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PJ and Dr. Paul Craddock explore the question, "How have different models of the body shaped medical practice and our sense of identity?" PJ also learns about the legal organ market in Iran.
Who thinks that they can subdue Leviathan? Strength resides in its neck; dismay goes before it. It is without fear. It looks down on all who are haughty; it is king over all who are proud. These words inspired PJ Wehry to create Chasing Leviathan. Chasing Leviathan was born out of two ideals: that truth is worth pursuing but will never be subjugated, and the discipline of listening is one of the most important habits anyone can develop. Every episode is a dialogue, a journey into the depths of a meaningful question explored through the lens of personal experience or professional expertise.
Paul Craddock 66:06
Today on Chasing Leviathan, we pursue the big question: How have different models of the body shaped medical practice and our sense of identity throughout history? My guest is Doctor Paul Craddock, author and senior research associate for the Science Museum Group.
We discuss the often gruesome history of transplant surgery, and I learn about the illegal organ market in Iran. So come, have a seat with us, and learn to listen with me.
P.J. As we get started, I want to thank you and ask you about your journey into this history of medicine and why did you choose to write this book in particular?
Dr. Craddock Thank you for having me, and I want to say I like the backdrop for your Chasing Leviathan there, it’s very nice. So, How did I get into transplant surgery, I suppose, is the question, because I’ve never been a patient. I have given blood, but I’ve never been a recipient of or donated a kidney or anything like that. But I’m also not a surgeon. It really started because I became interested in medicine and medical history in general, I got accepted into a PhD program, and you don’t necessarily know what you are going to research, and I was looking for some inspiration, and you and and your listeners can find this, just google Jennifer Sutton and the word “heart”.
PJ. Why do I know that name?
Dr. Craddock Because you’ve read my book. (laughs)
PJ Now I feel stupid, yup. (laughs) For those of you able to see on YouTube, here’s the cover, it’s “Spare Parts: The Story of Medicine Through the History of Transplant Surgery”, and it’s a really fun read as well as very informative. So, that’s also why I know the name Jennifer Sutton, and now I feel stupid, and it’s good. (Laughs)
Dr. Craddock I’m surprised you do, actually, because it was in the acknowledgements. Anyway, “Jennifer Sutton, Heart” basically I came across this picture when I was looking around for what to write my PhD on. It’s basically a photograph of a student, and she’s staring at her own heart.
PJ Wow.
Dr. Craddock It’s such an unlikely thing to come across. It was part of an exhibition, and the first exhibition of the Wellcome Collection which is a museum in London, not just of medical history, but medicine as well. Her story is that she had a condition called cardiomyopathy. Basically, the walls of her heart were thicker than they were meant to be, and the heart struggled to pump the blood throughout her body. The only cure for that is a transplant. She had that, and the Wellcome asked if they could have her heart in this temporary exhibit and she said yes, and there was a photographer there, and you can see that picture by searching “Jennifer Sutton” and “heart”. This picture sent shivers down my spine. I used to work at the NHS the National House Service, and I was a PA, the only male PA, in the part of the NHS where I worked. So I shared this appreciation for the health service for which this image sort of depicted, but more than that, I realized you can’t look at that without seeing an incredible intimacy. An intimacy between a woman and her own heart. But also, the intimacy of that woman and the donor of the heart beating inside her, yet that person has died. It’s a very intimate image, and the photographer did an amazing job capturing it. Seeing it led me to ask very deep questions everybody asks themselves: What does it mean to have a body? Especially if a part of your body–a particularly vital part of your body–can be outside of you and you’re looking at it, and still alive. And if you can accept parts of other people. So what does it mean to have a body, and what does it mean to have an identity in that case? What does it mean even to be human, or even alive? You know these very basic questions. And it struck me that transplant surgery has always been seen as, has a medical history sort of race to be the first to transplant such-and-such an organ. It’s always been seen as a kind of achievement, but actually it goes to the heart of what it means to be a human and to be alive, and that’s what I felt I needed to dedicate my time to. So that became my Phd topic, and I wrote about 18th century transplant surgery for Phd and I discovered that it goes well well! Much much further back. It goes back to ancient India. I’m very animated, I don’t know why, but you’re bringing it out in me.
