EXPERIMENTAL AND CLINICAL TRANSPLANTATION

It was in the 1950s that nephrology crystallized as an independent specialty out of internal medicine. However, references to modern nephrology appeared in the works of doctors much earlier. Some researchers consider Hippocrates to be the father of clinical nephrology, while John Merrill is widely regarded as a specialty founder of modern nephrology. The situation is similar in Poland, where early references to urinary tract diseases appeared in medieval works of Polish authors. Poland’s first clinic of nephrology, established in Wrocław in 1958, was managed by Zdzisław Wiktor. During the European Renal Association-European Dialysis and Transplant Association and International Association for the History of Nephology congresses, Polish authors presented precursors of nephrology, including Thomas of Wrocław, Simon Sirenius, Samuel Goldflam, Józef Dietl, Jędrzej Śniadecki, Marceli Landsberg, and Witold and Tadeusz Orłowski. This article focuses on late 19th and early 20th century giants who contributed to the development of nephrology in Poland. The period discussed covers memorable milestones in the history of Poland, ranging from the long-term Russian, Prussian, and Austro-Hungarian annexation through World War 1, after which the country regained its independence, to World War 2. These scientists represented clinical medicine and basic sciences, such as pathologic anatomy, physiology, and physiologic chemistry, and came from 3 different regions of Poland. Professor Tadeusz Browicz was associated with the Jagiellonian University in Kraków, Professor Anastazy Landau worked in Warsaw, and Stefan Dąbrowski represented the University of Poznań. Although based on the cooperation with European universities, their works were published in Polish, preventing them from gaining wide recognition in the European medical community of the time. Therefore, presenting their achievements to a wider group of historians after such a long time seems justified.

Key words : History of nephrology, Pioneers, Poland

The 1950s saw the emergence of modern nephrology as a medical speciality. Professor Murray Epstein viewed John Merrill as its father, while the outstanding contemporary nephrologist of world renown, Garabed Eknoyan, points at Hippocrates in this respect. Nevertheless, France’s Jean Hamburger and Sweden’s Nils Alwall, in the late 1940s and early 1950s, established the first nephrology clinics in Paris and Lund, respectively. Avoiding the long-established debate of which preceded which, let us say that Poland’s first nephrology clinic was, without a doubt, organized in Wrocław by Professor Zdzisław Wiktor in 1958. From that moment on, the lush development of nephrology in Poland began. However, one should not be misled to assume that the date marked the beginning of work on urinary tract diseases as we understand them today. Backtracking its development will take us as far back in time as the Middle Ages.^1,2

Often in collaboration with other Polish researchers, the author of this article has published numerous papers on the history of nephrology in Poland. These concerned Thomas of Wrocław, Simon Syrenius, Jędrzej Śniadecki, Józef Dietl, Samuel Goldflam, Marceli Landsberg, and Witold and Tadeusz Orłowski. This article focuses on the achievements of 3 other pioneers of nephrology in Poland: the pathological anatomist Tadeusz Browicz, the clinical internist Anastazy Landau, and the physiologist Stefan Dąbrowski.^3-7

Tadeusz Browicz (1847-1928)

Tadeusz Browicz was born in Lviv on October 15, 1847, to his parents Karol, a teacher, environmen-talist, and mathematician, and Katarzyna née Rosinkiewicz (Figure 1). T. Browicz graduated from a secondary school in Czerniowce and went on to study medicine at the Medical Faculty of the Jagiellonian University in Krakow, where in 1873 he received his PhD and habilitation 2 years later. Since 1876, he headed the Department of Pathological Anatomy and, in 1880, became professor. Twice, in 1886 and 1893, he was elected dean of the Faculty of Medicine, and from 1894 he was the rector of the Jagiellonian University. Browicz was a member of the Academy of Arts and Sciences in Krakow, the Czech Academy of Sciences and Skills, and the Academy of Medical Sciences in Warsaw. He founded the Krakow Hygiene Society. The University of Warsaw awarded him with an honorary doctorate, and the President of Poland, in recognition of his merits, presented him with the Commander’s Cross of the Order of Polonia Restituta.

