Several people before Bright had understood some aspects of the links between proteinuria, oedema, and kidney disease but failed to ‘put it all together’.
William Cruickshank (1745-1800) from Edinburgh. He had a section in his book on diabetes mellitus on detecting albuminuria by chemical testing (though he did not understand the cause or significance of the urine abnormality).
[The first person to detect albuminuria by showing that the urine was coaguable was probably the 18th Italian, Domenico Cotugno (1735-1820), who also completely missed the significance of his finding.]
William Wells (1757-1817) was an American emigré working at St. Thomas’s Hospital [1]. He published detailed observations on proteinuria in scarlatina (scarlet fever), and also proteinuria in a large series of ‘dropsical’ (i.e. oedematous) patients. He was the first to propose that the serum had somehow leaked into the urine. He observed post-mortem kidneys in only two patients; the kidney were diseased in one of them, but even so he failed to make the link between proteinuria and kidney disease,
John Blackall (1771-1860) was physician at the Devon & Exeter Hospital, and was present in 1811 when Wells showed his findings in dropsy. Blackall published his own book on dropsies including cases of syphilis treated with mercury, noting that proteinuria appeared after mercury was given. He too observed post-mortem kidneys in a few cases, but also failed to make the link wondering if the association of diseased kidneys with proteinuria was coincidental.
[1] Shapiro E. William Charles Wells (1775-1817) New Engl J Med 1959; 261:708
Last Updated on January 7, 2025 by neilturn