Osborne of Dublin and the Origin of Nephrology in Ireland J. F. M a h e r ~ and J. A. B. K e o g h ~
:Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A. and ZMeath Hospital, Heytesbury Street, Dublin 8. The landmark Irish contributions to medicine, for example, by Graves to endocrinology, by Colles to surgery, and by Stokes and by Cgrrigan to cardiology are well known. The pioneer nineteefith century Irish contributions to our understanding offiephrologyhave been inappropriatelyoverlooked or forgotten, but merit our recall. Shortly before Richard Bright of London ~ first associated albominuria with granular degeneration of the kidney in edematous patients, Johnathan Osborne~of Dublin reviewed the contemporary state of knowledge of nephrology, that is the physiology and pathology of urine. He credited Hippocrates with the observation that the sensible qualities of the urine are altered by the intake of food and drink. The normal urine was considered to be 93.3% water and to contain 3.0% urea (first detected in 1773), as well as smaller quantities of sulfate, phosphate, lactate, uric acid and sodium. The quantity of urine was noted to decrease when cutaneous exhalation increased, for example during summer in warm climates, and Osborne focused considerable attention on the interaction of the skin and the kidney, Affections of the kidney and bladder were indicated to early nineteenth century physicians by the presence of pus or blood in the urine which were ordinarily detected by visual inspection, even though Boerhaave had examined the urine with the assistance of a microscope a century earlier~. In "nephritis" the urine was reported to become scan ty and pale, but Osborne noted that often it became darker or even red from the admixture of red globules with it. When the nephritis proceednd to suppuration, a purulent discharge would occur in the urine. During attacks of gout, a brick-red sediment appeared. Citing Blackallz, Osbome ~ stated in 1820 (Figure 1) that dropsical urine sometimes presents a coagulation on the applieation of heat or of nitric acid. Until then, dropsy (edema) was considered to be a disease of the skin insteadofa symptom of an underlying systemic abnormality. The pathogenesis of dropsy was considered to be an imbalance of the exhalants and the absorbents often brought on by inflammation without any reference to the control of body fluid volumes by the kidney. Bright's important discovery in 1827 that albuminuria
A d d r e s s c o r r e s p o n d e n c e to: Dr. J. F, M a h e r ,
Professor of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814~799, U.S.A. The opinions and assertions contained herein are those of the authors and are not to be cortstrued as official or as representing those of the Uniformed Services University of the ftealth Sciences or the Department of Defense of Ihe U.S.A.
/t
SKETCH or T.~ PHYSIOLOGY
AND
PATHOLOGY
~P
URINE; AN HISTORICAl. INTRODUCTION.
.Y JO~r~TItJN OSBORNE, ~]I.R.T.C.D.
LO~I~ON: pz,mr;~,D r o a U u ~ E ~ A~,~J tULI., bmmc,~t ,BOO~:SRLL~,RS,
18'20.
Fig. 1 was associated with granular degeneration of the kidney, which in turn related to the occurrence of dropsy, was promptly and widely recognized and stimulated considerable interest in nephrulogy not only in England but worldwide. Albuminuria, despite some false positive tests, virtually became synonymous with Brighfs disease. Osborne+ stated that the merit of first distinctly tracing this disease (renal dropsy) to the kidneys belongs in the first instance to Dr. Bright. Nevertheless, Osborne, Dr. William Wells of St. Thomas' Hospilal, London, and Dr. John Blackan of Exeter had each previously noticed albuminous urine in some eases of dropsy, thereby paving the way for this discovery2,3.s.6. Not long after Bright's first publication, Osborne? questinned the reliability of this association of albuminuria as detected by coagulable urine and kidney disease. Among his 36 eases of albuminuria he identified some individuals in whom heat coagulable urine was demonstrated while they enjoyedgood health. He reasoned that if continuous secretion of coagulable urine by an individual could occur as he yet remains in undisturbed health and slrength, either the secretion is not due to disease or the disease is not importanP. Robert Gravess also questioned the universality of the association of albuminuria and Bright's disease, noting the variety of structural c,hanges identified. He inferred that it was not
VoL 161
No. 6
a change in the kidney but rather in the plasma protein that accounted for the proteinuria, suggesting the mechanism that is now known to occur with overflow proteinuria in myeloma. Osborne felt that diet could induce albuminuria, which at that time was detected by applying heat or by adding nitric acid or corrosive sublimate. A precipitate might also occur in a highly concentrated urine and he felt that a morning urine taken under fastingconditions would be mostreliable. Possibly he had encountered eases of postural proteinuria. Osborne4 also noted that in fevers and other inflammatory disorders the urine~aboands in urea and an albuminous deposit can be detected. Hence, this was not only recognition of febrile proteinuria ahead of his time, but also possibly the first evidence of the negative nitrogen balance accompanying the catabolism of systemic infection. In 1851 Osborne9 wrote more extensively on albuminous urine. Despite his initial skepticism because of albuminuria detected without concurrent kidney disease, he praised the original contributions of Dr. Bright in making the association and