The Transplantation of the Kidney

HiSTORICAL. SINCE ancient times the replacement of a diseased organ of one individual wvith a healthy organ from another has been a surgical dream. In ancient Egypt (3500 B.C.) and ancient India (200 B.C.) the repair of noses destroyed by syphilis or mutilation was frequently attempted with pedicle skin grafts. This art spread to Arabia, Greece, and finally to Ronme, where it was practised by Celsus (58 B.C.-A.D. 7) and Galen (A.D. 138-201). The art was lost during the Dark and Middle Ages and was not practised again until the fifteenth and sixteenth century. In the meantime it was still being used in India and was introduced into England in the early nineteenth century by the East India Company. During the late nineteenth century the free grafting of skin, bone, fat, and other tissues became popular and some of the early pioneers, Wolfe, Thiersch, and Reverdin, are remembered today by the type of graft which bear their names. Homografts, that is grafts between different individuals of the same species, wkvere slower in developing and do not appear to have been practised in ancient times. Two early paintings by Mantegna and Chirlandajo depict the Patron Saints of Surgery, St. Comos and St. Damian, transplanting a leg from one individual to another. John Hunter performed manv autoand homo-transplantation experiments and had quite a clinical practice in homotransplanting teeth (Palmer, 1935). In the seventeenith centurv Von Mackren repaired a cranial defect in man wvith bonc from a dog; however, he had to remove it again because the Church considered that it was "marring God's image of man." It was not until the b)eginning of the twentieth century that transplantation of organs, as distinct from tissues, was first attempted. Since then many tissues and organs have been autoand homo-transplanited with varying results and often enthusiastic claims. These historical aspects have been comprehensively reviewed by Fomon (1939), Maltz (1946), andl Woodruff (1960).