William Arbuthnot Lane contributed to the advancement of many fields of orthopedics, otolaryngology, and general surgery. He is credited for his  no-touch technique  and the invention of long-handled instruments, some of which are still in use today, to minimize tissue handling. He is most well known for his hypothesis that slowing of gastric contents could cause a variety of ailments and this became known as Lane\u27s disease. Although his surgical treatment of Lane\u27s disease is now defunct, it advanced the surgical technique in colorectal surgery. It seems likely that some of Lane\u27s  autointoxication  patients would be classified today as patients with colonic inertia, diverticulitis, colonic volvulus, and megacolon or, which are all treated with colectomy. Lane was a pioneer in multiple fields and a true general surgeon. He advanced colorectal surgery immensely and propelled the field of surgery into a new era

Cowan, Scott W.

Morris, Mackenzie

Phillips, Benjamin

Price, Thea

Yeo, Charles J.

English

William Arbuthnot Lane contributed to the advancement of many fields of orthopedics, otolaryngology, and general surgery. He is credited for his \u22no-touch technique\u22 and the invention of long-handled instruments, some of which are still in use today, to minimize tissue handling. He is most well known for his hypothesis that slowing of gastric contents could cause a variety of ailments and this became known as Lane\u27s disease. Although his surgical treatment of Lane\u27s disease is now defunct, it advanced the surgical technique in colorectal surgery. It seems likely that some of Lane\u27s \u22autointoxication\u22 patients would be classified today as patients with colonic inertia, diverticulitis, colonic volvulus, and megacolon or, which are all treated with colectomy. Lane was a pioneer in multiple fields and a true general surgeon. He advanced colorectal surgery immensely and propelled the field of surgery into a new era

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William Arbuthnot Lane (1856-1943): Surgical Innovator and His Theory of Autointoxication.

