The history
4,000 years from clay livers used to read the future to pills that cure hepatitis C and livers that regrow after being shared.
For thousands of years the liver was a mystery organ. Priests read omens in it, poets told of a god whose liver grew back every night, and doctors believed it turned food into blood. Slowly, people cut it open, looked through microscopes and tested its chemistry, and found a busy factory that stores sugar, makes proteins, cleans the blood and turns poison into waste. In the last sixty years that knowledge let doctors transplant livers, share them between living people, and find and beat the viruses that attack them.
c. 1900–1600 BCE
Clay models made to teach liver reading
Babylonian diviners, Sippar (Iraq)
1654
Book printed in England about a single organ from new research
Francis Glisson, London
1833
Hepatic lobule described
Francis Kiernan, London
1932
First metabolic cycle discovered (the urea cycle)
Hans Krebs and Kurt Henseleit, Freiburg
1967
First successful liver transplant
Thomas Starzl, Denver
1981
First vaccine able to prevent a human cancer
Hepatitis B vaccine, USA and France
1989
First successful living-donor liver transplant
Russell Strong, Brisbane
1998
India's first successful liver transplant
Indraprastha Apollo Hospital, New Delhi
2000 BCE – 100
In Mesopotamia and Etruria, priests study the livers of sacrificed sheep to read the will of the gods. The Greeks tell a myth about a liver that grows back.
1800 BCE
c. 1800 BCE
In the 1930s, archaeologists digging the palace of the ancient city of Mari found more than thirty clay models of sheep livers, each marked with an omen. They date to the Old Babylonian period, nearly 4,000 years ago. They are among the oldest detailed written records of liver reading.
Why it mattered. They show that people watched the liver's shape and marks closely long before anyone knew what it did.
1750 BCE
c. 1900–1600 BCE
A baked clay model of a sheep's liver, now in the British Museum, is divided into about 55 boxes, each with writing. Priests sacrificed a sheep, looked at its liver and matched every bump and groove to an omen. The model was probably used to teach trainee diviners.
Why it mattered. It is one of the oldest known models of a body organ, made to be studied in detail.
700 BCE
c. 700 BCE
In the poem Theogony, Hesiod tells how Zeus punished Prometheus for giving fire to people. An eagle ate his liver every day, and every night the liver grew back. Nobody knows if the Greeks really knew the liver can regrow, but doctors still use Prometheus as its symbol.
Why it mattered. It is the oldest famous story about the liver's real superpower: regrowing after damage.
100 BCE
late 2nd century BCE
A life-sized bronze sheep's liver, found by a farmer in 1877, is covered in the names of Etruscan gods. Each region of the liver belonged to a god, so a mark in that spot was a message from them. Etruscan liver readers were so famous that Romans hired them.
Why it mattered. It shows how the idea of reading livers spread from Mesopotamia across the ancient world.
100 – 1700
Galen teaches that the liver turns food into blood. His idea rules for more than a thousand years, until anatomists start looking for themselves.
170
2nd century CE
Galen taught that digested food travels up the portal vein to the liver, where it is turned into blood. The veins then carried that blood out to the body to be used up. Doctors followed his books for more than a thousand years.
Why it mattered. He was right that food goes straight to the liver, even though the liver does not make blood in adults.
1650 – 1900
Anatomists map the liver's wrapping, name its scarring disease, find its tiny six-sided units and spot the cells that eat germs.
1654
Glisson boiled livers and filled their vessels with liquids to trace them. His Anatomia Hepatis was the first book printed in England about a single organ based on new research. It described the tough sheath around the liver's vessels, now called Glisson's capsule, although the Dutch anatomist Johannes Walaeus had seen it a few years earlier.
Why it mattered. It treated the liver as a structure to be mapped, not a mystery to be guessed about.
1819
Laennec, who also invented the stethoscope, described the scarred, lumpy liver of a former soldier in a footnote to his famous book on listening to the chest. He called the disease cirrhosis, from the Greek kirrhos, meaning tawny yellow, the colour of the lumps. Earlier doctors had described it, but his name stuck.
Why it mattered. Cirrhosis, the end result of long liver damage, finally had a name that doctors everywhere used.
1833
Kiernan, an Irish-born anatomist, studied pig livers under the microscope. He saw that they are built from many small units, lobules, each roughly six-sided with a vein running through its middle and vessels at its corners. He published his work in the Philosophical Transactions of the Royal Society.
Why it mattered. The lobule is still how students learn the liver's basic building block.
