a b Whorton, Inner Hygiene (Oxford U P, 2000), p 6.
  86. ^
    PMID 23449159
    .
  87. PMID 23049207
    .
  88. S2CID 40439692
    .
  89. PMID 10561086
    .
  90. S2CID 41516509
    .
  91. PMID 22114754
    .
  92. PMID 22969211
    .
  93. PMID 23350051
    .
  94. ^
    ISBN 978-1-85233-724-7
    .
  95. S2CID 71832291
    .
  96. PMID 3690782
    .
  97. ^ Jorge, "Constipation" in Diseases of the Colon (Informa, 2007), p 117–18.

References

External links

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