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The Origins of Organ Transplantation

The Origins of Organ Transplantation: Surgery and Laboratory Science, 1880-1930

Thomas Schlich
Copyright Date: 2010
Edition: NED - New edition
Published by: Boydell and Brewer,
Pages: 365
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  • Book Info
    The Origins of Organ Transplantation
    Book Description:

    This book investigates a crucial-but forgotten-episode in the history of medicine. In it, Thomas Schlich systematically documents and analyzes the earliest clinical and experimental organ transplant surgeries. In so doing he lays open the historical origins of modern transplantation, offering a new and original analysis of its conceptual basis within a broader historical context. This first comprehensive account of the birth of modern transplant medicine examines how doctors and scientists between 1880 and 1930 developed the technology and rationale for performing surgical organ replacement within the epistemological and social context of experimental university medicine. The clinical application of organ replacement, however, met with formidable obstacles even as the procedure became more widely recognized. Schlich highlights various attempts to overcome these obstacles, including immunological explanations and new technologies of immune suppression, and documents the changes in surgical technique and research standards that led to the temporary abandonment of organ transplantation by the 1930s. Thomas Schlich is professor and Canada Research Chair in the History of Medicine at McGill University.

    eISBN: 978-1-58046-767-4
    Subjects: Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. List of Illustrations
    (pp. vii-viii)
  4. Acknowledgments
    (pp. ix-x)
  5. Part One: Introduction

    • Chapter One An Ancient Dream of Mankind? The Historicity of Organ Transplantation
      (pp. 3-13)

      A therapy “which aims at replacing the organ that has lost its function in the organism” is nothing to be made light of, the surgeon Otto Lanz warned his colleagues in 1894.¹ Today, no one would doubt the seriousness of a surgeon who treats a disease by replacing an organ. To us it seems self-evident that certain internal diseases result from the failure of a particular organ, and it makes sense to treat them by replacing that organ. This is why it may come as a surprise that before the 1880s no one had even dreamed of treating internal diseases...

    • Chapter Two What Is Special about Organ Transplantation?
      (pp. 14-20)

      The practice of transplanting living tissue was not limited to the transplantation of organs. Moving living tissue from one place to another was of interest in a number of different contexts. One of them was surgery. Being responsible for the treatment of wounds, surgeons had an inherent interest in the question of how to make separate parts of living organisms grow together.¹ They were also interested in the more specific question of whether living tissue was transplantable because transplants could be used to patch up injuries on the surface of the body, an approach that eventually became the domain of...

  6. Part Two: The Success of Organ Transplantation as a Concept

    • Chapter Three Before Organ Replacement: A Natural History Approach to Disease
      (pp. 23-30)

      When Theodor Kocher implanted fresh human thyroid tissue under the skin of a young man’s throat in July 1883, he performed the first organ transplant in today’s sense. It was an operation that generated “considerable general interest,” and “hence this issue never settled down again,” as an overview put it in 1919.¹ The thyroid gland became the paradigmatic organ of early transplant medicine. It provided the model for all further organ transplants, including the kidney. Until the early twentieth century, it was also the most common among organ transplants.² The redefinition of a class of disorders as thyroid insufficiency diseases...

    • Chapter Four The Invention of Organ Transplantation
      (pp. 31-46)

      The first organ transplant in 1883 was undertaken to reverse the undesirable consequences of a previous thyroidectomy. Theodor Kocher had introduced the practice of removing the whole organ—instead of the usual process of reducing the organ’s size by partial excision—in order to prevent the recurrence of goiter. Kocher had so perfected his surgical technique that he was able to remove the whole gland in a series of patients without having them die. He did not notice the consequences of the removals until later.

      Goiter was a serious medical problem. Before Kocher’s time, it was not uncommon for doctors...

    • Chapter Five Organotherapy and Organ Replacement
      (pp. 47-52)

      Theories about thyroid function had particularly gained plausibility toward the end of the nineteenth century. By then scientists had discovered that the gland secreted a physiologically active substance into the bloodstream—in other words, that it functioned through internal secretion. Until about 1900 the concept of organ replacement developed in tandem with the theory of internal secretion, and, at the time, organ replacement typically meant the replacement of an internal secretion. Thus the first organ transplants all concerned internal secretion glands and it was not until the early twentieth century that organ transplantation and the developing field of endocrinology diverged....

    • Chapter Six The Rise and Decline of Thyroid Transplantation
      (pp. 53-58)

      From 1890 on a whole series of reports was published on thyroid transplants. Many of them came from Great Britain; some also originated in France, Portugal, and Switzerland. The usual indication was myxedema, and the organs came mostly from sheep.¹ Most authors observed a positive effect on their patients but were usually not in a position to decide whether the results stemmed from the resorption of the thyroid fluid contained in the transplant or to a genuine survival and functioning of the transplanted tissue.