PJ No, that’s good! Is that another sixteen hundred years back? This is fascinating to me. I think 1600 years was the first mention of transplant surgery. It seems like the practice predated that mention, right? I was talking about the book you referenced at the beginning of your book, but I could be wrong.
Dr. Craddock The first book I talk about, right at the very beginning of the introduction, the first mention of a transplant operation is some time between the 2nd and 6th century BC. So that’s ancient India.
PJ Yes, very ancient.
Dr. Craddock Very ancient. The remarkable thing about that, if it’s not remarkable enough for you, is it’s the Sushruta Samhita, an ancient Ayurvedic surgical text. The procedures described in there, such as a cesarean section, or what now is known as a cesarean section, and cataract operations as well, were considered traditional even then, even back a millenia ago. So transplant surgery has a really ancient heritage, but after that period, it lost its place in a sort of legitimate medical system, because when we see evidence of skin grafts emerging, as you mentioned, it’s actually in the 1550s.
PJ Right, in Italy, if I remember.
Dr. Craddock Yes, in Italy, that’s absolutely right.
PJ I read the whole book, I didn’t just skim it, because it’s a really good read. I’m really tracking with you on all this, and for me it seems that there were a couple of threads that you kind of pulled throughout the whole book, right? One of them that you touched on, identity, right? This idea that we are, from any scientific perspective at least, embodied, laying aside ideas of disembodied consciousness, which we’ve never measured. Identity in embodyment is something that you talk about quite a bit, even starting with the idea of noses, and how important that was to someone’s identity. And then the ethics of it. It wasn’t until I got to Wilhelm Culth was such a wonderful person, and everything he did, and he was so kind, and he seemed so genuinely interested in his patients. After I read about him, I stopped and said “The rest of these people have been jerks!” I mean not all of them, but most of them have been pretty terrible people, and the idea of the ethics of it and the ego.
Dr. Craddock Yes, I’m formulating thoughts about this, because I can’t believe that these people were–the word “jerk” doesn’t come easily to an English person.
PJ That’s me, the New Englander, speaking. I probably have transgressed a boundary there. The words “Definitely unethical”.
Dr. Craddock The words I would say actually, you wouldn’t be able to broadcast, I don’t think. When doctors or scientists were communicating about their work, there are a certain set of formalities that you were expected to adhere to or uphold, and a certain attitude that your expected to have publicly. I don’t know, sometimes I think maybe these people were really lovely? I just like to give people the benefit of the doubt. That sounds a bit wet, doesn’t it? But I don’t want to judge these people as individuals. But they were certainly not nice to animals. They were awful to animals.
PJ That comes out, and I appreciate that you said that, because this has always come at a cost, right? There is a cost to the animals. And I think of when they were first transfusing blood, and they were trying to help the mad man. The scientists were competing over this man’s life as if he is an object–one scientist, because he wants his transfusion to succeed, not because he’s that worried about the mad man, and the other scientist because he doesn’t want the transfusion to succeed because he feels it’s a dangerous practice, and he wants to preserve his own place in the medical society. The mad man ends up dying in the middle of this.
Dr. Craddock But not because of the transfusion.
PJ Right, he dies because the other guy pays the scientist’s wife to come and poison him.
Dr. Craddock I don’t think she needed much encouragement.
PJ Possibly.
Dr. Craddock If you were married to a French, and you set fire to everything, and you just wandered around Paris naked, I think you’d probably–I don’t know–I have some sympathy for her.
PJ (laughing) That is not the response I was expecting!
Dr. Craddock What response were you expecting?
PJ I should have known though. That’s fair, though, you pointed out the fact that he’s a Frenchman, and you’re English. (laughing) He sets fire to everything, and he’s a Frenchman.
Dr. Craddock …and he’s French. (laughing)You know my wife and I did the 23 and me, you know the DNA testing thing. And it turns out she’s from all over the place, she’s actually from Vancouver, but I am the least diverse person you could hope to meet! I’m something like 99.7% British, but the 0.3% is French, so.
PJ There were all those invasions back and forth, so.
Dr. Craddock Sorry, I’m getting off topic there.
PJ No, that’s fine, it was clear that she didn’t take much encouragement. But it was also clear that it seems obvious that the other party did visit her before all that took place.
