- Email: [email protected]
1050 BRIGHT'S DISEASE: A STORY OF A FORGOTTEN PRESIDENT AND FORGOTTEN NEPHROLOGIC CONDITION
e422
THE JOURNAL OF UROLOGY姞
Society of Medicine library, Wellcome Trust History of Medicine library and British Library in London. A Medline search using the terms Swick, Berlin, excretory urography and contrast medium was also performed. RESULTS: As a Jewish American doctor finding it difficult to obtain postgraduate medical education in the USA, Dr Swick went to Germany at the age of 24. Working with Professor von Lichtenburg in Berlin, he devised and conducted the first animal and human studies using the intravenous contrast material uroselectan in 1929. He was unable to present his breakthrough at the 1930 AUA meeting; the rules stated that an intern could not present a paper. Despite his urgent pleas the honour went to Professor von Lichtenberg who was accepted as the sole originator whilst Swick became to be regarded as a plagiarist. On return to the States in 1931, he worked tirelessly to improve the performance of contrast media. He produced Hippuran, the forerunner to Renograffin. He continued to be shunned by the national and international community until Professor VF Marshall’s investigation led to Swick being awarded the Valentine Medal of the New York Academy of Medicine in 1966 after “30 unkind years of heartache and oblivion”. CONCLUSIONS: The American Congressional Record regards Swick’s work as one of the five major contributions of an individual to medicine. His life is a testament to the struggle for scientific integrity and fight against prejudice. Source of Funding: None
1049 PRESIDENT THEODORE ROOSEVELT: HOW MYOPIA MAY HAVE SAVED HIS LIFE! Jonathan Melquist*, Heather McCaffrey, David Schulsinger, Stony Brook, NY INTRODUCTION AND OBJECTIVES: Born October, 27, 1858, Theodore Roosevelt (TR) was sickly as a child. By the time he was 13, he was wearing thick glasses due to extreme nearsightedness. His childhood diseases included chicken pox, measles, mumps and asthma. TR held the vice-president position for less than a year before succeeding to the presidency after the assassination of President McKinley on September 14, 1901. He became the 26th President at the age of 42, the youngest in US history. On September 3, 1902, the President was seriously injured in the collision of his automobile with a trolley car in which one of his secret service men was killed. A left leg injury required two surgical procedures, the second of which was performed under cocaine anesthesia. Another serious accident occurred in the White House in December 1904 following a boxing–related injury with an artillery captain. A blow to his head damaged the president’s left eye and his vision diminished over time. Eventually, by 1908 he lost the sight in the left eye. TR’s closest call with death, however, came when campaigning for a third term in Milwaukee, Wisconsin, on October 14, 1912. The former president was struck with a bullet that lodged in his chest. Fortunate for TR, the bullet first penetrated both his steel eyeglass case and then a folded, 50-page copy of a speech in his breast pocket. Roosevelt, an experienced hunter and anatomist, correctly concluded that since he was not coughing blood, the bullet had not completely penetrated the chest wall to his lung. As such, he declined recommendations to proceed directly to the hospital. Instead, he delivered his scheduled speech, which lasted 90 minutes as blood seeped into his shirt. His opening comments to the gathered crowd were, “Ladies and gentlemen, I don’t know whether you fully understand that I have just been shot; but it takes more than that to kill a Bull Moose.” Afterward, probes and x-ray showed that the bullet had traversed three inches (76 mm) of tissue and lodged in Roosevelt’s chest muscle. It did not penetrate the pleura, and it would have been more dangerous to remove the bullet than to leave it. Roosevelt carried it with him for the rest of his life. The man known for the motto “speak softly and carry a big stick,” led people to believe that he was healthier than he truly was.
