Hammersmith’s first recognition as a renal centre came from its studies on Crush Syndrome (rhabdomyolysis) in the second world war, and subsequent development of methods for managing acute renal failure without dialysis. These were primarily clinical projects followed by laboratory studies. In 1946 they received one of Wilhelm Kolff’s rotating drum kidneys from Holland, publishing their results in 1958. Over the following decade it was the only centre able to perform dialysis, but it was scarcely used until in 1957 a new, French version of the Boston-modified Kolff rotating drum kidney was purchased.
Dialysis at Hammersmith in 1957
In the 1970s Keith Peters oversaw a blossoming of laboratory and clinical research at Hammersmith around complement, anti-GBM disease, vasculitis, and clinical immunology, among other topics. In the 2020s it remains one of the UK’s major renal research centres, and through amalgamation with Charing Cross and St Mary’s Hospitals, the largest renal unit in the UK.
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There is more on each of these headings at 1940s: Discovering AKI
During the bombing of British cities in the early part of the second world war, from September 1940, ‘crush syndrome’ became recognised in those recovered alive from under rubble. Eric Bywaters, a rheumatologist at Hammersmith, described a series of fatal cases in 1941, and went on to identify myoglobin as the nephrotoxin that caused it, leading to a recommended management strategy.
Graham Bull came to Hammersmith from South Africa in 1947, taking over the renal service in the same year when Bywaters left, and after the initial experience with dialysis (below). His name is associated with the protein-free, calorie rich diet that was part of the conservative regimen that he developed with Ken Lowe and Jo Joekes – the ‘Bull diet’ published in 1949. This work had a huge influence, but the team had a short life; Bull went to Belfast as professor of Medicine in 1952 (Bull on Wikipedia) when he was succeeded by Malcolm Milne, Lowe to Dundee the same year, and Joekes to St Mary’s soon after.
In 1946 Hammersmith received one of Wilhelm Kolff’s rotating drum kidneys from Holland. The initial contact was Dr Jo Joekes, who seems to have undertaken the major part in using it, and who took his dialysis expertise subsequently to RAF Halton and the Middlesex Hospital. Their results were published in 1948, ostensibly positive, but subsequent comments at meetings and in publications make their doubts apparent: huge effort and manpower was required to make the machine work safely and effectively.
Over the following decade conservative approaches were used almost exclusively in the UK, although it seems that dialysis was used very occasionally still at Hammersmith – the only centre in the UK able to perform it after 1948/49. Interestingly, an article in the 8 April 1950 edition of Picture Post seems to show a different dialysis machine with similarities to Gordon Murray’s machine in Toronto, but presumably made locally.
In 1956, Ralph Shackman, a urologist seeking to support his planned transplant programme, with Malcolm Milne, purchased and operated a French version of the Kolff-Brigham rotating drum machine (pictured in the video above). Milne led the renal service 1952-61 before going to Westminster as Professor of Medicine. Milne may have modified his thinking about dialysis when Belding Scribner visited in 1956, but his greater interests were in physiology, rather than managing uraemia. Nevertheless Shackman and Milne coauthored a paper describing their experience with some enthusiasm in 1958. Dialysis remained under the control of urologists until … ?
A long term dialysis programme was established only in 1966.
Ralph Shackman performed the first Hammersmith transplant in 1961(?), but there was a substantial prior history of laboratory work on transplantation and the nature of rejection at Hammersmith (see John Hopewell’s account). As in other centres at this time, the earliest accounts describe mostly failure, from inadequate or over-immunosuppression.
In preparation.
First published April 2025
Last Updated on April 24, 2025 by neilturn