Dr. Craddock It would seem to be the case, yes. There was a history of that party railing against the idea of transfusion, because back then transfusion was quite controversial in France, a Catholic country. You were talking about identity earlier, and today we think of transfusions as replacing a bit of lost fluid, don’t we? But back then, it was a collision between two medical systems. The first one being the idea that the body is at least in part mechanical. So you have the discovery of a circulatory system. You discover that the blood circulates the body, powered by the heart which acts as a pump. So that's an early 17th Century discovery, early 1600s, 1624, that theory was written up by William Harvey.
Transfusion occurs when that theory collides with older ideas–because we don’t know, in that era, what the blood is, what’s in the blood. So people begin to think of ancient Greek and Roman myths about Jason of the Argonauts, and the story of Medea. I was on NPR yesterday, and I told the whole story of Jason and the Argonauts, and it took about 15 minutes, so I’m not going to start at the beginning, but at the end, when Jason’s got the golden fleece, and he’s returning home with his men, the whole city is out to celebrate apart from his father, who is too old to come out. When he claimed the fleece, he also claimed the king’s daughter, who helped him with his challenges by casting magic spells, he asked her to cast another spell and said “Could you take some years off of my life and give them to my father?” She said “No, I don’t want to do that, but I will perform a ritual.” So she got the wizened old man out of his hut, placed him on the ground, and prepared a potion, which she collected by flying around the world in a chariot, a magical chariot, and she collected things like the beak of an old crow, and weird ingredients from around the known and unknown world. She made a potion out of them, and she slit his throat. And the blood came out of the wound, and she mixed the blood with the potion, and she put the blood back in. Some versions say he drank it, and some say she put it straight back in the cut. Then, he started to transform, and his hair returned to black from gray. His wrinkles disappeared.
For some early transfusionists, back in the 1640s in Britain, in England, in Oxford, actually, Francis Potter, he combined these two ideas of a circulatory system and the blood having some sort of magical power, and he thought, “If I transfuse some blood from a young animal into an old animal, then that old animal would become younger.” He tried it with chickens and hens and cockerels, and never made it work. He couldn’t get the blood across.
But I’ve sort of gone off course a bit here, we were talking about Identity. But it does come around to identity, there’s a lot to the history of blood transfusion, and the same story actually gives us the idea of intravenous feeding.
One thing I’ve got right here is a porcupine quill. It’s one of the things transfusionists used to transfuse blood. It’s kind of an articulation of that mechanical body. It’s a mechanical equivalent of a blood vessel. You snip the ends off and hollow it out. The first mechanical conduit to be used in a surgical procedure. I’m going off again.
PJ That’s great, but here you have I think, three threads, and they all weave in together. You have Identity, and you have Ethics, and the third one that really seems clear is the way that models influenced and wove into all of these. People’s understanding often changed when they received a new model, almost like Thomas Coon talking about scientific paradigms, they needed models, and that helped people shift their identity.
Dr. Craddock When it comes to blood transfusions and the connection to identity, and this is what I was going to say as well, it relates to what you were saying there, the idea of Identity that people had was that you were an essence. You were inhabiting your body, and maybe you were inhabiting your blood. And if that’s the case, a blood transfusion is both exciting and promising because maybe you can make someone younger by transfusing some young soul or vital priniciple into their body, or maybe you can make them sane if they are mad by transfusing a calm lamb’s blood into their body. The idea of Identity was very much at play in blood transfusions.
But that completely transformed a little bit later in the 18th century. I don’t know if you want to talk about the tooth transplants in particular, but they have a very distinct idea of Identity, a more modern idea of an individual.
PJ Yes, absolutely, and I really appreciate one thing that you shared, that if a listener is like “That Jason and the Argonaut story is really weird!” Well, it’s really important to understand that they have William Harvey explaining the circulatory system, and then you have people taking that new idea. And for us we just think “Oh, they understood that.” We transpose that to the modern understanding. That’s not how scientific progress–even today–it doesn’t seem to work. You’re piercing in very singular ways, and then you have to wait for the rest of everything to catch up. So they figured out the circulatory system, and then they applied the old Greek myths to it, and they applied Galen’s four humors to it, they applied vitalism to it. That was really eye opening for me, because when I was taught about it in school, we had William Harvey discovered the circulatory system, and then we understood the body.
