The comprehension of nephrology in America a century ago

In America 100 years ago, the leading clinician pathologists had an understanding of nephrology comparable to that in Europe. Emphasis was on clinical observations devoid of modern clinical laboratory assistance, but verified or disproved at autopsy. The clinician often functioned as the pathologist for his own patients, and although microscopy had been introduced a few decades earlier and many had the benefit of some training in Germany or elsewhere in Europe, diagnostic capabilities remained limited. Renal physiology and pathophysiology were at best embryonic in the United States and elsewhere. The frequency and severity of medical renal diseases maintained the interest of some of the most astute physicians of the late 19th century; however, they had to remain frustrated by their inadequate diagnostic and, especially, therapeutic ability.