The story of medicine through the history of transplant surgery
By Paul Craddock
Paul Craddock’s “Spare Parts: The Story of Medicine Through the History of Transplant Surgery” opens halfway through surgery, as a donor organ (“this lifeless gray matter,” as Craddock describes it) is sewn into place. Clamps released, the new kidney springs to life, or appears to do so. “Before my eyes, the surgeon removed these devices and within seconds the kidney turned from gray to pink and then almost red,” Craddock writes. “It seemed as if life itself had passed from one man’s body to another.” The surgery is described as state-of-the-art, but Craddock, a senior research associate in the department of surgery and interventional sciences at the University College of London’s medical school, wants to show the ancient roots of transplantation. “Transplant surgery is far from an exclusively modern phenomenon,” he writes, “with a surprisingly long and rich history dating back to the pyramids.”
And so we set off, on an exciting and often terrifying ride through transplantation and the theories and techniques that made it possible. It begins in Renaissance Italy, where the urge for rhinoplasty came not from kings, but from the general population, who had perfected skin grafts long before the European medical profession – as it was – was. (The “Sushruta Samhita,” a 500 BCE Sanskrit text that Craddock cites, described skin grafts and hundreds of other surgeries.) Craddock’s tantalizing opening claim is that late-16th-century specialists were only catching up with farmers, who long ago learned a way to transplant the skin from an arm to a nose, masking nasal bridge collapses caused by syphilis or duel mutilation, both common. “In Italy, skin grafting had evolved as a farming business, culturally and technically linked to the farmer’s procedure for grafting plants.”
The book is arranged chronologically by procedure: from that 16th-century skin graft to 17th-century blood transfusions to 18th-century tooth grafts. It jumps slightly over the 1800s (and the development of germ theory, anesthesia, and nursing) and ends with 20th-century kidney and heart transplants. Craddock explains the scientific theories underlying each new technique – and then he highlights a star, or several. In addition to nose repair, Leonardo Fioravanti claimed to have cured leprosy and discovered the antiseptic properties of aquavit and urine; in 16th-century Bologna, he urinated on patients (literally) while metaphorically urinating at a medical institution he saw as devoted to dying classical texts. As Craddock puts it, “Fioravanti preferred to base his own medical system on the collective, intuitive wisdom of the ages—a living tradition with no written component—as opposed to a set of dead knowledge learned from books.”
The prevailing text was by Galen of Pergamon, the first-century Greek philosopher, who was silent on skin grafts (Aristotle associated the body’s largest organ with the crust on a polenta), but famously described health in terms of the four body fluids: blood, yellow bile, phlegm, and black bile, whose flow was thought to be influenced by mood, personality, and the stars. Medicine was a matter of humoral balance, often regulated by bleeding. Galen’s anatomical descriptions, though still gospel in the 16th century, were hampered by a Roman rule against dissection of humans. When Andreas Vesalius, a Flemish anatomist, published “On the tissue of the human body” in 1543, based on his own dissection of corpses, it helped to emphasize the importance of scientific observation and to rethink the heart as pump-like. It also emphasized the idea that blood was better in the body than outside it — and inspired a slew of experiments that made life in Paris and London terrible for dogs. The heart was now seen as a ruler or king, “the seat and organ of all passions”, raising questions about dogs (“or a powerful Dog by often being newly filled with the blood of a coward Dog, maybe no longer tame”) and then people. In 1667, French doctors injected a man with calf’s blood, in part “to improve his character”. Sheep, docile in the Bible, were a go-to for human transfusion, though a butcher , administered by members of an English scientific society, annoyed doctors when he slaughtered and then ate his donor.By 1700, a vague professional decorum, heightened by public ridicule, halted the experiments.
The generally unsuccessful efforts to transplant teeth, Craddock argues, coincided with a vision of the body as a machine, complete with transferable parts — complicating the work of philosophers and enriching that of salespeople. Go to the dentist and offer advice (gargling with urine!) The new teeth were ultimately supplied by young and poor mouths: As Craddock points out, “the dystopian reality of body shopping has an obscure precedent in teeth.” The quest for what possessed the human machine also led to theories about nerves and their associated disorders that were found to primarily affect the more “educated” upper classes. The soul was bound to the body, ‘a material thing pulsating through it’.
Cut to 1901. Immunology is a new discipline, and the previous blood types—dog, cat, sheep, human—have evolved into our modern iteration, named by Viennese researcher Karl Landsteiner. In the same year, Alexis Carrel, a young French surgeon whose mother owned textile mills, studied with Marie-Anne Leroudier, one of Lyon’s best embroiderers (and one of the few women to be seen in ‘Spare Parts’). Leroudier’s dexterity at handling “unfathomably intricate” decaying substances taught the young surgeon how to sew blood vessels together, enabling kidney and heart transplants and bypass surgery, although her contributions were minimized by Carrel and most of western scientific history. After being drummed out of Europe, Carrel, whose experiments Dr. Making Frankenstein look like a genius Marcus Welby, in 1930s New York, where his passion for eugenics led him to befriend Charles Lindberg. Together, they would invent a perfusion device to keep an organ viable outside the body — all in the pursuit of removing the weak from society. Carrel’s book, “Man, the Unknown,” was an American bestseller in 1936; the German edition praised the Nazis’ eugenics work.
The first heart transplant surgeons were less health-oriented than price-oriented. As one physician put it: Virtually all patients subjected to the procedure died “after satisfying the macho aspirations of their surgeons.” Meanwhile, all the technical successes had more to do with medicine’s deeper common understanding of immunology — how to tackle organ rejection — than with surgical breakthroughs.
Craddock’s conclusion is hopeful: “According to colleagues at UCL in London, printing a complete replacement body part may only be a decade away.” But it doesn’t reassure the reader, especially given the case of Paolo Macchiarini, the UCL-affiliated celebrity surgeon (uncredited by Craddock) who was widely acclaimed for performing the world’s first synthetic trachea transplants using stem cells, but currently is being tried in Sweden for aggravated assault against his patients. What raises the most hope is what ultimately appears to be the accidental subtext of “Spare Parts.” It pertains to the way Renaissance Italian peasants saw themselves in trees: distinctly individual trees that, as Craddock points out, science has only recently become aware of, communicating with each other, not to mention us. If we look more closely at the forest, the past shows, we may be able to recover through the trees.