Dr. Craddock Laughs.
PJ No. (laughs) That was huge for me. So eventually we create this mechanistic model, Right? Which was very useful for advancing medicine, but the things that they kept alongside it are just mind boggling to us, because we can’t understand the inconsistency, but they didn’t know. That was fascinating for me.
Dr. Craddock Have you heard of an Irish healer called Valentine Greatrakes? I might be pronouncing it incorrectly because I’ve only ever seen it written. He’s not in the book, so it’s not something you missed. Basically, Valentine Greatrakes had a very unfortunate monaker. He was called “The Irish Stroker.”
PJ That is…unfortunate.
Dr. Craddock But he was called the Irish Stroker because he apparently cured all kinds of diseases by going up to people and sort of– (Waves hand over his body)
PJ Massaging them?
Dr. Craddock Not even touching them, he just sort of ran his hands along the body. And there are reports of people being healed of all manner of things after being “stroked” by the Irish Stroker. And people have put their names–serious scientists, Robert Boyle being one of them, John Wilks or Wilkins. I always mix them up. I think it’s Wilkins, isn’t it?
PJ I do not remember.
Dr. Craddock He was a member of the royal society and he put his name on it to say, “yes I’ve seen this happen.” So what they considered to pass as “knowledge” and as “legitimate” wasn’t exactly the same as what we today as scientists would accept. The term Scientists did not exist till the 19th century. So a “Proto-scientist, a virtuoso. Robert Boyle. We wouldn’t expect him to be taken in by a faith healer, essentially. But if you trust just your own senses, then I suppose you can be taken in by that type of thing.
PJ Right, and it gives us the idea that science moves as a community of peers. You can’t poll just one person and it’s a part of science. There’s a period of questioning and review. Oh, man! Who’s the famous gentleman who went around debunking faith healers?
Dr. Craddock Oh, Oh! The Amazing Randy. He’s a very funny man, too.
PJ Yes. And I think that’s valuable work, right? Sometimes there are predatory things that come along with those faith healing approaches.
Dr. Craddock Absolutely.
PJ But I did want to talk about the whole ethics of it. And this kind of goes with the models and the identity too. So when we as modern people see the story–and I don’t think you write him like this, but we see it this way– it’s hard for us not to see the guy who has visions of angels and they show him the terrible things that would happen with this transfusion of blood, and he comes out and is just fighting the other guy, what he was afraid of would happen? So we think, “He’s the bad guy in the story.” Well, yes and no. Because of the issues with the system, like, when you talk about teeth, the ethics of it– that section was horrifying! The idea of children selling their living teeth to rich people so that their family can survive–I don’t even have words for that!
Dr. Craddock It’s heartbreaking. And what’s more heartbreaking is that things happen many magnitudes worse than that nowadays with kidneys.
PJ Right. Now, fortunately as far as I know, that is restricted and only black market
Dr. Craddock I think it’s Iran, that you can sell your own organs.
PJ Yes, so you see people not understanding the cost of giving up an organ, seeing it as an easy way out. Every time there’s progress in science–you can look at it from the warfare stand-point where there was chemical warfare, and then nuclear warfare–we make this incredible scientific progress, then put it into this system that already has awful issues and problems, and it creates this horrific moment, right? Like the Cold war. And I know we still have use of chemical warfare, but at least it’s hidden? Because the countries of the world fortunately agreed, “This is terrible”. So that story has one good point even though it’s depressing.
So can you talk about the idea that we have an ethical challenge every time we have a new model or new technique? So every time we have scientific progress, it sort of stops people and poses new ethical questions. And it oftentimes exacerbates ethical problems that are already present in our current system.
Dr. Craddock Oh, yes. I think that’s the key. So in the case of the black market and organs, and in the tooth transplants, it’s part of the fabric of modern society that emerged in the 18th century, so it emerged with a new idea. Before this point, we mentioned having this identity of having a soul and you inhabited a body. Well in the 18th century that doesn’t make sense anymore, though the change was gradual. Now you have shopping, fashion, pantomimes, Christmas trees, coffee shops, the industrial revolution starting to bubble away, and with that you had a widening class system. Along with that came the new idea of identity. People stopped thinking of themselves as a soul inhabiting a body, but rather as being the body. So they identified themselves with the things that they bought, the things that they owned, the people that they hung around with, the things people did to them. All these external forces coming to make up who you are, this “Self” this “individual” in this modern idea. And it’s a product of these social changes, and I suppose a symptom of them.
