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Die Frühe Entwicklung Der Nierenchirurgie, Diagnostik Und Nierenphysiologie Zwischen 1869 Und 1914

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Die Frühe Entwicklung Der Nierenchirurgie, Diagnostik Und Nierenphysiologie Zwischen 1869 Und 1914 UNIVERSITÄTSKLINIKUM HAMBURG-EPPENDORF Zentrum für Psychosoziale Medizin Institut für Geschichte und Ethik der Medizin Direktor: Prof. Dr. med. Philipp Osten Die frühe Entwicklung der Nierenchirurgie, Diagnostik und Nierenphysiologie zwischen 1869 und 1914 Dissertation zur Erlangung des Grades eines Doktors der Medizin an der Medizinischen Fakultät der Universität Hamburg. vorgelegt von: Ulrike Julia Ribbe-Gutowski aus Berlin-Steglitz Hamburg 2020 1 (wird von der Medizinischen Fakultät ausgefüllt) Angenommen von der Medizinischen Fakultät der Universität Hamburg am: 12.06.2020 Veröffentlicht mit Genehmigung der Medizinischen Fakultät der Universität Hamburg. Prüfungsausschuss, der/die Vorsitzende: Prof. Dr. Heinz-Peter Schmiede- bach Prüfungsausschuss, zweite/r Gutachter/in: PD Dr. Christian Meyer 2 Inhaltsverzeichnis Inhaltsverzeichnis ..................................................................................................................................1 1. Einleitung ............................................................................................................................................5 1.1 FRAGESTELLUNG ..............................................................................................................................5 1.2 HISTORISCHER KONTEXT ............................................................................................................... 12 1.2.1 Die Entwicklung der Nierenchirurgie ab 1869 .................................................................................. 12 1.2.2 Voraussetzungen für die operative Entwicklung .............................................................................. 16 1.2.3 Nierenchirurgisches bis 1869 ........................................................................................................... 17 1.2.4 Geschichtliches zur Nierenphysiologie ............................................................................................ 19 1.2.5 Die Entwicklung der Nierendiagnostik .............................................................................................. 21 2. Material und Methoden ................................................................................................................... 26 3. Ergebnisse ....................................................................................................................................... 32 3.1 DIE NIERENCHIRURGIE AM BEISPIEL ZWEIER CHIRURGEN ................................................................. 32 3.1.1 Gustav Simon ....................................................................................................................... 32 3.1.1.1 Der Beginn der Nierenchirurgie .................................................................................................... 34 3.1.1.2 Neuerungen in der Diagnostik der Niere und ableitenden Harnwege ........................................... 52 3.1.2 James Israel ......................................................................................................................... 56 3.1.2.1 Israel unter Zeitgenossen ............................................................................................................. 57 3.1.2.2 Werke und Veröffentlichungen ...................................................................................................... 59 3.2 DIE ENTWICKLUNG DER OPERATIVEN THERAPIE VON NIERENKRANKHEITEN ....................................... 64 3.2.1 Anatomische Kenntnisse des Urogenitaltraktes ............................................................................... 64 3.2.2 Die Nephrektomie ............................................................................................................................ 67 3.2.3 Die Nephrotomie .............................................................................................................................. 72 3.2.4 Die Fixation der Wanderniere .......................................................................................................... 74 3.2.5 Nierenteilresektion ........................................................................................................................... 77 3.2.6 Nierendekapsulation und -scarification ............................................................................................ 80 3.2.7 Steinoperationen .............................................................................................................................. 83 3.2.8 Plastische Operationen .................................................................................................................... 86 3.2.9 Transplantationen ............................................................................................................................ 89 3.2.10 Einschätzung der Fortschritte durch Zeitgenossen ........................................................................ 92 3.3 NIERENDIAGNOSTIK ....................................................................................................................... 96 3.3.1 Einschätzung des anatomischen Zustandes der Niere ........................................................ 96 3.3.1.1 Palpation ....................................................................................................................................... 96 3.3.1.2 Perkussion .................................................................................................................................. 100 3.3.1.3 Röntgendarstellung ..................................................................................................................... 100 3.3.2 Die Kontroverse um die funktionelle Nierendiagnostik....................................................... 104 3.3.2.1 Technische Voraussetzungen für die funktionelle Nierendiagnostik ........................................... 104 3.3.2.2 Die Kryoskopie ............................................................................................................................ 110 3.3.2.3 Die Phloridzinmethode ................................................................................................................ 118 3 3.3.2.4 Die Indigokarminprobe ................................................................................................................ 122 3.3.2.5 Methylenblau und Phenolsulphthalein ........................................................................................ 124 3.3.2.6 Die Wasserprobe ........................................................................................................................ 126 3.3.2.7 Sonstige Methoden ..................................................................................................................... 127 3.3.2.8 Bestimmung des Kreatinins und Harnstoffs ................................................................................ 130 3.3.2.9 Vergleich der verschiedenen Methoden ...................................................................................... 132 3.3.2.10 Der Einfluss der funktionellen Nierendiagnostik auf die Chirurgie............................................. 135 3.4 DIE PHYSIOLOGIE UND PATHOLOGIE DER NIEREN .......................................................................... 140 3.4.1 Aufgaben der Niere ........................................................................................................................ 140 3.4.2 Zusammenhang zwischen Niere und Blutdruck ............................................................................. 143 3.4.3 Albuminurie und die Entstehung von Ödemen bei Nierenkranken ................................................. 146 3.4.4 Urämie ........................................................................................................................................... 150 3.4.5 Versuche zur Physiologie .............................................................................................................. 153 4. Diskussion ..................................................................................................................................... 157 5. Zusammenfassung ........................................................................................................................ 173 6. Abbildungsverzeichnis ................................................................................................................. 175 7. Literaturverzeichnis ...................................................................................................................... 177 8. Danksagung ................................................................................................................................... 224 9. Lebenslauf...................................................................................................................................... 225 10. Eidesstattliche Versicherung ..................................................................................................... 226 4 1. Einleitung 1.1 Fragestellung Die Geschichte der Nierenchirurgie in der zweiten Hälfte des 19. Jahrhunderts war geprägt durch eine spannende und vielfältige Entwicklung, die in einem engen Zusammenhang mit dem Verständnis der Physiologie der Nieren und dem Fort- schreiten der Diagnostik von Nierenkrankheiten stand. Die medizinhistorischen Quellen zur Geschichte von Erkrankungen der Niere zum heutigen Zeitpunkt beschäftigten sich zumeist mit der Entwicklung der Chirurgie, den Fortschritten der Physiologie und Diagnostik oder den Beiträgen einzelner herausragender
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