Sir William Arbuthnot Lane, 1st Baronet
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Sir William Arbuthnot Lane, 1st Baronet, CB,
FRCS Fellowship of the Royal Colleges of Surgeons (FRCS) is a professional certification, professional qualification to practise as a senior surgeon in Republic of Ireland, Ireland or the United Kingdom. It is bestowed on an wikt:intercollegiate, ...
(4 July 1856 – 16 January 1943) was a British surgeon and physician. He mastered
orthopaedic Orthopedic surgery or orthopedics ( alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
,
abdominal The abdomen (colloquially called the gut, belly, tummy, midriff, tucky, or stomach) is the front part of the torso between the thorax (chest) and pelvis in humans and in other vertebrates. The area occupied by the abdomen is called the abdominal ...
, and ear, nose and throat surgery, while designing new surgical instruments toward maximal
asepsis Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...
. He thus introduced the "no-touch technique", and some of his designed instruments remain in use. Lane pioneered
internal fixation Internal fixation is an Surgery, operation in orthopedics that involves the surgical implementation of Implant (medicine), implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable fo ...
of displaced fractures, procedures on
cleft palate A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate (the roof of the mouth) contains an opening into the nose. The ...
, and colon resection and
colectomy Colectomy (''wikt:colo-#Prefix, col-'' + ''wikt:-ectomy#Suffix, -ectomy'') is the surgical removal of any extent of the Large intestine#Structure, colon, the longest portion of the large bowel. Colectomy may be performed for prophylactic, curativ ...
to treat "Lane's disease"—now otherwise termed '' colonic inertia'', which he identified in 1908—which surgeries were controversial but advanced abdominal surgery. During
World War I World War I or the First World War (28 July 1914 – 11 November 1918), also known as the Great War, was a World war, global conflict between two coalitions: the Allies of World War I, Allies (or Entente) and the Central Powers. Fighting to ...
, as an officer with the
Royal Army Medical Corps The Royal Army Medical Corps (RAMC) was a specialist corps in the British Army which provided medical services to all Army personnel and their families, in war and in peace. On 15 November 2024, the corps was amalgamated with the Royal Army De ...
, he organised and opened Queen Mary's Hospital in
Sidcup Sidcup is an area of south-east London, England, primarily in the London Borough of Bexley. It is south-east of Charing Cross, bordering the London Boroughs of London Borough of Bromley, Bromley and Royal Borough of Greenwich, Greenwich. It was ...
, which pioneered
reconstructive surgery Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition. Description Reconstructive surgery is a term with training, clinical, and reimbursement implicat ...
. The late- Victorian and
Edwardian period In the United Kingdom, the Edwardian era was a period in the early 20th century that spanned the reign of King Edward VII from 1901 to 1910. It is commonly extended to the start of the First World War in 1914, during the early reign of King Ge ...
s' preeminent surgeon, Lane operated on
socialite A socialite is a person, typically a woman from a wealthy or aristocratic background, who is prominent in high society. A socialite generally spends a significant amount of time attending various fashionable social gatherings, instead of having ...
s, politicians, and royalty. Lane thus attained
baronet A baronet ( or ; abbreviated Bart or Bt) or the female equivalent, a baronetess (, , or ; abbreviation Btss), is the holder of a baronetcy, a hereditary title awarded by the British Crown. The title of baronet is mentioned as early as the 14th ...
cy in 1913. In the early 1920s, as an early advocate of dietary prevention of cancer, Lane met medical opposition, resigned from
British Medical Association The British Medical Association (BMA) is a registered trade union and professional body for physician, doctors in the United Kingdom. It does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The BMA ...
, and founded the New Health Society, the first organisation practising
social medicine Social medicine is an interdisciplinary field that focuses on the profound interplay between socio-economic factors and individual health outcomes. Rooted in the challenges of the Industrial Revolution, it seeks to: # Understand how specific soci ...
. Through newspapers and lectures, sometimes drawing large crowds, Lane promoted
whole food Whole foods are foods that are unprocessed and unrefined. Examples of whole foods include grains such as oatmeal and rice, fruits, vegetables, dried beans, nuts, seeds, unprocessed meats, and fish. Depending on the context this may sometimes refe ...
s, 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
autointoxication Colon cleansing, also known as colon therapy, colon hydrotherapy, a colonic, or colonic irrigation, encompasses a number of alternative medical therapies claimed to remove toxins from the colon and intestinal tract by removing accumulations o ...
is generally regarded by gastroenterologists as wholly fictitious, and Lane's earlier surgeries for chronic constipation have been depicted as baseless. Yet
constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The Human feces, stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the ...
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 Fort George near Inverness, Scotland, as the eldest of the eight children of Benjamin Lane,"Sir William Arbuthnot Lane (1856–1943)"
Historic Hospital Admission Records Project (HHARP), Website access: 1 October 2003.
a military surgeon enlisted to the
British Empire The British Empire comprised the dominions, Crown colony, colonies, protectorates, League of Nations mandate, mandates, and other Dependent territory, territories ruled or administered by the United Kingdom and its predecessor states. It bega ...
. William attended schools in eight countries on four continents—
Ireland Ireland (, ; ; Ulster Scots dialect, Ulster-Scots: ) is an island in the North Atlantic Ocean, in Northwestern Europe. Geopolitically, the island is divided between the Republic of Ireland (officially Names of the Irish state, named Irelan ...
,
India India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...
,
Corfu Corfu ( , ) or Kerkyra (, ) is a Greece, Greek island in the Ionian Sea, of the Ionian Islands; including its Greek islands, small satellite islands, it forms the margin of Greece's northwestern frontier. The island is part of the Corfu (regio ...
,
Malta Malta, officially the Republic of Malta, is an island country in Southern Europe located in the Mediterranean Sea, between Sicily and North Africa. It consists of an archipelago south of Italy, east of Tunisia, and north of Libya. The two ...
,
Canada Canada is a country in North America. Its Provinces and territories of Canada, ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, making it the world's List of coun ...
,
South Africa South Africa, officially the Republic of South Africa (RSA), is the Southern Africa, southernmost country in Africa. Its Provinces of South Africa, nine provinces are bounded to the south by of coastline that stretches along the Atlantic O ...
, and others—while his family followed the army regiment. Amid his mother's bearing seven children in rapid succession after him, William was often left in the care of military personnel.González-Crussi, ''Carrying the Heart'' (Kaplan, 2009)
p 73
At age 12, he was sent to boarding school at Stanley House School,
Bridge of Allan Bridge of Allan (, ), also known colloquially as ''Bofa'', is a former spa town in the Stirling (council area), Stirling council area in Scotland, just north of the city of Stirling. Overlooked by the National Wallace Monument, it lies on th ...
in Scotland.