PJ A Driving force of it as well?
Dr. Craddock Well it’s part of the social change as well as a product of it. Yes.
PJ There’s this back and forth play between: they would discover this about the body, and then that would play back into the social changes that would tell them more about the body, and back and forth.
Dr. Craddock When it all comes into focus, it’s a new science that emerged at that time, and that time it was the science of Dentistry. The term “Dentist” or “Dentiste”, was coined by Pierre Fouchard, and he basically pioneered Dentistry because of the growing concern over appearance and preserving one’s natural beauty. Previously, even the king would have had his teeth removed, and maybe cleaned with a rag. Very basic care, just aimed on removing pain, really. So Louis the XIV was toothless very early on in his life because he was also quite a glutton.
PJ It’s hard when you’re the king and no one can tell you “No.”
Dr. Craddock Well I can’t remember if I mention in the book that there are stories of him talking with his “operator for the teeth”, not dentist, to just treat him like a peasant, just to “Get rid of this damn tooth”, and he ends up removing part of his jaw, and for the rest of his life he whistled funnily when he spoke.
PJ (Laughs)
Dr. Craddock Which sort of is and isn’t funny. 1728 you have the term dentist and Pierre Fouchard set himself up in opposition to this sort of rural, backward looking idea of pulling teeth. He introduced the idea of filing them, cleaning the teeth, washing your mouth out with urine, something we don’t do so much now, and transplanting teeth.
PJ “So Much”. I think we run in different social circles. (Laughing)
Dr. Craddock I dare say we do! But I wasn’t referring to my own social circle! Although…I suppose there is Richard….(Laughing) Anyway, transplanting teeth was an item on his menu of treatments. That was a measure that was meant to retain your beauty. It was part of commercialization, all these revolutions and changes we discussed a moment ago, it was part of all that, and it thrived on this widening class system, this widening inequality between rich and poor.
PJ Very similar to the section on noses, how you could not be an emperor without a nose. How important that was to identity.
Dr. Craddock Well you couldn’t be till Justinian the Second was.
PJ Exactly. Like it was considered a barrier, and he was like “You know what, I don’t care.” Even the idea that it was a marr on your masculinity was fascinating to me. You see a connection to moral character, which is interesting to me because when you look at the description of the character it’s a defilitic nose. You wonder why that shows up in disney villains and stuff? When you think of Voldemort, or the horned king in the black cauldron? I don’t know if that represents a skull? Or if that traces back to the idea of low moral character.
Dr. Craddock Interesting! Well I have a friend, Dr. Lindsay Fitzharris, who has just released her new book “The Facemaker” and this is a point she talks about. “The Facemaker” is about the horrific injuries sustained by soldiers in the first world war, and the efforts of a surgeon Harold Gillies to recast those faces, so to speak, and to provide a surgical solution to what was then considered facial disfigurement, but you’d say facial difference or something now. She talks about this one character who is good until he had a facial injury, and then he becomes evil. That seems like you could have a listener competition: which one was it? Write in.
PJ Laughs.
Dr. Craddock There is that association between facial disfigurement and evilness. Which is very unfortunate. Yes, Phantom of the Opera. It’s very unfortunate.
PJ That’s where People said “Oh, we can’t trust this guy to be emperor”, and he shows up and forces it militarily, and then the thing with the teeth, “Everyone should have good looking teeth”, and that becomes an issue.
Dr. Craddock Well, not everyone. But if you want to get ahead and can afford to get ahead, you should have the freedom to spend your money in that way, and do someone else’s mouth in. Not to mention the fact that it didn’t work very well!
PJ Not very often, yes.
Dr. Craddock I mean it’s all marketing, but some doctors reported they lasted five years, some months, and were considered successes. Some of the teeth were living teeth from children, some of them were donor teeth so to speak, because they weren’t really donated, were they? Some of those teeth were collected from battlefields by the barrel load from the peninsula war, from Waterloo. Goya painted a scene of that.