      In 1892, Von Eiselsberg, who could look back upon his experimental autotransplants of feline thyroids, operated...

    • Chapter Seven The Discovery of a New Organ: The Parathyroid Gland
      (pp. 59-64)

      The parathyroid gland was only discovered as an anatomically and functionally distinct organ through resection and transplant experiments in animals. Tetany, the specific symptom associated with the failure of the parathyroid, had often been observed after goiter operations and experimental thyroid removals, but since no one knew this organ existed, many researchers attributed tetany to the removal of the thyroid gland itself. Especially after experimental thyroid removal in animals, tetany was the first and predominant symptom.¹Cachexia strumipriva, the long-term side effect of total thyroidectomy that Kocher observed, was sometimes even overlooked because tetany was so much more dramatic.² If...

    • Chapter Eight Laboratory and Clinic: Organ Replacement for Diabetes
      (pp. 65-77)

      Next to the thyroid gland, the pancreas was the other organ that demonstrated the importance of organ replacement to doctors and scientists at the turn of the twentieth century.¹ Before diabetes was associated with the pancreas, it was as much of a mystery as cretinism and myxedema had been. The disease entity of diabetes, however, was older and more clearly defined than the thyroid diseases. Its definition was based on the leading symptom, the presence of glucose in the urine (glycosuria), which gave the description of diabetes a continuity that can be traced back to antiquity. In the 1880s the...

    • Chapter Nine The Many Uses of the Adrenal Gland
      (pp. 78-84)

      The adrenal gland had been associated with a specific disease entity by the British doctor Thomas Addison as early as 1855. Using the approach typical for medical science in his day, Addison combined clinical with anatom-ico-pathological observations. The disease he described was characterized by anemia, overall weakness, and a bronze-colored darkening of the skin. In autopsies he observed that patients with this set of symptoms exhibited lesions of the adrenal gland after death. Addison therefore made the organ damage responsible for the clinical picture.¹

      Physiologists soon began to generate this clinical picture artificially by purposely destroying the adrenal glands in...

    • Chapter Ten Reconstructing Women: Ovarian Transplants
      (pp. 85-98)

      As in the case of the thyroid, transplantation of the ovaries was preceded by its opposite: their removal. Removing the ovaries from their intra-abdominal location had only become possible through the general expansion of surgery into the body cavity.¹ It was not before the 1870s that surgeons were able to remove ovaries safely even for the treatment of tumors. Subsequently, the removal of the healthy organs became a relatively common, though not undisputed, operation. Indications for the total removal of the ovaries, even if they showed no signs of pathology, consisted of a number of different health problems that were...

    • Chapter Eleven Rejuvenating Men: Testicle Transplants
      (pp. 99-115)

      The conspicuous phenomena observed in humans and animals after castration had long suggested that the reproductive glands had an important influence on the organism’s structure and function. It was therefore no coincidence that Brown-Séquard’s organotherapy started with the testicles. By administering testicular extract to improve physical strength and intellectual alertness, the scientist based his treatments on ideas generally accepted at the time about male sex glands. Eunuchs and castrati displayed what were considered mental and physical deficiencies that went beyond sexuality alone, and common opinion held that the loss of sperm caused a debilitation of the entire organism, especially of...

    • Chapter Twelve One Principle, Multiple Applications: Further Organs
      (pp. 116-121)

      The pituitary gland first attracted notice as a potentially transplantable gland when doctors found it enlarged after thyroid extirpation. Using the model of other glands, physiologists began probing into pituitary gland function with the help of extirpation experiments in the 1880s.¹ Victor Horsley, for instance, carried out experimental ablations of this organ in 1886,² and Eugène Gley destroyed pituitary glands experimentally in rabbits in 1891.³ Some researchers observed symptoms after pituitary gland removal that were similar to those after thyroidectomy. Because of the technical difficulties associated with the organ’s complete removal, however, the experiments were not, at the time, very...

    • Chapter Thirteen From Special Case to Prototype: The Kidney
      (pp. 122-132)

      Kidney transplantation is of particular interest from today’s perspective because it was with the kidney that organ transplantation resumed after 1945. In the early phase of transplant surgery, however, kidney transplants were an exception, because most transplants were done with organs of internal secretion. Like the adrenal gland, the kidney was one of the organs that had already been associated with a specific clinical picture in the context of pathological anatomy in the first half of the nineteenth century. When Richard Bright described an organ disease of the kidney for the first time in 1827, the combination of clinical observations...

