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  • History of the Treatment of Renal Failure by Dialysis
  • Steven J. Peitzman
J. Stewart Cameron . History of the Treatment of Renal Failure by Dialysis. Oxford: Oxford University Press, 2002. xiv + 353 pp. Ill. £49.95 (0-19-851547-2).

Himself a distinguished practitioner of nephrology in the United Kingdom, J. S. Cameron has compiled a comprehensive history of hemodialysis, or the "artificial kidney." As with others who have told this story more briefly, the author begins his account with the "vividiffusion" experiments of pharmacologist John Jacob Abel and colleagues Leonard Rowntree and Bernard Turner at Johns Hopkins University School of Medicine in the second decade of the twentieth century. Their device aimed more at the separation of solutes from the blood for research purposes than at the care of persons with failure of the kidneys, but this work established the feasibility of extracorporeal blood circulation through a [End Page 606] device centered on a semipermeable dialyzing membrane. There followed over the next several decades, mostly in Europe, scattered efforts to apply this principle to the removal of the toxic substances (exactly which ones are most deleterious remains unknown to this day) that accumulate in the blood and cells when the kidneys' excretory ability is impeded or eliminated by disease. Those somewhat familiar with this story will know the names of Willem Kolff of the Netherlands (and later the United States), Gordon Murray of Canada, and Nils Alwall of Sweden, each of whom during the 1940s independently, and seemingly unaware of the others, achieved at least technically successful—and occasionally life-saving—hemodialysis of patients. For reasons partly explored by Cameron, Kolff emerged as the "titular inventor" in a representative instance of "simultaneous invention."

The work of these three—two internists and one surgeon—"took." It made possible as routine applications the short-term replacement of kidney function for hospitalized patients suffering reversible renal failure (usually a consequence of some other illness or injury), and later the indefinite, repetitive treatments of individuals with permanent loss of that organ's activity—a number worldwide now approaching one million! This extraordinary form of medical care—the hemodialysis apparatus remains the only regularly deployed machine used to replace the function of a major organ—has become in the United States no small component of our medical-industrial-governmental alliance.

But even if all this rests most directly on the work of Alwall, Kolff, and Murray, there were precursors, and others toiling toward the same end contemporaneously with these three men. Dr. Cameron has taken extraordinary care to identify these obscure medical tinkerers in Europe and North America. Although the kidney (meaning the real one) is a remarkably subtle and complex organ, its primary function of removing from the body potentially toxic metabolic wastes can be replaced, at least clumsily, by a conceptually simple principle. This insight seemed to tantalize far-flung medical adventurers, most of whom had no idea that there were others out there with the same notion. Few of the earliest of these tinkerers worked at major medical schools or hospitals. A surprising number of them were of Jewish background, though the significance of this, if any, would be a matter of speculation. Clearly one of Cameron's objectives in creating this book was to document these largely forgotten men, to reveal and bear witness to their existence and their contributions, however fleeting and aborted some of their work may have been. Witness indeed: for Dr. Cameron deemed it essential to place in his volume a photograph or two of each of them, and it took some doing to obtain them (I even helped for an early Philadelphia pioneer). This represents a purpose, even a sort of mission, that will not seem compelling to most current readers of the Bulletin—yet it is so to an author who is a professional descendant, a member of a kind of family, whose strange ancestors in odd places persevered in sometimes very tough circumstances, doing work tinged with daring and folly.

Cameron's book, then, comprises mainly stories of incremental progress, however fitful, and of increasing technical competence, but it avoids adulation. He displays full familiarity with the ethical and economic questions raised...

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