572 SCIENCE PROGRESS 



MEDICINE By R. M. Wilson, M.B., Ch.B. 



A New Law in Medicine. — ^The most interesting medical 

 announcement during the last few months has come from the 

 new cHnic established by Sir James Mackenzie at St. Andrews. 

 It will be recalled that Sir James retired from consulting 

 practice in London with the avowed object of devoting the 

 rest of his working life to the study of the early symptoms of 

 disease. He held that, so far as the study of disease in organs 

 is concerned, we have reached a point beyond which progress 

 must necessarily be very slow. On the other hand, he believed 

 that, before organs begin to break down under the stress of 

 disease, there is a period of infection or intoxication referable 

 to the whole system, but not definitely located. 



This is the period of early signs and symptoms. The 

 symptoms are present, but, because they are not yet referable 

 to any one system or organ, are largely discounted, with the 

 result that opportunities which can never recur are missed. 



Necessarily the study of this vast and vague field demands 

 tireless energy. A beginning, however, was made in certain 

 directions, notably in connection with pain experienced over the 

 heart. This form of pain had been related to disease of the 

 heart by many observers. Investigation, however, soon showed 

 that it is met with in young and apparently strong persons who 

 have no signs of heart disease and who present no symptoms of 

 heart failure. It was manifest, therefore, that, while the pain 

 could arise from actual disease of the organ, it could arise also 

 in the absence of organic disease. 



There was a problem here of great difficulty. Happily, some 

 progress towards its solution had been made by a previous 

 observation that pain is not located in an organ, but in the skin 

 and muscle covering the organ. This presupposes a nervous 

 connection between the organ lying deeply and the skin covering 

 it. In the case of a diseased organ, the skin expresses or 

 signals the difficulty experienced. Thus, when the possessor 

 of a diseased heart attempts effort, pain comes on at once, and 

 the skin of the left breast becomes tender to touch. 



We have in this picture three factors : an organ in distress ; 

 a nervous reflex arc connecting the organ with the surface ; 

 and, finally, the painful area of the skin. Clearly enough, 

 alteration of any one of these factors may produce disturbances 

 in the others. For example, strenuous exertion will cause the 

 heart to overwork, and so cause pain in a healthy man. A 

 smaller degree of exertion in the case of disease of the heart will 

 cause pain. There remains the third case — pain caused by a 

 small degree of exertion when the heart is healthy and the skin 

 area normal. 