Education

In 1872, his father arranged for him, age 16, to study medicine at
Guy's Hospital Guy's Hospital is an NHS hospital founded by philanthropist Thomas Guy in 1721, located in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the Kin ...
. Apparently shy and appearing young even for his age, William initially had some troubles with fellow students, but they rapidly recognized his exceptional abilities.Mostofi, ''Who's Who in Orthopedics'' (Springer, 2005). Soon, he was persuaded to switch to surgery, however, a surer career than medicine. Later, he received the degrees bachelor of medicine and master of surgery from the
University of London The University of London (UoL; abbreviated as Lond or more rarely Londin in Post-nominal letters, post-nominals) is a collegiate university, federal Public university, public research university located in London, England, United Kingdom. The ...
.


Career

In 1877, at age 21, he qualified as a member of the
Royal College of Surgeons The Royal College of Surgeons is an ancient college (a form of corporation) established in England to regulate the activity of surgeons. Derivative organisations survive in many present and former members of the Commonwealth. These organisations ...
, and began to practise in
Chelsea, London Chelsea is an area in West London, England, due south-west of Kilometre zero#Great Britain, Charing Cross by approximately . It lies on the north bank of the River Thames and for postal purposes is part of the SW postcode area, south-western p ...
, at the Victoria Hospital for Children. In 1883, Lane became a Fellow of
Royal College of Surgeons The Royal College of Surgeons is an ancient college (a form of corporation) established in England to regulate the activity of surgeons. Derivative organisations survive in many present and former members of the Commonwealth. These organisations ...
and joined
Great Ormond Street Hospital Great Ormond Street Hospital (informally GOSH, formerly the Hospital for Sick Children) is a children's hospital located in the Bloomsbury area of the London Borough of Camden, and a part of Great Ormond Street Hospital for Children NHS F ...
, where he was consultant until 1916. In 1888, at age 32, Lane returned to Guy's Hospital as
anatomy Anatomy () is the branch of morphology concerned with the study of the internal structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old scien ...
demonstrator and assistant surgeon, and remained with Guy's for most of his career. Lane became especially known for
internal fixation Internal fixation is an Surgery, operation in orthopedics that involves the surgical implementation of Implant (medicine), implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable fo ...
of displaced fractures,
neonatal In common terminology, a baby is the very young offspring of adult human beings, while infant (from the Latin word ''infans'', meaning 'baby' or 'child') is a formal or specialised synonym. The terms may also be used to refer to Juvenile (orga ...
repair of
cleft palate A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate (the roof of the mouth) contains an opening into the nose. The ...
, and developing
colectomy Colectomy (''wikt:colo-#Prefix, col-'' + ''wikt:-ectomy#Suffix, -ectomy'') is the surgical removal of any extent of the Large intestine#Structure, colon, the longest portion of the large bowel. Colectomy may be performed for prophylactic, curativ ...
, which, although highly controversial and opposed by most surgical peers, notably advanced
abdominal surgery The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen (laparotomy). Surgery of each abdominal organ is dealt with separately in connection with the description of that organ (see stomach, kidney, liver, e ...
. Lane collaborated with Down Brothers to design a number of surgical instruments, including screw driver, periosteal elevator, tissue
forceps Forceps (: forceps or considered a plural noun without a singular, often a pair of forceps; the Latin plural ''forcipes'' is no longer recorded in most dictionaries) are a handheld, hinged instrument used for grasping and holding objects. Forcep ...
, intestinal
anastomosis An anastomosis (, : anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf veins, or streams. Such a connection may be normal (su ...
clamp, bone-holding forceps, and
osteotome An osteotome is an instrument used for cutting or preparing bone. Osteotomes are similar to a chisel but bevelled on both sides. They are used today in plastic surgery, orthopedic surgery and dental implantation. The chain osteotome, origina ...
. For his surgery on British royalty, he was awarded
baronet A baronet ( or ; abbreviated Bart or Bt) or the female equivalent, a baronetess (, , or ; abbreviation Btss), is the holder of a baronetcy, a hereditary title awarded by the British Crown. The title of baronet is mentioned as early as the 14th ...
cy in 1913. Lane became an officer in
Royal Army Medical Corps The Royal Army Medical Corps (RAMC) was a specialist corps in the British Army which provided medical services to all Army personnel and their families, in war and in peace. On 15 November 2024, the corps was amalgamated with the Royal Army De ...
, head of army surgery,Nicolson
''Great Silence''
(Grove/Atlantic, 2009).
during
World War I World War I or the First World War (28 July 1914 – 11 November 1918), also known as the Great War, was a World war, global conflict between two coalitions: the Allies of World War I, Allies (or Entente) and the Central Powers. Fighting to ...
(1914–18). For this work as consulting surgeon in
Aldershot Aldershot ( ) is a town in the Rushmoor district, Hampshire, England. It lies on heathland in the extreme north-east corner of the county, south-west of London. The town has a population of 37,131, while the Farnborough/Aldershot built-up are ...
at the Cambridge Military Hospital and for opening Queen Mary's Hospital in
Sidcup Sidcup is an area of south-east London, England, primarily in the London Borough of Bexley. It is south-east of Charing Cross, bordering the London Boroughs of London Borough of Bromley, Bromley and Royal Borough of Greenwich, Greenwich. It was ...
—where, overcoming government resistance to fund it, he gave
Harold Gillies Sir Harold Delf Gillies (17 June 1882 – 10 September 1960) was a New Zealand otolaryngologist and father of modern plastic surgery for the techniques he devised to repair the faces of wounded soldiers returning from World War I. Early life ...
a ward where Gillies pioneered
reconstructive surgery Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition. Description Reconstructive surgery is a term with training, clinical, and reimbursement implicat ...
—Lane was appointed Companion of The Most Honourable Order of the Bath. In 1920, rather soon after returning from wartime service, Lane retired from Guy's Hospital, yet continued private practice out his home office.


