At the Intersection of the Clinic and the Laboratory: The Invention, Dissemination, and Application of Organ Replacement Therapy in late-Victorian Medical Culture

Abstract

This thesis re-evaluates the initial use of organ replacement therapy in Britain during the 1890s with regard to the thyroid gland and the associated disease entity of myxoedema as paradigmatic examples. The scope of my argument, however, encompasses the period between the 1850s and 1910s, as it approaches this subject from three perspectives. Firstly, this thesis examines the difficult and multifaceted history of thyroid insufficiency disorders between 1850 and 1878, such as endemic cretinism and goitre. Secondly, the introduction of myxoedema as a distinct clinical entity between 1878 and 1888 is discussed. Finally, the professional debates surrounding the new therapeutic approach of organ replacement therapy and its clinical application and scientific assessment are analysed for the period from the 1890s onward.

By focussing on the notions of disease causation via key historical figures and their publications, I argue that there was a mutual influence between the conception of myxoedema and organ replacement therapy, and that neither one would otherwise have become acceptable by the standards of late-nineteenth and early-twentieth-century scientific medicine. The origins of the ensemble of the new concepts and practices that constitute myxoedema and the associated organ replacement therapy can thereby be situated within a specific timeframe and context. They did not simply arise from contemporary medical knowledge, nor were they the culmination of some long-held desire of the medical community, or solely the result of medical progress. Instead, the practice of organ replacement therapy, as well as the new disease entity of myxoedema, depended on a view of the human body that assumed the medical possibility and desirability of replacing an organ’s lost function.

This view was part of the concept of organ replacement, which emerged in the specific context of an experiment-oriented style of university medicine that predominated in the late nineteenth and early twentieth centuries. Its emergence depended on contemporary clinical and scientific practices as well as on the institutional and epistemological context within which these practices were embedded. As this thesis demonstrates, various social, scientific, and technical conditions needed to concur before organ replacement therapy could become part of medical reality.