In Episode 7 of Under The Knife, I discuss how a pot of pee used to be a crucial diagnostic tool in the past. Learn all about piss prophets and medieval urine wheels!
Today isn’t just Valentine’s Day. It’s also the end of Congenital Heart Defects Awareness Week. With that in mind, here’s a short piece on the history of heart transplants.
When Boyd Rush, aged 68, was admitted to the University of Mississippi Medical Center on 23 January 1964, Dr James Hardy [below] was waiting for him. Hardy, who had been conducting research on organ transplantation since the mid-1950s and had successfully performed a lung transplant the year before, wanted to replace Rush’s heart with a human equivalent. Unfortunately, strict medical regulations did not recognise brain cessation as a sign of death, which meant that a surgeon had to wait till a person’s heart stopped before it could be used for transplantation.
‘The prospective recipient went into terminal shock at approximately 6 p.m., with a blood pressure of 70 and virtually without respiration except for the continued use of the mechanical ventilation through a tracheotomy tube’, Hardy later recalled in his memoirs. ‘Death was clearly imminent and it was obvious that if heart transplantation was to be performed, it had to be done at once’. 
Rush was wheeled into the operating theatre, where Hardy polled his surgical team about whether or not a transplant attempt should be made using a chimpanzee’s heart.
‘I polled each of the five primary members of the transplant team individually, and their votes were recorded. Four voted to proceed with transplantation… The fifth abstained’. 
The surgery went ahead even though everyone in the room was ‘well aware that any transplantation of a heart in man would be followed by public consternation’ and that ‘the use of a chimpanzee heart would augment the criticism immeasurably’. Hardy later described it as a ‘profoundly sober moment for all’. 
Several hours later, Hardy and his team made history by performing the first ever heart transplant. The chimp’s heart beat for 90 minutes inside Rush’s chest, but unfortunately proved too small to keep its new human body alive. Hardy’s patient died shortly after the operation was complete.
Hardy’s decision to use a chimpanzee’s heart fell under immediate attack from both the public, as well as those within the medical community. The operation ‘precipitated intense ethical, moral, social, religious, financial, governmental and even legal concerns’, Dr. Hardy wrote years later. ‘We had not transplanted merely a human heart, we had transplanted a subhuman heart’. 
Undeniably, the heart is one of the most vital organs in the human body. Without it, we would die. However, the controversy that arose in the 1960s when Hardy implanted a chimpanzee’s heart into Rush had less to do with physiology than it had to do with philosophy. For thousands of years, the heart was considered to be the seat of the human soul. Over time, the scientific community came to recognise the role the brain played in human consciousness. Nevertheless, people continued to equate emotions with the heart. Indeed, to some extent, we still do this today.
The ‘criticism from the media and our peers was vicious’, Hardy’s daughter remembered. ‘Many believed that if you transplanted the heart, you transplanted the soul. Even at school, we were aware that people were upset. As a child, it was difficult to understand why’. 
Hardy’s systematic murder of chimpanzees for use of their organs was also controversial. Invited to speak at a surgical conference in New York City several days after the historic operation, Hardy was shocked when the moderator introduced him by saying: ‘In Mississippi, they keep the chimpanzees in one cage and the Negroes in another cage, don’t they, Dr. Hardy?’ 
Over the next several months, some of the criticism within the medical community waned after Hardy published a paper in the Journal of the American Medical Association in which he described the strict ethical guidelines he and his team had followed when evaluating both donor and recipient. [Note: for more about the use of animals in medicine, click here].
It wasn’t until 1967 that the first human-to-human heart transplant took place at the Groote Schuur Hospital in Cape Town, South Africa, where a young surgeon named Christiaan Barnard was experimenting with pioneering surgical procedures. Barnard’s patient was 55-year-old Louis Washkansky, who was suffering from incurable heart disease. Washkansky could either wait for death, or risk undergoing surgery.
‘For a dying man it is not a difficult decision because he knows he is at the end’, Barnard later recalled. ‘If a lion chases you to the bank of a river filled with crocodiles, you will leap into the water convinced you have a chance to swim to the other side. But you would never accept such odds if there were no lion’. 