Writing

He first published in 1883, seven years after starting his surgery career. He published about 189 articles, including 72 on fractures, 16 on harelip and
cleft palate A cleft lip contains an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. A cleft palate occurs when the palate (the roof of the mouth) contains an opening into the nose. The ...
, many others on other subjects, and, after year 1903, 89 articles directly on chronic intestinal stasis—which, like many Victorians, Lane experienced. He wrote several books, including one on cleft palate, one on surgery for chronic intestinal stasis, and one on ''New Health''. Not for print, his autobiography—manuscript dated March 1936, soon before his 80th birthday—was written for family at the urging of his children.Dally, ''Fantasy Surgery'' (Rodopi, 1996)
p 85


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. 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, and yet he often exhibited strong opinions. It was often said that Lane was
George Bernard Shaw George Bernard Shaw (26 July 1856 – 2 November 1950), known at his insistence as Bernard Shaw, was an Irish playwright, critic, polemicist and political activist. His influence on Western theatre, culture and politics extended from the 188 ...
'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''.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".
Yet the play was nearly surely about Sir Almroth Wright, whom Lane knew well. 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". And the play well suggests the view of Lane as held by many of Lane's contemporaries. After 1924, abandoning his private medical practice as well as surgery, Lane's public devotion was
social medicine Social medicine is an interdisciplinary field that focuses on the profound interplay between socio-economic factors and individual health outcomes. Rooted in the challenges of the Industrial Revolution, it seeks to: # Understand how specific soci ...
and public education on dietary and lifestyle subversion of constipation and promotion of general wellbeing, his ''New Health''. Of diverse interests, Lane traveled frequently, often visiting America, while gaining friends and colleagues internationally. Among his associates and acquaintances were Alexis Carrel, John Benjamin Murphy, Elie Metchnikoff, Sir James Mackenzie, William Worrall Mayo and sons
William James Mayo William James Mayo (June 29, 1861 – July 28, 1939) was a physician and surgeon in the United States and one of the seven founders of the Mayo Clinic. He and his brother, Charles Horace Mayo, both joined their father's private medical practice ...
and
Charles Horace Mayo Charles Horace Mayo (July 19, 1865 – May 26, 1939) was an American medical practitioner and was one of the founders of the Mayo Clinic along with his brother William James Mayo, Augustus Stinchfield, Christopher Graham, Edward Star Judd ...
of
Mayo Clinic Mayo Clinic () is a Nonprofit organization, private American Academic health science centre, academic Medical centers in the United States, medical center focused on integrated health care, healthcare, Mayo Clinic College of Medicine and Science ...
fame. Quotes of Lane by his Guy's Hospital house surgeon and biographer, William E Tanner: *''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, 46 Westbourne Terrace, Paddington, London, W2.


Medical spotlight


Surgery master

By 1886, Lane authored a surgery textbook. In 1889 in America at Johns Hopkins University's medical school,
William Halsted William Stewart Halsted, M.D. (September 23, 1852 – September 7, 1922) was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced sever ...
, a pioneer of abdominal surgery, introduced surgical gloves, and then contracted Goodyear Rubber Company to manufacture thin ones to preserve hands' tactile sensitivity. In the 1890s, glove use still uncommon, Lane introduced long surgical instruments to keep even gloves off of tissues. In his open reductions and plating of fractured bones, Lane introduced the "no-touch technique". Thus pioneering ''a''septic surgery, an advance beyond ''anti''septic surgery, Lane enabled new surgeries previously too dangerous.Martin Pugh, ''We Danced All Night'' (Bodley Head, 2008)
p 48
Widely renowned, Lane's surgical skill exhibited imperturbable calm at difficulties encountered during the operations. 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". 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 London is the Capital city, capital and List of urban areas in the United Kingdom, largest city of both England and the United Kingdom, with a population of in . London metropolitan area, Its wider metropolitan area is the largest in Wester ...
's best surgeon as to technique.


Internal fixation

Only
anecdotal Anecdotal evidence (or anecdata) is evidence based on descriptions and reports of individual, personal experiences, or observations, collected in a non- systematic manner. The term ''anecdotal'' encompasses a variety of forms of evidence. This ...
reports of using
internal fixation Internal fixation is an Surgery, operation in orthopedics that involves the surgical implementation of Implant (medicine), implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable fo ...
to set displaced fractures predate
Joseph Lister Joseph Lister, 1st Baron Lister, (5 April 1827 – 10 February 1912) was a British surgeon, medical scientist, experimental pathologist and pioneer of aseptic, antiseptic surgery and preventive healthcare. Joseph Lister revolutionised the Sur ...
's 1865 introduction of ''anti''septic surgery, whereupon Lister reported
silver Silver is a chemical element; it has Symbol (chemistry), symbol Ag () and atomic number 47. A soft, whitish-gray, lustrous transition metal, it exhibits the highest electrical conductivity, thermal conductivity, and reflectivity of any metal. ...
wire on a displaced petellar fracture. Yet even before
radiography Radiography is an imaging technology, imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical ("diagnostic" radiog ...
, Lane had found that conventional setting by manipulation and splints yielded poor outcomes—bone disunion and joint changes or wear in individuals under much physical activity—and Lane started using wires and screws in 1892. Amid the conservative medical community's vehement opposition, Lane's approach was so revolutionary that organizations certifying surgeons sometimes automatically dismissed students able to elaborate on such procedures, as nearly 50% of patients whose closed fractures were opened died by ensuing infections. Yet with not antiseptic, but
aseptic Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...
, surgical techniques, previously unheard of, Lane forged ahead. In the meantime, other surgeons' poor results, such as
sepsis Sepsis is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage of sepsis is followed by suppression of the immune system. Common signs and s ...
causing failed union, were sometimes erroneously associated with Lane. The
British Medical Association The British Medical Association (BMA) is a registered trade union and professional body for physician, doctors in the United Kingdom. It does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The BMA ...
appointed a committee to investigate Lane's practise—and ruled in Lane's favour.González-Crussi, ''Carrying the Heart'' (Kaplan, 2009)
p 74–75
Whereas other surgeons would attempt
asepsis Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...
but lapse, perhaps touching an unsterilized surface, Lane's utterly fastidious protocol was unrelenting. His 1905 book ''The Operative Treatment of Fractures'' reported good results. And in 1907, Lane introduced plates, made of
steel Steel is an alloy of iron and carbon that demonstrates improved mechanical properties compared to the pure form of iron. Due to steel's high Young's modulus, elastic modulus, Yield (engineering), yield strength, Fracture, fracture strength a ...
. (
Stainless steel Stainless steel, also known as inox, corrosion-resistant steel (CRES), or rustless steel, is an iron-based alloy that contains chromium, making it resistant to rust and corrosion. Stainless steel's resistance to corrosion comes from its chromi ...
, discovered the next decade, was not widely used in medicine or surgery until much later.) And later, Lane's assertion of frequent disunion via nonsurgical intervention was vindicated by radiography. 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.