    • Chapter Fourteen Ethical Problems with Organ Transplantation
      (pp. 133-145)

      From the start, organ transplantation was associated with questions and problems that went beyond the immediate scientific and medical domain. As a scientific and surgical practice it involved the values, norms, and cultural ideas of doctors, patients, and society. How closely scientific subjects were interrelated with subjects outside the scientific field shows in the fact that, implicitly or explicitly, doctors and scientists concerned themselves with ethical issues even in their professional articles. Some of the problems still connected to organ transplantation today were already being brought up in medical-scientific literature between the 1880s and 1930s, though not usually in relation...

    • Chapter Fifteen Laboratory and Clinic: The Epistemic and Social Context
      (pp. 146-162)

      It was no coincidence that organ transplantation was invented in the late nineteenth century. Its underlying disease concept and its therapeutic approach are representative of a contemporary type of medicine that was trying to base its practice on knowledge derived from experimental physiology. This type of medicine arose in the research universities of the second half of the nineteenth century and remained predominant until the first half of the twentieth. The importance of this context becomes evident in the fact that the first attempts at isolating specific organ functions—Berthold’s transplantation experiments in 1849, Brown-Séquard’s ablation experiments with adrenal glands...

  7. Part Three: The Failure of Organ Transplantation in Practice

    • Chapter Sixteen Methods of Monitoring the Success of Transplants
      (pp. 165-182)

      Organ transplantation was eventually abandoned because doctors and scientists gradually became convinced that allogenic and xenogenic transplantations usually do not work. From today’s perspective, the question arises how it was even possible, at a time when immunosuppression did not exist, that so many organ transplantations were carried out in the first place. One wonders whether doctors noticed that their transplantations were not working, which leads to the more general question of how surgeons could tell whether a transplantation was successful or not. The criteria used for answering this question shifted in the course of the several decades during which surgeons...

    • Chapter Seventeen Disillusionment: The Clinical Failure of Organ Transplantation
      (pp. 183-192)

      The development and establishment of the organ replacement concept had been completed by about 1900. Determining whether organ replacement made sense had by now become less and less of a concern. Its validity had been established as a scientific fact, particularly in connection with internal secretions, and no longer needed proving. Organ transplantation was now considered an ideal therapy. The only remaining hitch was in its practical application,¹ but even this problem did not affect the validity of the underlying rationale, as Heinrich Bircher emphasized in 1890.² Replacing a deficient organ was, as Kocher wrote in 1908, the “obvious” thing...

    • Chapter Eighteen The Strategy of Technical Perfection
      (pp. 193-206)

      Until about World War I, the main strategy for making allotransplantation viable focused on surgical technique.¹ As Payr put it in 1906, “The circumstances that have to concur favorably are so numerous in their nature and in part probably still unknown that everyone has to be content with a certain percentage of successful cases. However, I maintain that with enhanced technique the results will improve.”² Surgeons therefore emphasized the necessity for perfect surgical conditions, such as asepsis. They also tried to find the best implantation sites for their transplants; to provide better conditions for blood supply, either by opening up...

    • Chapter Nineteen A New Direction: Transplant Immunology
      (pp. 207-223)

      Although most allotransplantations done between the 1880s and the 1930s failed, the fact that some of them seemed successful led many surgeons to look for ways of making them work.¹ As described in the previous chapter, surgeons first tried to improve surgical technique. Obviously factors such as blood supply, variations in transplantability of different tissues, and the technical details of transplant removal, interim storage, and implantation all had an influence on the outcome of an allotransplant.² Many surgeons thought that their transplants died because of infections or from blood clots in the vascular linkups or within the transplanted organs themselves.³...

    • Chapter Twenty Chance or Necessity: A Fresh Start for Organ Transplantation
      (pp. 224-229)

      As shown in the preceding chapters, the question of organ transplantation had narrowed down to the control of allotransplant rejection since the time of World War I. Ultimately, it was because of this problem that organ transplantation was generally abandoned. By the 1930s, practitioners in all related disciplines and fields of research—surgery, cancer research, biology—had lost interest in further investigating the immunological problems posed by transplants. Each group had its own particular reasons. Basic scientists lacked experimental methods that would make working on such complex problems a promising topic;¹ surgeons saw no means of applying the new research...

    • Chapter Twenty-One Summary and Conclusion
      (pp. 230-240)

      Virtually no one today would question the use of organ transplants to treat diseases. As universal as the concept might appear to us, however, transplant medicine in both theory and practice did not develop until the period between 1880 and 1930, and it did so only because of particular conditions in knowledge, technology, and society at the time. The history of the development of transplant medicine can be divided into two contrasting categories: the first is the emergence and dissemination of the concept of organ replacement; the second is the concept’s practical application. As a concept, organ replacement was a...

  8. Abbreviations
    (pp. 241-242)
  9. Notes
    (pp. 243-310)
  10. Bibliography
    (pp. 311-340)
  11. Index
    (pp. 341-356)
  12. Back Matter
    (pp. 357-357)