In his publications, Browicz discussed anatomic changes in the kidneys in the course of acute inflammatory lesions in the renal parenchyma. With Carl Kupffer, he is considered the discoverer of Browicz-Kupffer cells. He also discovered and described typhoid bacilli and showed their etiological connection with the disease. His deep knowledge, extraordinary diligence, and strictness toward students, coworkers, and himself became legendary. He died on March 19, 1928 in Krakow and was buried at the Rakowicki Cemetery.^8-10

Browicz dealt with the pathology of inflammations and neoplasms, bacteriology, blood pathophysiology, and medical terminology. He also published 3 papers on the urinary system. The first 2 works, titled “Incident of experimental examination of renal lesions in acute inflammation”¹¹ and “A few words about lesions in the kidneys in acute parenchymal inflammation,”¹² were based on Western European reference literature. The author describes acute lesions in the renal parenchyma and interstitium, which depend on the period and degree of inflammation.He reported on kidney enlargement, lesions (enlargement) in the Malpighi glomerulus in the case of parenchymal inflammation, and lesions in the interstitium (fibrosis) without changes in the glomeruli in the case of interstitial inflammation.

In his third paper, titled “The structure of the Malpighi glomerulus,”¹³ Browicz claims that the structure of the Malpighi glomerulus differs from that of ordinary capillaries. These are tubules made of a homogeneous mass with no trace of cell nuclei. There is no connective tissue between the ganglia, only epithelial cells. According to Browicz, the epithelium is not epithelial but rather endothelial.

Anastazy Landau (1876-1957)

Anastazy Landau was born on August 18, 1876, in Żychlin to his parents Herman, a merchant, and Maria née Lasman (Figure 2). After graduating from the 5th State Secondary School in Warsaw, Landau studied medicine at the Medical Faculty of the Imperial University, also in the Polish capital, where he received a medical doctor diploma in 1899. Immediately after that, he started working at the Department of Internal Medicine with Prof. Teodor Dunin at the Infant Jesus Hospital in Warsaw. In the same year, he defended his doctorate based on the thesis “On less known and unknown symptoms of typhoid fever.” He then did research internships at Carl von Noorden’s clinic in Frankfurt am Main and Nathan Zuntz’s Department of Physiology in Berlin.

After the outbreak of World War I, he became head of the internal and infectious departments at the hospital in Płock. He was then appointed head of the hospital ward and an expert in the field of poisoning with combat gases in Russia. He returned to Warsaw after the end of the war in 1918. Following a competition in 1921, he took on the position of the head of the Department of Internal Diseases at the Wolski Hospital in Warsaw, which he held until the outbreak of World War II. In 1940, he managed to leave the country and became a consultant at the Ignacy Paderewski Polish Hospital in Edinburgh, Scotland, founded by Prof. Antoni Jurasz.

After the war, in 1948, Landau became an associate professor at the University of Warsaw for the thesis “The evolution of concepts in pathology and treatment of pneumonia.” From 1953, he worked at the Institute of Improvement and Specialisation of Medical Personnel in Warsaw. The activities of the Institute marked the beginning of postgraduate training for doctors in Poland.

Anastazy Landau was a member of many scientific associations, including the Warsaw Scientific Society, Warsaw Medical Society, Polish Society of Internal Medicine, Polish Academy of Sciences, French Society of Cardiology, Royal Society of Medicine, and others.

He was known for his exceptional intuition and thorough medical examination, believing that “the most important skill of a doctor is to be able to look at a sick person and think.” For his achievements, he was awarded the Commander’s Cross of Polonia Restituta and the Order of the Banner of Work, 1st class. He died on February 6, 1957, in Warsaw and was buried at the Powązki Cemetery in Warsaw.^14-16

Landau authored papers on renal physiology, chronic renal failure, glomerulonephritis, and nephrosis. The paper titled “Research on kidney function using methylene blue”¹⁷ described the determination of the time from administration to the appearance of the dye in the urine and determination of the time necessary to eliminate the dye. It also included the critical evaluation of the method: (1) normal blue dye elimination in the case of uremic poisoning and without uremia and (2) blue dye secretion depending on the activity of other blue dye-processing organs and the kidneys.

Another work, “New (Koranyi) theory of urine formation in the light of facts and criticism”¹⁸ stated that the glomeruli secrete water in a daily amount that is several times higher than that of urine output, attributed to the convoluted tubules, where a certain amount of it is reabsorbed. The renal secretion of water is regulated by 2 activities: secretory, which occurs in the glomeruli, and absorptive in the tubules.

In his publication, “Osmotic pressure of blood and urine in healthy and sick people,”¹⁹ he referred to the previous article, covering terms such as diffusion, osmosis, urine, and blood osmotic pressure and describing methods for determining the work of the kidneys using the freezing point of urine. The freezing point of urine in healthy individuals ranges from -1.3 to -2.2 °C. The freezing point of urine in patients with uremia does not exceed -1.0° C.

