"A clue in a labyrinth:" The medico-chemistry of the stone in the life of Edward Darrell Smith.

This article will argue that Edward Darrell Smith engaged in chemical analysis in order to broaden his understanding of the body, particularly stones, in a humoral framework. At the time, Antoine Lavoisier's chemical innovations were exciting the medical world, and Lavoisier himself was pursuing medical questions in his chemical research. Medical students from Philadelphia to Charleston were writing dissertations on the different types of stones and concretions found in the body. Smith practiced medicine in a world in which the remedy for the stone was compelling and a long awaited discovery. By examining Edward Darrell Smith's biography, we can get a vista into this world.

Firsts surgical care of Mexican children in the nineteenth century. / Primicias de la atención quirúrgica de los niños mexicanos en el siglo XIX

Here, two papers are presented, which constitute the first reports of surgical procedures in Mexican children performed at the 19th century. The two publications refer to surgical operations for the extraction of bladder stones. At that time, there was no anesthesia, so part of the description alludes to the suffering of the patients and the operative difficulties. The first case, is referred to as a lithotomy in a 17-year-old girl, performed by surgeon José Victoriano Guerrero in Guadalajara in 1822. The publication is not an academic report, but a pamphlet written as a gift to Emperor Augustin I to celebrate his ascension to the throne. The second work, is a lateral lithotomy in a 5-year-old boy, published by Dr. Luis Jecker in the first issue of the Periódico de la Academia de Medicina de Mégico in 1836.

Se presentan dos trabajos que constituyen los primeros informes de procedimientos quirúrgicos en niños mexicanos en el siglo XIX. Las dos publicaciones se refieren a operaciones para la extracción de cálculos vesicales. En ese tiempo no existía anestesia, por lo que parte de la descripción incluye el sufrimiento de los pacientes y las dificultades operatorias. El primer caso está referido como una litotomía en una joven de 17 años, operada por el cirujano José Victoriano Guerrero en Guadalajara en 1822. La publicación no constituye un informe académico, sino un folleto escrito como un obsequio para el emperador Agustín I para celebrar su ascensión al trono. El segundo trabajo es una talla lateral en un niño de 5 años edad, publicado por el doctor Luis Jecker en el primer número del Periódico de la Academia de Medicina de Mégico en 1836.

Seventeenth-century 'treasure' found in Royal Society archives: the Ludus helmontii and the stone disease.

Our archival researches at the Royal Society reveal that a small envelope attached to a 1675 letter from an Antwerp apothecary, A. Boutens, contained a sample of the 'Ludus' prepared as a remedy for the 'stone disease' then sweeping through Europe, which was first announced in J. B. van Helmont's De lithiasi (1644). After examining the fascination with the medical use of the Ludus (which required the 'alkahest' for its preparation) and the tenacious efforts to procure it, we trace the fortunae of two other ludi in England, brought to and offered by Francis Mercurius van Helmont during his English sojourn. Both eventually found their way to the geologist John Woodward, one of them through Sir Isaac Newton. Finally we show how the allure of the Ludus helmontii vanished, with transformations in mineral analysis and reclassifications from Woodward to John Hill.

The history of calculus mendax and the following surgery on the prostate.

In this paper we would like to present probably the first surgery performed on the prostate gland followed by microscopic analysis of the obtained tumor tissue sample. We based on the existing correspondence between Ludwig von Hammen and Johann N. Pechlin, and their successors in this field as well. Von Hammen seems to be a pioneer in the area of not only urological surgery but in directing this part of medical practice from "lithotomists" to physicians, much better educated than barbers in physiology but first of all in anatomy. This 17th century physician from Gdansk tried to set new standards both for surgical medical practice but histopathological examination of the excised material as well. Due to the change of the operational skills and procedures von Hammen's work got almost forgotten, but remains remembered due to the work of historians of the medicine from following centuries.

The history of urinary stones: in parallel with civilization.

