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Belding H. Scribner was born in Chicago, Illinois in 1921. He received his M.D. degree from Stanford University in 1945 and prior to that, his M.S. degree from the University of Minnesota and his A.B. degree from the University of California Berkeley. Scribner joined the University of Washington faculty in 1951 and served as a professor of medicine and chair of the Nephrology Division (1958-1982) in Department of Medicine. His research focused on hemodialysis techniques, and he and co-workers established the first hemodialysis for chronic kidney failure and development of the arteriovenus shunt. Belding also served as chair of the Medical Advisory Committee of the Seattle Artificial Kidney Center from 1961 to 1964. Dr. Scribner died on June 19, 2003.

Dr. Scribner developed an interest in fluid balance and nephritis or end-stage glomerular nephritis, while working at Stanford. Later he went to the Mayo clinic and while there he attended a lecture by John Merrill of Harvard on the artificial kidney. (The rotating drum artificial kidney was invented in 1945.) Dr. Scribner was interested in this - not to save lives or to do therapy with a donor; but he saw its potential as a research tool for being able to manipulate sodium, potassium, and bicarbonate.

After Mayo's showing a lack of support for and the rejection of his desire for developing a dialysis machine and finding a great deal of prejudice towards his ideas for research by the physiologists there, Dr. Scribner left Mayo. He took his family to California to visit a grandparent and while there asked around about possibilities for doing research in fluid balance. He was given no hope there but was advised about a new medical school just opened in Seattle, Washington. He flew up and was interviewed by Robert Williams, head of the department of Internal Medicine; but his greatest chance came when he visited a former instructor at Stanford, Robert Evans, who had just been made head of the new VA Hospital in Seattle. Evans conferred with Dr. Williams and Dr. Scribner was invited to become a member of the Faculty of the University of Washington Medical School in 1951.

Dr. Scribner worked in the research program with the artificial kidney, a research tool worth something according to him. He chose a non-conventional dialyzer, the Skeggs-Leonard dialyzer from Cleveland, actually devised to extract some substances to deal with hypertension. He did not want to use the rotating drum dialyzer because of problems of blood volume and control, so that he built a mobile unit and went to various hospitals in the night in order to dialyze patients to study fluid imbalance. In the late 1950’s he changed to a Kolff’s twin coil with a disposable unit which really worked. He also began working with Ph v. potassium and potassium acid base and developed bedside tests for potassium and urea. The bedside kit measured salts in the blood to control the patient’s electrolyte level (fluid balance).

In 1960, Dr. Scribner won the Markle fellowship and moved from the VA Hospital to the new University Hospital. The fellowship then allowed him to go to England, where he worked with Malcolm Milne at the Post-Graduate Medical School in Hammersmith doing basic research in non-ionic diffusion. During this time Dr. Milne wrote the definitive work, Non-Ionic Diffusion, which, was edited by Dr. Scribner.

Also, he developed an interest in wine while in England which led to illegal wine collecting, when he returned to Washington State; his cellar was raided by the WA State Liquor Board, and he and others were arrested and jailed. But after his and others’ protests, WA State law was Changed, and the state’s wine industry was legalized and flourished. There is also a discussion of his wife, his family, and his marriage.

The Scribner Shunt was developed around March of 1960. He had a patient arrive from Spokane with all the critical symptoms of renal failure, including heart failure. Dr. Scribner took off fluid with a dialyzer and the patient recovered enough to get up and walk around. He then became anuric (no urine was produced by the kidney), and on renal biopsy it was found that the patient had glomerulo-nephritis and all glomeruli were fibrosed. With no chance of survival he was sent home and died in three weeks. This case led Dr. Scribner to work harder on the concept of dialysis; and he tried putting a tube in an artery and in the vein then pulling off a shunt and putting on a dialyzer. The shunt that Dr. Scribner used was made of teflon. This came through the advice of Dr. Wintershott, who was using it in the dog lab and found that it was a non-reactive substance that did not cause inflammation. Thus, the shunt stayed open with no clotting, because teflon is so slippery. The first patient to get this treatment was Clyde Shields who lived for eleven years without kidneys.

Ca. 1958-59, Dr. Thomas Mar of Spokane demonstrated a Gastric Dialysis and presented a paper to the American Society for Artificial Internal Organs, which was published in The Journal of Clinical Investigation. This brought to Dr. Mar and Dr. Scribner an invitation to join the society. By 1960 it was decided that the Artificial Kidney technic of continuous flow of hemo-dialysis became ideal for chronic care, especially when he discovered how to bend teflon to make the shunt. At a meeting in Chicago he presented the only two patients he had for the above work. From this presentation came his Citation Classic Paper (a paper cited so many times that it becomes a classic), i.e., the breakthrough “Commutations of Blood Vessels” the first paper quoted about blood dialysis written by Quinton, Dillard, and Scribner. In 1963, Nephrology became the definitive term for this kind of work.