Vol. 185, No. 4S, Supplement, Monday, May 16, 2011
From a president known for many quotes, his last words spoken to his friend and former valet, James Amos, at the time of his death (January 6th, 1919) were “Please put out the light, James”. The cause of death was believed to be due to a coronary embolism. METHODS: see above RESULTS: see above CONCLUSIONS: see above Source of Funding: None
1050 BRIGHT’S DISEASE: A STORY OF A FORGOTTEN PRESIDENT AND FORGOTTEN NEPHROLOGIC CONDITION Jonathan Melquist*, Stony Brook, NY; Heather McCaffrey, Hauppauge, NY; Howard Adler, Stony Brook, NY INTRODUCTION AND OBJECTIVES: Chester Arthur is, to say the least, a lesser known President of the United States. He is not remembered in the likeness of Abraham Lincoln, Theodore Roosevelt, or even Woodrow Wilson. Rather he served quietly in the Guilded Age of the Industrial Revolution (1881–1885) with few notable achievements. Arthur was one of the first in a long line of American presidents from Grover Cleveland to Franklin Delano Roosevelt to Dwight D Eisenhower that kept his medical ailments from the public. As historical and forgotten is Arthur, so is the disease from which he suffered. Bright’s Disease is the nearly-forgotten ailment afflicting President Arthur during his term. The diagnosis encompassed a broad swath of nephrologic disease processes we recognize today. In one regard, we are not completely sure what Arthur had. Insight into the disease understanding of the time can be found in the teachings of Dr. Charles Purdy who describes the fundamentals of the disease process in great detail. Published the very year of Arthur’s ultimate death from the disease, Dr. Purdy describes in his book “Bright’s Disease: and Allied Affections of the Kidneys” (1886) the clinical manifestations of the disease being proteinuria, hematuria, hypertension, and edema. He further describes prognostic outcomes of the disease being “uremic convulsions” known as “acute Bright’s Disease” or “convulsions of chronic Bright’s disease” which are “less remediable by medication.” Treatment for President Arthur and those afflicted with Bright’s Disease was limited. This was in part based on the limited understanding of pathophysiology. For example, albuminuria was well- correlated to the disease at the time and, subsequently, patients were recommended to avoid “albuminous food” such as eggs. Interestingly, however, the “liberal use of fluids between meals” was recommended in “facilitating urinary filtration.” Arthur’s efforts to stave off the effects of his condition were ultimately to no avail. He succumbed to coronary complications of Bright’s disease—likely heart failure—in 1886 when he died. The evolution of inflammatory conditions of kidney is an interesting one. Today it is understood that Bright’s Disease encompassed many now distinct processes of glomerulonephritis and glomerulonephropathies. Only with scientific investigation and perseverance was Medicine able to delineate and better treat the disease that ailed one of the first presidents masking a debilitating disease. METHODS: . RESULTS: . CONCLUSIONS: . Source of Funding: None
1051 THE ETYMOLOGY OF PROTEUS: AN EVOLUTION FROM MYTHOLOGY AND HISTORY TO PRESENT DAY Senthy Sellaturay*, Sanjeev Madaan, Ian Dickinson, Seshadri Sriprasad, Dartford, United Kingdom INTRODUCTION AND OBJECTIVES: It is common urological knowledge that proteus bacteria are associated with urinary infections
THE JOURNAL OF UROLOGY姞
Society of Medicine library, Wellcome Trust History of Medicine library and British Library in London. A Medline search using the terms Swick, Berlin, excretory urography and contrast medium was also performed. RESULTS: As a Jewish American doctor finding it difficult to obtain postgraduate medical education in the USA, Dr Swick went to Germany at the age of 24. Working with Professor von Lichtenburg in Berlin, he devised and conducted the first animal and human studies using the intravenous contrast material uroselectan in 1929. He was unable to present his breakthrough at the 1930 AUA meeting; the rules stated that an intern could not present a paper. Despite his urgent pleas the honour went to Professor von Lichtenberg who was accepted as the sole originator whilst Swick became to be regarded as a plagiarist. On return to the States in 1931, he worked tirelessly to improve the performance of contrast media. He produced Hippuran, the forerunner to Renograffin. He continued to be shunned by the national and international community until Professor VF Marshall’s investigation led to Swick being awarded the Valentine Medal of the New York Academy of Medicine in 1966 after “30 unkind years of heartache and oblivion”. CONCLUSIONS: The American Congressional Record regards Swick’s work as one of the five major contributions of an individual to medicine. His life is a testament to the struggle for scientific integrity and fight against prejudice. Source of Funding: None
1049 PRESIDENT THEODORE ROOSEVELT: HOW MYOPIA MAY HAVE SAVED HIS LIFE! Jonathan Melquist*, Heather McCaffrey, David Schulsinger, Stony Brook, NY INTRODUCTION AND OBJECTIVES: Born October, 27, 1858, Theodore Roosevelt (TR) was sickly as a child. By the time he was 13, he was wearing thick glasses due to extreme nearsightedness. His childhood diseases included chicken pox, measles, mumps and asthma. TR held the vice-president position for less than a year before succeeding to the presidency after the assassination of President McKinley on September 14, 1901. He became the 26th President at the age of 42, the youngest in US history. On September 3, 1902, the President was seriously injured in the collision of his automobile with a trolley car in which one of his secret service men was killed. A left leg injury required two surgical procedures, the second of which was performed under cocaine anesthesia. Another serious accident occurred in the White House in December 1904 following a boxing–related injury with an artillery captain. A blow to his head damaged the president’s left eye and his vision diminished over time. Eventually, by 1908 he lost the sight in the left eye. TR’s closest call with death, however, came when campaigning for a third term in Milwaukee, Wisconsin, on October 14, 1912. The former president was struck with a bullet that lodged in his chest. Fortunate for TR, the bullet first penetrated both his steel eyeglass case and then a folded, 50-page copy of a speech in his breast pocket. Roosevelt, an experienced hunter and anatomist, correctly concluded that since he was not coughing blood, the bullet had not completely penetrated the chest wall to his lung. As such, he declined recommendations to proceed directly to the hospital. Instead, he delivered his scheduled speech, which lasted 90 minutes as blood seeped into his shirt. His opening comments to the gathered crowd were, “Ladies and gentlemen, I don’t know whether you fully understand that I have just been shot; but it takes more than that to kill a Bull Moose.” Afterward, probes and x-ray showed that the bullet had traversed three inches (76 mm) of tissue and lodged in Roosevelt’s chest muscle. It did not penetrate the pleura, and it would have been more dangerous to remove the bullet than to leave it. Roosevelt carried it with him for the rest of his life. The man known for the motto “speak softly and carry a big stick,” led people to believe that he was healthier than he truly was.
