Since the demonstration in the 1940s that hemodialysis can sustain life and relieve the symptoms of uremia, the widespread access to dialysis that began in the 1970s has been lifesaving for patients with kidney failure or end-stage renal disease. Today, over 1 million people worldwide are alive because of long-term dialysis; thousands of others have gone on to receive kidney transplants after variable periods of maintenance dialysis.
Like many other therapeutic advances, the advent of dialysis was slow, and bursts of progress were based on the work of pioneers from various disciplines. Thomas Graham (1805-1869), a physical chemist, is credited for coining the term ``dialysis'' in his 1854 description of the diffusion of crystalloids and the movement of water across semipermeable membranes. Some 60 years later, the term ``artificial kidney'' was coined by a pharmacologist, John Abel (1857-1938), and his associates, who used the principle of diffusion for the removal of substances from the blood of rabbits and dogs by perfusing it in colloidin tubes immersed in a dialysate bath. In 1924, George Haas (1886-1971), a surgeon, performed dialysis in humans but gave up his efforts because of technical difficulties and limited clinical success. About 20 years later, hemodialysis became a reality through the pioneering work of an internist, Willem J. Kolff (born in 1910). The introduction of a permanent vascular-access device by another internist, Belding Scribner (born in 1920), allowed for long-term dialysis in 1960. Countless others, who contributed various components, modifications, and refinements to the seminal work of these investigators, have been instrumental in the development of a successful technology that replaces a failed kidney.
The story of dialysis has been told in several articles and books published over the past two decades. Like much of medical history written by physicians or medical scientists, these accounts center on the role of individual investigators in determining the course of events. This approach to history has been faulted as antiquated by modern historians for its failure to consider the sociological, political, environmental, and circumstantial influences that ultimately shape history. Nevertheless, the fact remains that there have been pathfinders in the history of science in general and of medicine in particular who, through their singular perseverance and dedication, have made breakthroughs for which they should be recognized according to any historical criteria. In the history of dialysis, the work of Willem J. Kolff is one such example, particularly when one considers the difficult circumstances in the Nazi-occupied Netherlands, the scarcity of resources, and the small hospital in Kampen where the artificial kidney was developed and shown to preserve life.
In Dialysing for Life, Jacob van Noordwijk, one of Kolff's assistants in Kampen, recounts the difficult but critical times in the development of the artificial kidney. His personal account, which constitutes the first half of this small book, provides invaluable insight into the stages of development of the artificial kidney, the preceptors and collaborators who stimulated and supported Kolff's work, and Kolff's immediate post-war efforts to promulgate the use of the artificial kidney for the treatment of acute renal failure. The second half of the book, although informative, is less valuable. It is selective in its coverage, delves into ethical and financial considerations on the basis of decade-old figures, and only superficially touches on the contributions of some of the key investigators in the early days of long-term maintenance dialysis.
Parts of the story have appeared in articles written in English by the author. Its availability as a book, translated from the Dutch, provides an informative, brief, and easy-to-read work for anyone interested in the history of dialysis. Particularly valuable are its illustrations, but the clarity of the reproductions is less than optimal. Most chapters are well annotated but have only selective reference lists. The book is not indexed. Van Noordwijk's first-hand account and perception of events in the first part of Dialysing for Life should provide future historians of medicine with a primary source of information when the history of dialysis is recounted more objectively, within the general context of the times.
Garabed Eknoyan, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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