PJ Of the hanged, executed criminal and them taking the…. Oopffffhh. Fair warning to our listeners, if you read the book, it is quite gruesome. It is transplant surgeries, but if you like true crime.
Dr. Craddock Can I just say, listeners, as well that I try to be vivid in my descriptions, but I don’t actually go in for gore. I’m not that kind of person.
PJ That was very clear, yes.
Dr. Craddock And I believe it’s the writer’s responsibility to make the scene before you present. And if it’s uncomfortable, it’s because the practices were damned uncomfortable.
PJ And that’s my point, if I misspoke there. It was very vivid. It did not feel like you were like the Stephen King of medical history. (Laughs)
Dr. Craddock I have been called the Bill Brisen of medical history, which is very nice. (laughs)
PJ Laughs
Dr. Craddock And fortunately it was an Amazon review and not an actual critic, but still.
PJ I guess you have to take what you can get.
Dr. Craddock Absolutely (laughs)
PJ So I definitely want to cover the surgeons and their ego. Competing to be first. Which is where I brought up Willam Culth, and he seemed to be very charitable and very generous, it seems he genuinely did it for the right reason, and you have these other surgeons who become famous, and who become renowned for their infidelity as they’re going on tour to talk about how they've done the first heart transplant that only lasted for a little bit. Can you talk about that, how the ego of the surgeons played into this new era of organ transplants.
Dr. Craddock It’s really difficult to know how to pitch this. A lot of the things you read from the 1950s onwards, mainly around kidneys, hearts– livers and pancreas I don’t cover in my book. I don’t know, I felt that would go on too long, and I wouldn’t be able to say anything new about those things. But when you’re dealing with organ transplants, you do tend to have this narrative of some asshole surgeon really leaning into their being an asshole, just being really difficult to work with, such a nasty character, inflexible, and just arrogant. They know best, they are their own hero of the story and everybody else needs to understand that and work around it. Now, I have met quite a few surgeons from that period, actually, though most have died. I know one who’s still alive who’s an incredible person. In fact, every surgeon I’ve spoken to from that period I have found to be uniformly lovely, to be quite honest. I’ve reflected on this because I never met Christian Bernard, he died well before I developed any interest in transplant surgery. I know people who worked with him and apparently he really was a tyrant. But those who I have met have been absolutely lovely. I think reflecting on the story that we get told about transplant surgery usually we have this narrative, from the patient perspective–which I obviously can’t speak to, I’ve never been a transplant patient–a patient’s memoire, or it’s some kind of history told by one of these surgeons or someone who’s bigging them up in a way. I learnt fairly recently that in the 1960s, hospitals and doctors and surgeons began to get wise to PR, and the idea of crafting a narrative around themselves. That marries up with the fact that, in that period, post second world war, where we’ve just gone through a terrible time in world history, that period is a period of optimism. People want to believe that there are heros out there, and that men, particularly, can make miracles happen. So part of me thinks that these people who come across as assholes are not assholes at all, they are just building their own character as society has demanded it to be built. One example of a character who I have met. John Wickham. Now I don’t think he was particularly active in transplants though, and he wasn’t even really famous, but he was extremely important. He was one of the people who introduced laparoscopic surgery, or keyhole surgery into general surgery. Before, only specialists used it, but John Wickham introduced it into general use in collaboration with radiographers and instrument makers. And I interviewed John about this lifetime of achievement that he had. By the way, I was born prematurely, and without his work I wouldn’t be alive. I said to him, “John, how would you like to be remembered?” He said “Oh, I don’t know. Maybe I’ve saved a person or two a little bit of bother.” (laughs) But he said that genuinely. So I thought, oh, that’s lovely.
And I did mention a surgeon earlier as well whose book I showed you who doesn’t do a really good job of presenting himself. I won’t mention him by name because he’s still alive, but I can say he looks like a poor man’s Columbo. (Laughs)
PJ Laughs.
Dr. Craddock We came to agree on that, didn’t we? (laughs)
PJ Yes we did, and if I mention him, then people will look up the book and I don’t want to cause any twitter beef for you. But the book title is very self aggrandizing? He might be lovely in person, but when you tout these sort of titles for yourself, rather than letting others speak of you, you do come across as sort of an asshole.