1876
Using a gold stain, Kupffer saw star-shaped cells, which he called Sternzellen, along the liver's tiny blood channels. At first he thought they were a kind of connective tissue cell. Some historians think he was actually seeing a different cell type that stores vitamin A.
Why it mattered. It started the hunt for the liver's own cleaning cells.
1898
The Polish pathologist Browicz saw cells lining the liver's blood channels that had swallowed red blood cells and other material. He recognised them as macrophages, cells that eat germs and debris. Kupffer revised his own view the same year. Today they are called Kupffer cells, or sometimes Browicz-Kupffer cells.
Why it mattered. These cells catch almost all the gut bacteria that reach the liver before they can spread.
1840 – 1960
Chemists and physiologists show the liver makes sugar, stores it as glycogen and turns poisonous ammonia into urea. Surgeons map its eight segments.
1848
Bernard found sugar in the liver, even in animals that had eaten no sugar, while other tissues had none. Scientists had thought only plants could make sugar and animals just burned it. Bernard showed the liver makes sugar itself and releases it into the blood.
Why it mattered. It proved animal bodies build chemicals, not only break them down.
1857
21 March 1857
Bernard washed a liver clean of sugar, yet found new sugar in it the next day. Something in the liver was turning into sugar. In 1857 he isolated that substance and described it as animal starch. We call it glycogen.
Why it mattered. It explained how the liver stores energy after a meal and releases it between meals.
1932
Krebs and his student Henseleit fed slices of liver different chemicals and measured the urea they made. Adding a substance called ornithine made urea pour out, yet the ornithine was not used up. They worked out a loop of reactions that turns toxic ammonia into harmless urea.
Why it mattered. It was the first metabolic cycle ever discovered, and it explains why liver failure can poison the brain.
1957
1954–1957
Couinaud studied the vessels and bile ducts inside the liver. He showed it is made of eight segments, each with its own blood supply and bile drain, first in 1954 and then in his 1957 book Le Foie. The outside shape of the liver, he found, does not match how it works inside.
Why it mattered. Surgeons can remove segments safely, and that makes split and living-donor transplants possible.
1955 – today
Surgeons learn to drain bile in babies, transplant whole livers, and then share part of a living person's liver, which regrows. India joins in 1998.
1955
1955, reported 1959
Babies born with biliary atresia have no working bile ducts, and most died within months. At Tohoku University, Kasai joined a loop of intestine straight to the liver so bile could drain out. He reported it in Japanese in 1959, and the world learned of it in English in 1968.
Why it mattered. The Kasai operation still saves or buys time for many babies, some of whom later get transplants.
1963
Starzl's team tried the first human liver transplants in Denver. The patients lived no more than 23 days. Starzl paused and spent four years improving the surgery and the drugs that stop the body rejecting a new organ.
Why it mattered. The failures taught surgeons what they needed to fix before transplants could work.
1967
With better surgery and a new mix of anti-rejection drugs, Starzl's team transplanted livers into several children in 1967, and this time they survived the operation and went home. It was the first time a liver transplant had truly worked.
Why it mattered. Liver transplants now save tens of thousands of lives around the world every year.
1989
December 1988 and 1989
In December 1988, Silvano Raia's team in Brazil gave a child part of an adult's liver, but the child lived only six days. In 1989, Russell Strong in Brisbane transplanted part of a mother's liver into her baby son, and both did well.
Why it mattered. Because the liver regrows, a living parent can now save a child without waiting for a donor who has died.
1998
15 November 1998
Sanjay Kandasamy, a 20-month-old boy from Tamil Nadu with biliary atresia, received part of his father's liver. He became India's first successful liver transplant patient. He grew up to become a doctor himself.
Why it mattered. It opened the way for India to become one of the busiest countries in the world for living-donor liver transplants.
1965 – today
Scientists find hepatitis B and C, make a vaccine for B and, after decades of weak treatments, pills that cure C. The world sets a goal to end hepatitis as a public health threat.
1965
Blumberg was studying how people's blood proteins differ when he found a strange protein in the blood of an Aboriginal Australian man. He called it the Australia antigen. Over the next few years he showed it was part of the virus that causes hepatitis B, and in 1976 he shared the Nobel Prize for this work.
Why it mattered. It led to a blood test for hepatitis B and then to a vaccine.
1981
The first hepatitis B vaccines were made from purified virus proteins taken from the blood of infected people. They were licensed in 1981 in the United States and France. Because long hepatitis B infection can cause liver cancer, it was the first vaccine able to prevent a human cancer.
