Insipid diabetes
History of Nephrology
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2y ago
A disease of 1769 becomes a treatment in 2015 The Edinburgh physician William Cullen described the difference between ‘sweet’ diabetes (mellitus = honey), and rare cases where the urine tasted ‘insipid’, in 1769. There were no dipsticks then, so the basis of distinction was indeed taste. There is huge variation in how much people drink. But not so many causes of extreme polyuria. In 1792 two remarkable cases from the lay press (the Paris Journal in 1789, and Lincoln Mercury in 1791), were recounted in a medical journal. They were a French woman thirsty from birth, said to have drunk ..read more
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Historyofnephrology in Nephmadness
History of Nephrology
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2y ago
Not sure we understand this, but we're in it. #NephMadness  Click to participate; watch 1 min explanation video 4 History contenders - we have 4 history topics in two pairs, up against each other till we end up with one to go through to compete with the others. You have to vote; then after that, for the history topic vs. the others. More info and how to. Inventions of Maintenance HD, vs. Transplantation Ray Jones began treatment in 1963 Imagine it’s 1963 and you have end stage renal failure. Nobody knows whether there is any long term hope for Scribner’s crazy maintenan ..read more
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Hundreds of local stories in the development of dialysis
History of Nephrology
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2y ago
Illustrated in 1960s Augusta, Georgia An account at the coincidence of racial desegregation and the first hints of feasibility of long term dialysis and transplantation. George Van Giesen and Maytag washing machine (with permission of the author). George Van Giesen entered private practice in Augusta in 1963 from a two-year nephrology/metabolic fellowship in Dallas under Donald Seldin. There he encountered  not only dialysis for acute renal failure, but also a Norwegian visiting professor Fredrik Kiil, who had just invented the flat plate dialyser, which came to be a mainstay o ..read more
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High blood pressure becomes treatable
History of Nephrology
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2y ago
The first unequivocally useful drug, 1964 Robust and practical sphygmomanometers (mercury and aneroid) became available in the early 1900s, but regular recording of blood pressure did not become widely routine until the 1920s and 30s. Until then, palpating the pulse offered the only insight, except that ophthalmoscopy could show severe hypertensive retinal changes, neuro-retinitis albuminurica (Figure). The ophthalmoscope had been invented in 1851, but only had electric bulbs after 1900. From Kempner 1946 Courtesy of the New York Academy of Medicine Library Essential and malignant h ..read more
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The doctor's bag circa 1910
History of Nephrology
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2y ago
This doctor’s bag is in the London Science Museum. Though dated 1890-1930 much of its contents look very early 20th century. What it doesn’t contain is significant. It belonged to John Hill Abram (1863-1933), a Liverpool physician who later became Professor of Medicine.  He was also president of the Association of Physicians in 1928 – perhaps it is likely that he was not doing many housecalls in his senior years.  But how difficult it would have been to diagnose kidney disease. There is no way of measuring blood pressure.  Useful sphygmomanometers were coming into use only e ..read more
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Lithotomists: the first nephro-urological specialists
History of Nephrology
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2y ago
A sound has been passed from the penis into the bladder. With the genitalia held out of the way, and the patient strapped firmly to the table and held down by strong men, the surgeon cuts down onto the sound through an incision in the perineum. The incision is then widened a little, and the stone grasped in special forceps and removed intact if possible.  The illustration also explains the origin of the ‘lithotomy position’.  (From Litotomia, by Tommaso Alghisi, Florence 1707.  Wellcome Images, Creative Commons.) This terrifying operation to remove bladder stones w ..read more
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Home haemodialysis - how far can it go?
History of Nephrology
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2y ago
The home dialysis expansion of the 1960s and 70s Olga Heppel - one of the UK's first home haemodialysis patients at home in 1964.  Watch the movie at britishpathe.com. It came as a surprise to many that haemodialysis could be more than a short-term treatment.  But pressures on capacity were immediate, varying methods being used to decide 'who shall live'.  Part of the remarkable response to this was that in 1964 teams in Seattle, Boston and London trained and began to send patients home to run their own dialysis.  There followed a flurry of development to make this ..read more
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Marathon nephritis and postural proteinuria
History of Nephrology
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2y ago
When urinary abnormalities don’t indicate renal disease From Tom Brown at Oxford (1861) illust Sydney P Hall (1903 edition) Richard Bright’s 1827 description of the association of proteinuria with dropsy and serious kidney disease led to doctors of the 1800s kitting up with apparatus to test for proteinuria, long before they could measure blood pressure.  Uroscopy (looking at urine) had after all for centuries been a key element of the theatre of medical consultation.  But proteinuria was now definitely associated with renal disease, and soon enough it became associ ..read more
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Monkey glands and the science of renal hypertension
History of Nephrology
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2y ago
Quack medicine and technology contributed to the discovery of Renin in 1898 A 1928 advert exploiting the Monkey Gland craze.  Source In 1889 the renowned scientist Brown-Sequard at the age of 72 publicly recounted how how he felt rejuvenated after injecting himself with extracts of animal testis.  This led to an extraordinary wave of quack medicine involving injections with all types of organ extracts (organotherapy), peaking most infamously with a fashion for transplantation of monkey testicles into rich men seeking rejuvenation. Surgeon Serge Voronoff working in France in the 19 ..read more
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Blood pressure is linked to kidney disease in the 1870s
History of Nephrology
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2y ago
Revealed by Mahomed’s sphygmograph The discovery of hypertension and its linkage with renal disease came remarkably late.  Richard Bright (1836) observed that “the hypertrophy of the heart seems, in some degree, to have kept pace with the advance of disease of the kidneys”.  But he had no way to measure blood pressure, and even by the early 1900s a doctor’s bag was likely to contain a urine testing kit, but not a device for measuring blood pressure.  It was 35 years before blood pressure measurements became possible and 35 more before it began to become an everyday practice.&nb ..read more
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