At University Hospital, Dr. Scribner had to work against the antipathy of other physicians; he had no money and no kidney center. The NIH was very unsympathetic to his cause and felt that Scribner’s work threatened that of physiologists already supported, until Lou Welt positively overrode the decision of a study committee. Dr. Aagaard, the Dean of the Medical School also gave $3500. However, Associate Dean John Hogness proved very unsupportive, and they fought bitterly over a patient of Dr. Scribner, Jim Albers, who was treated by him and as his longest surviving patient went on to become President of Western Washington University. Actually, the first patient to be treated in University Hospital was John Myers, according to Dr. Blagg.

Dr. Scribner was later given the Seattle Artificial Kidney Center through the efforts and funding of C.P. Roy, Head of the A&P Stores with a gift of $300,000. At the time Dr. Scribner’s committee became well known to everybody, though it remained notorious in the Medical Society.

As for the Seattle Life and Death Committee and the Issue of Selection of Patients for Dialysis, interest in this topic began with a paper given at the Federation Meetings in Atlantic City, 1962, where was Dr. Scibnner’s first contact with the press occurred: The New York Times and The Herald Tribune . Afterward, Life Magazine sent Shana Alexander to do an article on the Seattle Committee, i.e., how patients were selected for dialysis and who was worthy. Flaws in reasoning became an issue of hot debate in legal literature. This was diminished by 1970 with state funding for dialysis and ended in 1972 with Medicare funding. Also, the efficacy of dialysis was being questioned, although Seattle was more successful at keeping patients alive longer. Later it was mentioned by Dr. Blagg that this was largely because there was no real transplant program in Seattle, so that the people here worked harder to make the dialysis program successful.

New dialysis techniques also played a part in the success of the program: The Middle Molecule idea, allowing home dialysis, played a large part in dealing with the two kinds of toxins, small and large, causing uremia problems and alleviating that. Molecule hypothesis had an enormous impact on the development of new membranes. For example: new dialysis techniques and new definitions of the adequacy of dialysis as a whole series of experiments were designed to demonstrate that this was so. Peritoneal dialysis saved patients who were dying even with the artificial kidney shunt. There was a great danger of peritonitis, but if a catheter was inserted each time, so that fluid was flushed in and out of the area cleansing blood in the peritoneum, this danger was diminished.

The Tenckhoff Catheter designed by Russell Palmer, and Quinton developed tunneling under the peritoneum, and made it possible to have permanent access to the peritoneum. Two cuffs were hooked on to the peritoneal catheter, which gave access to the peritoneum and became the standard access to this day. Peritoneal dialysis invented by Fred Boone took off with Continuous Ambulatory Peritoneal Dialysis created by Popovich, a student of L. Babb in the department of Nuclear Engineering CAPD, allowed peritoneal permeability. It used the peritoneal membrane to introduce fluid in each, 6 hours 7 days a week or fewer days depending on the patient’s size and activities. Even though Seattle was successful with dialysis, other cities and medicinal centers were not, and the establishment did not accept Seattle’s, being afraid of the cost. But the prevention of kidney disease would continue to be underfunded, and no one has yet discovered the identity of the toxic substance, which causes the kidney disease itself.

Other interests of Dr. Scribner: The growing importance of catheter use, which occurred with the Artificial Gut or home parenteral nutrition using the Broliac catheter (1969) (People with serious bowel disease have ruined blood vessels in the gut as in Krohn’s disease). Those patients died of starvation; but with the Artificial Gut a lumen catheter is firmly planted in the chest, and fluid with protein, salts, and sugars are pumped into the chest. This was a successful procedure by 1975, though there was disapproval and non-acceptance by the department of Gastroenterology. In Oncology triple lumen catheters are inserted with drugs, nutrition, and one for sampling. These are used at the Fred Hutchinson Center. Patients who lose their bowel function are dependent upon these catheters.

Transplantation was introduced in Seattle, but the shortage of donors was acute, and thus the dialysis program prospered here.

Death with Dignity is another issue with which Dr. Scribner is concerned, especially with terminating the care for those patients who no longer want to carry on. He apparently has spent much time trying to deal sympathetically with this issue. Henry Jackson, and Senators Hill and Long were influential in these crucial problems, both with whom shall be given dialysis and whoever shall be allowed to die who wants to do so. Also, a movie, “Who Shall Die?” was made concerning the issue of nursing homes keeping patients alive against their will in order to receive remuneration for doing so.

Dr. Scribner received many awards, the most important, he feels, being the Markle Award. Another was being chosen as one of the eight Fellows of the Hammersmith Post-Graduate Medical School, where he had worked many years before. During a talk given at the dedication, he was asked to demonstrate to the Queen on how to mold by hand the Teflon shunt used in the artificial kidney machine. Added to the awards, $1,000,000 has been given for a Scribner Chair in the UWMC, which he hopes (in 1986) will be dedicated to clinical investigation. Also, nearly one-half million people have benefited from dialysis of which the shunt was the beginning; but there are many problems still caused by dialysis that need to be addressed, such as dialysis arthritis. Dr. Scribner firmly admits that Kidney dialysis is in need of better equipment still.