Why it mattered. It showed a vaccine could protect the liver for life.
1986
Scientists put the gene for one hepatitis B protein into yeast, which then made the protein in huge amounts. The new vaccine needed no human blood. Licensed in 1986, it was the first vaccine made with genetic engineering, and vaccines like it are still used today.
Why it mattered. A cheap, safe vaccine made it possible to vaccinate babies all over the world.
1989
Harvey Alter had shown in the 1970s that an unknown virus was causing hepatitis after blood transfusions. Houghton's team at Chiron copied genes from infected blood into bacteria and used patients' antibodies to fish out the virus's genes. They named it hepatitis C virus and published in 1989.
Why it mattered. Blood banks could now test for it, making transfusions far safer.
2002
2002–2011
India began giving hepatitis B vaccine in its free national immunisation programme in 2002, starting in 14 cities and then 33 districts. It spread to ten states in 2007–2008 and to the whole country by 2011.
Why it mattered. Millions of Indian children now grow up protected from the most common cause of liver cancer.
2013
December 2013 and October 2014
In December 2013 the drug sofosbuvir was approved in the United States. In October 2014 it was combined with ledipasvir in a single daily pill, and trials cured 94 to 99 percent of patients. Old interferon injections had cured only about half of patients at best and made people feel very ill.
Why it mattered. A virus that caused cirrhosis and liver cancer became curable with a short course of pills.
2016
May 2016
All 194 WHO member states agreed a plan to eliminate viral hepatitis as a public health threat by 2030. That means cutting new infections by 90 percent and deaths by 65 percent.
Why it mattered. It was the first time the whole world set a deadline for beating hepatitis.
2018
28 July 2018
On World Hepatitis Day, India launched the National Viral Hepatitis Control Programme. It offers free testing and treatment for hepatitis B and C through a network of hospitals and clinics across the country.
Why it mattered. It puts hepatitis C cures within reach of millions of Indians.
2020
October 2020
The Nobel Prize in Physiology or Medicine went to three scientists for discovering hepatitis C virus. Alter showed an unknown virus existed, Houghton found its genes, and Rice proved the virus alone causes the disease.
Why it mattered. It honoured a discovery that led to blood tests and cures that have saved millions of lives.
2024
April 2024
WHO's Global Hepatitis Report said 254 million people were living with hepatitis B and 50 million with hepatitis C in 2022. Viral hepatitis killed about 1.3 million people a year. India had about 29.8 million people with hepatitis B and 5.5 million with hepatitis C, the second largest total after China.
Why it mattered. We have a vaccine and a cure, but most people with hepatitis still have not been tested.
By the numbers
Share of patients cured (a sustained virological response) in major trials of each treatment era. Figures are rounded and mix virus types, so read them as a rough guide.
Did you know?
The liver is built from 50,000 to 100,000 lobules, each only about 0.8 to 2 millimetres across.
About 1.35 litres of blood flows through your liver every minute, around a quarter of everything your heart pumps at rest.
Your liver clears roughly one UK unit (8 grams) of alcohol an hour, and coffee or a cold shower does not speed it up.
After a living donor gives part of their liver, it grows back to full size in about two to three months.
The people
c. 1597 – 1677 · Physician and anatomist · England
Wrote the first detailed English book on the liver, Anatomia Hepatis.
1800 – 1874 · Anatomist · Ireland, worked in London
Showed the liver is built from many tiny six-sided lobules.
1813 – 1878 · Physiologist · France
Found that the liver makes sugar and stores it as glycogen.
1829 – 1902 · Anatomist · Born in Courland (Latvia), worked in Germany
Described star-shaped cells in the liver's blood channels.
1847 – 1928 · Pathologist · Poland
Recognised the liver's lining cells as germ-eating macrophages.
1900 – 1981 · Biochemist · Germany, later the UK
Worked out the urea cycle with Kurt Henseleit, and later won a Nobel Prize for the citric acid cycle.
1922 – 2008 · Paediatric surgeon · Japan
Invented the operation that lets bile drain from the livers of babies with biliary atresia.
1925 – 2011 · Physician and scientist · United States
Found the Australia antigen, the key to hepatitis B tests and vaccines.
1926 – 2017 · Transplant surgeon · United States
Performed the first liver transplants and the first successful one.
born 1949 · Virologist · United Kingdom, worked in the USA and Canada
Led the Chiron team that found hepatitis C virus.
Where it happened
Sources
Dates marked “c.” are approximate, and historians sometimes disagree about who was first. If you spot a mistake, tell us.
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