The roots of modern science and history of urinary stone disease go back to the Ancient Egyptians and Mesopotamia. Hippocrates defined the symptoms of bladder stones. The first recorded details of "perineal lithotomy" were those of Cornelius Celsus. Ancient Arabic medicine was based mainly on classical Greco-Roman works. Interestingly, the Fourth Lateran Council in 1215 forbade physicians from performing surgical procedures, as contact with blood or body fluids was viewed as contaminating to men. With Renaissance new procedures could be tried on criminals. The first recorded suprapubic lithotomy was carried out by Pierre Franco in 1561. In 1874, Bigelow developed a lithotrite, which was introduced into the bladder under anaesthesia (called as "litholopaxy"). Young was the first to report ureteroscopy (1929). With advances in intracorporeal lithotripsy techniques, ureteroscopy became the treatment of choice for ureteric stones. In 1976, Fernstrom and Johannson established percutaneous access to remove a renal stone. However, with the introduction of the first extracorporeal shock wave machine in 1980, a dramatic change in stone management was observed. Civilization in parallel with scientific developments has brought us to a point where we try not to "cut" our patients for stone disease, as Hippocrates admonishes, but rather manage them with minimal invasive alternatives.

The history of urologic surgery: from reeds to robotics.

Bladder function has interested man since prehistoric times. Evidence of health and well being was often measured from observation of urine. When urologic function was impaired, the extent of the ensuing pain often called for dramatic measures to obtain relief. The practice of urology has advanced substantially since the days when reeds were used to alleviate obstruction of the bladder. This article presents a brief historical overview of urology and the strides made in prostate surgery with modern technology.

[Infrared spectroscopy of urinary calculi before 1900 in votive offerings of the Bavarian pilgrimage church at Grafrath]. / Infrarotspektroskopie von alten Harnsteinen aus den Votivgaben der Wallfahrtskirche Grafrath.

BACKGROUND: The old urinary calculi of the votive offerings in the pilgrimage church at Grafrath offer the possibility of analysing the components by infrared spectroscopy to give insights into factors that might influence their formation. A total of 166 specimens were taken from 139 objects (134 stones, 5 bones), in some stones from different layers. MATERIAL AND METHODS: Spectral analysis showed typical components for urinary calculi in 127 stones. These were compared with a control group of 98 urinary stones from carriers (77 male, 21 female) during 2007/2008 in Bavaria. RESULTS: The percentage of occurrence of ammonium acid urate (NH(4)U) was high in the old stones (68.0%) versus the 2007/2008 group (1.0%). In uric acid (HS) there was no relevant difference between the two groups, whereas the occurrence of the oxalates whewellite (Whe) and weddellite (Wed) was much less in the old stones (Whe 18.1-69.4%, Wed 7.9-26.5 %). The phosphates differ in the components in favour of brushite in the old stones. The high occurrence of NH(4) in the old stones is comparable with (a) the old pre-1900 collection of Norwich (England), especially with the pre-1800 juvenile bladder stones, and (b) urinary stones in endemic areas of stone disease in children such as in North Thailand. Data about the Grafrath stone carriers (name, age, hometown) are not available but can indirectly be derived from the miracle books (1444-1728) of Grafrath with 12,131 reports; 1,165 had urologic disease of which 70% were children with urinary calculi coming from areas of Upper Bavaria and Swabia. CONCLUSION: The finding of a high NH(4)U content indicates that this area might have been a stone belt for bladder stones in children. Under- or malnutrition with low protein and low fluid intake may be the aetiologic factor.

A written consent five centuries ago.

The term informed consent does not have long historical roots. Until recent centuries, healthcare professionals were not held responsible for providing information to patients. The author reports a written consent from Anatolia dated almost five centuries ago. The contract was signed in 1539 in Gaziantep, Turkey (formerly known as Aintab, Ottoman Empire). The document, of course, differs from modern counterparts. It lacks details of interventions. The author believes this to be the first written consent in medical history. Further investigations of court registers should be made to ascertain the earliest date of their appearance.

[William Cheselden: singular lithotomist and great illustrator of the XVIII Century]. / William Cheselden, singular litotomista y gran ilustrador inglés del siglo XVIII.

We present a brief historic reference of who probably was the most famous English urologist-surgeon of the 18th century, and who, following the chronicle writers, holds the record for extraction of a bladder stone (between 24 and 54 seconds). He also was an example of humanism related to the medical profession: he was an extraordinary illustrator of his own books with the help of the "dark chamber", so frequently used by Renaissance artists, contributed to the design and performance of civil architectonic work, had relationships with the literature world through poetry, and decisively influenced the reformation and separation of barbers and surgeons, which ultimately lead to the creation of the Royal College of Surgeons.

