Originally published in Volume 37 Issue 4 of Artificial Organs, 05 April 2013
The first hemodialysis was done by Pim Kolff on March 15, 1943 in the hospital in Kampen, Holland, and I believe the first in the USA was done at the Peter Bent Brigham Hospital in Boston, MA, in 1946 or 1947 by John Merrill and George Thorn. It was late academic year 1949 or the beginning of 1950 that I became John Merrill’s designated helper. It began with shaking hands in the lobby of the Peter Bent Brigham Hospital and immediately going to the lab to measure serum and urine osmolalities by freezing point depression before I even put my suitcase down. After finding a room, I went to the dialysis unit to boil cellophane and then help roll it on the drums of the kidney. John was my teacher but the next person I met, William Murphy (Bill), was my tutor. Bill had the heart of a clinician but the mind of an engineer who thought with his fingers and made sure I understood how to manage the artificial kidney under all circumstances. Then, I practiced heating Tygon—drawing it out to make cannulae of different sizes which provided vascular access to connect the patient and artificial kidney. Finally, a surgeon was needed and Charlie Hufnagel, yet to become famous, filled that role at the Brigham and then at Georgetown where for over 6 h of work he sometimes received US$25.00.
The patients transferred to the Brigham were posttraumatic—be it injuries, fractures, crushes, surgical complications, gynecological and obstetrical emergencies, transfusion reactions, poisonings, even plain water irrigations. They had received intensive care and were stabilized but there was little or no urine output with continuing tissue breakdown. Cellular components and elements accumulated in the blood due to lack of kidney function—this complication nearly doubles the mortality rate. The stakes were high as the body had been damaged, but the kidneys had only been stunned and within 30 days could recover if given the chance.
The medical care was personal. One or two doctors directed everything—the times and frequency of dialysis, the participation of the specialists, and the daily management of the patient for as long as it took. We were internal medicine clinicians, whole body doctors, wearing stethoscopes, using blood pressure cuffs, carrying reflex hammers: John had a urinometer in his pocket, I had an otoscope and eyepiece in mine. He was in his second year without a vacation, I did not want one and was thrilled to be saving lives rather than being limited to prescribing phenobarbital, digitalis, a mercurial diuretic, and cautious amounts of penicillin. We were pleased if our efforts were successful, sad if the patient died in the first 7–10 days, bitter if on day 21.
I returned to Georgetown with the artificial kidney and a confidence provided by John finally taking time off, allowing me to be in charge long enough to run a patient and gain the Brigham embrace (Fig. 1). Georgetown was the first satellite, had John’s continuous support and in the next 18 months confirmed its worth: life saving in a woman with mercury poisoning who was highly catabolic with rectal hemorrhaging; life extending in the case of a man with terminal renal failure which enabled him to return to Florida and sign papers; application to acetylsalicylic acid intoxication 1, the same drug shown to be hemodialyzable by Abel et al. in 1913–1914 with the original artificial kidney and suggesting such use. Drug removal also funded the “kidney” at Georgetown. This case was memorable if not historic because the Kolff–Brigham version was demonstrated for Leonard Rowntree whose job on the original kidney was to actually operate the apparatus after crushing leeches to obtain the anticoagulant. He also learned of the careful work underway on barbiturates 2. He told us the artificial kidney might have come to an early and final end had he not caught it after letting it slip from his grip on a bus in Brussels.