Dr. Craddock Yes, in a lifetime of achievements in transplant surgery is something to be demonstrated, not stated. That’s a lesson that we could all sometimes do with learning.
PJ Yes, let another man praise you, and not your own mouth. But you mention this, and I don’t even begin to understand the industry from this perspective, but you said that they became wise to PR, and this is how they got donors. You wonder how much of this is driven by the fact that they want to pull in donations. If you can look at an example from your book, the Golden Hands, that’s a great selling point for donations, right?
Dr. Craddock Ah, Dr. Christiaan Bernard. I suppose that speaks for PR points, doesn’t it? But he didn’t come up with the term “Golden hands” for himself; his patient did. But he does seem to have run with it.
PJ As we start to wrap up here, in “The Story of Medicine Through the History of Transplant Surgery”, the one central question for you is identity. Even the questions of ethics and models were kind of subservient to that. Tell us what that main idea of identity is, that main thread throughout the book.
Dr. Craddock Well first of all, here’s the original british copy of my book. Notice the subtitle.
PJ AH.
Dr. Craddock Yes, the surprising history of transplants. I didn’t mean for that to go on there, it was supposed to be an unexpected history of transplants. But the editorial assistant wrote down the wrong thing and I maybe didn’t correct it. Anyway, it’s beside the point. The point is showing you that the subtitle of the American version, “The story of medicine through the history of transplant surgery”, that was also sort of given to me, because I could never defend that, because it doesn’t go through the whole history of medicine, it’s bloody massive! I could never as a historian stand by that subtitle. But the thread throughout the book was initially a collection of metaphors by which we understand our bodies and our relationships with our bodies. It was a kind of a mediation on what it means to be. So we started out with the agricultural metaphor. Transplant surgery at the beginning was a direct transposition of a horticultural technique. It was derived straight from farming. So clearly, the person who transcribed it, Leonardo Theorovanti, who stole it from a secretive Italian family, called it “The farming of men”, transplant surgery. “The agriculture of the body”. That was it.
PJ The exact model . They took what they did to bark, and applied it to humans.
Dr. Craddock Well here I’ve just opened up to it naturally, you can look on YouTube and that’s an 18th century illustration, but it’s the “You can attach to beings to each other, and those two beings can feed a third.” That technique is applied, and that’s what a skin graft is, the first transplant. It’s an agricultural frame we work in. Also culturally, it’s also to do with the land of the trees, it was emphatically not a part of legitimate medicine of the time. We move from that agricultural understanding of a body to a kind of a mechanical one. We talked about blood transfusions and the investment in the idea that the blood circulates around the body is pumped around by a beating heart, a pump, a mechanism, and going into the 18th century that’s joined by an economic idea. A notion of body parts that can be cut off from a source of life or given life. If you transplant an arm–not an arm! That never happened in that period–if you transplant a tooth, say, into someone else’s body, then what proto-scientist thought happened in that period is that an invisible life, a living principle, a vital principle made its way into that dead part and it brought it to life again. And that really works as an economic metaphor. If you cut off a village from a source of income, a source of finance, it withers and dies, but you can introduce finance again and it will revive. So you have this economic metaphor coming in again. Which of course resonates with the massive changes happening in society at that time. I’m going to say one thing about the 19th century. For one the word “scientist” was coined in the 19th century. Throughout that century there were massive changes. Anesthesia, for instance. Virology bacteriology, x-rays. Things that we just can’t imagine getting along without, they came along in the 19th century, and by the end of the 19th century, transplant surgery and blood transfusions seemed barbaric. It’s ancient barbaric stuff that people’s great great great great grandfather’s practiced. We think of it as a hyper modern thing, don’t we? But it’s got such a long history. AT the end of the 19th century, we get the ideas of blood types and bodies being chemically compatible with each other, and that’s immunology, another one of those sciences to come from the 19th century, you have that, and you have new operating techniques for sewing blood vessels together. A technique called vascular anastomosis. And in my book I make the argument, and in peer reviewed research that you can access in university libraries and such, I make the argument that organ transplant surgery, at least partially, emerged from 19th century French embroidery.
