Fantasy Surgery, 1880-1930: With Special Reference to Sir William Arbuthnot Lane (review)

The main subject of Fantasy Surgery is Sir Arbuthnot Lane, a turn-of-the-century British surgeon, and his fixation on the concepts of ptosis, intestinal stasis, and autointoxication. My problems with the book began early with Dally’s statement that “medical historians have tended to ignore Lane or to distort his interests, ideas and achievements” (p. 84). Considering his historical weight, Lane has not been neglected: he has had two book-length biographies (W. E. Tanner, Sir W. Arbuthnot Lane: His Life and Work [1946], and T. B. Layton, Sir William Arbuthnot Lane: An Enquiry into the Mind and Influence of a Surgeon [1956]) and a nice clinical assessment by J. L. Smith. ¹ There is also my offering, “Theory and Therapy: Ptosis, Stasis, and Autointoxication,” ² which is listed in Dally’s bibliography but not cited in the text. Modesty aside, my article could serve as a reasonable précis of this book. The two pieces share the same major historical threads and conclusions. As I moved through Dally’s book I was flattered that she found so many of my choice quotations also to her liking. The problem arose when I began finding my own sentences reproduced with scanty alterations; there are far too many copied passages with token paraphrasing and no attribution. ³ I have not attempted to determine if this applied to other authors as well.

Beyond the above, the book presents significant difficulties. In a number of passages, and with no citations, today’s medicine is indicted for the sins of Lane and his contemporaries. These remarks are often not merely judgmental but censorious. There is only lip sympathy for the foibles of humanity and the fact that physicians have always had to practice in relative ignorance. One example can catch the flavor of this. After concluding that Lane’s admirers and critics generally accepted his views on constipation (intestinal stasis), autointoxication, and the uselessness of the human colon, Dally writes: “This may seem odd and their deficiencies may seem ludicrously obvious, but in medicine, as in other areas, there are plenty of things just as illogical that most doctors believe or accept without question today” (p. 154).

There are lapses in Dally’s own logic. After stating that “a search of the literature has failed to reveal any writer who offered evidence . . . or even tried to explain why he believed” that ptosis could cause somatic or mental symptoms (p. 47), she lists various physicians for whom the mechanism of ptosis was malnourishment from liver disease, tight corsets, evolutionary changes associated with assuming an upright posture, and irregular bowel habits resulting in excessive ptomaines. As pointed out in the Bulletin article, there were valid new scientific observations that underpinned the theories of ptosis and autointoxication, such as X rays using contrast media that showed the stomach drooping into the pelvis, and the discovery of toxin-producing bacteria in the colon. Dally describes these but has no patience for the fact that, given the science of the time, these discoveries had a reasonable connection to stasis and autointoxication, which led to Lane’s surgical approach. At times she seems to understand that the social nature of science leads to error and correction, but when mistakes are made, she sees them as reprehensible. For Dally, as her title tells us, surgical practices that were later abandoned are better dismissed as fantastic.