''Intestinal stasis''


Backdrop

At 1886, Russian emigrant Elie Metchnikoff—discoverer of
phagocyte Phagocytes are cells that protect the body by ingesting harmful foreign particles, bacteria, and dead or dying cells. Their name comes from the Greek ', "to eat" or "devour", and "-cyte", the suffix in biology denoting "cell", from the Greek ...
s mediating
innate immunity The innate immune system or nonspecific immune system is one of the two main immunity strategies in vertebrates (the other being the adaptive immune system). The innate immune system is an alternate defense strategy and is the dominant immune s ...
—was welcomed to Paris by
Louis Pasteur Louis Pasteur (, ; 27 December 1822 – 28 September 1895) was a French chemist, pharmacist, and microbiologist renowned for his discoveries of the principles of vaccination, Fermentation, microbial fermentation, and pasteurization, the la ...
with an entire floor at the
Pasteur Institute The Pasteur Institute (, ) is a French non-profit private foundation dedicated to the study of biology, micro-organisms, diseases, and vaccines. It is named after Louis Pasteur, who invented pasteurization and vaccines for anthrax and rabies. Th ...
.Tauber & Chernyak, ''Metchnikoff and the Origins of Immunology'' (Oxford, 1991), p
viii11
As did
Paul Ehrlich Paul Ehrlich (; 14 March 1854 – 20 August 1915) was a Nobel Prize-winning German physician and scientist who worked in the fields of hematology, immunology and antimicrobial chemotherapy. Among his foremost achievements were finding a cure fo ...
—theorist on
antibody An antibody (Ab) or immunoglobulin (Ig) is a large, Y-shaped protein belonging to the immunoglobulin superfamily which is used by the immune system to identify and neutralize antigens such as pathogenic bacteria, bacteria and viruses, includin ...
mediating
acquired immunity The adaptive immune system (AIS), also known as the acquired immune system, or specific immune system is a subsystem of the immune system that is composed of specialized cells, organs, and processes that eliminate pathogens specifically. The ac ...
—and as did Pasteur, Metchnikoff believed nutrition to influence immunity. Sharing Pasteur's vision of science as a
means Means may refer to: * Means LLC, an anti-capitalist media worker cooperative * Means (band), a Christian hardcore band from Regina, Saskatchewan * Means, Kentucky, a town in the US * Means (surname) * Means Johnston Jr. (1916–1989), US Navy ...
to combat humankind's woes, Metchnikoff brought France its first yogurt cultures, aiming its
probiotic Probiotics are live microorganisms that provide health benefits when consumed, generally by improving or restoring the microbiota in the gut. Probiotics are considered generally safe to consume, but may cause bacteria– host interactions ...
microorganisms to suppress the colon's putrefactive microorganisms allegedly causing toxic seepage, ''
autointoxication Colon cleansing, also known as colon therapy, colon hydrotherapy, a colonic, or colonic irrigation, encompasses a number of alternative medical therapies claimed to remove toxins from the colon and intestinal tract by removing accumulations o ...
''. Later the Pasteur Institute's director and a 1908 Nobelist, Metchnikoff viewed the colon as a primitive organ that had stored our wild ancestors' waste for long periods, a survival advantage amid abundant predators, but a liability since civilization had freed humans to excrete without peril. Metchnikoff predicted the colon's evolutionary shrinkage until, allegedly alike the appendix, it became
vestigial Vestigiality is the retention, during the process of evolution, of genetically determined structures or attributes that have lost some or all of the ancestral function in a given species. Assessment of the vestigiality must generally rely on co ...
.González-Crussi, ''Carrying the Heart'' (Kaplan, 2009)
pp 76–78
Metchnikoff's book ''La Vie Humaine'' foresaw a courageous surgeon removing the colon. Lane and Metchnikoff met in Lane's home. The pioneer British psychiatrist
Henry Maudsley Henry Maudsley (5 February 183523 January 1918) was a pioneering English psychiatrist, commemorated in the Maudsley Hospital in London and in the annual Maudsley Lecture of the Royal College of Psychiatrists. Life and career Maudsley was b ...
asserted much "evidence that organic morbid poisons bred in the organism or in the blood itself may act in the most baneful manner upon the supreme nervous centers. The earliest and mildest mental effect by which a perverted state of blood declares itself is not in the production of positive delusion or incoherence of thought, but in a modification of mental tone", then perhaps "a chronic delusion of some kind", though "its more acute action is to produce more or less active delirium and general incoherence of thought". Famed British surgeon William Hunter incriminated ''oral sepsis'' in 1900, and lectured to a Canadian medical faculty in Montreal in 1910. Two years later, Chicago physician Frank Billings termed it ''focal infection''. Within the
English-speaking world The English-speaking world comprises the 88 countries and territories in which English language, English is an official, administrative, or cultural language. In the early 2000s, between one and two billion people spoke English, making it the ...
, the lectures of Hunter and of Billings "ignited the fires of focal infection",Ingle, ''PDQ Endodontics'', 2nd edn (People's Medical, 2009)
p xiv
whose
theory A theory is a systematic and rational form of abstract thinking about a phenomenon, or the conclusions derived from such thinking. It involves contemplative and logical reasoning, often supported by processes such as observation, experimentation, ...
converged with the autointoxication principle.Noll, ''American Madness'' (Harvard U P, 2011)
pp 117–21
Since 1875, American medical doctor
John Harvey Kellogg John Harvey Kellogg (February 26, 1852 – December 14, 1943) was an American businessman, Invention, inventor, physician, and advocate of the Progressive Era, Progressive Movement. He was the director of the Battle Creek Sanitarium in Battle Cr ...
in
Battle Creek, Michigan Battle Creek is a city in northwestern Calhoun County, Michigan, United States, at the confluence of the Kalamazoo River, Kalamazoo and Battle Creek River, Battle Creek rivers. As of the 2020 United States census, 2020 census, the city had a tota ...
, 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''.Scull, ''Madhouse'' (Yale U P, 2005)
pp 34–36
John H Kellogg, ''Autointoxication Or Intestinal Toxemia'', 2nd edn (Battle Creek MI: Modern Medicine Publishing, 1919)
"Preface"
pp 3–11.
In the early 20th century, rebuking alleged "health faddists" like Kellogg and
Sylvester Graham Sylvester Graham (July 5, 1794 – September 11, 1851) was an American Presbyterian minister and dietary reformer. He was known for his emphasis on vegetarianism, the temperance movement, and eating whole-grain bread. His preaching inspired th ...
, American physicians who embraced focal infection theory cast themselves in the German tradition of "scientific medicine".Scull, ''Madhouse'' (Yale U P, 2005)
p 33
Kellogg argued that German researchers ostensibly repudiated the autointoxication principle, but, by using different terminology, supported it circuitously. Since French pathologist
Charles Jacques Bouchard Charles Jacques Bouchard (6 September 1837 – 28 October 1915) was a French pathologist and an esperantist born in Montier-en-Der, a commune the department of Haute-Marne. Biography He studied medicine in Lyon and Paris, where he obtained his ...
, in his 1887 book, coined the term ''autointoxication'', French researchers had investigated and openly advocated the principle, already presaged by multiple researchers in Europe and America. Meanwhile, British surgeons still knife-happy, Hunter warned of "intestinal stasis" impairing mental stability, and called for "surgical bacteriology".Scull, ''Madhouse'' (Yale U P, 2005)
p 37