opening the subject for future study, and also commended the researches of Christisoo and of Gregory in Edinburgh, and of Solon in Paris. He noted the low urinary specific gravity of patients with Bright's disease which he attributed to a deficiency of mea; a few years earlier, Corrigan~~bad more correctly explained the low specific gravity by a deficiency of "saline matters" of die urine noting, "in Bright's disease the urine becomes deprived of its salts and its peculiar principle, urea". Osborne9 attributed albuminuria to inflammation of the kidney, approproately termed "nephritis", when his contemporatries considered Bright's disease a degeneration. He enumerated purulent cystitis,renal vein obstruction, fever, and the agonal state as examples ofalbuminuria without renal disease. Bright's disease, he wrote, has the following constellation of symptoms: dull loin pain (variable); albuminuria, sometimes with blood in the urine; deficiency of urea in the urine and its presence in the blood; generalized edema with serous effusions; feeble pulse and decreased perspiration; and gastrointestinal irritation with a tendency to coma or convulsions9. Although he incorrectly attributed the pathogenesis of the renal disease to impaired perspiration with vicarious renal elimination of retained proteinaceous dermal secretions, he had an early nineteenth century state of the art understanding of glomemlonephritis. Osborne9 attributed the serositis and gastrointestinal distress to the toxicity of retained urea, which he also believed caused nervous system abnormalities by inducing an arachnoidids. He recommended diaphoretic treatment and supplemented iron, noting the anaemia, but cautioned against the excessive therapeutic use of mercury. In this paper he also rcported a patient with anuria due to carcinomatous obstruction and described her 14-day course of fatal uremia. These contributions can merit for Dr. Osborne consideration as Ireland's first nephrologist. Born in Dublin in 1794,he graduated from Trinity College, Dublin with a B.A. in 1815 and obtained his M.B. in 1818, and M.D. in 1837 from the University of Dublin ~1. He served as King's Professor of Pharmacy and Materia Medica in the School of Physic, Dublin, and as Clinical Physician to Sir Patrick Dnn's and
Osborne and the origin of nephrology 421 Mercer's hospitals. He was a member of the Royal Irish Academy and of the Royal Society of Quebec, and in 1834 was elected President of the King and Queen's College of Physicians in Ireland. His writings were characterized by originality of thought and by classical learningt2. His peers considered him an admirable teacher with an original mind and ardent thirst for knowledgeL He was full of information and none could communicate it more happily. Osborne died in Blackrock, near Dublin, in 1864. Other Irish physicians who made important nineteenth century contributions to nephrology include Teeling7, Who in 1824 reported one of the first recorded cases of anuria. It was confirmed by bladder catheterization, and eventuated in hiccoughs, diarrhoea and fatal coma and convulsions. Kidd15,from Limerick, extensively reviewed renal physiology in 1844. His state of the art descriptions of microanatomyreflected Bowman's recent studies, and his detailed accounts of the chemical composition of the urine and its analysis in health and disease could cam him distinction as the pioneer Irish renal physiologist. He identified the rapid appearance of dyes in the urine, described the methodological difficulties in assay of urea in the blood, and recognised that urea was produced by the liver and excreted by the kidney. Aldridge16also wrote about the urine, emphasizing chemical analysis in his monograph and recording one of the first uses of microscopy to distinguish different deposits in the urine, including fibrinous casts of the conduits. In the middle of the nineteenth century, Sir Dominic Corrigan7 also was interested in renal disease noting the distinctions between two separate forms of Bright's disease. The large, smooth, avascalar, fatty kidney was likely to be found in those with dropsy. In conrast, the small scabrous kidney with the adherent capsule would lead to coma and failure to excrete urine and salts. Ahead of his contemporaries he concluded that these represented two distinct diseases, not merely different stages of the same disease. He recognized that ascites in those with Bright's disease was not due to an anatomic connection with the kidney or to vascular congestion, and could not be explained by heart disease or disease of the peritoneum7. Hence the exhalant/absorbent concept of the pathogenesis of edema was an insufficient explanation. Leesis, a contemporary of William Stokes at the Meath Hospital, recognized that the anemia of renal disease could not be explained by hematuria alone, but rather interpreted that the altered condition of the blood interfered with the development of the red corpuscles. He recommended iron for this abnormality. He was also not satisfied with attributing uremic toxicity to retention of urea alonc because of the poor correlation of blood levels and symptoms, and he did not accept that popular theory of decomposition of urea to ammonium carbonate to explain uremia because he did not detect ammonia in expired air. Davy~9, the distinguished Irish chemist, is credited with the first description of a simple method of determining the quantity of urea in the urine. The assay used sodium hypochlorite as the reagent, and was later modified to hypobromite and became popularly known as the Esbach method.