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Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Surgery, Gibbon Society HistoricalProfiles Department of Surgery1-2017William Arbuthnot Lane (1856-1943): SurgicalInnovator and His Theory of Autointoxication.Mackenzie MorrisThomas Jefferson UniversityThea PriceThomas Jefferson University, Thea.price@jefferson.eduScott W. CowanThomas Jefferson University, Scott.Cowan@jefferson.eduCharles J. YeoThomas Jefferson University, Charles.Yeo@jefferson.eduBenjamin PhillipsThomas Jefferson University, benjamin.phillips@jefferson.eduLet us know how access to this document benefits youFollow this and additional works at: http://jdc.jefferson.edu/gibbonsocietyprofilesPart of the History of Science, Technology, and Medicine Commons, and the Surgery CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inDepartment of Surgery, Gibbon Society Historical Profiles by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationMorris, Mackenzie; Price, Thea; Cowan, Scott W.; Yeo, Charles J.; and Phillips, Benjamin, "WilliamArbuthnot Lane (1856-1943): Surgical Innovator and His Theory of Autointoxication." (2017).Department of Surgery, Gibbon Society Historical Profiles. Paper 48.http://jdc.jefferson.edu/gibbonsocietyprofiles/48Surgical HistoryWilliam Arbuthnot Lane (1856–1943): SurgicalInnovator and His Theory of AutointoxicationMACKENZIE MORRIS, M.D., THEA PRICE, M.D., SCOTT W. COWAN, M.D., CHARLES J. YEO, M.D.,BENJAMIN PHILLIPS, M.D.From Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals,Philadelphia, PennsylvaniaWilliam Arbuthnot Lane contributed to the advancement of many fields of orthopedics, otolar-yngology, and general surgery. He is credited for his “no-touch technique” and the invention oflong-handled instruments, some of which are still in use today, to minimize tissue handling. He ismost well known for his hypothesis that slowing of gastric contents could cause a variety ofailments and this became known as Lane’s disease. Although his surgical treatment of Lane’sdisease is now defunct, it advanced the surgical technique in colorectal surgery. It seems likelythat some of Lane’s “autointoxication” patients would be classified today as patients with colonicinertia, diverticulitis, colonic volvulus, and megacolon or, which are all treated with colectomy.Lane was a pioneer in multiple fields and a true general surgeon. He advanced colorectal surgeryimmensely and propelled the field of surgery into a new era.W ILLIAM ARBUTHNOT LANE was born on July 4,1856 in Inverness, Scotland (Fig. 1). He wasdestined to follow in his father’s footsteps as a dis-tinguished military surgeon. Over the course of hislifetime, Lane made major contributions to the field ofgeneral and colorectal surgery and the surgical tech-niques he developed are still in use today.For most of his early life, William Lane wasgroomed for surgery as he traveled alongside his fatherto military medical stations throughout Europe. At just16 years of age, Lane’s medical education officiallycommenced at Guy’s Hospital (London, England).After earning a Master of Surgery degree at the Uni-versity of London, Lane worked as a skeletal anato-mist, researching skeletal function and the impact ofoccupation on bone structure.1 He was an accom-plished author on the topic of middle ear disease andwas one of the first to surgically explore the mastoidantrum.2 In 1905, Lane published a book on cleftpalate management advocating early repair allowingthe child relatively normal growth and increasedfunction.2 He is also credited for a landmark operationin which he resected an esophageal carcinoma, whichpurportedly served as an inspiration for William Trotter’ssurgical resection of pharyngeal carcinomas.2 Lane de-veloped several operative instruments, some of which arestill in use today. His “no-touch technique” involving thecreation of long handled instruments to keep glovedhands off of tissue, is considered by some as his greatestcontribution to the field of surgery.The latter years of Lane’s career focused largely onthe concept of “intestinal autointoxication.” Lane hy-pothesized that the colon was used solely to store wasteand regulate elimination during fight-or-flight situa-tions.1 He believed the evolution of quadruped pri-mates into biped Homo sapiens complicated thismechanism. The stress of the upright human on thetransverse colon combined with the simple force ofgravity slowed transit. These stresses resulted in theformation of bands, most notably Lane’s band at theterminal ileum. Lane hypothesized that these bandscaused intestinal stasis with local changes in bowelflora resulting in systemic sequelae including gastriccancer, atheromatous plaque formation, duodenal ul-cers, pancreatitis, cancer, and gallstones. Lane believedthat the absorption of these intestinal toxins had de-generative effects on many major organ systems andcould cause mental disorders, going as far as stating thattuberculosis and rheumatoid arthritis could only exist ina person who was inflicted with autointoxication.1After Lane proposed his theory of intestinal stasis,a test of this hypothesis was necessary—the colec-tomy. In this series of surgical experiments, Lane re-moved sections of the colon with seeming resolutionof symptoms. In 