Historical perspectives in clinical pathology: a history of glucose measurement.

This is the second in the series of historical articles dealing with developments in clinical pathology. As one of the most commonly measured analytes in pathology, the assessment of glucose dates back to the time of the ancient Egyptians. It was only in the 19th century that advances in chemistry led to the identification of the sugar in urine being glucose. The following century witnessed the development of more chemical and enzymatic methods which became incorporated into the modern analysers and point-of-care instruments which are as ubiquitous as the modern day cellphones. Tracking the milestones in these developments shows the striking paradigms and the many parallels in the development of other clinical chemistry methods.

[Technization of the senses--from uroscopy to urinalysis. The example of urine sugar]. / Technisierung der Sinne--von der Harnschau zur Urinanalyse. Das Beispiel der Harnzuckerbestimmung.

Since antiquity, medical semiotics has been based on signs solely accessible to the physician's sensory perception. In the 19th century, the spectrum of signs was extended by using new techniques and instruments, as well as chemical analytical procedures. Transferring technoscientific methods to the medical area led to a paradigm shift: Qualitative signs, which had been adequate for "humoral pathology", were by no means sufficient for epistemological investigations based on quantifiable data.This paper examines this process of "technization", using the example of measuring sugar in patients' urine. We reconstruct the evolution of technical methods for analyzing urine during the 18th and 19th centuries and show that traditionally oriented physicians and many patients showed a lack of understanding or even disapproval of the new "iatrotechnic" methods. Only very slowly were they willing and able to adjust to a semiotic turn, i.e., the increasing replacement of linguistic signs by abstract data.It is argued that only a complex of compromises--incorporating transdisciplinary receptiveness, professional isolation, economic viability, and sufficient accuracy, handiness, and manageability of instruments--gave rise to the broad acceptance of technical means to measure the amount of sugar in urine.

[Apollinaire Bouchardat and diabetes]. / Apollinaire Bouchardat et le diabète.

Apollinaire Bouchardat (1806-1886) begins its hospital formation by the pharmacy internship and then starts his medical studies. He becomes chief pharmacist of the Hôtel-Dieu in 1835 and during 20 years, he devotes his life to the study of diabetes. Through observations and experiments, he builds new concepts allowing to establish the bases of clinical diabetology due to a solid competence in fundamental sciences and his intelligence in semiologic observations. He studied urine glucose as a reflect of the clinical state of the patients and, in order to carry out its exact measurement, he recommended the use of the polarimeter. He engaged himself in many studies concerning well as the patients diet as to their way of life. Thus he recommended a large decrease in starchy foods and sugars, he encouraged physical exercise and considered that, since the assumption of responsibility of the diabetic was serious, it could foresee the remission of disease. Due to encouraging results, he developed self-monitoring by the patients by the means of simple chemical reagents, convinced that making patients responsible, despite difficulties of the diet, could modify their attitude. Precursor of the modern diabetology, one can consider that he founded it as a true medical discipline. Its major work: De la Glycosurie ou diabète sucré, son traitement hygénigue is pro-bably the first textbook on diabetes, associating clinical observations, experimental steps and proposals for a treatment based on the patients' way of life: mainly diet and exercise: still preached steps, a hundred and fifty years later.

[Apollinaire Bouchardat, pharmacist, nutritionist]. / Apollinaire Bouchardat, pharmacien, nutritionniste.

Apollinaire Bouchardat (1806-1886) began his hospital internship after a brilliant career as a student at the Ecole de pharmacie de Paris and the Muséum d'Histoire Naturelle, He was named chief-pharmacist at the Hôtel-Dieu and focused his studies on diabetes and nutritional diseases. His work was based on a thorough knowledge of the fundamental sciences. He defined urinary sugar concentration as an indication of the patient's clinical condition. In order to obtain an accurate measurement of this parameter, Bouchardat advocated the polarimeter as the reference method. After 20 years at the Hôtel-Dieu (1835-1855), he gave up his hospital life to become professor of hygiene at the Faculté de médecine. He undertook numerous studies concerning metabolic diseases, food chemistry, hygiene, environment. He founded a new medical science: diabetology, the importance of which is still growing and remains, 150 years later, a major clinical field at the Hôtel-Dieu.

A marvel of colors and ingredients. The story of urine test strip.

The history of the urinary test papers does not being in the post-war period. As early as the 1880's some practitioners and pharmacists tried to replace the complicated wet-chemical procedures and apparatus by "dry chemistry." The first popular test paper for sugar and albumin originated in England in 1883. Dry reagents for proving hematuria have been available since the beginning of this century. Until the 1930s a wide palette of commercial urine tests with "modern" brand names was established. A methodological breakthrough was created by the spot test chemistry inaugurated by the Austrian, Fritz Feigl, about 1920. Using the capillary properties of filter paper in enhancing color reactions he founded a new area of analytical chemistry. Many of the pioneers were recruited from Jewish scientists. In this lecture is proposed that their emigration and banishment as well as the Second World War have stopped the development of urinary diagnostics on the European continent. In the post-war period the American industry succeeded to the leading position in the researching and marketing of test papers. In 1956, the triumphal progress of the "stick tests" began with the "Clinistix" (Ames Company, today Bayer Diagnostic).

From chemistry of life to chemistry of disease: the rise of clinical biochemistry.

Any young scientific discipline may experience difficulties in determining its position. For a young discipline placed at the juncture between potent branches of science with a long tradition, as is the case for Clinical Biochemistry, this is especially true. In such a situation, a look backwards to identify first origins and to follow trends of development can be helpful. Moreover, the close relationship between the history and the philosophy of science should provide insight into the nature of our present work and the potential for future work. Our discipline originated with the emergence of modern chemistry at the end of the 18th century. Methods for the chemical analysis of plant and animal material were developed first. The examination of chemical processes in living organisms followed. Only after these successes did chemical investigations of causes and mechanisms of human disease become possible. A few selected milestones in this evolution can illustrate the medical, philosophical, intellectual and social background which has shaped the rise of Clinical Biochemistry.