I.LM.S. June, 1992
422 MaherandKeogh
Normal values for volume and composition of urine were
established by Haughton2~ who also determined variations induced by diet, age, sex and exercise. Some other notable contributions to nineteenth century Irish nephrologicai literature include an interesting description by Sir Henry Marsh21 of edema complicating malnulrition, a differential diagnosis by Kennedyz'-of albuminuria and a strong recommendation in favor of mercurial therapy, a very early description of cystic disease of the kidney by Duffey z~, and further reports of Bright's disease by Moore~. The earty~andmid nineteenthcenturyrepresent the beginning of com;ersion of medicine from ignorant empiricism to a scientific approach to the diagnosis and treatment of disease. Yet this scientific method depended largely on bedside observation; it was not dominated by complex and increasingly expensive technology. It was in this milieu that the giants of Irish medicine gained such prominence. It is not surprising that at the same time the origins of renal medicine in Ireland were established. Other Irish physicians may have gained greater recognition25. Yet it seems that the pioneering contributions of Jonathan Osborne in nephrology, although emphasized somewhat less by historians, were important enough to be remembered~s. Because of Osborne's influence as well as that of his successors, Irish medicine appears to have also been in the forefront of the development of clinical nephrology in the nineteenth century. References 1. Bright, R. Cases and observations illustrative of renal disease accompanied with the secretion of albuminous urine. Guys IIosp. Rep. t 836: 12, 338-379. 2. Osborne, J. A SkewJa on the Physiology and Pathology of Urine. London; Burgess & Hill, 1820: pp. 80. 3. Blackall, J. Observations on the Nature and Cure of Drupsies. London; Longman, Hat, t, Rees, Orme and Brown, 1818: pp. 416. 4. Osborne, J. On Drol~ies Connetaed with Suppressed Perspiration and Coagulable Urine. London; Shenvood, Gilbert & Piper, 1835: pp. 64. 5. WelLs, W. C. On the pres~ee of the red matter and serum of blood in the urine of dropsy which has not originated from scarlet fever. Trans. Soc. Improvement Med. Chir. Knowledge 1812: 3, 194-240. 6, Little. J. Jonathan Osborne MD; a biographical sketch. Dublin J. Med. Sci. 1915: 139, 16i-164.