So the surgeon and his patient waited for the right moment. Then one day in early December, a woman named Denise Darvall was brought to Barnard’s hospital after incurring fatal injuries in a car accident. She and Washkansky shared the same blood type; her heart was still healthy. On the 3rd, Barnard prepped his patient for surgery. Over the next 5 hours, he would successfully replace Washkansky’s diseased heart with Darvall’s healthy one.
Washkansky’s new heart beat strongly and steadily. Unfortunately, due to a suppressed immune system, he contracted double pneumonia and died 18 days later. Nevertheless, his case would signal a turning point in the history of medicine.
Years later, Barnard recalled how the landmark surgery changed his life: ‘On Saturday, I was a surgeon in South Africa, very little known. On Monday, I was world-renowned’.  Barnard, more than Hardy, was celebrated for his accomplishments, appearing on the covers of magazines and touring the world with stories of his success.
Christiaan’s brother, Dr Mario S. Barnard, published a paper in the South African Medical Journal describing the historic operation. In it, he credited Hardy and the Mississippi team for paving the way, arguing that this earlier operation proved that ‘the feasibility of cardiac transplantation was now irrefutable’. 
Even after the first successful human-to-human heart transplant, surgeons continued to experiment with animal hearts. Between 1964 and 1977, sheep, baboon and chimpanzee hearts were transplanted into at least four adults, all of whom died within a few days of the operation. It wasn’t until 20 years after Hardy’s operation on Rush that surgeons were somewhat successful with a cross-species heart transplant.
On 14 October 1984, Stephanie Fae Beauclair was born prematurely with hypoplastic left heart syndrome, a rare congenital defect in which the left ventricle is severely underdeveloped. Baby Fae’s parents took her to Loma Linda University Medical Center in California, where they met with Dr Leonard Bailey.
‘In those days, the advice to parents was to leave the baby here to die or take it home to die’, Bailey recalled. 
Bailey, who had performed more than 150 heart transplants on various species over the past 6 years, offered the grief-stricken parents a second option. He proposed replacing their daughter’s defective heart with that of a baboon. On 26 October 1984, Bailey and his surgical team did just that.
Baby Fae lived for 21 days, two weeks longer than any previous baboon heart transplant recipient. At a news conference following the child’s death, Bailey told reporters: ‘Infants with heart disease yet to be born will some day soon have the opportunity to live, thanks to the courage of this infant and her parents’. 
Shortly after this feat, surgeons abandoned inter-species heart transplants due to the high risk of infection that followed such operations.
Today, approximately 3,500 human heart transplants are performed annually worldwide. The vast majority of these are done in the United States. Due to the development of powerful anti-rejection drugs, 85% of patients survive up to one year after surgery; 75% make it to their third year.
And it all began on 23 January 1964 with the heart of a chimpanzee.
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1.James Hardy, According to The World of Surgery 1945-1985: Memoirs of One Participant.
5. Quoted in Lynne Jeter, ‘Having a Heart-to-Heart’, Mississipi Medical News (2008).
6. Quoted in Tony Stark, Knife to the Heart: The Story of Transplant Surgery (1996), p. 162.
7. Quoted in D. McRae, Every Second Counts: The Extraordinary Race to Transplant the First Human Heart (2007).
8. Quoted in Fred C. Pampel & Seth Pauley, Progress Against Heart Disease (2004), p. 78.
9. M. S. Barnard, ‘Heart Transplantation: An Experimental Review and Preliminary Research’, South African Medical Journal (30 December 1967), p. 12.
10. Quoted in Ansel Oliver, ‘Surgeon Bailey Reflects 25 Years After “Baby Fae”’, Adventist News Network.
11. Quoted in Claudia Wallis, ‘Medicine: Baby Fae Loses Her Battle’, Time Magazine (26 November 1984), p. 88.
In Episode 6 of Under The Knife, I take on an internet myth involving iron cages, old graveyards, and the undead. Check out our new video on the history of mortsafes in ‘Bodysnatchers vs Vampires’!
The last time I saw Paul Koudounaris, he was sitting, cross-legged, atop a small table in front of an old medieval church. He was regaling an audience with stories of demon cats, using language that was as colourful as the clothes he had donned. One of his slides featured a rendering of Da Vinci’s Last Supper, with a giant cat replacing Christ as the central figure.
