Lumleian Lectures on Bright's Disease
Authors: R. Southey
Journal: BMJ (1881)

HIIPPOCRATES, in his Prognostics (21), distinguishes the dropsies origin- ating from the flanks or loins from those which are due to disease of the lver; and although, in his description of the diseases of the kidneys, we find nothing to prove that he was acquainted with any pathological con- ditions other than those which are provoked by gravel, calculus, or by extensions of mischief from the bladder up into the kidney, it is obvious, from remarks found scattered through his writings, that he had not failed to observe diminished urination associated with general dropsy, beginning in the feet, and attended by obstinate diarrhcea, which failed to relieve or empty the abdomen.In Section 7, Aphorism 66, he advises that in all diseases the urine should claim special attention, since information as to the soundness or unsoundness of the body was to be obtained by inspection of this important excretion.In Section 7, Aphorism 34, we read: Bubbles maintained uDon the top of the urine signify a disease of the reins, and likewise its long con- tinuance; a fact which remained unimportant until the end of the last century, when it was ascertained that albuminous urine held a froth of bubbles on its surface.In Section 4, Aphorism 70, he observes that those who have their uxine troubled or unclean, after the habit of cattle, are or shall be troubled withheadache.In Sir Conrad Sprengel's Tranis/ation of the Aphorisms, published in 1735, p. 267, I find these noticeable remarksmade upon Aphorism 77 (Section 7): "The urine generally discovers to us the state of the blood: stringy and lint-like ramenta in the urine denote a crude and unsdigested chyle; and the thicker they are in the urine, the more there must be likewise in the blood.This kind of urine I have lately observed in a gentleman that had ruined his body by intemperate drinking and contracting great cold.He had a great appetite tohis victuals,but more to his drink."..." His stomach (was) hard, painful, and swelled, his legs likewise swelled, and his face pale and bloated."This was surely a case of renal dropsy and granular kidneys.Aretzeus the Cappadocian (Adams's edition, London,I856, 342) makes some observations upon blood in the urine which, interpreted by our present knowledge, and although vague and rather spoiled by being mixed up with remarks onhbomorrhoids, show at all events that he recognised the association of pallor, sluggishness, proclivity to head- ache, and epileptic attacks, in some forms of urinary disease, as well as general anasarca and dropsy in others.It is probable that Aretqeus was a contemporary of Galen, which takes us back, therefore, to the certain date, A.D. 131.Towards the close of the sixteenth century, necropsies became more frequent; and several medical authors makemention of dropsy in con- nection with abnormal conditions of the kidneys.J. B. Morgagni, Epistle 42, DC Selibus et Catisis 'fforboruem, describes the case of a dropsical patient who died suddenly, and whose body he examined." Renis utriusque structura intima confusa apparuit"; and, in Epistle 40,he anatomises the kidneys of an old woman."Ren uterque inxequali erat superficii et maculis albis hic illic variegata."Morgagni notices, in Epistle 41, art.4, a case of acute renal dropsy, provoked doubtless by exposure of the body to cold in the treatment of itch.Morgagni writes: "The kidneys were larger than normal."(I remember seeing an exactly parallel examp!e in Vienna in IHebra's clinic.)The itch was treated by an ointment rubbed into the skin: suppression of urine and vomiting followed, pain in the left lumbar region, general dropsy, and death.Granular kidneys and large white kidneys had therefore been discovered before Bright wrote ; while Avi- cenna, in i64*, was certainly before him in distinguishing between the Avicenna, Libriins -e .eIdiceomzites (lib.3, fin.I4, tract.cap. 4).de Hydro- pisi, 769, in foliis Venetiis."A renibus vero non solum fit communicantia noxae per se, sed ex accidenti, si aquositatem non purgent, unde multa in venis; fitque sanguis aquosus et excolitur serum."dropsies consequent upon disease of the liver, and those which followed upon disease of the kidney.It is to Cotugno, however, in 1770 (De Ischiade Nervosd Comment., Vienna, p. 24-25), that we are indebted for the discovery of albumen in the urine of dropsical persons, which he attributed to the passage of the dropsical eflusion over into the urine, and regarded, unfortunately most incorrectly, as nature's mode of resisting and repairing disease.In 1798, Cruickshank advanced matters a step further (vide Rollo, Cases of Diabetes Mel/i/tus, chapter vi, London), by recognising the fact that in some cases of dropsy albumen did appear in the urine, while in others it did not.