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 constipation''as well as ''colonic inertia''.WR Schouten & AF Engel, ch 19 "Motility disorders of the distal gastrointestinal tract", subch "Surgical aspects", § "Slow transit constipation without megacolon", in JJB van Lanschot, DJ Gouma, GNJ Tytgat ''et al'', eds, ''Integrated Medical And Surgical Gastroenterology'' (New York: Thieme, 2004)
p 365
"This condition, also described as colonic inertia, occurs almost entirely in women. Patients with this syndrome have infrequent defecation, two or less bowel actions per week, due to a marked prolongation of colonic transit time. Most patients develop the first symptoms around the time of their first menstruation. Sometimes, colonic inertia develops shortly after childbirth or
hysterectomy Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes ( salpi ...
. All patients with this syndrome have a colon of normal size. Routine
histopathologic Histopathology (compound of three Greek language, Greek words: 'tissue', 'suffering', and ''-logy, -logia'' 'study of') is the light microscope, microscopic examination of Tissue (biology), tissue in order to study the manifestations of dis ...
examination of the large bowel does not reveal any abnormality. Most patients with colonic inertia present with associated symptoms, such as general
malaise In medicine, malaise is a feeling of general discomfort, uneasiness or lack of wellbeing and often the first sign of an infection or other disease. It is considered a vague termdescribing the state of simply not feeling well. The word has exist ...
, bloating, abdominal pain, nausea and vomiting, which interfere with the ability to work and enjoy social activities. Many patients also have gynecologic and/or
urologic Urology (from Greek οὖρον ''ouron'' "urine" and ''-logia'' "study of"), also known as genitourinary surgery, is the branch of medicine that focuses on surgical and medical diseases of the urinary system and the reproductive organs. Org ...
problems. A delay in gastric emptying and a prolonged
small bowel The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...
transit have also been found, suggesting that inertia of the
large bowel The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces before being rem ...
might be the colonic manifestation of a gastrointestinal motility disorder. Medical treatment with laxatives, enemas and prokinetic agents, such as cisapride, does not relieve the burdensome symptoms. Retrograde colonic irrigation has limited value".
That same year, Lane treated it by surgery. The following year, Lane's book ''The Operative Treatment of Chronic Constipation'' was published in London. Lane began with colon bypass, and then, at insufficient improvements, performed total colectomy. Famed for an
appendectomy An appendectomy (American English) or appendicectomy (British English) is a Surgery, surgical operation in which the vermiform appendix (a portion of the intestine) is removed. Appendectomy is normally performed as an urgent or emergency procedur ...
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. 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.Dally, ''Fantasy Surgery'' (Rodopi, 1996)
p 154
Apparently, Lane had had trouble publishing in the ''
British Medical Journal ''The BMJ'' is a fortnightly peer-reviewed medical journal, published by BMJ Publishing Group Ltd, which in turn is wholly-owned by the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world ...
'' and in ''
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...
'' his first articles on chronic intestinal stasis. 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.Adolphe Combe & Albert Fournier, ''Intestinal Auto-Intoxication'', English trans by William G States (London: Rebman, 1908), p
72107–08110415
In any case, most surgeons opposed Lane's operating on constipation. The
Royal Society of Medicine The Royal Society of Medicine (RSM) is a medical society based at 1 Wimpole Street, London, UK. It is a registered charity, with admission through membership. Its Chief Executive is Michele Acton. History The Royal Society of Medicine (R ...
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''. Several authors, including Lane, presented papers, whereupon some two dozen responded from April to May. 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.
World War I World War I or the First World War (28 July 1914 – 11 November 1918), also known as the Great War, was a World war, global conflict between two coalitions: the Allies of World War I, Allies (or Entente) and the Central Powers. Fighting to ...
broke out in 1914, diverting the attention of Lane, newly head of army surgery. Returning from war service, Lane retired from
Guy's Hospital Guy's Hospital is an NHS hospital founded by philanthropist Thomas Guy in 1721, located in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the Kin ...
in 1920, and continued in private practice. From then onward, Lane wrote almost only on chronic intestinal stasis. Meanwhile,
focal infection theory Focal infection theory is the historical concept that many chronic diseases, including systemic disease, systemic and common ones, are caused by focal infections. A focal infection is a localized infection, often asymptomatic, that causes disease ...
—a primary means of interpreting the autointoxication principle—was "coming of age". In 1916, Henry Cotton in America had embraced focal infection theory with unmatched zeal, became the first to apply it to
psychiatry Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior. ...
, and rapidly rose to international fame for prescribing removal of
dentition Dentition pertains to the development of teeth and their arrangement in the mouth. In particular, it is the characteristic arrangement, kind, and number of teeth in a given species at a given age. That is, the number, type, and morpho-physiology ...
, sex glands, and internal organs—most controversially the colon—to treat
schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...
and
manic depression Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks, and in some cases months. If the elevated m ...
, while claiming up to some 80% cure rate, seemingly worth the 30% death rate. (Soon, independent investigators ventured to Cotton's facility and performed, it seems, psychiatry's first two controlled clinical trials, finding Cotton's claims false.) In 1923, on his European lecture tour, Cotton arrived in Britain, where he learned from Lane an improved surgical technique—as well as a new, far less radical surgical procedure. In autumn 1923, Lane had performed the first 19 "pericolic membranotomies", putatively releasing intestinal adhesions. Wherever apparently possible, Lane replaced colon bypass and
colectomy Colectomy (''wikt:colo-#Prefix, col-'' + ''wikt:-ectomy#Suffix, -ectomy'') is the surgical removal of any extent of the Large intestine#Structure, colon, the longest portion of the large bowel. Colectomy may be performed for prophylactic, curativ ...
with pericolic membranotomy.Scull, ''Madhouse'' (Yale U P, 2005), p
126