1908, Lane published an article inthe British Medical Journal titled, “Remarks on theAddress correspondence and reprint requests to Scott W.Cowan, M.D., 1025 Walnut Street, Suite 607, Philadelphia, PA19107. E-mail: scott.cowan@jefferson.edu.1Operative Treatment of Chronic Constipation.”3 Thisarticle described cases in which total or partial colec-tomy was used to treat patients with “intestinal auto-intoxication.” Originally, the procedure was only usedfor pain, but after recognizing the “immense advan-tages” which his patients received, he began performingcolectomies in patients where “pain was not necessarilysuch a marked feature, but where life was becominga burden through the misery and distress induced byautointoxication and its results.”4 He remarked on theabrupt change in his patients after surgery. Thirty-ninecases were contained in the series, and he describedgreat improvement, noting many patients’ claimed thatthey “felt the best they have in years.”3Total colectomy, ileosigmoidostomy, and other var-iations of colon resection quickly spread in popularitythroughout Europe and the United States. The overallmortality of the procedures during this time is notknown with certainty, however, Lane is said to havehad a lower mortality rate when compared with the16.5 per cent that was reported as the overall mortalityrate of Guy’s Hospital.5 American surgeons were in-trigued by the operation for intestinal stasis, or “Lane’sdisease” as some called it, and invited Lane to speak atthe International Congress in New York in 1911. Lanerecalls that his talk received “perhaps the greatestovation he ever had.”1Although his ideas held perhaps some scientificbasis and had various supporters, others criticized thetheory as “total nonsense.”1 One of Lane’s biggestcritics, Arthur F. Hurst, remarked that the offendingorganisms and their toxins may produce disease, butthe liver must filter these organisms, thus concludingthat “autointoxication” is more of a hepatic illness.1Dr. Hurst remarked that he only wavered in his op-position to Lane and his ideas when asked to see twospecific patients with miraculous resolution of systemicillnesses after surgery. However, after one patient’ssymptoms returned, Hurst ultimately opposed Lane’sideas entirely.1, 6 Another contemporary, AnthonyBassler, published an article condemning Lane.7 Hebelieved that colectomy was only warranted forobstruction and that the relief experienced by Lane’spatients was a placebo effect. He also highlighted thehigh percentage of patients who had a recurrence ofsymptoms years later.7 Further observations failed tovalidate autointoxication.By 1915, the theory of intestinal stasis and autointox-ication had waned. Ten years later, the routine surgicaltreatment of intestinal stasis was a thing of the past.Guy’s Hospital was only performing about one case peryear, and it was no longer performed at the Mayo Clinicnor at other hospitals in the United States. AlthoughLane’s theory of intestinal stasis and its surgical repairwere no longer accepted, its lasting legacy is the per-fection of his techniques for safe colorectal surgery,particularly the ileocolic and ileorectal anastomoses.8At the end of his career, Lane was satisfied with thesuccess of his operative treatment for Lane’s diseasedespite frequent failures. He believed these successesproved his theory, and that the disease could be pre-vented by certain habits. He became interested in theimpact that roughage had on intestinal stasis. Hefounded the New Health Society, toured Europe, andgave lectures about the benefits of fruits, vegetables,sunshine, and exercise. The medical community, es-pecially the British Medical Association, resisted hisideas. However, this did not deter Dr. Lane and his firmbelief in autointoxication led to his eventual resigna-tion from the British Medical Association in 1924.1Lane’s tireless efforts ultimately served to advance thefield of colorectal surgery immeasurably, and indeedhis improvisation and curiosity propelled all of surgeryinto a new era.1REFERENCES1. William E T. Sir Arbuthnot Lane, Bart., C.B., M.S., F.R.C.S.:His Life and Work. London: Balliere, Tyndall and Cox, 1946.2. Jones AR. Sir William Arbuthnot Lane. J Bone Joint Surg1952;34:478–82.3. Lane WA. Results of the operative treatment of chronicconstipation. BMJ 1908;1:126.4. Lane WA. Chronic intestinal stasis: what are the indicationsfor operative interference. Lancet 1919;193:333–4.5. Smith JL. Sir Arbuthnot Lane, chronic intestinal stasis, andautointoxication. Ann Intern Med 1982;96:365–9.6. Hurst, AF. Discussion on the after-results of colectomy(partial and complete) performed for colon stasis. Proc R Soc Med1922; 15(Surg Sect): 61–66.7. Bassler A. Discussion of the surgical theories of intestinalstasis. JAMA 63;7:1914.8. Lane Wm. Arbuthnot. The operative technique of ileocolos-tomy and of colectomy. Br J Surg 1914;2:599–608.FIG. 1. Alexander Bassano. (Photographer). Sir (William)Arbuthnot Lane, 1st Baronet 1938. National Portrait Gallery. Web.July 1, 2015.THE AMERICAN SURGEON January 20172 Vol. 83

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William Arbuthnot Lane (1856-1943): Surgical Innovator and His Theory of Autointoxication.

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