The great mass of the nation did not eat too much. Eightyfive per cent. of the workers ate just about what they needed to keep up their strength and vigour. . . . Sugar was of great importance. It was one of the most digestible of foods, and medical opinion was coming to the conclusion that 1 lb. of sugar a day was a desirable figure for every one in peace time.'

Thus the teaching and practice of fifty years are jettisoned.

As a last instance, there could be no better illustration of the fact that the successful introduction of a discovery in the medical world has been due to the personality, perseverance, and indomitable endeavours of the individual, generally in the face of dogged opposition, than the case of Sir James Mackenzie, the great heart specialist, whose life has just been published. Mackenzie began his career as a general practitioner at Burnley in Lancashire in the year 1879. He was impressed at the outset with the necessity for understanding the meaning of signs and symptoms in relation to the patient's future safety, a question not so much as mentioned in the great works on medicine in vogue at that time. He resolved, therefore, in 1883 or 1884, to begin a series of experiments for his own improvement, keeping two definite objects before him, viz. understanding (1) the mechanism of symptoms; (2) their prognostic significance.

A pathetic incident led him, almost unconsciously, to concentrate specially on the investigation of heart failure. Twenty years of patient clinical study, the collection and constant comparison of countless records,† and the exercise of his profound powers of reasoning, enabled him to arrive at conclusions which proved to be one of the most momentous discoveries of the age, in the field of medicine. The true nature of Heart Failure had never yet been understood by the specialist, and, at this time, 'irregularity' of the pulse, and 'murmurs' were invariably regarded as dangers, and the patient was forbidden all exercise, frequently relegated to long

* The Food and Nutritional Diseases of an Army,' Chadwick Lecture, delivered by Dr Woods Hutchinson at the Robert Barnes Hall, Wimpole Street, Nov. 14, 1917.

These records were made by means of clockwork instruments, viz. Dudgeon's Sphygmograph, Marey's Tambour,' and his own ink polygraph.

NE

I TO

periods in bed, and generally terrified into the belief that his heart was diseased, and his life in danger. The doctrine of 'Back Pressure' and 'Compensation' and other specious fallacies were taught with the utmost conviction in all the medical schools and accepted as 'articles of faith' by the whole profession. Mackenzie's investigations exploded these heresies, and afforded absolute proof that there were three kinds of pulse irregularities,' two of which were not dangerous at all; and also that 'murmurs' were not indicative of danger unless progressive.

The profession was, however, not eager to share his knowledge, and the great heart specialists in London were ready to dispute his findings. His first hearttracings he carried about from one physiologist to another; but they either could not, or would not, assist him in the interpretation of their meaning. He sent article after article to the leading medical Journals, announcing his methods, investigations, and discoveries; but they were invariably refused. He was only a general practitioner. It was clear that he would have to fight; therefore, in 1902, at the age of 49, he went behind the press and appealed to the public in a volume, which he entitled 'The Study of the Pulse.'

The pundits in London slumbered peacefully in their mantles of self-satisfaction; if they were to learn,' their instructor must come from Harley Street, from the College of Physicians, from the Laboratory, or the Hospital-not from the ranks of the general practitioner. Long before they opened their eyes, the book was recognised in America, in Germany, and other foreign countries. Within a short time he was known in Germany as the best of English physicians, and his methods were extensively employed. Invitations came to him to visit Canada, America, and the Continent, but never to visit London. Foreign physicians from America, Canada, France, Germany, Holland, and Scandinavia made pilgrimage to Burnley; but never a pundit from London. At length he deemed it his duty to move to the Metropolis; but still London stood cold, and there were many weary days of waiting. In his first year he earned 1147. At

*

* Sir William Osler was the solitary exception; but he was Canadian rather than English.

length, certain professional colleagues interested themselves and he became physician to several hospitals. In 1908 he published the greatest of his works, 'Diseases of the Heart,' which produced at once an overwhelming sensation and rapidly brought him to fame. His waitingrooms were filled to overflowing; he became the busiest man in London, perhaps in the world. Rewards were showered upon him-he found himself elected F.R.C.P., F.R.S., and a Knighthood soon followed these academic honours. His leap to fame was astonishing; yet, even so, he had sorrowfully to confess that he had failed to get the majority of members of his profession to realise the need for obtaining the kind of knowledge which his methods required. Yet the fact remains-it is his greatest memorial-that owing to his discoveries hundreds of thousands of heart cripples are to-day inspired with hope, who previously would have passed their days in anxiety and semi-torpor. In citing such instances of opposition to change, it must be made clear that we make no charge against the individual members of the profession; our unstinted admiration of them has been expressed on an earlier page. For some strange reason doctors and surgeons, in representative bodies, seem to lose the broad-minded humanity which they so amply display as individuals.

or

We now turn to the question of bonesetting. The bonesetter exists to-day because, for some reason other, the faculty have always set their face against acquiring knowledge in this definite department of surgery. They have been aware of the work of the bonesetter, and have advised students in a casual way 'to copy what is good in practice'; but that practice has never been officially investigated, or taught as part of the curriculum in the medical schools.