7, Osborne, J. Oit the nature and treatment of dropsies accompanied by coagulable urine and suppressed perspiration. Dublin J. Med. Chem. Sci. 1833/4: 4, 361-37L 8. Graves, R. J. Observations on the treatment of various diseases Dublin L Med, Sci. 1837: 11,391-408. 9. Osborne, J. Some further observations on dropises with albuminous urine. Dublin Q. J. Med. S~fi. 1851: 12, 1-18. 10. Corrlgan, D . J . On Bright's diseases of the kidneys. Med. Times (London) 1845: 12, 2 3. 11. Kirkpatfick, T. P. C. Chronological list of the published writings of Jonathan Osborne, M.D., F.K. & Q.C,P.I., M.R.I.A., Kings plofessor of materia medica and pharmacy in the School of Physic in Ireland; and physician to Sir Patrick Dun's and Mercer's Hospitals, Dublin. Physic L Med. Sci. 1915: 139, 164-172. 12. Anonymous. Ohit~ary; Jonathan Osborne. Med. Times Gazette (London) 1864: 1, 132. 13. AtJonymous. Obituary;JonathanDsbome. DublinQ.J. Med.Sci. 1864: 37, 249. 14. Teeling, C, A case of suppression of urine. Trans. Assoc. King's Queen's Coil. Physicians Ireland 1824: 4, 169-180. 15, Kidd, C. Observations on renal physiology with cases of the several affections of the kidney. Dublin Med. Press 1844: 12, 134-236, 151155,184-186, 218-219.233-234,247-249, 293-295, 310-312,358-360, 376-378; 1845: 13, 35-38, 51-54, 68-71. 16. Aldridge, J. Lectures on the Urine and on the Physiology, Diagnosis and Treatment of Urinary Disease. Dublin; Samuel J. Machen, 1846: pp. 80. 17. Corrigan, D. ]]right's disease of the k i d n ~ - two forms of - essentially distinct in their pathology and progresg, l)ublin Hosp. Gaz. 1854: 1, 346-347. 18. Lees, C. On the treatment of albuminuria by the administration of preparations of ir~m. Dublin Q, J. Med. Sci. 1852: 14, 33-47, 19. Davy, E.W. On a new and simple method of detemdning the amount of urea in the urinary secrerior~ Dublin ltosp. Gaz. 1854: 1,134-236. 20. Haughtun, S. On the natural constants of the healthy urine of man. Dublin Q. J. Med. Sci. 1859: 28, 1-17; 1960: 30, 1-18. 21. Marsh, H, Reflections on the causes of dropsy. Dublin Q. J. Med. Sci. 1853: 16, 1-17; 1855: 19, 252-269. 22, Kennedy, H. On the coexistence of functitmal and orgattie disease of the kidney; and on the use of mercm-y in some cases of Bright's disease. Dublin Q. J. Mcd. Sci. 1856: 22, 21-27. 23. Duffey, G. Cystic disease of the kidneys. Dublin Q. J. Med. Sci. 18(~5: 41, 438-441. 24. Moore, J. W, Parenchymatous nephritis. Dublin L Med. Sci, 1876: 62, 235-255, 25. Fleetwood, J. F. The Ilistory of Medicine in Ireland. Dublin, Skeliig Press, 1983: pp. 373. 26. Widdess, J. D.H. A History of the Royal College of Physicians of Ireland 1654-1963. Edinburgh, Livingstone, 1963: pp. 255.
:Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A. and ZMeath Hospital, Heytesbury Street, Dublin 8. The landmark Irish contributions to medicine, for example, by Graves to endocrinology, by Colles to surgery, and by Stokes and by Cgrrigan to cardiology are well known. The pioneer nineteefith century Irish contributions to our understanding offiephrologyhave been inappropriatelyoverlooked or forgotten, but merit our recall. Shortly before Richard Bright of London ~ first associated albominuria with granular degeneration of the kidney in edematous patients, Johnathan Osborne~of Dublin reviewed the contemporary state of knowledge of nephrology, that is the physiology and pathology of urine. He credited Hippocrates with the observation that the sensible qualities of the urine are altered by the intake of food and drink. The normal urine was considered to be 93.3% water and to contain 3.0% urea (first detected in 1773), as well as smaller quantities of sulfate, phosphate, lactate, uric acid and sodium. The quantity of urine was noted to decrease when cutaneous exhalation increased, for example during summer in warm climates, and Osborne focused considerable attention on the interaction of the skin and the kidney, Affections of the kidney and bladder were indicated to early nineteenth century physicians by the presence of pus or blood in the urine which were ordinarily detected by visual inspection, even though Boerhaave had examined the urine with the assistance of a microscope a century earlier~. In "nephritis" the urine was reported to become scan ty and pale, but Osborne noted that often it became darker or even red from the admixture of red globules with it. When the nephritis proceednd to suppuration, a purulent discharge would occur in the urine. During attacks of gout, a brick-red sediment appeared. Citing Blackallz, Osbome ~ stated in 1820 (Figure 1) that dropsical urine sometimes presents a coagulation on the applieation of heat or of nitric acid. Until then, dropsy (edema) was considered to be a disease of the skin insteadofa symptom of an underlying systemic abnormality. The pathogenesis of dropsy was considered to be an imbalance of the exhalants and the absorbents often brought on by inflammation without any reference to the control of body fluid volumes by the kidney. Bright's important discovery in 1827 that albuminuria
A d d r e s s c o r r e s p o n d e n c e to: Dr. J. F, M a h e r ,
Professor of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814~799, U.S.A. The opinions and assertions contained herein are those of the authors and are not to be cortstrued as official or as representing those of the Uniformed Services University of the ftealth Sciences or the Department of Defense of Ihe U.S.A.
