[Pierre J. Desault and the birth of nephrology 1785-1795]. / La néphrologie naît avec Pierre J. Desault en 1785-1795.

Desault's genius and methods opened up a new field, the pathology of those medical conditions which afflict the urinary apparatus. Though he was a surgeon and therefore an anatomically based clinician, his most important discoveries were in pathological physiology, the polyuria of atrophic kidneys, the fatal dehydratation which follows the various forms of polyuric diabetes, and the oligo-anurias which follow excess water loss from the gut, the lungs ... etc. In the last two conditions the kidneys might look normal and therefore might be presumed normal. If Desault's work had survived this physiological eruption into renal disorders would have been the first decisive step of modern nephrology. His message, though excellent, was delivered too soon and on barren soil, to poorly educated physicians who paid little attention. But then, one has to remember that Desault was just a surgeon!

[Pierre Rayer and the foundation in 1858 of the AGMF: an underrated social-political event]. / Pierre Rayer et la Fondation en 1858 de l'Association Générale des Médecins de France, un événement socio-politique méconnu.

The founding by Rayer in 1858 of the Association Générale des Médecins de France (AGMF), which gathered academic, hospital, and rural or urban doctors, was an act of professional solidarity. This action had a major social and political impact, making obsolete the Le Chapelier law of 1791, which limited to local communities the activity of provident societies. The AGMF also fought against illegal medical acts and for the dignity of medical care. It organized social health care, free for the poor and negotiated for local mutualists, helped establish relations between health care and government, and prepared the 1868 law on industrial injuries. Rayer financed the AGMF from the beginning, and devoted himself to it as a renowned clinician fully aware of the medical applications of science and as the founding President of the Société de Biologie and of Napoléon III's private physician, who fully supported the AGMF.

[The Society of Renal Pathology (1948-1949)]. / La société de pathologie rénale (1948-1959).

Founded in 1948 under the leadership J. Hamburger, the Société de pathologie rénale played an important role for the development of what will become within 10 years a new discipline, Nephrology. Our discipline is unique since it does not come from internal medicine but from fundamental biology which is needed to analyze and understand the normal and diseased kidney. In the Société, where European and Francophone investigators met, several aspects of Nephrology were presented, discussed and sometimes solved such as acute renal failure and its treatment by peritoneal dialysis or hemodialysis, electrolytic disorders and their correction sin intensive care units, renal biopsies in primitive and secondary renal diseases. In 1959, this society became Société de néphrologie, preceding the first international congress of Nephrology, another success of J. Hamburger.

[Medicine in the Cuvier Report on Natural Sciences (1810)]. / La medecine dans le Rapport Historique sur les Progres des Sciences Naturelles de Georges Cuvier (1810).

Through that many sided Report to Napoleon, Cuvier delivers a plain view upon European medicine in 1800. That document remained somewhat ignored as biochemical and physiological information are scattered throughout the text, with no clear link with the "Medicine, an applied science" chapter. Chemistry and physiology of animal beings include most of the recent true data about digestion, metabolism, respiration and nervous system added to the classic irritability. Proved data, still very few, are completed by logical and well organized but theoretical concepts forshadowing future physiology, "milieu interieur" and thermal regulation among everything. But the anatomist Cuvier did not link chemistry to physiology. Clinical practice fascinate Cuvier. Nosology, thoroughly studied, disappointed the naturalist for its incapability of establishing a classification of diseases. Morbid anatomy and physical investigation, the just appearing percussion, are welcome with hope as well as experimental pharmacology and hygiene. But normal and pathological chemistry and biology are not integrated to clinical medicine leading to neglect Bichat's works and those on experimental asphyxiation ...etc. Cuvier, who was not a physician, deliberately adopted this attitude : didn't he change the effect of an expert memoir he had asked J.N. Halle, a famous physician and scientist ? But nevertheless he stated that progress in medicine is experimental! This statement report, written by a critic scientist, is an important reference mark of time, when medicine shifted, ceasing to be only empirical.

[Natural science and introduction to physical chemistry in nephrology]. / Sciences naturelles et introduction de la chimie physique en néphrologie.