*

'On the part of the vast mass of practitioners, however, there is nothing but uninformed prejudice against the methods and the men who employ them, and a stupid refusal

* Sir James Paget, lecturing at St Bartholomew's Hospital, advised the students 'to copy what is good in the practice of Bonesetters.' He said: 'Few of you are likely to practise without having a bonesetter for an enemy, and if he can cure a case which you have failed to cure, his future may be made and yours marred.' Vide 'Modern Bonesetting for the Medical Profession,' by Frank Romer, M.R.C.S. (Eng.), p. 6.

to give the men who can instruct them, the opportunity of doing so.'

Dr. Romer tells us:

'During my student days, though we were taught the pathology of adhesions, and the possibility of their appearance in joints after injury, beyond the fact that the ensuing disability could be remedied by "breaking down," no instructions or information was vouchsafed as to the best way for setting about the act.' t

In 1871, Dr Wharton Hood had published in the 'Lancet 'a series of articles, describing, from person al observation, the methods used by Hutton, a bonesetter of world-wide reputation. These observations were embodied in two volumes, which, it is said, soon became widely known in the profession; but Dr Alexander Bryce in 1910 set forth incontrovertible arguments to show that there is still a hinterland in surgery comparatively unexplored in spite of Dr Wharton Hood's publication, which he stated had been almost forgotten, and his precepts neglected.' ‡

The medical correspondent of the 'Times' (Feb. 24, 1911) states:

'If Dr Wharton Hood had held an appointment in a London Hospital, and had done his work before students, it would long ago have been universally known and imitated by surgeons. But the actual teachers were not sufficiently prompt to acknowledge and welcome the work of a man who was not a member of their own body, and the students had no opportunity of seeing its value.'

Sir William Arbuthnot Lane, F.R.C.S., declares 'the bonesetter has profited by the inexperience of the profession and by the tendency which exists amongst its members of adhering blindly to creeds whose only claim to consideration is their antiquity.' In a lecture on 'Fractures' he also stated, 'The bonesetter flourishes because the surgeon is deficient in a certain knowledge.'

* Vide 'Bonesetting and the Faculty,' by Walter Whitehead, F.R.C.S. (Edin.), President of the British Medical Association, 1902. English Review,' June 1911.

† Vide Romer, Introductory, p. ix.

Mechano-Therapy in Disease,' by Dr Alexander Bryce, in the 'British Medical Journal,' Sept. 10, 1910.

474

Mr Steward, another leading surgeon, has said that 'the failure of the medical profession was due to & lack of the study of the conditions present, and of the methods used by the bonesetter.' The 'British Medical Journal' is fully aware of this undeveloped land' of surgery. A writer in the issue of Sept. 3, 1910, says:

'It (i.e. the "undeveloped land") comprises many methods of treatment which are scarcely taught at all in the schools, which find no place in the text-books, and which consequently "the superior person" passes with gown uplifted to avoid a touch that is deemed pollution. The superior person is, as has been more than once pointed out, one of the greatest obstacles to progress. The damage done to the profession by their neglect of things, which, if properly applied, hold within them large possibilities of usefulness for the relief of suffering, is very great. Rational medicine should take as its motto Molière's saying: "Je prends mon bien où je le trouve"; whatever can be used as a weapon in the warfare against disease belongs to it of right.

...

'These things, therefore, should not be dismissed with a foolish contempt; they should be studied, and the secret of whatever good there may be in them should be discovered. . . . The undeveloped land which rightly belongs to medicine should not be left to be cultivated by those not of the household of science.' *

So far as bonesetting is concerned, they have had an ever increasing body of evidence during the last two hundred and fifty years. The Hutton family resided in the North of England for upwards of two hundred years farming the land, and also acting as bonesetters for the benefit of their neighbours. Richard Hutton migrated to London and started as a professional at Wyndham Place, Crawford Street, and died there at the age of 70, on Jan. 6, 1871. Between the years 1863 to 1869, he was assisted by his nephew, Robert, who resided with him for that period, and then set up for himself. His fame spread all over the world and he amassed a large fortune. His successor was Atkinson, who opened

* In the Lancet' of November 1839, a reviewer of Dr Little's work observes: 'We have on more than one occasion seen that in England charlatans generally endeavour to appropriate to themselves certain operations and modes of treatment of diseases which have been, comparatively speaking, neglected by the regularly educated medical practitioner.'