A Medical History of Transplant Surgery That’s Not for the Squeamish

SPARE PARTS
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 midoperation, as a donor organ (“this lifeless gray mass,” as Craddock describes it) is sewn into place. Clamps released, the new kidney comes alive, or appears to. “Before my eyes, the surgeon removed these devices and in a matter of seconds the kidney turned from gray to pink, then almost red,” Craddock writes. “It seemed as if life itself had cascaded from one man’s body into another’s.” The operation is described as state of the art, yet Craddock, a senior research associate in the division of surgery and interventional sciences at the University College of London’s medical school, sets out 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 that stretches back as far as the pyramids.”

And so we are off, on a thrilling and often terrifying ride through transplantation and the theories and techniques that made it possible. It begins in Renaissance Italy, where the push for rhinoplasty came not from kings but from the general population, who had perfected skin grafts long before the European medical profession – such as it was. (The “Sushruta Samhita,” a 500 BC Sanskrit text that Craddock cites, described skin grafts, among hundreds of other surgeries.) Craddock’s tantalizing opening assertion is that late-16th-century specialists were merely catching up with farmers, who had long ago learned a way to graft skin from an arm to a nose, masking nasal bridge collapses caused by syphilis or mutilation from duels, both common. “In Italy, skin grafting had evolved as a peasant’s operation, linked culturally and technically to the farmer’s procedure of plant grafting.”

The book is arranged chronologically by procedure: from that 16th-century skin grafting to 17th-century blood transfusions to 18th-century tooth transplants. It skips lightly over the 1800s (and the development of germ theory, anesthesia and nursing) and winds up 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 attributes of aquavit and urine; in 16th-century Bologna, he urinated on patients (literally) while metaphorically urinating on a medical establishment he saw as devoted to moribund classical texts. As Craddock puts it, “Fioravanti preferred to base his own medical system on the collective, intuitive wisdom of centuries – a live tradition with no written component – as opposed to a raft of dead, book-learned knowledge.”

The reigning such text was by Galen of Pergamon, the first-century Greek philosopher, who was silent on skin grafts (Aristotle related the body’s largest organ to the crust on a polenta) but famously described health in terms of the four humors – blood, yellow bile, phlegm and black bile, the flow of which was thought to be affected 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 Fabric of the Human Body” in 1543, based on his own dissection of corpses, it helped to highlight the importance of scientific observation and to reconceive the heart as pumplike. It also stressed the idea that blood was better inside the body than out – inspiring a slew of experiments that made life in Paris and London horrible for dogs. The heart was now perceived as a ruler or king, “the seat and organ of all passions,” prompting questions about dogs (“whether a fierce Dog by being often new stocked with the blood of a cowardly Dog, may not be more tame ”) and then humans. In 1667, French doctors infused 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, infused by members of an English scientific society, irritated doctors when he slaughtered and then ate his donor. By 1700, a faint professional decorum, fortified by public ridicule, shut the experiments down.

The generally unsuccessful attempts to transplant teeth, Craddock argues, coincided with a view of the body as a machine, complete with transferable parts – complicating the work of philosophers, and enriching that of salespeople. Enter the dentist, offering advice (gargle with urine!) And private tooth transplants to fancy customers put off by public tooth-yankers. The new teeth were eventually supplied by young and poor mouths: As Craddock points out, “the dystopian reality of body shopping has a dark precedent in teeth.” The search for what animated the human machine also led to theories on nerves and the associated disorders observed to particularly affect the more “developed” upper classes. The soul was body-bound, “a material thing that pulsed 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 the Viennese researcher Karl Landsteiner. In the same year, Alexis Carrel, a young French surgeon whose mother owned textile factories, studied with Marie-Anne Leroudier, one of Lyon’s finest embroiderers (and one of very few women featured in “Spare Parts”). Leroudier’s dexterity in handling “unfathomable intricate” decaying fabrics taught the young surgeon how to stitch together blood vessels, making kidney and heart transplants as well as bypass surgery possible, though her contributions were minimized by Carrel and the bulk of Western scientific history. After being drummed out of Europe, Carrel, whose experiments make Dr. Frankenstein look like a genius Marcus Welby, landed in 1930s New York, where his passion for eugenics earned him the friendship of Charles Lindberg. Together, they would invent a perfusion device to keep an organ viable outside the body – all in the pursuit of weeding the weak from society. Carrel’s book, “Man, the Unknown,” was a US best seller in 1936; the German edition praised the Nazis’ eugenics work.

The first heart transplant surgeons were less health- than prize-oriented. As one doctor put it: Virtually all the patients subject to the procedure died, “having satisfied the macho aspirations of their surgeons.” Meanwhile, any technical successes had more to do with medicine’s deeper communal understanding of immunology – how to address organ rejection – than with surgical breakthroughs.

Craddock’s conclusion is meant to feel hopeful: “According to colleagues at UCL in London, printing an entire replacement body part might only be a decade away.” But it doesn’t reassure so much as concern a reader, especially given the case of Paolo Macchiarini, the UCL-affiliated celebrity surgeon (unmentioned by Craddock) widely lauded for performing the world’s first synthetic trachea transplants using stem cells but currently on trial in Sweden for aggravated assault against his patients. In fact, what inspires most hope is what ends up seeming like the accidental subtext of “Spare Parts.” It relates to the way Renaissance Italian farmers saw themselves in trees: distinctly individual trees that, as Craddock notes, science has only recently become aware are in communication with one another, not to mention us. If we look more carefully at the forest, the past indicates, we just might repair ourselves through the trees.

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