STUDY OF DISEASE.

Otago Daily Times, Issue 19946, 13 November 1926, Page 26

STUDY OF DISEASE.

GREAT PHYSICIAN’S WORK. REVOLUTION OF METHODS. In January, 1925, there died at the little Scottish town of St. Andrews, which is famous as the headquarters of the Royal and ancient game of golf, and possesses the oldest golf course in the world, a remarkable man who achieved world-wide fame as a specialist in diseases of the heart, and after practising in London as a consultant among the giants of the profession left his lucrative practice and established at St. Andrews a medical research institute, for the purpose of studying diseases at their earliest stages with the help of the general practitioners of that town. This famous physician, Sir James Mackenzie, had preached in London the heterodox doctrine that the method of studying medicine, as practised in the hospitals and by the distinguished doctors who are at the head of the various branches of the profession is entirely wrong because attention is concentrated on the final stages of disease instead of on its initiatory stages. There are four stages ot disease —the predisposing stage, the early stage, the advanced' stage, and the final stage. But medical science, instead of being directed to the study of disease from the predisposing stage, begins at the end and tries to work backwards. “Ample provision has been made for the study of disease after it has killed its victim,”'said Sir James Mackenzie in the course of a lecture delivered to members of the profession in London. Provision has also been made on a generous scale for the study of the advanced stage, but the predisposing stage and the early stage are not adequately studied, and therefore the profession as a whole cannot foresee the approach of disease in a patient in time to ward it off. “If the conditions which predispose to. or provoke disease are to be recognised,” he said in the course of one of his lectures, “the investigator must have the opportunity for seeing the circumstances which led up to the invasion of the disease. It is manifest that neither the laboratory worker nor the hospital physician, who are the mainly concerned with research, has this opportunity. The early stages of disease are as a rule insidious and are indicated mainly by subjective sensations. The patient becoming .conscious that something is amiss with him, does not as a rule seek help from the hospital physician, but, from his family doctor. The bulk of patients in the early stage of disease are never seen by those who are systematically engaged in its investigation.”