PJ Yes, I remember you saying that, and that plays into what we said about the egos of surgeons. This woman’s incredible contribution to something that is essential to transplanting is just kind of veiled over, papered over so that the surgeon can receive the credit.
Dr. Craddock That’s sort of fair, sort of not fair. I don’t want to stick up for a eugenicist or a suspected nazi. But partly that’s the case. I don’t think he would have acknowledged a professional debt to a woman because he thought they were inferior.
PJ Was the woman a eugenicist?
Dr. Craddock No, no. She was Lexi Corelle was the person who–
PJ Well we could stick up for her.
Dr. Craddock So he would not have acknowledged a professional debt to her, but by the same token, the kind of contribution that she made to science and to transplant surgery would not have been recognized in the terms of the science of the day. In fact only now, historians are recognizing that to know something involves the body. You make things. In Columbia University, you have Pamela H. Smith working on this very idea that to make something is to know something. This connection between the body and the brain. Which is not controversial to say that there is a connection between the body and the brain and they’re actually the same thing. But it’s the way that scientists and in fact scholars in general, you would think that if you did something with your body, it was completely nothing to do with any contribution to knowledge.
But back to the metaphors, because of the concern with the materiality of the early 20th century, you now have a new metaphor emerging: the metaphor of the fabric body. Now, historians treating transplant surgery before this book have just gone with this idea of the body being a machine. That’s a few centuries earlier. But they think it sort of continues and maybe gets more pronounced when you start comparing our bodies to airplanes and computers and things. But actually in the 20th century, and it’s down to the embroidery engagement, the big change is that you get surgeons developing their fine motor skills and manipulating the fine material of the body, and that material is very difficult to put into words. But that’s the great change that occurs, and that’s what enables organs to be transferred, and it’s that really serious and intense concern with the craft of surgery.
PJ Yes, and that’s very evident in your book as you go through it, because another thought you develop throughout is that early on, the doctors were men who would never put their hands on someone. That was something barbers or semi-skilled laborers would do. It was a lowly occupation. The phrase was you either lied like a dentist or you lied like a tooth-puller. This idea that these guys get their hands dirty, you can’t listen to them. You listen to the men of science who never actually get their hands dirty, and so that movement. Now, I’m extremely happy that someone who actually understands the science actually operating on bodies. (laughing)
Dr. Craddock Well I think people are always happy to have someone who has experience with bodies operating on them. When surgeons, when physicians had this dedication to Galen, and wouldn’t touch you, then a lot of the peasantry wouldn’t really stand for that. It would be expensive as well.
PJ Exactly. So as we finish here, if you could leave our audience with one thing, besides, obviously, buy and read the book, which is a really enjoyable read, what is the one lesson for them or the one call to action?
Dr. Craddock Oh, that’s an interesting question. The thing that came to my mind initially was: be an organ donor. (laughs) I suppose that would be my call to action. Well, a less direct call to action would be to think. That sounds patronizing (laughing) The book really is about meditating on what it means to be, which is something I said earlier. So two life lessons, one is try to taste life as much as possible, and two is don’t be an asshole.
PJ Yep. Words to live by.
Dr. Craddock I don't say that so much in the book, but it’s concerned with transplant surgery as a culturally and socially important kind of thing, and a way to think about what it means to live and what it means to have an identity. I think the lessons that you can take from thinking like that and being sensitive to the complexity and the beauty and the troubling aspects as well of life, it does come down to don’t be an asshole, and enjoy yourself is later than you think.
PJ Well, I love that. And I think it’s really a history of the dignity of humans, or the indignities we often visit on others. Right? This idea of a black market where we just steal things from people. Those stories were horrific. A lot of this is constantly preying on people, and you clearly represent a lot of principles that we take for granted in our current science, like “Oh, I can’t believe they did that!”, were seen as common-place and acceptable a couple centuries ago. You’re talking about the 1950s and 60s where it is articulated, about what is okay to do in transplant surgery. I love that you said to meditate on that and just let it sink into our ethical consciousness because man! We cannot lose this. It’s only just taken root, and we cannot lose this idea that we cannot do this to other people. It’s very clear that people did. Again, thankyou for your work; I really enjoyed reading it. And it’s been a pleasure having you on the show.
Dr. Craddock Thanks so much PJ, and it’s been a real pleasure being on.