Vol. 185, No. 4S, Supplement, Monday, May 16, 2011
From a president known for many quotes, his last words spoken to his friend and former valet, James Amos, at the time of his death (January 6th, 1919) were “Please put out the light, James”. The cause of death was believed to be due to a coronary embolism. METHODS: see above RESULTS: see above CONCLUSIONS: see above Source of Funding: None
1050 BRIGHT’S DISEASE: A STORY OF A FORGOTTEN PRESIDENT AND FORGOTTEN NEPHROLOGIC CONDITION Jonathan Melquist*, Stony Brook, NY; Heather McCaffrey, Hauppauge, NY; Howard Adler, Stony Brook, NY INTRODUCTION AND OBJECTIVES: Chester Arthur is, to say the least, a lesser known President of the United States. He is not remembered in the likeness of Abraham Lincoln, Theodore Roosevelt, or even Woodrow Wilson. Rather he served quietly in the Guilded Age of the Industrial Revolution (1881–1885) with few notable achievements. Arthur was one of the first in a long line of American presidents from Grover Cleveland to Franklin Delano Roosevelt to Dwight D Eisenhower that kept his medical ailments from the public. As historical and forgotten is Arthur, so is the disease from which he suffered. Bright’s Disease is the nearly-forgotten ailment afflicting President Arthur during his term. The diagnosis encompassed a broad swath of nephrologic disease processes we recognize today. In one regard, we are not completely sure what Arthur had. Insight into the disease understanding of the time can be found in the teachings of Dr. Charles Purdy who describes the fundamentals of the disease process in great detail. Published the very year of Arthur’s ultimate death from the disease, Dr. Purdy describes in his book “Bright’s Disease: and Allied Affections of the Kidneys” (1886) the clinical manifestations of the disease being proteinuria, hematuria, hypertension, and edema. He further describes prognostic outcomes of the disease being “uremic convulsions” known as “acute Bright’s Disease” or “convulsions of chronic Bright’s disease” which are “less remediable by medication.” Treatment for President Arthur and those afflicted with Bright’s Disease was limited. This was in part based on the limited understanding of pathophysiology. For example, albuminuria was well- correlated to the disease at the time and, subsequently, patients were recommended to avoid “albuminous food” such as eggs. Interestingly, however, the “liberal use of fluids between meals” was recommended in “facilitating urinary filtration.” Arthur’s efforts to stave off the effects of his condition were ultimately to no avail. He succumbed to coronary complications of Bright’s disease—likely heart failure—in 1886 when he died. The evolution of inflammatory conditions of kidney is an interesting one. Today it is understood that Bright’s Disease encompassed many now distinct processes of glomerulonephritis and glomerulonephropathies. Only with scientific investigation and perseverance was Medicine able to delineate and better treat the disease that ailed one of the first presidents masking a debilitating disease. METHODS: . RESULTS: . CONCLUSIONS: . Source of Funding: None
1051 THE ETYMOLOGY OF PROTEUS: AN EVOLUTION FROM MYTHOLOGY AND HISTORY TO PRESENT DAY Senthy Sellaturay*, Sanjeev Madaan, Ian Dickinson, Seshadri Sriprasad, Dartford, United Kingdom INTRODUCTION AND OBJECTIVES: It is common urological knowledge that proteus bacteria are associated with urinary infections