8 DO UNTO YOURSELF AS WOULD UNDO TO OTHERS - SELF EXPERIMENTATION IN UROLOGY

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Albucasis treatises in urology



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Johann Peter Frank: Revisiting the forgotten founder of the modern healthcare system

Al-Sudani M.L.

Ückert S.1, Albrecht K.1, Dauenhauer A.2, Bannowsky A.3, Loch T.3, Kuczyk M.A.1

Kettering General Hospital, Dept. of Urology, Kettering, United Kingdom Introduction & Objectives: Albucasis (A.D 936 – 1031) was born, studied and practised medicine in Cordova, Spain. He wrote several books in surgery, the most famous of all was Altasrif. Albucasis described a wide range of surgical instruments and procedures for various diseases including urological problems. Material & Methods: Altasrif was a self-contained manual of different treatises in medical specialities. The first treaty contained information about anatomy and drugs. The second treaty was on symptoms and their treatments. The third and the most important of all was on the subject of surgery. Albucasis stressed the importance of anatomy for surgeons and advised a great consideration of patients’ general condition. Altasrif was translated to Latin to become a major source of surgical knowledge in Europe for centuries to come. Guy de Chauliac and Fabricus ranked Albucasis work with those of Hippocrates and Galan. The first translation of Altasrif appeared in Venice in 1497 and further Turkish translation appeared later with remarkable illustration of surgical instruments and procedures. The first modern edition with Latin translation appeared at Oxford in 1778. Results: Albucasis, in his treatises on urology, described cases of congenital anomalies with lack of sex differentiation and their treatment. He advised no treatment for those with complex intersex cases. He described a cannula for hydrocele drainage and also described in details methods for excision of hydrocele. Circumcision was commonly performed in his time; in addition to different techniques, he also described treatment of complications. The ancient Greek doctors already mentioned urinary catheter. Albucasis, however, produced for the first time a straight catheter different from the S-shaped described by Galan. He also mentioned the technique to deal with bladder neck angulation during difficult catheterisation. Albucasis gave original and comprehensive description of bladder irrigation using purposely designed a new syringe device. Lithotomy was wellknown procedure practised by many surgeons for treatment of bladder stones. Albucasis added new ideas describing a straight-toothed forceps for the extraction of difficult stones. He also proposed the idea of breaking large stones inside the bladder to minimise trauma and allow complete removal. He also described a drill like tool to deal with impacted urethral stone. Conclusions: Albucasis’ treatises in medicine, surgical instruments and illustrations remained as a major source of knowledge and teaching of the art in Medieval Europe for many centuries. Surgical instruments, which he described in lithotomy, can possibly be considered as the first lithotrites.







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Castrates -everything for fameHatzinger M., Vöge D., Häfele J., Sohn M. Markus Krankenhaus, Dept. of Urology, Frankfurt, Germany Introduction & Objectives: The phenomenon castration is wedded to barock. This epoch stands for pure sensual pleasure. Those who could afford it, tried to create their earthly days as enjoyable as possible. A pervert bloom of this ambition was the angel-like voices of the castrates. The voices and its supernatural sound were meant to let the opera-visitors escape into another world. The High-Society was almost addicted to those voices. On the other hand nobody showed interest in the spiritual life of the castrates. Farinelli, Nicolini und Senesiono, three of the most famous castrates were the first musical superstars of the 18th Century. Their voices moved the decadent Barock-audience to tears and ravished them to standing ovations. But the price for this fame was high. Only through castration in their boyhood could this bell-like voice be kept. Because of the sensational success of the castrates a huge castration-wave swept over Italy. Ambitious parents had their boys castrated, hoping that they would become also famous opera stars. It is estimated that alone Italy had over 1 million boys were victims of this garbling procedure within the 18th Century. Because the castration was officially forbidden it was done “behind closed doors” by not trained barbers and of course went along with a high morbidity rate. The blossom-time of the castrates ended with the fading 18th Century. The last castrate Alessandro Morschi was engaged as a choir-singer and soloist at the Sistine Chapel in the Vatican. He was pensioned off by Pope Pius X in the year 1903 after an official ban for the castrated singers was imposed. With that a very impressive part of musichistory had ended.