259


New Health

In the early 1920s, Lane began advocating cancer prevention through diet, but, thereby drawing conflict with the
British Medical Association The British Medical Association (BMA) is a registered trade union and professional body for physician, doctors in the United Kingdom. It does not regulate or certify doctors, a responsibility which lies with the General Medical Council. The BMA ...
, resigned from the association in 1924, renouncing his lucrative private medical and surgical practice, some 10 000 pounds a year. In 1925, Lane founded the New Health Society, the first organised body for
social medicine Social medicine is an interdisciplinary field that focuses on the profound interplay between socio-economic factors and individual health outcomes. Rooted in the challenges of the Industrial Revolution, it seeks to: # Understand how specific soci ...
, which German pathologist and statesman
Rudolf Virchow Rudolf Ludwig Carl Virchow ( ; ; 13 October 18215 September 1902) was a German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician. He is known as "the father of modern pathology" and as the founder o ...
had pioneered in late 19th century to undo disease's
sociopolitical Political sociology is an interdisciplinary field of study concerned with exploring how governance and society interact and influence one another at the micro to macro levels of analysis. Interested in the social causes and consequences of how p ...
causes. The term ''New Health'' largely referred to nonsurgical healthcare against constipation.Dally, ''Fantasy Surgery'' (Rodopi, 1996)
p 86
With advertising by physicians being forbidden, Lane averted disciplining by the
General Medical Council The General Medical Council (GMC) is a public body that maintains the official register of physician, medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the pu ...
by having his name deleted from the Medical Register. 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 B vitamins are a class of water-soluble vitamins that play important roles in Cell (biology), cell metabolism and synthesis of red blood cells. They are a chemically diverse class of compounds. Dietary supplements containing all eight are referr ...
—Lane's plan to foster defecation thrice daily, cancer prevention, general health, and longevity. Meanwhile,
colectomy Colectomy (''wikt:colo-#Prefix, col-'' + ''wikt:-ectomy#Suffix, -ectomy'') is the surgical removal of any extent of the Large intestine#Structure, colon, the longest portion of the large bowel. Colectomy may be performed for prophylactic, curativ ...
for constipation was abandoned amid low success rates but high complication rates. New Health Society sought to transform the "rapidly degenerating community" into a "nation composed of healthy, vigorous members". Blending a
utopian A utopia ( ) typically describes an imagined community or society that possesses highly desirable or near-perfect qualities for its members. It was coined by Sir Thomas More for his 1516 book ''Utopia'', which describes a fictional island soci ...
vision, progressive gender ideology,
social darwinist Charles Darwin, after whom social Darwinism is named Social Darwinism is a body of pseudoscientific theories and societal practices that purport to apply biological concepts of natural selection and survival of the fittest to sociology, economic ...
rhetoric, and eugenic rationales—which, altogether, reflected the period's prevailing framework—New Health Society's view, not hereditarian, however, depicted humankind's regeneration as pivoting on health education. Sidestepping issues of poverty and inequality, it took health as a personal responsibility and duty of citizenship, whereby health and happiness were attainable by all who consumed a high-fibre diet, exercised, and got ample sunshine, while using
birth control Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only be ...
and reforming men's dress. Although embracing modern science, technology, and
mass media Mass media include the diverse arrays of media that reach a large audience via mass communication. Broadcast media transmit information electronically via media such as films, radio, recorded music, or television. Digital media comprises b ...
, New Health Society suggested
valorisation In Marxism, the valorisation or valorization of capital is the increase in the value of capital assets through the application of value-forming labour in production. The German original term is "''Verwertung''" (specifically ''Kapitalverwertung'') ...
of "native" culture, and found the bowels central to health, while constipation anchored many of civilisation's ills. Lane said that his lecture in 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".Scull, ''Madhouse'' (Yale U P, 2005)
p 34


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".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.
Rather, two of his former house surgeons at
Guy's Hospital Guy's Hospital is an NHS hospital founded by philanthropist Thomas Guy in 1721, located in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the Kin ...
—first W. E. Tanner and later T. B. Layton—would borrow from it to author biographies on Lane. By then, however, consensus had formed that Lane's surgeries to treat constipation had been misguided, and perhaps even Lane himself had concluded so.Bashford, ''
Spectator ''Spectator'' or ''The Spectator'' may refer to: *Spectator sport, a sport that is characterized by the presence of spectators, or watchers, at its matches *Audience Publications Canada * '' The Hamilton Spectator'', a Hamilton, Ontario, Canada, ...
''
1946
(Website access: 2 October 2013).
By 1982, colectomy for constipation was declared "clinically futile". 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.


