Submission Period: January 31st, 2017
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OLIVER AND FEIGL—TWO FORGOTTEN FATHERS OF URINE STICK TESTING
Stewart Cameron1 and Guy Neild2
1King’s College London, 2University College London, UK
“Dipstick” testing for the detection of proteinuria is a central part of the evaluation of any
patient, especially one with suspected renal disease, following the emphasis of Bright and many
others on the primacy of proteinuria as a sign of renal damage. The introduction into clinical
medicine of “dipstick” testing is often assumed to have followed the work of Albert Free (1913-
2000) his wife Helen and other colleagues in the Miles-Ames Research Laboratory, Elkhart,
Indiana, USA (now part of Bayer) in the late 1950s and early 19660s. This exploited the pH
change in dyes such as bromophenol blue in the presence of even trace amounts of albumin –
the “protein error” of indicators, described by Sørensen in 1902. Free’s paper does acknowledge any previous work, but the idea of 2dipstic” testing, or “dry chemistry”, has a long history, going back at least 150 years, and perhaps even into the antiquity. In 19th century Europe, urine testing for protein at first largely involved such dangerous agents as Johann Florian Haller’s concentrated nitric acid “ring” test, which precluded use at the bedside, and above all was similarly restricted.
Two of the early and productive advocates of paper reagent testing of urine to replace this
awkward or even dangerous “wet” chemistry were George Oliver (1841-1915) a general
practitioner and notable laboratory researcher who discovered adrenaline – of Harrogate,
England; and Fritz Feigl (1891-1971) a biochemist from Vienna, Austria. Neither enjoy any
reputation or even awareness today amongst nephrologists, except in the little-cited review of
the historian Woswinkel in 1994.
In 1883-4 Oliver published first a paper in the Lancet, and then a short book on bed side urine
testing: qualitative albumen and sugar (HK Lewis, London, 1884) describing the use of “test
papers” for the detection of albumen and glucose, the two most commonly sought abnormal
substances in the urine. After several preliminary assays using different reagents, his “albumen”
test papers involved first acidifying the urine using citrate impregnated paper, then the use of
leached out of the paper. His test papers were used extensively in the late 19th century England,
but by the beginning of the 20th century interest died out for reason unknown, although the
manufacture of his papers continued in Germany.
Obviously the principle of Oliver’s methodology differed from modern stick testing. This was
not the case with Feigl, however, who in the 1920s and 1930s exploited Sorensen’s protein
iundicator change, using tetrabromphenolphatelin to detect protein, one of many
“Tüpefelreaktions” (spot tests) he described. Perhaps the subsequent ignorance of his work
amongst clinicians despite his major reputation as a chemist arose, first because in 1938 being Jewish he emigrated from Austria to Brazil via appointments in Switzerland, Belgium and
France,where he was put in a camp by the Nazis. Second because of all his prolific papers
(over 400) were published in German-language chemical publication, rather than clinical
Journals, although in a review of one of his several books in the Wiener Klin Wschr in 1931 indicated its potential importance.