They Removed a Healthy Kidney and She Lived to Tell It: The First Planned Nephrectomy
A woman who washed clothes, a surgeon in Heidelberg and an operation nobody had ever performed: removing a kidney on purpose.
Heidelberg, 2 August 1869. Margaretha Kleb, from Offenbach, had been leaking urine day and night for a year and a half: during an earlier operation her ureter, the tube that carries urine from the kidney to the bladder, had been cut by accident. Professor Gustav Simon tried three times to close the fistula, without success. He then proposed what nobody had dared to do: remove a healthy kidney so that it would stop producing the urine that was escaping. He tested the idea first on more than thirty dogs. She asked for the operation "even at the risk of losing her life". It took forty minutes, under chloroform, in a theatre full of doctors and students. On the thirty-eighth day she got out of bed, dry, and she later went back to her home and her work.
That day proved something we still rely on: a person can live with a single kidney. Today a ureteral injury like hers is repaired and the kidney is preserved. And when a kidney does have to be removed, for a tumour for instance, it is usually done by laparoscopic or robotic surgery, through small incisions; whenever possible only the tumour is removed and the rest of the kidney is kept.
Historical context
- It was not the first kidney ever removed, but it was the first planned nephrectomy and the first the patient survived. Kidneys had been removed before by accident or through a mistaken diagnosis (Wolcott, 1861; Spiegelberg, 1867), and those patients died.
- The kidney was healthy: the problem was the severed ureter. After three closure operations and two failed cauterisations, Simon wrote that only removal of the kidney remained.
- No direct words and no portrait of Margaretha Kleb survive. From Simon we know she was 46, married, had two children and washed clothes to help support her household; the phrase "even at the risk of losing her life" is recorded by him. She returned to Offenbach in November 1870 and was still in good health two years after the operation. We do not know when she died.
- Recovery was hard: vomiting, fever, erysipelas and wound infection. Simon repeated the operation in 1871, on a kidney with stones, and that patient died. He himself died in 1876.
Sources and image credits
- Simon G. Chirurgie der Nieren. I. Theil: Glückliche Exstirpation einer Niere zur Heilung einer Harnleiter-Bauchfistel. Erlangen: Enke, 1871. https://archive.org/details/chirurgiedernier1871simo
- Simon G. Exstirpation einer Niere bei Steinkrankheit. Archiv für klinische Chirurgie 1874;16:48-57.
- Ribbe-Gutowski UJ. Die frühe Entwicklung der Nierenchirurgie, Diagnostik und Nierenphysiologie zwischen 1869 und 1914. Doctoral thesis, University of Hamburg, 2020. https://d-nb.info/1214811795/34
- Herr HW. Surgical management of renal tumors: a historical perspective. Urol Clin North Am 2008;35(4):543-9.
- Plates shown on screen, all authentic period material: G. Simon, Chirurgie der Nieren, 1871 and 1876 (Wellcome Collection, Public Domain Mark) · H. Daumier, The Laundress, 1863 (The Metropolitan Museum of Art, CC0) · H. Jouvin, the Old Bridge at Heidelberg, 1860-65 (Rijksmuseum, CC0) · Bourgery and Jacob, Traité complet de l'anatomie de l'homme, pl. 53 (BIU Santé, Paris, open licence) · Portrait of Gustav Simon, c. 1870 (Heidelberg University Library, CC BY-SA 4.0) · A. F. Seligmann, Billroth's lecture theatre, Vienna, 1888-90 (Belvedere, public domain) · Chloroform inhaler, 1858 (Wellcome Collection, CC BY 4.0) · A. W. Leu, Washerwomen on the riverbank, 1868 (public domain). The Daumier, Seligmann and Leu are period images for atmosphere, not views of Heidelberg.
Historical recreation
Margaretha Kleb, her voice and the bank of the Neckar are AI-assisted recreations. They are not original footage or recordings. No portrait of her survives: her appearance is a recreation and does not claim any likeness. The narration is a first-person dramatisation based on Simon's clinical account, not a literal quotation. Quotations are translated from German.
If you or a family member would like advice on a urological problem, meet the ICUA team and request an assessment. Contact ICUA