Autointoxication

The
autointoxication Colon cleansing, also known as colon therapy, colon hydrotherapy, a colonic, or colonic irrigation, encompasses a number of alternative medical therapies claimed to remove toxins from the colon and intestinal tract by removing accumulations o ...
principle became an alleged myth scientifically discredited, while interventions to subvert it were deemed
quackery Quackery, often synonymous with health fraud, is the promotion of fraudulent or Ignorance, ignorant medicine, medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or public ...
.Stephen Barrett
"Gastrointestinal quackery: Colonics, laxatives, and more"
''
Quackwatch Quackwatch is a United States-based website focused on promoting consumer protection and providing information about health related frauds, myths, fads, fallacies, and misconduct. It primarily targets alternative medicine, questionable health cl ...
'', 4 August 2010 (last revised), Website access: 2 October 2013.
Lane's rationale and his era's very notion of autointoxication have been depicted as wholly unfounded and irrational or "illogical," due to a pervasive psychological effect of
toilet training Toilet training (also potty training or toilet learning) is the process of training someone, particularly a toddler or infant, to use the toilet for urination and defecation. Attitudes toward training in recent history have fluctuated substantial ...
or a figment of the
Victorian era In the history of the United Kingdom and the British Empire, the Victorian era was the reign of Queen Victoria, from 20 June 1837 until her death on 22 January 1901. Slightly different definitions are sometimes used. The era followed the ...
's culture.González-Crussi, ''Carrying the Heart'' (Kaplan, 2009)
p 77–82
Yet by the late 1990s, the autointoxication concept and thereby colon cleansing was being renewed in alternative healthcare, allegedly upon a fictitious basis. Combating alleged myths, some gastroenterologists asserted that "no evidence" supports the autointoxication concept that toxins are absorbed from waste in the large intestine. In
basic research Basic research, also called pure research, fundamental research, basic science, or pure science, is a type of scientific research with the aim of improving scientific theories for better understanding and prediction of natural or other phenome ...
, if freed from its simplistic reduction to constipation, the autointoxication principle has now been substantially supported as an independent mechanism whereby gastrointestinal microorganisms contain or
produce In American English, produce generally refers to wikt:fresh, fresh List of culinary fruits, fruits and Vegetable, vegetables intended to be Eating, eaten by humans, although other food products such as Dairy product, dairy products or Nut (foo ...
toxins exhibiting systemic effects—as by transmigration into circulation and driving systemic inflammation—effects that include the psychological. Apparent instances of autointoxication associate not merely with constipation, however, but principally with alternating constipation and diarrhea, as Lane had noted in his 1908 paper that described constipation as but the earlier, underlying
etiological Etiology (; alternatively spelled aetiology or ætiology) is the study of causation or origination. The word is derived from the Greek word ''()'', meaning "giving a reason for" (). More completely, etiology is the study of the causes, origin ...
factor whereby autointoxication may incite diarrhea, too.


Constipation

There is much disagreement over the meaning of ''
constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The Human feces, stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the ...
'', far overreported by the general public versus conventional medical criteria—under two defecations per week. 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.Whorton, ''Inner Hygiene'' (Oxford U P, 2000)
pp 7–8
Still, constipation remains a "major health problem". Gastroenterologists attribute chronic constipation's associated signs and symptoms to slow colon transit, to
irritable bowel syndrome Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a group of symptoms that commonly include abdominal pain, abdominal bloating, and changes in the consistency of bowel movements. These symptoms may ...
, to pelvic floor dysfunction—apparently a cause of
refractory In materials science, a refractory (or refractory material) is a material that is resistant to decomposition by heat or chemical attack and that retains its strength and rigidity at high temperatures. They are inorganic, non-metallic compound ...
constipation in
adolescent Adolescence () is a transitional stage of human physical and psychological development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majority). Adolescence is usually associated w ...
s, too—or to
obstructed defecation Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying ...
, which along with slow colon transit have remained incompletely understood. Individuals have varied complaints and try many remedies for signs and symptoms. Treating constipation, gastroenterologists' first line of intervention is now dietary—
whole food Whole foods are foods that are unprocessed and unrefined. Examples of whole foods include grains such as oatmeal and rice, fruits, vegetables, dried beans, nuts, seeds, unprocessed meats, and fish. Depending on the context this may sometimes refe ...
s, principally vegetables, fruits, and grains—or fiber supplements. Meanwhile, roles for lifestyle—exercise, mindset,
socioeconomic Economics () is a behavioral science that studies the Production (economics), production, distribution (economics), distribution, and Consumption (economics), consumption of goods and services. Economics focuses on the behaviour and interac ...
status—have been recognized,Whorton, ''Inner Hygiene'' (Oxford U P, 2000)
p 6
although some gastroenterologists as recently as 2012 have claimed that there is "no evidence" supporting a role for exercise. Some 15% to 30% of constipation patients exhibit slow colon transit, which
laxative Laxatives, purgatives, or aperients are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation. Laxatives vary as to how they work and the side effects they may have. Certain stimulant, lubri ...
s and medical drugs do not amend. Thus,
refractory In materials science, a refractory (or refractory material) is a material that is resistant to decomposition by heat or chemical attack and that retains its strength and rigidity at high temperatures. They are inorganic, non-metallic compound ...
constipation is sometimes treated surgically reportedly successfully, but sometimes successfully, or even worsening abdominal pain.