After that experience, I thought I knew Paul well enough to conclude that he could do nothing to surprise me. And yet when his new book, Memento Mori, arrived at my doorstep, I actually gasped. The cover itself is a thing of extraordinary beauty. Its satiny binding is cobalt blue, and reminds me of the type of cloth in which Renaissance artists often draped the Virgin Mary. It is rare to find a book these days that could be considered a piece of art in-and-of-itself.
I washed my hands before holding it.
Over the years, I’ve come to think of Paul as a wordless storyteller. It is through his photographs that he tells a great many tales about the diverse ways in which humans, both past and present, have interacted with the dead. From the burial caves of Indonesia to the colourful celebration of the Festival of the Skulls in Bolivia, Memento Mori features photographs from more than 250 sites and 30 separate countries.
Flipping through the glossy pages of this extraordinary book, I begin to understand just how varied our treatment of the dead has been across time and space. But what of the similarities?
‘As diverse as their sources may be’, Paul tells me, ‘there is nevertheless a lot that is similar about a decorated skull from Tibet and the jewelled bones I photographed in Europe, for instance. Or an old Christian charnel house and a burial cave on Sulawesi’.
Paul—who has a PhD in Art History from UCLA—is nevertheless cautious about drawing too many parallels.
‘Judging on those external similarities invites ethnographic projection, which can often be highly deceptive. The underlying belief systems between all these cultures can be vastly different’.
One of Memento Mori’s most striking features is the flashes of colour which pop up throughout the book. To most Westerners—who are used to thinking of death with some degree of solemnity—the hot pinks, bright yellows and fiery oranges can be shocking.
‘That’s our context’, Paul says. ‘It’s the vision we’ve created. We’ve determined over the last century and a half that death is a one-way portal that indelibly erases a person from society… That makes death ultimately a lonely and tragic event. So, yeah, in our culture we think of it solemn terms’.
But this isn’t the case for all people, some of whom ‘conceive of death as an open door through which a dialogue is still possible’. For them, ‘the “dead” can be a very lively group’, Paul explains.
‘The first time that dichotomy ever really made a big impression on me was when I initially went down to the Fiesta de las Ñatitas in La Paz, Bolivia. All the European charnel houses I photographed in Empire of Death were still very solemn sites to me. Even though I later came to realize that they were once very lively, loving places, we had managed to project our modern Western solemnity on them. Down in La Paz, with the incredible beauty, colours, love, and general atmosphere of celebration the dead were being feted with, I realized very quickly how culturally conditioned I was’.
Was he surprised by this new, colourful way of treating the dead?
‘Not really. I think unconsciously I had been gravitating towards this vision for a long time, and that’s no doubt why I was seeking it out. It didn’t really surprise me as much as it liberated me’.
At the beginning of Memento Mori, Paul tells a story of a guide he met on his travels to Indonesia who, as a boy, slept in the same bed as his mummified grandfather. This man’s life has not just been shaped by his relationship with the dead; it has been defined by it. That got me wondering about how Paul’s own life has been affected by his interactions with the thousands upon thousands of the dead he has photographed.
‘I am sure that over time I will discover more and more ways that this has all affected me. One thing it has done, however, is impress upon me a sense of unity. Dealing with the dead has made me understand that no matter how different we think we are, we are all part of cycle that transcends place and time—whether you want to define it in spiritual or existential terms, there’s an underlying oneness, death makes all that very clear’.
Although Paul’s work focuses on the dead, the story he is trying to convey in Memento Mori is one of life.
‘I would have called it “Memento Vitae” if I could have, because it’s as much if not more about being a reminder of life as of death…In my parlance, death and dead are two different and very specific things. The dead are a group, those who have passed on. Death is the border between us and them. As such, it’s an intellectual construction that is culturally relative’.
‘This is something that I have a hard time getting some people to accept, but it’s true. Once you start realizing that the border is something more than just defining where life ceases, it becomes very arbitrary. Where do we keep the dead? How do we treat them? Do we allow them to still have a role to play within society, or is the space between us and the impassable? So the book is very specifically about places where the border is at its most passable, and that makes it as much about life as about death, or rather about the unity that I mentioned’.