Methods of lithotripsy in ancient Greece and Byzantium.

PURPOSE: In this article we present the medical methods of lithotripsy applied by ancient Greek and Byzantine physicians, and their influence on the development of surgery after that time. MATERIALS AND METHODS: Study and analysis of the original texts of the Byzantine medical writers, written in Greek and containing the knowledge of the ancient Greek, Hellenistic and Roman periods, were performed. RESULTS: The Byzantine method of lithotripsy was the result of the eternal knowledge of the spasmolytic, analgesic and lithotriptic effect of various herbs, together with ancient surgical techniques of stone removal from Hellenistic and Roman periods. No operation was attempted for the extraction of stones from kidneys. Rather the idea was to drop the stones to the bladder or into the urethra, or dilute them into smaller pieces with various herbs. CONCLUSIONS: Ancient Greek and Byzantine physicians described conservative and surgical methods, derived from the texts of early surgeons, to which they added their own observations.

[Descriptions of treatment in the Hippocratic Collection with special reference to surgery, particularly for urinary stones].

PURPOSE: I analyzed mentions of treatment in the Hippocratic Collection. MATERIALS AND METHODS: I examined quantitatively mentions of treatments in the Hippocratic Collection (Roeb edition, Otsuki edition, and Kon edition) to compare preferences for therapy between the Kos and Knidos schools. RESULTS: Treatments, mentioned in 2,687 passages, were medical in 2,319 (86%), and surgical in 368 (14%). These 2,687 descriptions included 1,023 (38%) from the Kos, 1,261 (47%) from the Knidos school, and 403 (15%) from unspecified schools. Of the 2,319 descriptions of medical treatment, 560 (24%) referred to medicines and 466 (20%) to diet, followed by baths, vapor baths, exercise, running, walking, warm applications, and others. The 368 surgical descriptions involved traction and adjustment for treating fractures of bones or dislocation of joints in 166 (45%) and surgery using knife or fire in 202 (55%). Of the latter 202 mentions, 87 (43%) referred to incision with knife, 74 (37%) to cauterization and 73 (37%) to bloodletting. Diet, exercises, running, walks, traction, adjustment and bloodletting were mentioned more frequently by the Kos school than the Knidos school, while medicines, baths, vapor baths (for gynecological diseases) and incision were mentioned more frequently by the Knidos school (chi-squared test, p < 0.01). Medicines, diet, baths, warm applications, and incision over the kidney were mentioned among treatments for urinary stones, but cystolithotomy was not. Hippocates stated in "Aphorisms" that diseases that medicines do not cure can be cured by the knife. He also, stressed that any one intending to practice surgery for wounds arising in military service must serve in the army. CONCLUSIONS: A large number of medical treatments were mentioned in Hippocratic Collection, while surgical treatments also were emphasized. Hippocrates warned beginning doctors not to used unproven treatments for urinary stone in the introduction to the "Oath", but did not forbid surgical treatments.

Thirty-eight years of stone meetings in Europe.

