Department of Internal Medicine Lund Hospital 3- 4 September 1946
During the night between September 3 and 4 1946 things are stirring in the basement of the old Department of Internal Medicine at the University hospital in Lund. A 47-year old man has been taken down unconscious. He is still in his bed. His main problem is uraemia, but he is also suffering from silicosis complicated by pneumonia. His kidneys have shut down and waste products and liquid are accumulating in his body. His eyelids are swollen so he cannot see.
Under local anaesthesia, the surgeon on-call has opened two vessels in the patient’s wrist and inserted glass cannulae into a vein and an artery. A strange machine, constructed in the workshops of the Department of Physiology and the hospitalstands on the floor. It consists of a large glass container with a cylinder of stainless wire netting inside. A flattened cellophane tube is wrapped around it. The tube is actually an eleven-meter long sausage casing. When the machine is hooked up, the blood from the patient’s artery runs through the tube and back into his vein. As the blood travels through the casing, a large quantity of waste products leaves the blood and entersthe liquid outside; the cleansed blood is then returned to the patient. This exchange of substances through the sausage casing is called “dialysis”.
During the course of the night, the patient regains consciousness until finally he is able to open his eyes and talk. Sadly, his life is to be claimed by pneumonia just twenty-four hours later. Nevertheless, everyone present is aware that they have witnessed something of a miracle – the first kidney dialysis.
The device was designed by a 42-year-old associate professor, Nils Alwall. He had been trained in physiology and pharmacology before embarking on a career in internal medicine He had been deeply moved by the tragic situation of patients with renal failure, for which there was no cure. Strict bedrest and diet constituted the only treatment. Patients were not even allowed to leave the bed to use the toilet and their food did not contain salt, protein, or spices – all in an effort to reduce the formation of nitrogenous waste products. After a few weeks, however, the boredom became almost intolerable.
During the war years, Dr. Alwall experimented with dialysis on rabbits, applying the knowledge of physiology he had gained as a research assistant. As a result, his device was able to mimic normal kidney function better than the dialysis machine developed by the Dutchman Willem Kolff. Kolff and Alwall worked independently of each other, though Kolff was a few years ahead.
Dialysis soon became an important method of managing temporary impairment of renal function, such as after surgery or severe trauma. Compensating for permanent kidney damage required two things: the opportunity to repeatedly connect the artificial kidney to the patient's vascular system and a convenient disposable filter. The first condition was met when doctors learned to “enlarge” the vein by surgically connecting it to an artery, an arteriovenous shunt. The second condition was met by the company Gambro, which had been founded by Holger Crafoord after Alwall convinced him of the clinical and commercial significance of a “disposable filter” for dialysis.
Crafoord sold his holdings in two major Lund-based companies - Åkerlund & Rausing and TetraPak - to his partner Ruben Rausing and invested a large part of his new capital in Gambro. The company went through many lean years before breaking even, but eventually Gambro stock skyrocketed. The company was also the origin of the Crafoord foundation in Lund, one of the most important research financiers in Sweden. Lund University has received big grants from the foundation, including funds for building the Holger Crafoord Ekonomicentrum, which houses the School of Economics and Management. The Faculty of Medicine has also received generous contributions from the foundation. Nils Alwall would have approved: as a young associate professor he pleaded for a greater commitment to clinical research.
The development of “the artificial kidney” was based on animal experiments and Alwall's knowledge of physiology – a brilliant example of what people now call translation research – from experiments on rabbits to a new life-saving medical treatment and a global healthcare company. You can't ask for more than that.
Text: Håkan Westling