“What,” he asked, “are the methods adopted to instruct students in the early* signs of disease? Ip the hospitals, where all instruction in clinical medicine is given, the patients in the early stages go to the out-patient departments. Common sense would say, therefore, where the signs of disease are the most difficult to make out, and the hope of cure is at its highest, the most experienced physicians should be employed, and that all the aids of the laboratory technique ■ would be at hand to help in the recognition of the disease. In no teaching institution is this ever done. Here instead is placed the youngest member of the staff, lacking in experience, ignorant of the meaning of signs, and incapable of eliciting them. He searches carefully for physical signs, and if there are no physical signs the patient is cither discharged with a bottle of physic or told to return from time to time until a physical sign is discovered; then, and not till then, is he sent to be under the cave of the skilled physician; then, and not till then, does he receive the assistance of laboratory methods in his examination. On the other hand, in the wards where disease has advanced so far as to produce physical or other demonstrable signs mostly easy of recognition, we have the trained physician, the research student, and all the paraphernalia of laboratory assistance.” This attack on the recognised methods of studying disease naturally annoyed the giants of the profession in London. It indicated that the future of medicine had little or nothing to expect from them, since the knowledge they were able to acquire by their methods concerned only late and hopeless stages of illness. It indicated that the way to study disease was to call in the aid of" the general practitioner, and to attend the _ outpatients’ department of the hospitals. No greater insult could be hurled at a consultant than to suggest that he does not know as much as a general practitioner, for there is a wide professional gulf between the rank and file of medicine in England and the great consultants with their I'ooms in Harley street. The consultant regards himself as the embodiment of scientific knowledge, and he has a great contempt for the “put-out-your tongue” diagnosis, which he contemptuously regards the sheet anchor of the general practitioner. Sir James Mackenzie began ms career as a general i raetitioner. and for many years after he had won fame on the Continent and America as the foremost authority in the world on diseases of the heart he was ignored in England by the giants in Harley street. The story of his career is told in Cornhill Magazine by Dr R. Macnair Wilson, who served under him when Sir James Mackenzie was plain Dr Mackenzie in general practice in the cotton manufacturing town of Burnley, in Lancashire. He began to specialise in diseases of the heart early in his career, after witnessing the death of a young mother in childbed from heart failure. He knew that medical science was not able to foresee danger in heart cases. He noted 11 the symptoms usually associated with heart trouble in the patients who came to him at Burnley, and he adopted a system of research based on keeping in constant contact with such patients, in order to see what happened to them. After he had collected a great deal of data he endeavoured to get the medical journals in England to take contributions from him on diseases ot the heart, but the editors of these papers, who belonged to the medical profession, could not be induced to take from a general practitioner articles which were at variance with i ccepted theories. In 100-, after he had been in practice at Burnley more than 20 years, he published a'book on the subject, “The Study of the Pulse,” which was soon translated into German, and it attracted a great deal ot attention among hading members ot the profession in Germany. In England it was ignored to a large extent because it was written by a general practitioner. Gradually his fame spread, but it spread more rapidly abroad than in England. Ho was better known abroad than any of the giants of the profession in England, but he was almost unknown in? his own country. Physicians from the United States, Canada, Germany, France, Holland, and Scandinavia visited Dr Mackenzie at Burnley in order to study his methods. When he was 54 years of age, and had been in practice in Burnley ,26 years, he decided to remove to London and set up in practice as a consultant, in the hope of obtaining an appointment at one of the great hospitals of the metropolis and making his methods more widely known among the younger members of the profession He was so completely ignored by the profession that in his first year in London he earned only £ll4. In the following year he published his famous book, “ Diseases of the Heart,” which was translated into German, French, and Italian. It made such a stir on the Continent that it became impossible for the big men in London to ignore him any longer. “ The great book fell among the giants like a live bomb,” writes Dr Macnair Wilson. “It was more than disturbing; it was devastating, overwhelming. Here was not merely a good account of diseases of the heart, but an exposition of diseases of that organ unknown to medical science. And not that only. Each disease was illustrated by dozens of tracings; each had been analysed and examined with the most amazing care. But these merits, great and signal as they were, I were not the book’s chief title to fame. Its chief title was its immediate practical utility. It afforded information which might be applied intelligently by any prac titioner, and which must enable him to foresee and discount danger. It was ihus a new and most powerful weapon placed in the hands of the common soldier of the nrofession.” Honours were showered upon Dr Mackenzie. “Within an incredibly short space f time the man of Burnley found hirnelf invited to become the sole head of a npeially created heart department at the London Hospital, to become a great teachei n a groat institution." writes Dr Macnair Wilson. “Ho found the entire resources ot this hospital, one of the most justly famous in the world, placed unreservedly at his disposal. Ho found himself elected eagerly a member of the Royal College of Physicians of London, after an e» «o«ination in which every possible facility wa* afforded I, itn of displaying to the full his matchless ■ knowledge. He learned that the Royal

Society—the moat illustrious scientific body of the British Empire, or indeed of the world —was about to bestow on him its coveted fellowship. So many honours of so pure a lustre had surely never befallen in so short a time to the lot of any physician. That a general practitioner, ..but yestcrd iy arrived from the provinces, should obtain them was amazing, incredible, unheard of.” But there was a comic feature in the situation. Dr Mackenzie thought that these honours were bestowed on him in recognition of the value of his method of studying disease. Ho thought he had converted the great consultants of Harleystrect to his view that disease must be studied in its beginnings, that is through. the general practitioner to ■ whom the patient goes for advice at the first symptoms of disease. But the big men of the profession thought that they were doing honour to a general practitioner, who by his great gifts had raised himself out of the rank and file, and reached the status of a consultant by the adoption of scientific methods of studying disease which they themselves employed. After the war ended Sir James Mackenzie —he was knighted in 1915—decided to put his method of studying disease into wider practice by establishing at St. Andrews a medical research institute, where with the co-opera-tion of the local doctors he could investigate the beginnings, of disease. Medical records of all patients who passed through the hands of the doctors at St. Andrews were filed at the institute. St. Andrews is a small town, and for generations most of the inhabitants have spent their whole lives there. Therefore, if the present generation continues in the footsteps of its forefathers, it will be possible to keep a continuous medical record of most of the patients from the time each first consulted a doctor. In this way it will be possible to learn ,a real deagl about the beginnings of disease, and its progress. Sir James Mackenzie successfully launched this great experiment, which has -ttracted the attention of the medical profession in all parts of the world, but did not live to see even the first fruits of his labour. This great specialist in diseases of the heart died of heart failure in January, 1925, at the age of 72.