/t
SKETCH or T.~ PHYSIOLOGY
AND
PATHOLOGY
~P
URINE; AN HISTORICAl. INTRODUCTION.
.Y JO~r~TItJN OSBORNE, ~]I.R.T.C.D.
LO~I~ON: pz,mr;~,D r o a U u ~ E ~ A~,~J tULI., bmmc,~t ,BOO~:SRLL~,RS,
18'20.
Fig. 1 was associated with granular degeneration of the kidney, which in turn related to the occurrence of dropsy, was promptly and widely recognized and stimulated considerable interest in nephrulogy not only in England but worldwide. Albuminuria, despite some false positive tests, virtually became synonymous with Brighfs disease. Osborne+ stated that the merit of first distinctly tracing this disease (renal dropsy) to the kidneys belongs in the first instance to Dr. Bright. Nevertheless, Osborne, Dr. William Wells of St. Thomas' Hospilal, London, and Dr. John Blackan of Exeter had each previously noticed albuminous urine in some eases of dropsy, thereby paving the way for this discovery2,3.s.6. Not long after Bright's first publication, Osborne? questinned the reliability of this association of albuminuria as detected by coagulable urine and kidney disease. Among his 36 eases of albuminuria he identified some individuals in whom heat coagulable urine was demonstrated while they enjoyedgood health. He reasoned that if continuous secretion of coagulable urine by an individual could occur as he yet remains in undisturbed health and slrength, either the secretion is not due to disease or the disease is not importanP. Robert Gravess also questioned the universality of the association of albuminuria and Bright's disease, noting the variety of structural c,hanges identified. He inferred that it was not
VoL 161
No. 6
a change in the kidney but rather in the plasma protein that accounted for the proteinuria, suggesting the mechanism that is now known to occur with overflow proteinuria in myeloma. Osborne felt that diet could induce albuminuria, which at that time was detected by applying heat or by adding nitric acid or corrosive sublimate. A precipitate might also occur in a highly concentrated urine and he felt that a morning urine taken under fastingconditions would be mostreliable. Possibly he had encountered eases of postural proteinuria. Osborne4 also noted that in fevers and other inflammatory disorders the urine~aboands in urea and an albuminous deposit can be detected. Hence, this was not only recognition of febrile proteinuria ahead of his time, but also possibly the first evidence of the negative nitrogen balance accompanying the catabolism of systemic infection. In 1851 Osborne9 wrote more extensively on albuminous urine. Despite his initial skepticism because of albuminuria detected without concurrent kidney disease, he praised the original contributions of Dr. Bright in making the association and opening the subject for future study, and also commended the researches of Christisoo and of Gregory in Edinburgh, and of Solon in Paris. He noted the low urinary specific gravity of patients with Bright's disease which he attributed to a deficiency of mea; a few years earlier, Corrigan~~bad more correctly explained the low specific gravity by a deficiency of "saline matters" of die urine noting, "in Bright's disease the urine becomes deprived of its salts and its peculiar principle, urea". Osborne9 attributed albuminuria to inflammation of the kidney, approproately termed "nephritis", when his contemporatries considered Bright's disease a degeneration. He enumerated purulent cystitis,renal vein obstruction, fever, and the agonal state as examples ofalbuminuria without renal disease. Bright's disease, he wrote, has the following constellation of symptoms: dull loin pain (variable); albuminuria, sometimes with blood in the urine; deficiency of urea in the urine and its presence in the blood; generalized edema with serous effusions; feeble pulse and decreased perspiration; and gastrointestinal irritation with a tendency to coma or convulsions9. Although he incorrectly attributed the pathogenesis of the renal disease to impaired perspiration with vicarious renal elimination of retained proteinaceous dermal secretions, he had an early nineteenth century state of the art understanding of glomemlonephritis. Osborne9 attributed the serositis and gastrointestinal distress to the toxicity of retained urea, which he also believed caused nervous system abnormalities by inducing an arachnoidids. He recommended diaphoretic treatment and supplemented iron, noting the anaemia, but cautioned against the excessive therapeutic use of mercury. In this paper he also rcported a patient with anuria due to carcinomatous obstruction and described her 14-day course of fatal uremia. These contributions can merit for Dr. Osborne consideration as Ireland's first nephrologist. Born in Dublin in 1794,he graduated from Trinity College, Dublin with a B.A. in 1815 and obtained his M.B. in 1818, and M.D. in 1837 from the University of Dublin ~1. He served as King's Professor of Pharmacy and Materia Medica in the School of Physic, Dublin, and as Clinical Physician to Sir Patrick Dnn's and