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'',Jorge, "Constipation" in ''Diseases of the Colon'' (Informa, 2007)
pp 118–19
exhibited by some 15% to 30% of constipation patients. By 1985, Lane's early article on surgical treatment of chronic constipation had become a classic, while physiologic testing and more accurate patient selection renewed interest in total colectomy with ileorectal anastomosis—that is, removing the entire
large intestine The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the Digestion, digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces befor ...
and joining the
small intestine The small intestine or small bowel is an organ (anatomy), organ in the human gastrointestinal tract, gastrointestinal tract where most of the #Absorption, absorption of nutrients from food takes place. It lies between the stomach and large intes ...
's outlet to the
rectum The rectum (: rectums or recta) is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. Before expulsion through the anus or cloaca, the rectum stores the feces temporarily. The adult ...
—to treat colonic inertia, Lane disease. 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.Jorge, "Constipation" in ''Diseases of the Colon'' (Informa, 2007)
p 117–18
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.


Relevance

Willie Lane was among the last surgeons of an era where one could master three specialties—
orthopaedic Orthopedic surgery or orthopedics ( alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
,
abdominal The abdomen (colloquially called the gut, belly, tummy, midriff, tucky, or stomach) is the front part of the torso between the thorax (chest) and pelvis in humans and in other vertebrates. The area occupied by the abdomen is called the abdominal ...
, and ear nose and throat—and some of his designed surgical instruments are still used today. Lane's introduction of the "no-touch technique", which permitted
aseptic Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...
surgery, is perhaps his greatest contribution to surgery. Even in the 21st century, particular descriptions by Lane "should be required reading by
orthopaedic Orthopedic surgery or orthopedics ( alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
surgeons". Lane's life ought to interest historians of medicine as well as believers in
holistic medicine Alternative medicine refers to practices that aim to achieve the healing effects of conventional medicine, but that typically lack biological plausibility, testability, repeatability, or supporting evidence of effectiveness. Such practices ar ...
. In his time, some thought Lane a genius, while others disagreed, including Sir Arthur Keith who claimed him not clever but carried by faith. In any event, Lane can be characterised as "a crusader, a perfectionist, and an extraordinarily talented surgeon".Dally, ''Fantasy Surgery'' (Rodopi, 1996)
p 88


Footnotes


References

* Bashford, H H
"Books of the day: Arbuthnot Lane"
''
Spectator ''Spectator'' or ''The Spectator'' may refer to: *Spectator sport, a sport that is characterized by the presence of spectators, or watchers, at its matches *Audience Publications Canada * '' The Hamilton Spectator'', a Hamilton, Ontario, Canada, ...
'', 25 Apr 1946, pp 16–17. * * Dally, Ann, ''Fantasy Surgery 1880–1930'' (Amsterdam & Atlanta GA: Rodopi B V, 1996). * González-Crussi, F, ''Carrying the Heart: Exploring the Worlds Within Us'' (New York: Kaplan Publishing, 2009). * Ingle, John I, ''PDQ Endodontics'', 2nd edn (Shelton CT: People's Medical Publishing House, 2009). * Mostofi, Seyed B, ed, ''Who's Who in Orthopedics'' (London:
Springer-Verlag Springer Science+Business Media, commonly known as Springer, is a German multinational publishing company of books, e-books and peer-reviewed journals in science, humanities, technical and medical (STM) publishing. Originally founded in 1842 in ...
, 2005)
"Sir William Arbuthnot Lane"
pp 183–86. * Nicolson, Juliet
''The Great Silence: Britain from the Shadow of the First World War to the Dawn of the Jazz Age''
(New York: Grove/Atlantic, 2009). * Noll, Richard, ''American Madness: The Rise and Fall of Dementia Praecox'' (Cambridge MA:
Harvard University Press Harvard University Press (HUP) is an academic publishing house established on January 13, 1913, as a division of Harvard University. It is a member of the Association of University Presses. Its director since 2017 is George Andreou. The pres ...
, 2011). * Pugh, Martin
''We Danced All Night: A Social History of Britain Between the Wars''
(London:
Bodley Head The Bodley Head is an English book publishing imprint of Penguin Random House. Founded in 1887 by John Lane and Elkin Mathews, The Bodley Head existed as an independent entity or as part of multiple consortia until it was acquired by Random ...
, 2008). * * Scull, Andrew, ''Madhouse: A Tragic Tale of Megalomania and Modern Medicine'' (New Haven:
Yale University Press Yale University Press is the university press of Yale University. It was founded in 1908 by George Parmly Day and Clarence Day, grandsons of Benjamin Day, and became a department of Yale University in 1961, but it remains financially and ope ...
, 2005). * Tauber, Alfred I & Leon Chernyak, ''Metchnikoff and the Origins of Immunology: From Metaphor to Theory'' (New York:
Oxford University Press Oxford University Press (OUP) is the publishing house of the University of Oxford. It is the largest university press in the world. Its first book was printed in Oxford in 1478, with the Press officially granted the legal right to print books ...
, 1991). * Whorton, James C, ''Inner Hygiene: Constipation and the Pursuit of Health in Modern Society'' (New York:
Oxford University Press Oxford University Press (OUP) is the publishing house of the University of Oxford. It is the largest university press in the world. Its first book was printed in Oxford in 1478, with the Press officially granted the legal right to print books ...
, 2000). * * Jorge, J Marcio N, ch 5 "Constipation—including sigmoidocele and rectocele", in ''Diseases of the Colon'' (New York: Informa Healthcare, 2007), D Wexner Steven & Neil Stollman, eds. * Wong, Shing W & David Z Lubowski, ch 15 "Surgical treatment of colonic inertia", in ''Constipation: Etiology, Evaluation and Management'', 2nd edn (London: Springer-Verlag, 2006), Steven D Wexner & Graeme S Duthie, eds.


External links

* * * {{DEFAULTSORT:Arbuthnot-Lane, William, Sir, 1st Bt 1856 births 1943 deaths Alternative detoxification promoters Alumni of the University of London Baronets in the Baronetage of the United Kingdom Companions of the Order of the Bath Diet food advocates Fellows of the Royal College of Surgeons of England Scottish surgeons Honorary medical staff at King Edward VII's Hospital for Officers