| Popis: |
Dialysis was the first instance of the possibility of replacement of organ function by a machine. Although now an established medical activity, it was only slowly adopted. The early machines were laboriously difficult in practice and appeared to have no clear indication for use. There was, however, a conjunction of this different mode of treatment with the identification of a disease suitable for its use: acute renal failure. The changing faces of dialysis and ARF form the substance of this thesis. The recognition of ARF and the concurrent invention of dialysis formed the basis and context for the specialty of nephrology. From this beginning grew a medical-industrial monolith in which the lives of hundreds of thousands of patients worldwide are supported by dialysis and transplantation at extraordinary cost – financial, personal, psychological, medical, and social. Dialysis and nephrology did not appear de novo, fully fashioned in 1960; rather, there was a gestation in the course of which not only did practitioners and their machine struggle for identity and acceptance but also the form and pattern of subsequent practice were established. It is these prodromal activities which are addressed in the first part of the present work which considers the founding of nephrology, the invention and dispersal of dialysis, and the role of the newly-defined condition of ARF in the conceptual framework of the specialty and as a motor for the adoption of dialysis technology. The intention is to provide a review of the secondary literature within an introduction for the reader of the three interrelated tropes elaborated through this thesis. Nephrological themes mirror much in the more general literature, particularly when comparisons are drawn with other specialities. The establishment of the first British ‘Artificial Kidney Unit’ at Leeds General Infirmary in 1956 was a direct challenge to established medical opinion and a trigger for the development of nephrology and renal services in the UK, which briefly centred on Leeds. The Leeds story is taken to the early 1960s to illustrate how the emphasis in renal medicine shifted from the acutely ill patient to the lifelong maintenance of those with chronic disease. Again, Leeds here provides an example of global events. This redirected gaze is returned to in the final section, in which the tropes of acute renal failure and its technology continue in Chapters 7 and 8, which in a sense reflect Chapters 2 and 3 by considering the changes which accumulated up to the end of the 20th century. ARF in the 1950s proved to be the justification for dialysis. The technology continued to change, in part through commercial competition but mainly in response to new ideas and problems thrown up by changing practice. Late in the century, these technological modifications were re-applied to the treatment of acute renal failure. The disorder also changed over time, becoming an increasingly problematic fellow-traveller of techno-medicine as applied to a shifting patient population. Dialysis and acute renal failure provide a paradigm for late 20th century technology-defined, organ-specific medical specialisation. |