Osborne and the origin of nephrology 421 Mercer's hospitals. He was a member of the Royal Irish Academy and of the Royal Society of Quebec, and in 1834 was elected President of the King and Queen's College of Physicians in Ireland. His writings were characterized by originality of thought and by classical learningt2. His peers considered him an admirable teacher with an original mind and ardent thirst for knowledgeL He was full of information and none could communicate it more happily. Osborne died in Blackrock, near Dublin, in 1864. Other Irish physicians who made important nineteenth century contributions to nephrology include Teeling7, Who in 1824 reported one of the first recorded cases of anuria. It was confirmed by bladder catheterization, and eventuated in hiccoughs, diarrhoea and fatal coma and convulsions. Kidd15,from Limerick, extensively reviewed renal physiology in 1844. His state of the art descriptions of microanatomyreflected Bowman's recent studies, and his detailed accounts of the chemical composition of the urine and its analysis in health and disease could cam him distinction as the pioneer Irish renal physiologist. He identified the rapid appearance of dyes in the urine, described the methodological difficulties in assay of urea in the blood, and recognised that urea was produced by the liver and excreted by the kidney. Aldridge16also wrote about the urine, emphasizing chemical analysis in his monograph and recording one of the first uses of microscopy to distinguish different deposits in the urine, including fibrinous casts of the conduits. In the middle of the nineteenth century, Sir Dominic Corrigan7 also was interested in renal disease noting the distinctions between two separate forms of Bright's disease. The large, smooth, avascalar, fatty kidney was likely to be found in those with dropsy. In conrast, the small scabrous kidney with the adherent capsule would lead to coma and failure to excrete urine and salts. Ahead of his contemporaries he concluded that these represented two distinct diseases, not merely different stages of the same disease. He recognized that ascites in those with Bright's disease was not due to an anatomic connection with the kidney or to vascular congestion, and could not be explained by heart disease or disease of the peritoneum7. Hence the exhalant/absorbent concept of the pathogenesis of edema was an insufficient explanation. Leesis, a contemporary of William Stokes at the Meath Hospital, recognized that the anemia of renal disease could not be explained by hematuria alone, but rather interpreted that the altered condition of the blood interfered with the development of the red corpuscles. He recommended iron for this abnormality. He was also not satisfied with attributing uremic toxicity to retention of urea alonc because of the poor correlation of blood levels and symptoms, and he did not accept that popular theory of decomposition of urea to ammonium carbonate to explain uremia because he did not detect ammonia in expired air. Davy~9, the distinguished Irish chemist, is credited with the first description of a simple method of determining the quantity of urea in the urine. The assay used sodium hypochlorite as the reagent, and was later modified to hypobromite and became popularly known as the Esbach method.
I.LM.S. June, 1992
422 MaherandKeogh
Normal values for volume and composition of urine were
established by Haughton2~ who also determined variations induced by diet, age, sex and exercise. Some other notable contributions to nineteenth century Irish nephrologicai literature include an interesting description by Sir Henry Marsh21 of edema complicating malnulrition, a differential diagnosis by Kennedyz'-of albuminuria and a strong recommendation in favor of mercurial therapy, a very early description of cystic disease of the kidney by Duffey z~, and further reports of Bright's disease by Moore~. The earty~andmid nineteenthcenturyrepresent the beginning of com;ersion of medicine from ignorant empiricism to a scientific approach to the diagnosis and treatment of disease. Yet this scientific method depended largely on bedside observation; it was not dominated by complex and increasingly expensive technology. It was in this milieu that the giants of Irish medicine gained such prominence. It is not surprising that at the same time the origins of renal medicine in Ireland were established. Other Irish physicians may have gained greater recognition25. Yet it seems that the pioneering contributions of Jonathan Osborne in nephrology, although emphasized somewhat less by historians, were important enough to be remembered~s. Because of Osborne's influence as well as that of his successors, Irish medicine appears to have also been in the forefront of the development of clinical nephrology in the nineteenth century. References 1. Bright, R. Cases and observations illustrative of renal disease accompanied with the secretion of albuminous urine. Guys IIosp. Rep. t 836: 12, 338-379. 2. Osborne, J. A SkewJa on the Physiology and Pathology of Urine. London; Burgess & Hill, 1820: pp. 80. 3. Blackall, J. Observations on the Nature and Cure of Drupsies. London; Longman, Hat, t, Rees, Orme and Brown, 1818: pp. 416. 4. Osborne, J. On Drol~ies Connetaed with Suppressed Perspiration and Coagulable Urine. London; Shenvood, Gilbert & Piper, 1835: pp. 64. 5. WelLs, W. C. On the pres~ee of the red matter and serum of blood in the urine of dropsy which has not originated from scarlet fever. Trans. Soc. Improvement Med. Chir. Knowledge 1812: 3, 194-240. 6, Little. J. Jonathan Osborne MD; a biographical sketch. Dublin J. Med. Sci. 1915: 139, 16i-164.
