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.

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 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.

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.

"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.

Uric acid, uric acid dihydrate, and urates in urinary calculi, ancient and modern.

Uric acid, uric acid dihydrate, and ammnoniumn acid urate occur in bladder stones both ancient and modern. They are seldomn abuindant in stones fromn technically developed areas. Urates are usually confined to children's endemic bladder stones; uric acid dihydrate is rare, but uric acid used to be commzinon in bladder stones from elderly men.

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.

[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.

[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.

Epidemiology of urolithiasis.

The epidemiology of urolithiasis differs according to geographical area and historical period: changing socio-economic conditions have generated changes in the incidence and type of lithiasis in terms of both the site and the physical-chemical composition of the calculi. Reno-ureteral calculosis typical of adult age and featuring mainly calcium oxalate and phosphate is currently more frequent in economically developed countries, where the prevalence rate hovers between 4% and 20% and the annual incidence of hospitalization for calculosis ranges from 0.03 to 0.1%. On the contrary "primitive" vesical calculosis is fairly widespread in Asia, with calculi composed of ammonium urate and calcium oxalate. Vesical calculosis, due to malnutrition in the very early years of life, is currently frequent in huge areas of Turkey, Iran, India, China, Indochina and Indonesia, although the incidence is decreasing in proportion as social conditions gradually improve. At the beginning of the 20th century primitive vesical calculosis was relatively frequent in Europe also, but in the course of the last 100 years, there has been a gradual decrease in its incidence, while the reno-ureteral calculosis has become more common. This trend definited as "stone wave" has been explained in terms of changing social conditions and the consequent changes in eating habits. In Europe, Northern America, Australia, Japan, and, more recently, Saudi Arabia affluence has spread to all social classes, and with it the tendency to eat "rich" food in large quantities. Calcium oxalate and/or phosphate stones account for almost 70% of all renal stones observed in economically developed countries. The prevalence of this type of stones varies considerably on account of environmental factors, especially dietary intake and lifestyle, while radiolucent and infection stones seem to be less influenced by environmental conditions. In the seventies the pathogenetic role for calcium oxalate stones of a diet rich in proteins, refined carbohydrate and sodium has become evident, while the effect of alimentary calcium and oxalate is still debated. However, the concurrence of a genetic predisposition seem to be crucial for calcium stone formation. In fact the importance of family history for idiopathic calcium stone disease is clearly demonstrated, although little is known about the metabolic alterations underlying this predisposition and their genetic transmission mechanisms.

[Julián Gutiérrez de Toledo and his book "Cure of the stone and pain in the loin and/or renal colic" in 1498]. / Julián Gutiérrez de Toledo y su libro "Cura de la piedra y dolor de yjada o/y colica renal" en 1498.

The physician Julián Gutiérrez de Toledo, born in the Imperial Town halfway through the Fifteenth Century and deceased around 1520, has a great relevance in the History of Urology for being the first writer of a treatise on urological topics in the Castilian language with his work "Cure of the stone and loin pain or/and renal colic" (Editor Melchor Gorricio, Printer Pedro de Hagembach, Toledo 1498). His work marks the transit from The Middle Ages to the Modern Times in what refers to awareness of the urinary tract diseases. The book "Cure of the stone..." has 85 pages written in two columns of 40 lines each with gothic characters. On the cover there is an engraving of the saint physicians Cosme and Damian, and on the last page is the printer's coat-of-arms. The book consists of five parts as all books from late Middle Ages: Of the Causes, Signs and Prognosis, Preservation, Of the Cure, Misgivings. The value of the treaty is that it compiles all that was known at the time on urinary lithiasis showing a marked Avicenna-like Galenism to which the author adds his own observations that show the Renaissance man. An exceptional witness of the reign of the Catholic King and Queen, this incunabular should be known by the Spanish speaking urologist as illustrious predecessor.

[Three therapeutic recipes from the pages of the baptismal record book of the Kastel Parish in Istria]. / Tri recepta sa stranica maticne knjige krstenih zupe Kastel u Istri.

In Croatian archives a rich collection of registers is preserved. Among the oldest and best-conserved collections of such valuable sources in Europe, are those from the territory of Istria. Investigating these sources we focused our attention on three recipes for treatment of calculi and cuts found on pages of Kastel baptismal's record (1749-1815) in Istria. Similar to other recipes found in various other recipe collections they mirror interlace of folk experience and theurgical views of healing which was detected unexpectedly sometimes on unconventional places, have survived on Croatian territory throughout centuries.

[The lithiasis of urinary tract and its treatment by Ambroise Paré (1509-1590)]. / La lithiase urinaire et son traitement par Ambroise Paré (1509-1590).

Ambroise Paré, founder of surgery, by his research and books concerning urology, made an enormous contribution to the foundation of this discipline. The treatment of urinary tract's lithiasis in the Works of Paré.

[Bladder surgery and the Hippocratic oath]. / La taille vésicale et le serment hippocratique.

Referring to the famous prohibition "I will not cut persons laboring under the stone but will leave this to be done by practitioners of this work", which appears in the hippocratic oath, the authors attempt an explanation of the real meaning of this phrase. They come to the conclusion that through this prohibition Hippocrates favoured the birth of urology, protecting his students from the danger of professional defamation.

Advances in lithotripsy and stone disease treatment.

Stone disease can be traced back as far as the human record. This article traces the diagnosis and treatment of stone disease from primitive attempts at stone removal in ancient civilizations to the advent of extracorporeal shock wave lithotripsy (ESWL) in the 1970s. ESWL revolutionized the treatment of stone disease, offering patients a less painful alternative to the traditional surgical removal of stones. This article discusses recent advances in ESWL, describes the radiologic technologist's role in diagnosing and managing stone disease, and outlines future prospects in the treatment of stone disease.

[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.