Borrowing Life

Spare parts surgery

The giving and taking of organs

When first kidney transplant

1954 December

youngest person to be named Mosley Professor of Surgery at Harvard

Franny Moore

Peter worked in military 1944

Valley Forge Military Hospital, Phoenixville, PN

How much fuel delivered

28,000 gallons to Flying Tigers

Flying the Hump

Kurmitola, India to Lyuliang, China - 500 miles over Himalayas

Coconut Grove Fire, Boston

One of worst civilian disasters in history

How did fire

1,000 ppl, flammable curtains, overcrowded

How many died in fire

400+ ppl

Carbon monoxide poisoning

Cherry pink blood, dyes led to similar to mustard gas poisoning

How most died

Suffocation, sitting rigid at tables

Immediate danger to Charles

Suffocation, swelling burned airway— used tubes

Second danger to Charles

70% skin burned - fluid loss and INFECTION

Allograft - Autograft

Taking skin from someone else - skin from yourself to treat burns

How long to reject allograft

10-14 days - shrunk, turn gray, or will it scar enough to help heal person

First (only) situation of allografts working out

Dr. James Barrett Brown, cross grafted on identical twins

Peters ideas for burned spitfire pilot

Use tissue culture to expand available skin, seed areas of raw skin. Didn't work

Peters second big investigation question thing

How to exchange skin without rejection, how the skin recognizes tissue is borrowed - 14 years

Literature that talks about impossibility of transplanting tissues

The Biological Basis of Individuality by Dr. Leo Loeb

Who build first dialysis machine, "artificial kidney"

Willem Kolff

Crush Syndrome / temporary renal failure

London attacks, ppl crushed. Shock —> kidney stopped functioning. Blood transfusions, recovered after days or weeks.

Materials in first dialysis machine

Cellophane tubing from sausage casing, tomato cans, and salt water

What made dialysis a success - innovations

Heparin - chemical substance prevent blood clotting. Long cellophane tubing. Published in Scandinavian journal.

Second set phenomenon/acquired immunity

2nd allograft rejected faster than 1st, immune system has memory with foreign invaders, prepare and fight back twice as hard. With ss Tom Gibson

What Peter researching for

Ways to treat Spitfire pilots burns after crashes (saw one near his house)

Inflammation

Blood vessels dilate, increase blood flow. Help fight off infections

When inflammation becomes dangerous, sees itself as foreign

Chronic inflammation, autoimmune diseases

Louis Pasteur

Father of modern medicine, germ theory (foreign invaders, general bacteria), hygiene and sterilization

Élie Metchnikoff

Observed white blood cells assaulting and digesting disease germs

Joe make eyelids for Charles

Cut scars off, take skin from collarbone

Charles pain medication

Used 4 shots morphine stead of 6 to avoid addiction. Used local anesthesia (more pain) instead of general anastgesia cause heart stopped.

Joe make Charles Nose

1500s Italy, attach arm to nose to keep blood flowing, pedicles stalks grew, cut away, sculpt nose (22 days)

How did FDR die

Cerebral hemorrhage (sick from poliovirus)

Joe make thumbs, fingertips for Charles

Bones and muscles from palm, then add skin

Joe specialty

Plastic surgery, deformities - from reconstructing Charles

Peters work to duplicate second set phenomenon

Operated on rabbits, cutting and staining microscopic sections to document. 25 rabbits, 600 grafts. —> immunity provoking factor caused rejection

Peter false hypothesis about pigment spread

Spotted guinea pigs, friesan cattle — dark pigment infect skin, signal to manufacture it

Atomic bomb survivors

Suppressed immune systems, —> use X-ray beams to get body to accept foreign organ

How Charles hurt right eye

Cut in surgery when scalper slipped, Jabbed at when wrestling with his son

Peter, invited, zoologist professor

By Sir Norman Haworth, type H pneumococcal polysaccharide, Birmingham Uni

Joe surgical residency

Peter Bent Brigham Hospital, Boston

1947, Kolff visit Brigham with blueprint, improvements

Improve with polyethylene tubing, rotation apparatus to filter blood — remove toxins. Renal research

3 diseases that cause kidney failure

Bright's disease/glomerulonephritis, chronic pyelonephritus (nephritis), malformation of kidney

Bright's disease/glomerulonephritus

Inflammation of little cups (glomeruli) in kidney,

Chronic pyelonephritis (nephritis)

Kidney infection, starts in kidney drainage system in pelvis

Malformation of kidneys

Cysts, "horseshoe kidney" - joined together, hardened arteries in old

Symptoms of kidney failure

Yellow pasty skin, lose appetite, weight loss, no pee, swollen ankles. Fluid collects in abdomen

People who died from kidney failure

Teddy's wife Alice Lee, Woodrow's wife Ellen,

Harvard - Charles Elliot reforms

1870, entrance exams, measures of achievement, before MD

Dead patients

Ward X, sent to Allen street

Innovations in surgery

Lister paper- Need surgical cleanliness, prevent infection, (also understanding germs, anesthesia, ether, setting bones)

Franny first death - Cancerous tumor, walked and fell dead.