In his subsequent publication, “The transfor-mation of purine bodies in the human system and the impact of alcohol on it,”²⁰ from 1908, for which he received an award from the Warsaw Medical Society, he emphasized that the science of the transformation of purine bodies in the system is the achievement of the previous 20 years. Purine bodies such as adenine, guanine, hypoxanthine, and xanthine are subject to deamination and oxidation. The study of 8 patients consisted of daily administration of 150 mL of 57% alcohol. The experiment showed that alcohol increases the content of purines and uric acid in the urine.

The next paper, “On Bright’s disease,”²¹ conta-ined a detailed description of Bright’s disease, including the classification, clinical picture, and treatment.The last and probably the most significant work, “Severe paroxysmal hypertension syndrome associated with a paragangliomatosis tumour of the adrenal gland,”²² published in 1935, contained Poland’s first, operationally verified, description of a pheochromocytoma diagnosed during a patient’s lifetime. The patient was successfully operated on by Prof. Manteuffel in Warsaw, Poland.

Stefan Dąbrowski (1877-1947)

Stefan Dąbrowski was born on January 31, 1877, in Warsaw to his parents Stefan and Hortensja née Lombard (Figure 3). He graduated from the 4th Classical Secondary School in Warsaw and studied medicine at the Medical Faulty of the Imperial University in the Polish capital. In 1900, he joined the Department of Medical Chemistry at the Medical Faculty of the Paris Sorbonne, where, supervised by Professor Armand Goutier, he conducted expe-rimental work on kidney function.

In 1908, he obtained the degree of habilitated doctor; during 1908 to 1911, he was under scholarship from the Academy of Learning under Prof. Jean Perrin in Paris, France. After returning to Poland in 1911, he became an associate professor of physiology at the Agricultural Academy Dublany near Lviv, modern Ukraine.

In 1913, he became a professor of chemistry at the Veterinary Academy in Lviv. When Poland regained independence after the war, in 1919 to 1920, he worked at the Department of Medical Chemistry at the University of Lviv. In 1920, Dąbrowski became a professor of medical chemistry at the University of Poznań, where in 1920 and 1921 he was the head of the Department of Physiology and in 1921 to 1938 he managed the Department of Physiological Chemistry and the Department of General Chemistry.

From 1937 to 1939, Dąbrowski served as the Dean of the Faculty of Medicine at the University of Poznań. In May 1939, he was elected Rector, the position that he never took up due to the outbreak of World War II. During the occupation, although he had to hide, he still conducted research and practiced as a doctor. In March 1945, he returned to Poznań, resumed office, and rebuilt the University’s structures.

Dąbrowski was a member of many societies, including the Faculty of Medicine of the Polish Academy of Arts and Sciences, Poznań Society of Friends of Sciences, Warsaw Scientific Society, Academy of Medical Sciences in Warsaw, and the Krakow Bishops’ Aid Committee. For his outstanding scientific achievements, he received numerous decorations: the Cross of Valour (1921), the Cross of the Defenders of Lviv (1921), the Commander’s Cross with Star of the Star of Romania (1922), the Order of the Legion of Honour (1925), the Saint Sava Yugoslav Cross (1932), and the Independence Cross (1933). Professor Stefan Dąbrowski died on March 23, 1947, in Poznań.^23-25

Dąbrowski published books and papers on kidney function, including diffusion and absorption in the kidney and the chemical nature of urochrome. In his first publication, “On the group of organic acids containing nitrogen and sulfur, components of normal human urine,”²⁶ he separated 2 basic groups of protein acids with high content of sulfur and low content of nitrogen and with high content of nitrogen and low content of sulfur.

In the preface to Bronisława Leleszowa’s book Practicum in physiological chemistry,²⁷ Dąbrowski stressed the increasing importance of physiological chemistry in medical science, both in terms of testing the components of tissues and plasma and in functions of organs in normal states and cases of diseases. In his publication “On diffusion and absorption in the kidney,”²⁸ he presented bodies that concentrate and those that fail to do so in the kidney. In his last work, “The Department of Physiological Chemistry of the University of Poznań,”²⁹ he addressed the Department, emphasizing the importance and scope of work on new theories in kidney physiology, including Ambard’s laws.

The 3 giants of Polish medicine and their achieve-ments in the field of urinary tract diseases undoubtedly had no small impact on the future development of nephrology in Poland. Their work was inspirational for many successors in the field of anatomy, physiology, and clinical kidney diseases. Outstanding Polish nephrologists of the 20th century, such as professors Jan Roguski (1900-1971), Jakub Penson (1899-1971), Andrzej Manitius (1921-2001), Kazimierz Bączyk (1926-2016), Franciszek Kokot (1929-2021), and Stefan Angielski (1929-2022), are already waiting to be presented in future papers on this subject.

Volume: 21 Issue: 6 June 2023 - Supplement - 2

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