7, Osborne, J. Oit the nature and treatment of dropsies accompanied by coagulable urine and suppressed perspiration. Dublin J. Med. Chem. Sci. 1833/4: 4, 361-37L 8. Graves, R. J. Observations on the treatment of various diseases Dublin L Med, Sci. 1837: 11,391-408. 9. Osborne, J. Some further observations on dropises with albuminous urine. Dublin Q. J. Med. S~fi. 1851: 12, 1-18. 10. Corrlgan, D . J . On Bright's diseases of the kidneys. Med. Times (London) 1845: 12, 2 3. 11. Kirkpatfick, T. P. C. Chronological list of the published writings of Jonathan Osborne, M.D., F.K. & Q.C,P.I., M.R.I.A., Kings plofessor of materia medica and pharmacy in the School of Physic in Ireland; and physician to Sir Patrick Dun's and Mercer's Hospitals, Dublin. Physic L Med. Sci. 1915: 139, 164-172. 12. Anonymous. Ohit~ary; Jonathan Osborne. Med. Times Gazette (London) 1864: 1, 132. 13. AtJonymous. Obituary;JonathanDsbome. DublinQ.J. Med.Sci. 1864: 37, 249. 14. Teeling, C, A case of suppression of urine. Trans. Assoc. King's Queen's Coil. Physicians Ireland 1824: 4, 169-180. 15, Kidd, C. Observations on renal physiology with cases of the several affections of the kidney. Dublin Med. Press 1844: 12, 134-236, 151155,184-186, 218-219.233-234,247-249, 293-295, 310-312,358-360, 376-378; 1845: 13, 35-38, 51-54, 68-71. 16. Aldridge, J. Lectures on the Urine and on the Physiology, Diagnosis and Treatment of Urinary Disease. Dublin; Samuel J. Machen, 1846: pp. 80. 17. Corrigan, D. ]]right's disease of the k i d n ~ - two forms of - essentially distinct in their pathology and progresg, l)ublin Hosp. Gaz. 1854: 1, 346-347. 18. Lees, C. On the treatment of albuminuria by the administration of preparations of ir~m. Dublin Q, J. Med. Sci. 1852: 14, 33-47, 19. Davy, E.W. On a new and simple method of detemdning the amount of urea in the urinary secrerior~ Dublin ltosp. Gaz. 1854: 1,134-236. 20. Haughtun, S. On the natural constants of the healthy urine of man. Dublin Q. J. Med. Sci. 1859: 28, 1-17; 1960: 30, 1-18. 21. Marsh, H, Reflections on the causes of dropsy. Dublin Q. J. Med. Sci. 1853: 16, 1-17; 1855: 19, 252-269. 22, Kennedy, H. On the coexistence of functitmal and orgattie disease of the kidney; and on the use of mercm-y in some cases of Bright's disease. Dublin Q. J. Mcd. Sci. 1856: 22, 21-27. 23. Duffey, G. Cystic disease of the kidneys. Dublin Q. J. Med. Sci. 18(~5: 41, 438-441. 24. Moore, J. W, Parenchymatous nephritis. Dublin L Med. Sci, 1876: 62, 235-255, 25. Fleetwood, J. F. The Ilistory of Medicine in Ireland. Dublin, Skeliig Press, 1983: pp. 373. 26. Widdess, J. D.H. A History of the Royal College of Physicians of Ireland 1654-1963. Edinburgh, Livingstone, 1963: pp. 255.