In Memento Mori, you will not find the same level of historical and cultural contextualization that you found in Paul’s previous two books, Empire of Death and Heavenly Bodies. This book, more than the others, is a testament to Paul’s extraordinary skills as a photographer and as an artist. It is a feast for the eyes. With its heavy emphasis on images, Memento Mori invites the reader to gaze unashamedly into the world of the dead, and to find the beauty that lies within.
‘With the previous books, I felt frustrated as a photographer because the photos were captive to the text’, Paul tells me. ‘I never felt like their voice and their power were fully being heard. The text predicated which ones we would use, where they would go, how they would be displayed’.
With Memento Mori, Paul worked closely with the book’s designer, Barnbrook, first grouping together the photos in a way that made visual sense, and then adding text later after everything had been laid out.
‘Its approach is drastically different than the other two books. This time the photos do the talking, not the author. Because of this, I think Memento Mori is a much more beautiful, nuanced, and moving book’.
But what about the historical and cultural context? In Western society, we often have to intellectualize our interactions with the dead in order to avoid appearing voyeuristic. For instance, we can gaze upon body parts floating in jars as long as we rationalize that experience using a medical narrative. Flipping through the beautiful pages of Memento Mori, however, we must ask ourselves: is it possible to appreciate the dead purely from an aesthetic perspective?
Although Paul has his own view on this matter, he won’t tell me. ‘This question is central to the book. I want people to look through it and come up with their own opinion’, he says. ‘Letting people make that judgment is the very point of Memento Mori.
Memento Mori goes on sale next month. You can pre-order your copy by clicking here.
In Episode 5 of Under The Knife, I discuss the dark history behind anthropodermic bibliopegy, or binding books with human skin. Why was it done? And how exactly did tanners use human skin to create covers in the past?
I often write about rare medical disorders, but there is one extraordinary case which is so strange, that there is only one documented instance of it in medical history. It involves a man who was both a dwarf as well as a giant over the course of his lifetime.
Adam Rainer was born in Graz, Austria to average-sized parents in 1899. When WW1 broke out, Rainer tried to enlist in the army, but at 4’6.3’’ inches tall, he was deemed too short and weak. A year later, Rainer tried again, and although he had grown a full 2 inches, the army rejected him once more on the basis of his height. Standing 4’8.3’’ inches tall at the age of 19, Rainer was considered a dwarf, being nearly 2 inches below the cut-off (4’10’’).
Although he was short, medical reports from the period state that Rainer had abnormally large hands and feet for his height. When he first tried to enlist in the army, he wore shoes sized US 10 (EU 43). Three years later, his feet had doubled to a size US 20 (EU 53), though his height remained relatively static. To put this in perspective: US basketball player, Shaquille O’Neal, wears shoes sized US 23.
At the age of 21, all this changed.
Rainer (pictured right) suddenly began growing at an alarming pace. Over the next decade, he grew from just under 4’10’’ to a shocking 7’1’’. During this period, Rainer also began developing a severe spinal curvature.
What exactly was the cause behind this growth spurt?
Between 1930 and 1931, Rainer was examined by Drs A. Mandl and F. Windholz, during which time they discovered he was suffering from a condition known as acromegaly. In Rainer’s case, this was caused by a tumour on his pituitary gland which led to an overproduction of growth hormones in his body. This was the reason behind his strange appearance, for Rainer didn’t just have abnormally large hands and feet. He also had a protruding forehead and jaw, as well as thick lips set over widely-spaced teeth. Below are images of man with acromegaly – you can see the effects of this syndrome on his facial features as he ages:
The two doctors decided to operate despite believing the chances for success were small given the fact that the tumour had been growing for over a decade. A few months after surgery, Rainer was measured again. His standing height had remained the same, though his spinal curvature was more severe, indicating that he was still growing, albeit at a much slower rate.
Rainer’s health continued to deteriorate. He went blind in his right eye, and began suffering hearing loss in his left ear. Over time, his spinal deformity became so pronounced, Rainer was confined to bed.
He died, aged 51, measuring 7’8’’ – though some newspapers reported his height as 7’10”. He is the only man in history to be classified as both a dwarf as well a giant; and for me, he is a testament to the marvels of the human body.
After failing to turn on the microphone during a daytime shoot, I jump a wall to film a video in Ecton Graveyard in the middle of the night… all in an attempt to win your support for Under The Knife! If you’d like to make a donation to our project, please click here.
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