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Nephrology in the United States from Osler to the Artificial Kidney
Abstract
Modem knowledge of renal physiology, kidney disease, and the body fluids in American medicine was established largely by Donald D. Van Slyke, Thomas Addis, John P. Peters, Homer W. Smith, and Alfred Newton Richards. Only two of these men were physicians, and through this group future nephrology was shaped by a dominant interest in metabolic problems and pathophysiology. Acute renal failure emerged as a new syndrome during World War II and fostered interest in hemodialysis and renal biopsy. Dialysis, when applied to chronic renal failure, eventually spawned an army of renal clinicians; and biopsy provided a specialist's nosology of what had once enjoyed the unity of "Bright's disease." A society and subspecialty board came late to nephrology and have been directed largely by renal academicians of the metabolic tradition. Nephrology is in the 1980s a bipartite subspecialty, its senior leaders still cherishing the metabolic-physiologic tradition, and a growing army of dialysis practitioners mostly looking after patients with chronic and acute renal failure.
- acid-base imbalance
- acute kidney failure
- Thomas Addis
- American Heart Association
- American Society of Nephrology
- biopsy
- Bright's disease
- chronic kidney failure
- dialysis
- Otto Folin
- James L. Gamble
- glomerulonephritis
- hemodialysis
- history of medicine, 20th century
- Robert M. Kark
- John P. Merrill
- nephrology
- William Osler
- John Punnett Peters
- physiology
- renal biopsy
- Alfred Newton Richards
- Belding Scribner
- Homer W. Smith
- Donald D. Van Slyke
- water-electrolyte balance
Article and Author Information
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▸From the Division of Nephrology and Hypertension, Department of Medicine, The Medical College of Pennsylvania; Philadelphia, Pennsylvania.
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▸The original version of this paper was commissioned for a conference on the history of internal medicine at the Francis C. Wood Institute for the History of Medicine, College of Physicians of Philadelphia, in March 1986. It is the fourth in a series being published in the History of Medicine section in the academic year 1986-87. Russell C. Maulitz, M.D., Ph.D., and Diane E. Long, Ph.D., are editors for the series. The full versions of these papers and several others will appear in a proceeding entitled Grand Rounds, to be published by the University of Pennsylvania Press in 1987. The copyright to this and the other papers in the series is owned by the University of Pennsylvania Press.
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▸Requests for reprints should be addressed to Steven J. Peitzman, M.D.; The Medical College of Pennsylvania, 3300 Henry Avenue; Philadelphia, PA 19129.
