GEORG GANTER A FATHER OF PERITONEAL DIALYSIS

Abstract

In 1861, Thomas Graham introduced the term «dialysis» to describe the separation of substances across semi-permeable membranes. Between 1912-14, J. Abel, L. Rowntree and B. Turner in Baltimore (USA) created the first «artificial kidney» consisting of several handmade tubes of collodion which served as semi-permeable membrane. The blood of the experimental animal circulated through the extracorporal system using the force of the heart. In Germany, both H.Necheles (Hamburg) and G.Haas (Giessen) built haemodialysis devices with the purpose to remove the uremic toxins from the blood. The apparatus of Necheles consisted of a tube system made of sheep peritoneum. Haas constructed his dialyzer from collodion tubes. All of above mentioned authors used hirudin as an anticoagulant. Georg Ganter (Wurzburg) proposed an alternative mode suggesting the use of peritoneum as an especially large endogeneous membrane. Between 1922-23, he performed serial experiments on ureter-ligated guinea-pigs and rabbits. Ganter was able to demonstrate that the single or repeated instillation of physiological NaCl solution in the abdominal cavity improved both the uremic symptoms and the blood urea nitrogen level. In two patients the new method was implemented only in the form of a single fluid instillation: in a female patient with acute uremia as a consequence of bilateral ureter occlusion due to uterus carcinoma, and in a patient with a diabetic coma. In 1923, G.Ganter published his classical paper «Ueber die Beseitigung giftiger Stoffe aus dem Blute durch Dialyse» («About the removal of toxins from the blood through dialysis»).