W. J. Kolff's development of the first clinical dialysis device was a remarkable achievement in the absence of any previous extensive laboratory or experimental data. An examination of the four decades before the emergence of dialysis provides a unique occasion to see how science and medical technology evolved relative to the growth of complex bodies of knowledge. Dialysis emerged from the development of six distinct scientific and medical knowledge bases: 1) mechanical forces (diffusion and convection); 2) anticoagulants (hirudin and heparin); 3) membranes (collodion and cellophane); 4) kidney physiology; 5) serum and urine analysis; and 6) clinical perceptions and treatment. Each area progressed independent of the others and at different rates of speed. Basic sources of information were found in Index Medicus, Biological Abstracts, and Chemical Abstracts between 1900 and 1945. These references were surveyed for articles and the main reference works that delineated historic stages in each. With a critical mass of knowledge, Kolff envisioned a technologic solution to specific clinical needs. His work is illustrative of how medical science and practitioners work in a dynamic manner drawing from a wide array of scientific areas to meet clinical needs.
(C)1999Amercian Society of Artificial Internal Organs