Osmosis, as described in 1825 by H.J. Dutrochet, played a role in the role in the beginning of physical chemistry and of the evaluation of renal functions. In 1871, the osmotic pressure, not so well understood by scientists, was again suggested by de Vries who described the "plasmolysis", a phenomenon corresponding to cell retraction when incubated in high molecular concentration solutions. Although the results were not well interpretated, this phenomenon was related to the osmotic pressure. Van't Hoff studied the mechanisms phenomena and compared it to the gas volume/pressure relationship. Dreser measured in urine the cryoscopic delta that had just discovered by Raoult in animal and man, after a water load (-0.20 degree C) or a water restriction (-2.50 degrees C) and calculated approximately the amount of energy required to eliminate water at various different concentrations of solutes. Koranyi used the same methods in disease states. The loss of difference between the maximal and minimal delta indicates a functional renal insufficiency. This was the term first proposed by Koranyi outlining the role of the kidney in the regulation of the milieu interieur and more specifically in the regulation of water and solute concentration. Hyposthenuria, best named isosthenuria, in the range of osmotic pressure usually indicates terminal renal failure. Koranyi named this test funktionelle Nierendiagnostik, a start for the physiological investigations of renal functions.

The contribution of French-speaking scientists to the origins of renal physiology and pathophysiology (1790-1910).

Some contributions: (1) urinary urea, its chemical composition and physiological meaning, Fourcroy and Vauquelin (1790-1808); (2) in binephrectomized animals blood urea is high and chemically identical to that of urine, Prevost and Dumas (1821); (3) urea level in renal vein blood is 50% of that in the arteries, Picard (1856); (4) retained potassium is the uremic poison, Feltz and Ritter (1881); (5) polyuria induced by intravenous injections of sugars or urea, Richet and Moutard Martin (1880); is the kidney in command of the concentration of the blood? Using cryoscopy, Hédon got the clue, the osmotic load (1900); (6) methylene dye excretion measures the global renal function and thus the degree of renal failure, Achard and Castaigne (1897); (7) the disentanglement of chronic uremia and edema, Widal and Achard (1900-1910); (8) evaluation of the global renal function by the ratio plasma urea/urine urea output, Ambard's Constant (1905), initial step of the concept of clearance; (9) a circulating nephropoietic factor in one-kidney animals, Carnot (1910). In bled animals he also disclosed a hemopoietic factor which later became the renal erythropoietin.

[The discovery of anaphylaxis: 19 days after an anodyne account of toxicology, it is shown that immunity is perhaps pathogenic]. / La découverte de l'anaphylaxie: dix-neuf jours après une note anodine de toxicologie, il est montré que l'immunité peut être pathogène.

While studying the toxicology of various coelenteres fishing filament poisons, Charles Richet and Paul Portier observed cases of rapid death which had no correlation with the injected doses. In dogs, death only occurred in those which, more than 15 days beforehand, had withstood well an injection more concentrated or identical to the later fatal one. The authors created the neologism 'anaphylaxis' which signifies 'non-protection'. Thus, it appeared that an immune response could be pathological. This discovery opened the subject area of immunopathology at a period of time when, in contrast, vaccination and serotherapy researches were prominent.

Hamburger's achievement with early renal transplants.

In 1947 Hamburger mapped out his course of action to achieve successful renal transplantation and then undertook what he had predicted. His steps were as follows: in 1952, graft of a kidney from a mother to her son, a failure providing more information than any experimental attempt; in 1959, a transplantation from a non-identical twin to his irradiated brother, a rare success with this dangerous immunosuppression; in 1964, a successful graft from a dead donor, with Dausset's introduction of HLA typing to match the donor and the recipient. Hamburger's and Crosnier's endeavours were interwoven with those of other physicians and surgeons: in Paris, Küss and Legrain, in Boston, Murray and, especially, Merrill, with whom Hamburger shared more than a friendship.

The chemistry of urinary stones around 1800: a first in clinical chemistry.

At the end of the 18th century, as soon as modern chemistry was created, dedicated physicians tried to apply it to medicine. A rewarding field was that of urinary lithiasis. Stones offered a sufficient amount of a relatively pure chemical present in the body. Indeed, urine and the solidified matter was within the analytical grasp of the existing techniques. The first step was made by Scheele in Sweden who identified uric acid in calculi and normal human urine. During the following thirty years, Fourcroy and Vauquelin in Paris and Wollaston, Pearson, Marcet and Prout in London identified the various salts, uric acid, urate, various phosphates, oxalate, calcium, ammonium and magnesium forming current calculi. The conditions of their solubility in vitro were described. Even rare components such as cystine and xanthine were unraveled in London. The impetus given by these studies offered a good start to clinical chemistry in general and to the understanding of urinary lithiasis in particular. This led to the discovery of the corresponding solutes in the urine of such patients. Unfortunately, during the following decades nothing was added to these chemical investigations, and most of what had been acquired was forgotten. Research was concentrated on clinical pathology. The implementation of chemistry to medicine had to wait.