Massive clot in leg, traveled to lungs. —> Now get them walking to prevent pulmonary embolisms.

2nd death - infant boy, nurse picked up baby to ward.

Anesthesia paralyzed blood vessels, blood pooled to legs. —> Now lay infantas down in wheeled cribs

Franny, find out how much water in body

Dose of heavy water (non radioactive dose of hydrogen), dilution show water volume, 2.5 years

Franny titles

Surgeon in chief at Brigham, Mosley Professor of Surgery at Harvard

Franny book on surgical care

The Metabolic Care of the Surgical Patient

Henry Cushing

Moseley, science of medicine, model for surgeon-scientist, neurosurgery, chart to monitor anesthesia, demand doctors specialize in anesthesia

Charles Woods investments

Construction, tv

Joe work ppl deformities, experience plastic surgery

Neurosurgery, Boston Children's Hospital —— Memorial Hospital, with Sloan Kettering Cancer Institute in NYC —— NY Hospital

First working kidney surgery, 1946

Shock, attached kidney to her arm, suture anastomosis to join blood vessels, it worked, removed and she walked away

Alexis Carrel

Suture anastomosis NP, transplanting, also a Nazi racist, Lindbergh on blood pump for heart surgery

Hugh Donald

Scottish Vet, need way to distinguish fraternal and identical cattle twins. Peter suggested skin grafts.

Cattle skin grafts

Peter, Bill Billingham. All the grafts accepted.

Ray Owen, the production of antibodies

Tolerance - all cattle twins share blood before birth

Antigens

Foreign material that invades the body

Antibodies

Proteins that attack antigens

1929, Stanford study,

Attach colored feathers to hatched chickens but not adults (Rhode Island Red and Plymouth Rock)

Milan Hašek, discovery

Chicken embryos United in utero, made chickens accept skin grafts

Privileged sites

Places free of immune system, foreign bodies not attacked

Privileged time

Pre-birth, time when foreign bodies not attacked

vivisection

Cutting on live animals

Jonas Salk, 17,000 monkeys

1954, three strains of poliovirus, create vaccine (hurt 30-50k/year)

Francois Magendie

Spinal cord, cruel practices on animals.

Louis Pasteur, dogs

Rabies vaccine

Dogs, kidney transplants

Joe, work, 1951 Boston

plastic surgical consultant to Dr. Bradford Cannon —- Brigham

Joe, impatient

Tongue cancer invade jawbone — immediate reconstruction, proved himself

(37) man, glomeronephritis after streptococcal sore throat

Dr. Scola, died after kidney transplant,

1951 Kidney thigh trials

Local anesthetic, easily monitored and rmoved — use donated kidneys from Don Matson. Directed by David Hume.

Don Matson, Hydrocephalus (water in brain)

Place shunt to drain fluid thru bladder, sacrifice kidney —— first detail text on neurosurgery if infancy and childhood

Boston Children's Hospital, Dr. John Enders

Got kidneys, grow viruses and make vaccines — 1954 NP

Peter title, 1951

Dean, professor at Birmingham Uni —- Jodrell Chair of Zoology at London Uni

Peter Mice results

Inject embryo with living cells of other mouse, skin grafts in adults worked — produced tolerance

Peter Chicken results (Milan)

Artificial twins, 2nd gen chimeric chickens, skin grafts

Peter Official findings

Second set phenomenon - fight off foreign faster the second time. Manipulate embryos before birth (privileged time).

Rockefeller Institute, center for biomedical knowledge - invited Peter speak

At Harvard, immunology, 1949

Who pioneered technique using radioactive isotopes to locate abscesses and tumors

Franny Moore

1950 England, three boys case

Skin grafts used to establish identity, two were identical boys

Tolerance

Findings in Heredity journal, skin grafts to distinguish between twin types. Then in Nature

1952-3, Dr with chronic glomerulonephritis

Kidney for 175 days before heart failure, hardening kidney arteries, must be genetically compatible (less related, more reject)

Three conditions for first transplant

Privileged situation to prevent reject. Change kidney to make it not antigenic (hostile). Change body, make no antibiotics to attack. ((Identical twins))

Dr. David Miller - Richard Herrick, Bright's Disease

First successful kidney transplant, Ronald Herrick kidney.

Dr. John Merrill

Head of nephrology, dialysis

Acquired immune tolerance

Expose to antigen, no response from immune system. It learns to tolerate it.

Prepare for 1st kidney transplant (Herrick)

Blood test, genetics tests, fingerprints

How many people with only one kidney

1 in thousand

Most critical conditions affecting single kidney

Trauma and cancer. (Most renal disease affects both)

Who removes Ronald Kidney

Dr. Hartwell Harrison

Who carries Ronald kidney to Joe & Richard

Franny

Franny example of immune system fighting disease

Lobar pneumonia. Dramatic fever and/or death.