A Natural History Approach to Disease

When Theodor Kocher implanted fresh human thyroid tissue under the skin of a young man’s throat in July 1883, he performed the first organ transplant in today’s sense. It was an operation that generated “considerable general interest,” and “hence this issue never settled down again,” as an overview put it in 1919. The thyroid gland became the paradigmatic organ of early transplant medicine. It provided the model for all further organ transplants, including the kidney. Until the early twentieth century, it was also the most common among organ transplants. The redefinition of a class of disorders as thyroid insufficiency diseases was a decisive step in the process that led to the invention of organ transplantation. In order to analyze the concept of organ replacement, we must first turn to the earlier, nonorgan- based understanding of those diseases.

The diseases that were later ascribed to thyroid failure had already existed in other forms that can be described as “disease entities,” with the two most important being cretinism and myxedema. A disease entity results from assigning the diseases of individual people to a specific disease designation. Looking at how disease entities changed in tandem with new treatment concepts will help identify the ways in which organ transplantation represented a completely new approach to curing diseases.

The explanation, definition, and treatment of cretinism and myxedema did not at first refer to any particular organ. A two-part work by Carl Rösch and Johann Jacob Maffei published in 1844 represents the typical approach to cretinism before 1883. This book is of special interest because it served as a reference resource until Theodor Kocher’s time. Its authors practiced as doctors in areas where cases of cretinism were common. In order to get to the bottom of this problem, they began collecting data. Like their contemporary natural scientists and explorers, they investigated the phenomenon of cretinism in the area where it occurred. They looked at cretins, spoke with the indigenous population, wrote everything down, and compared and selected their data. With their emphatically empirical approach, Rösch and Maffei were typical proponents of the turn toward empirical experience in the scientific and medical discourse, a change that succeeded the interest in theory that had prevailed during the preceding era of “romantic natural philosophy.”