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The Early Modern Kidney—Nephrology in and about the Nineteenth Century (Part 1)

Authors


Address correspondence to: Garabed Eknoyan, M.D., Department of Medicine (523-D), Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, Tel.: 713 798 4748, Fax: 713 790 0681, or e-mail: geknoyan@bcm.edu.

Abstract

The 19th century was a period of momentous scientific discoveries, technological achievements, and societal changes. A beneficiary of these revolutionary upheavals was medical empiricism that supplanted the rationalism of the past giving rise to early modern scientific medicine. Continued reliance on sensory data now magnified by technical advances generated new medical information that could be quantified with increasing precision, verified by repeated experimentation, and validated by statistical analysis. The institutionalization and integration of these methodologies into medical education were a defining step that assured their progress and perpetuation. Major advances were made in the nosography of diseases of the kidney, notably that of the diagnosis of progressive kidney disease from the presence of albuminuria by Richard Bright (1789–1858); and of renal structure and function, notably the demonstration of the continuity of the glomerular capsule with the tubular basement membrane by William Bowman (1816–1892), and the arguments for hemodynamic physical forces mediated glomerular filtration by Carl Ludwig (1816–1895) and for active tubular transport by Rudolf Heidenhain (1834–1897). Improvements in microscopy and tissue processing were instrumental in describing the cellular ultrastructure of the glomerulus and tubular segments, but their integrated function remained to be elucidated. The kidney continued to be considered a tubular secretory organ and its pathology attributed to injury of the interstitium (interstitial nephritis) or tubules (parenchymatous nephritis).

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