Of decisive importance for the many research groups all over Europe were the scientific symposia dealing with the theoretical foundations and clinical aspects of urinary stone disease. There were several sources from which today's European Urinary Stone meetings and the "Eurolithiasis Society" itself arose. It was a long way from Leeds in 1968 to Jena 1970, Bonn-Vienna in 1972 and to 11 European meetings from 1989 to 2005. Which developments in urinary stone disease research have been presented at our congresses during the past 40 years? The 1970s and 1980s are the years marked by efforts to measure the important lithogenic substances such as calcium, ionized calcium, uric acid, phosphate, oxalate with reliable methods. Hypercalciuria and specifically mild hyperoxaluria were the topics of numerous investigations in the 1970s, 1980s and 1990s. The calcium-loading test described by Pak has been discussed frequently since its application. It became apparent that oxalic acid is more important in urinary stone formation than hypercalciuria. Of importance were investigations done by Robertson and his colleagues on the influence of diet (in particular, an animal protein-rich diet) on urinary stone formation. Another emphasis of research was investigation of the crystallization process: supersaturation, crystal growth and aggregation are important steps in urinary stone formation. Of great importance in the formation of urinary stones are inhibitors (inhibitory activity): citrate, magnesium, pyrophosphate, macromolecules: GAGs, THP etc. and it became possible in the early 1970s to determine substances such as Tamm-Horsfall protein (THP) and GAGs. Much attention in the 1970s and 1980s was focused on urinary stone analysis (X-ray diffraction, infrared spectroscopy, polarization microscopy) and standardization of these methods. In the mid-1980s, a whole series of epidemiological studies were carried out, with data for the Federal Republic of Germany, East Germany, Czechoslovakia and Austria. The search for "stone-removing" medications, their description and clinical use was the subject of much clinical research and in vitro examinations. A definite advance occurred in the 1980s with the development of new instrumental technologies for the management of urinary stones such as shockwave ("Stosswelle") lithotripsy, percutaneous nephrolithotomy and ureterorenoscopy (" breakthrough innovations"). Since the 8th European Urolithiasis Symposium there have regularly been presentations pertaining to the topic of the molecular basis of inherited lithiasis. The last 10-15 years have shown an increasing turning toward the importance of cellular alterations and supersaturation and their relation to stone formation. In conclusion, I would like to note that it is of decisive importance for the research groups all over Europe to organize scientific symposia dealing with the theoretical foundations and clinical aspects of urinary stone disease under the protection of the European Urolithiasis Society.

[Descriptions of urinary stone in the Hippocratic collection].

PURPOSE: Hippocrates was a famous physician of Kos in ancient Greece (c. 460 B.C.). His works later were described in the Hippocratic Collection, in which I studied references to urinary stones. MATERIALS AND METHODS: I collected mentions of urinary stones from the Hippocratic Collection (Roeb, Otsuki, and Kon editions) to compared descriptions of urinary stones between the Kos and Knidos schools. RESULTS: Urinary stones were mentioned in 24 passages of the collection: 12 (50%) referred to pathogenesis of urinary stones; 6 (25%) to symptoms; 4 (17%) to treatment, and 2 (8%) to other aspects. Symptoms of urinary stones included hematuria, colic, painful urination, difficult urination, and passing a urinary stone. Bladder stones were mentioned in 15 passages (63%), renal stones in 4 (17%), and both bladder and renal stones in 2 (8%). Although no site was mentioned directly in 7 passages (29%), these appeared most likely to refer to bladder stones. Descriptions by Kos, Knidos, and unspecified schools accounted for 15 (63%), 4 (17%), and 5 (21%) of mentions of urinary stones. Descriptions of bladder stones by the Kos school were relatively numerous, while most of the few renal stones were described by the Knidos school. Treatments for urinary stone included medication, presumably to aid in passing the stone or to relieve pain; warm soaks or applications to treat pain; and incision over the kidney, when the affected area showed swelling with elevation. CONCLUSIONS: Urinary stones were mentioned in the Hippocratic Collection more frequently by the Kos school. No description of cystolitotomy included. The Oath of Hippocrates proscribed use of the knife to treat urinary stones, however, incision over the kidney (presumably nephrolithotomy) was mentioned in "Internal Affection" by the Knidos school.

[The beneficial effect of mineral waters of Fiuggi on Pope Bonifacio VIII and Michelangelo: two prominent calculous patients]. / L'action bénéfique des eaux minérales de Fiuggi sur deux malades calculeux illustres: le pape Boniface VIII (1235-1303) et Michel Ange Buonarroti (1475-1564).

Going back to the dawn of time, we deal with two historical figures, that of Pope Bonifacio VIII, and that of the hierophant of art, Michelangelo Buonarroti. The texts and the codes of the British Museum (Department of Manuscripts), of the Biblioteca Medica Laurenziana (Archivio Buonarroti) of Florence, and the Biblioteca Apostolica of Vatican, convincing detalled evidence that both figures were urological patients. It concerns two clinical cases with especially pertain to the history of lithiasis of urinary tract. Even though, both of them--the first with nephrolithiasis or gravel, and the second with a bladder stone--were historically bound with the well-known cures of Fiuggi in Italy.