Views & Reviews

The greatest emergency of all

BMJ 2008; 336 doi: (Published 17 January 2008) Cite this as: BMJ 2008;336:158
  1. Seye Abimbola, preregistration house officer (and former BMJ Clegg scholar)1
  1. 1Wesley Guild Hospital, Ilesha, Nigeria
  1. seyeabimbola{at}

    The peculiar character of an idea [is that] . . . no one possesses the less because everyone possesses the whole of it. He who receives an idea from me receives [it] without lessening [me], as he who lights his [candle] at mine receives light without darkening me.

    Thomas Jefferson (1743-1826)

    I once read of a man, Belding Scribner, in my favourite medical school textbook, the Oxford Handbook of Clinical Medicine. He invented the Scribner shunt. I had heard the eponym mentioned many times but never had I ventured to find out its origin, until I chanced upon it in the handbook, on one of the several interesting and inspiring pages that discussed sociological and ethical issues, interspersed between the pages of serious medical stuff. These pages easily won the book its well deserved place as the favourite textbook of several generations of students in my medical school. However, as many of us could not afford the sleek leatherbound edition of the book, we opted for a readily available third world alternative, the much cheaper Indian paperback reprints.

    Like every inventor, Belding Scribner, a US physician, saw a problem in need of a solution. Patients with chronic renal failure could have dialysis for just five to seven times during a painful operation; damage to blood vessels would make further treatments impossible. A caring and passionate physician, and himself a lifelong patient, Scribner was inspired to invent the shunt, haunted by a patient who had made a startling recovery through dialysis but died soon after. Allowing haemodialysis to be repeated as often as needed, the shunt transformed chronic renal failure from a disease that was 100% …

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