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      Friedrich Theodor von Frerichs (1819–1885) and Bright’s Disease

      American Journal of Nephrology

      S. Karger AG

      Friedrich Theodor von Frerichs (1819–1885), Bright’s disease, Germany, 19th century

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          Background: Richard Bright (1789–1858) discovered that edema and proteinuria are linked with renal disease. Friedrich Theodor von Frerichs (1819–1885) performed microscopic studies on Bright’s disease and wrote the first German textbook of nephrology. The present contribution analyzes Frerichs’ work. Methods: Frerichs’ career and his book Die Bright`sche Nierenkrankheit und deren Behandlung are examined in terms of contemporary medical knowledge. Results: Frerichs conducted clinical and microscopic studies that led him to conclude that Bright’s disease is a single pathological entity with many possible causes. Frerichs identified three stages through which the condition progresses. Although an oversimplification, Frerichs’ various stages are reflected in the current notion that chronic renal disease, irrespectively of its etiology, relentlessly progresses to end-stage renal failure with common features of tubulointerstitial fibrosis and tubular atrophy. After writing his monograph, Frerichs never touched on renal disease again and is actually better known for his contributions to hepatology. Frerichs was a volatile and difficult person who was not always fair to his students and colleagues. Conclusion: Frerichs put the study of renal diseases on the map in Germany and made the novel observation that chronic renal diseases follow similar morphological patterns despite multiple origins.

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          The Concept of ‘Glomerulonephritis’

          Though the term ‘nephritis’ first appeared in the 19th century, this word did not bear the same meaning as it does today; indeed, for many years it was used to indicate ‘renal diseases’ (in the sense of Bright’s disease) in a larger sense. This review summarizes the long gestation of the concept of ‘glomerulonephritis’ from the prehistory of medicine up to the beginning of the second half of the 20th century with emphasis on Italy and, in particular, on Torino, which was the capital of the Kingdom of Italy from 1861 to 1865. To the best of our kowledge, this is the first study reporting an epidemiology survey of Bright’s disease in Italy from 1880 up to 1960. Towards the end of the 19th century, Bright’s disease accounted for 26 deaths/year/10 5 population (in comparison with more than 200 from tuberculosis) in Italy, roughly paralleling that reported in the USA. At the beginning of the 20th century, Bright’s disease was the seventh cause of death (almost 1% of total deaths) in Italy. Furthermore, in Italy, as elsewhere, autopsy studies showed a higher percentage of deaths attributed to Bright’s disease (5–7%) in comparison with those obtained from vital statistics. In 1960, just before the beginning of renal replacement therapy, Bright’s disease accounted for 15.7 deaths/year/10 5 population (= 1.46% of all deaths), roughly paralleling that reported in the United Kingdom (13.8/10 5 population = 1.25% of deaths). Probably, it was difficult to recognize the real incidence of chronic renal diseases leading to death in the 1960s, and vital statistics were able to furnish only approximate estimates. However, noteworthy is the fact that these values were very close to those estimated as being the annual need for renal replacement therapy (10–20 cases/year/10 5 population).

            Author and article information

            Am J Nephrol
            American Journal of Nephrology
            S. Karger AG
            December 2002
            07 October 2002
            : 22
            : 5-6
            : 596-602
            Division of Nephrology and Osteology, Department of Medicine, University of Hamburg, Germany
            65291 Am J Nephrol 2002;22:596–602
            © 2002 S. Karger AG, Basel

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            Page count
            Figures: 3, References: 22, Pages: 7
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            Historical Section


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