by Paul Craddock
Thanks to dazzling advances in xenotransplantation and stem cell research, transplant surgery appears to be going through a new Renaissance. But where did transplants come from? We tend to put them into the same category as the moon landings, indicative of a post-war optimism and confidence in the human capacity to excel. But transplant surgery is far, far older. Here are three transplant pioneers from well before Christiaan Barnard earned the moniker “golden hands.”
Leonardo Fioravanti and the first modern skin grafts, 1549
Since about the 1400s, families of peasant surgeons cultivated their own skin graft techniques, lifting skin from a person’s forehead to be transplanted elsewhere on their face. A talented surgeon could use this method to replace the lost noses, damaged ears and sliced lips of the men queuing up at his door. The techniques were family secrets. At least they were until 1549 when the surgeon Leonardo Fioravanti knocked on the Vianeo family’s door. Claiming to be the relative of a potential patient, Fioravanti finagled an invitation from the family to watch them operate. He pretended to be shocked by the whole bloody affair, and for good measure put his hands up to his face. But from behind splayed fingers he took mental notes. And what he saw similar to the technique for grafting apple trees. The horticultural and surgical techniques were so close, in fact, that when he wrote up his observations, he referred to transplant surgery as ‘the farming of men’. These early skin grafts were by all accounts effective, but no one in the medical establishment took them seriously. Fioravanti was a man shunned by his peers, who were suspicious of the peasant remedies he championed. It took a further fifty years for the medical world to take notice of transplant surgery, by which time Fioravanti had died.
John Hunter and the first ‘scientific’ theory of transplantation, 1771
Today, John Hunter is remembered as one of the most distinguished surgeons of the eighteenth century. Scientists the world over eulogise him for bringing prestige to their craft by insisting on an experimental approach to surgery. His scientific methods were embraced by his students, including William Shippen Jr, who implemented them when founding America’s first medical school. Hunter amassed one of the world’s grandest collections of anatomical specimens, too, documenting the planet’s rainbow of lifeforms in their sickness and health. But it was his commitment to the decidedly unscientific notion of a ‘vital principle’ that made him into a transplant surgeon. Many nights he spent huddled over the specimens in his collection, searching for a single body part they all shared. If he could find one, he reasoned, it would be the one part responsible for life. Hearts and brains, it seemed, were early candidates. But creatures like starfish don’t have these, despite clearly being alive. Other scientists had suggested the nerves might be responsible for life, but Hunter pointed out that you can cut a body part off from the nerves without killing it. The blood was more promising. Nothing could live without blood, or an equivalent liquid. There must be some invisible, undetectable particle circulating in every living thing, without which it would die. Taking this theory a step further, he suggested that if you could attach a dead body part to a living body and encourage the blood to flow between the two, the body could claim the new part and bring it back to life, wherever it might come from. This became the theory behind a mid-eighteenth-century fad for tooth transplants, where dentists would cajole the newly-erupted adult teeth from poor children, and sell them to the rotten-mouthed rich, to be transplanted directly into their heads. The practice fizzled out by the start of the nineteenth century, denounced even by Hunter himself, when more and more wealthy recipients succumbed to infections.
Marie Anne Leroudier and the first organ transplants, 1900
Alexis Carrel went down in history as the man to invent a reliable way to sew organs into bodies. This achievement made him the first organ transplant surgeon. Marie Anne Leroudier was his teacher. She embroidered the gold thread on the Paris Opera House curtains, and her work is owned by the textile museum in Lyon, as well as the Vatican. She also won a gold medal at the 1885 World Fair in Amsterdam, and exhibited some ornamental panels at the 1893 Columbian Exposition in Chicago. The master seamstress was lauded for her needlework, and attracted the young Carrel as her student. He watched her carefully, studying how she handled her needle, how she worked deftly with one hand, how she worked economically with the thread, making it go wherever she desired. These were advanced skills not shared by Carrel’s peers, who most likely learned to sew from their mothers or sisters. Carrel would show off to them, packing 500 end-to-end stitches into a cigarette paper. Eventually, he applied his new techniques to blood vessels, coming up with a reliable method to sew them together. This made him the ‘father’ of vascular surgery and transplantation, and he accepted a Nobel Prize and sole credit for the achievement. Yet, for all his genius, Carrel owed a professional debt to Marie Anne Leroudier, whose techniques at least partly inform organ transplant surgery. It was a debt neither he or any of his biographers would ever fully acknowledge.
Paul Craddock is Honorary Senior Research Associate in the Division of Surgery and Interventional Sciences at UCL Medical School in London. His PhD explored how transplants have for centuries invited reflection on human identity, a subject on which he has also lectured internationally. Spare Parts is his first book.