Voronoff and Steinach

Serge Voronoff, the Russian surgeon of Paris who leaped into notoriety about three years ago with his gland transplantation experiments, came into his own at the International Congress of Surgeons in London last week, when 700 of the world's leading surgeons applauded the success of his work in the " rejuvenation " of old men. The sensational claims and misleading publicity which attend the work of seekers after the elixir of youth have obscured Voronoff's careful experimental basis and have made him suspect with conservative scientific men. But professional opinion is growing more lenient as increasing numbers of surgeons in various countries are experimenting with these methods. In America, Dr. G. Frank Lydston, the eminent Chicago specialist who died last winter, was a pioneer in gland implantation. Voronoff's book, Life, in which he set forth some of his theories, appeared in English in 1920, and his scientific papers in French journals have been well received.

At London, Voronoff presented moving pictures showing the transference of monkey glands to human beings, with "before-and-after" effects on three specimen cases-- men aged 65, 74 and 77, respectively, in more or less advanced stages of decrepitude. Within periods of four to 20 months after the operations, the films showed them as hale and active, apparently in middle age, riding horseback, rowing and doing other athletic feats. In another film the ancient ram on which Voronoff performed his original gland-grafting experiments was shown gamboling like a kid. Voronoff announced that 44 men over 60 years of age on whom the transplantation has been performed are vigorous and sound today. They remain anonymous, but rumor has it that several of his first patients were doctors, and the others included "statesmen, actors, millionaires."

To understand the methods of Voronoff and Eugen Steinach, the Viennese surgeon, who works on a quite different principle, some knowledge of the glandular system of the body is essential. The glands may be roughly divided into three types. There are the familiar glands of secretion and excretion, such as the salivary glands, the kidneys, the tear glands, the pyloric glands of the stomach, et cetera, which have ducts through which the secreted juices or waste products are carried to the surface or to the appropriate organ.

Then there are the "endocrine" or ductless glands, whose functions have only recently begun to be discovered, and which form the subject matter of one of the newest and most absorbing chapters of medicine. These include the adrenals (or suprarenals), the source of adrenalin; the thyroid and thymus, in the neck; the pineal and pituitary, near the base of the brain. The secretions of the ductless glands, called "hormones," are poured into the blood stream by little understood processes, and have remarkable effects on various organs and functions of the body. They are concerned with growth, muscle tone, pugnacity and other emotional attributes, gigantism and dwarfism, sex development, et cetera. Much nonsense has been written about them and their possibilities, but there is no question that they have definite and far-reaching influences on life, health and disposition. (A reliable popular book on endocrinology is Benjamin Harrow's The Glands in Health and Disease-- Button, 1922.)

Finally there are a few glands which have a double function and may be called " mixed " glands. They have ducts which carry secretions for a specific purpose, but they also pro- duce hormones which have quite different functions. The pancreas is such a gland, and it is the internal secretion of the pancreas, distinct from the pancreatic juice, from which insulin, the diabetes specific, is derived. Other mixed glands are the " gonads," or reproductive glands (ovaries and testes), which form the basis of Voronoff's and Steinach's work. The primary business of gonads is to produce ova and semen, but they also contain so-called interstitial cells, secreting hormones which are distributed through the body and affect the secondary sex differences as well as the general vigor and well-being of the entire system.

Voronoff puts his patient and a healthy young monkey side by side on operating tables. A local anaesthetic is given the man, and a general one to the monkey. The incisions are made, and one of the monkey's gonads is sliced into six pieces thin enough for the interstitial cells of the patient quickly to interpenetrate them. In earlier operations Voronoff had failures because the transplanted portions were too thick and died before they could knit up with the human glands. Within a few weeks the new tissue becomes continuous with the old, and its hormones begin their beneficial flow. Blood pressure diminishes, sight improves, metabolism is intensified, muscles regain their spring, and new hair grows. Voronoff told the surgeons that a great park is being constructed in Africa under French auspices for the breeding of chimpanzees and other apes and monkeys. The supply of animal glands is too limited at present to accommodate those who desire transplantation. The reason for the use of these species is, of course, their physiological similarity to man. Other animals might theoretically be used just as well, but the results might not be so satisfactory.

In Steinach's operation, no new material is transplanted. He discovered that if the reproductive function of the gonads is stopped by removing part of their duct (called the "vas deferens"), or even by tying it off, the reproductive cells atrophy and the interstitial cells multiply and occupy the space, greatly increasing the flow of the hormones. The effect is to turn the gonad into an exclusively ductless gland. The same general results are produced as in the case of transplantation. Steinach himself makes no extravagant claims. He calls the effect " arrest within modest limits of the process of senility," and says the use of the term " rejuvenation " is unfortunate. It is merely the prolongation for varying periods of the normal functions of middle life.

Preliminary experiments on rats have shown that the process cannot be continued indefinitely. The two gonads may be operated on in turn, and then new cells may be transplanted, but each time the return of senility is more acute, and the vitality burns out more quickly. So that human beings who contemplate the Steinach or Voronoff operations may find their last state worse than their first. Other critics have pointed out that the sex glands are only one factor in the regulation of old age, and that for complete arrest of senility, all the ductless glands would have to be renewed, not to mention other physiological changes. But Dr. Peter Schmidt, a colleague of Steinach, who claims to have performed 85 of the operations himself, made very rosy predictions in an address at Berlin last week. Indefinite prolongation of life by a series of Steinach operations is well within the bounds of possibility, he said, asserting that thin men might be made fat, and fat men thin, the timbre of the voice transformed, and arterio -sclerosis cured. Steinach himself is expecting to undergo his operation shortly, it is said, though he is not yet an old man.

All of the experiments so far have been done on men. Corresponding operations with women (suggested by Gertrude Atherton in Black Oxen) are possible, but more difficult, owing to the greater inaccessibility of the female gonads.