Hanover Medical School, Dept. of Urology, Hanover, Germany, 2Johann-Peter-Frank Society, Historical Archive, Rodalben, Germany, 3DIAKO Protestant Hospital, Dept. of Urology, Flensburg, Germany

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Introduction & Objectives: In modern westernized countries, urology as we know it, is an integrated part of an efficient healthcare system committed to high common standards of education and quality of surgical and non-surgical treatment, supervised by government authorities. Nevertheless, Johann Peter Frank (1745 - 1821), the man who has greatly contributed by his innovative ideas and work to the creation of this system, is only randomly known. Material & Methods: A search of primary and secondary sources (books, journals, internet) was conducted in order to reproduce the life and work of Johann Peter Frank. Results: Johann Peter Frank received his degree as a medical doctor from Heidelberg University in 1766. At that time, medicine in central Europe was not dominated by welleducated physicians but by the activities of barbers, dressers, bladder stone surgeons and midwifes. Due to their lack of knowledge, the life of thousands of patients was put at risk. In 1779, during his occupation as the private physician of the Fürstbischof of Speyer, Count of Limburg-Styrum, Frank conceived his vision of a modern and beneficial health care system, “Die Medicinische Polizey”. He presented the ideas of a standardized academic education of physicians, bed-side teaching, safe hygienic regulations and government funding in order to create an infrastructure of hospitals and an administrative institution supervising the entire health care business. In 1784, as professor of the University of Pavia, under the hospices of his great mentor, Franz II, Emperor of Austria, Frank set out to accomplish what he had outlined in “Die Medicinische Polizey”: improving the medical infrastructure, supporting and standardizing academic education of doctors, fighting against quackery by a system of supervision and control, and setting up a network of physician’s offices in rural regions. Conclusions: The achievements of Johann Peter Frank undoubtedly led European medicine and surgery into a new era. The significant role he played in the progress of modern medicine is most certainly due to his dedication and fervent conviction by which he made healthcare issues a matter of political discussion.





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Do unto yourself as would undo to others - self experimentation in urology Thomas J.S., Karim O.M.A., Motiwala H., Laniado M., Rao A.R. Wexham Park Hospital, Dept. of Urology, Slough, United Kingdom Introduction & Objectives: Progress in medicine is often made due to unexpected research by scientists experimenting what they believe strongly on themselves. Often, novel theories are met with disbelief when presented, and scientists can be forced to prove these theories upon themselves. Their strong beliefs in themselves and their ideas, has resulted in many of the modern advancements in medicine witnessed in the 20thcentury. Material & Methods: A MEDLINE search was carried out on scientist’s who had performed self-experimentation of themselves in the name of medical research. Images of the results of the experiments will be used in the presentation Results: We concentrate on the following findings: Wilhem Röntgen: Today, X-rays are used as the most basic on investigation in urology. In 1895, Wilhem Röntgen a German physicist, was experimenting with the phenomena of passing an electric current through agas of extremely low pressure. He discovered that if the discharge tube is surrounded by darkness, a paper plate covered on one side with bariumpalatocyanide placed in the path of the rays became fluorescent. Friedrich Meyer-Betz: The use of photodynamic therapy in the treatment of urological cancer is a growing field, using porfirmer sodium, a synthetic porphyrin deriative. In October 1912, MeyerBetz, a German physician, injected himself with 200mg of haematoporphyr into test whether it made humans sensitive to light. He then irradiated his forearm with a Finsen light source noticed ulceration at the site of irradiation. However, he accidentally exposed himself to sunlight and suffered from a massive phototoxic reaction, even outside the irradiation site. Werner Forssmann: Born in Berlin in 1904, Werner Forssmann performed the first human cardiac catheterisation on himself, age 25. He introduced a 4 Ch ureteral catheter into his left cubital vein, passed it 60 cm through the vein and into his right atrium. He confirmed the position with X-rays and went on to publish his findings. Following difficulties pursuing a career in academic cardiology, he became urological surgeon. In 1956 he was awarded the Nobel prize for his work which he shared with Dickenson and Counard. His wife was also one of the first women physicians in urology. Giles Brindley: Giles Brindley was a British physiologist and urologist. In 1983, at the American Urological Association he paved the way in the field of erectile dysfunction by performing intra-cavernosal injection of the alpha-blocker phenoxybenzamine on himself. He demonstrated the erection he sustained following this injection, to his audience at AUA. Thus, he proved that muscle relaxation is key in the physiology of priapism. Conclusions: We hope to have demonstrated how self-experimentation has had a profound effect on a variety of areas within the Urological field. These courageous scientists, some after having suffered side-effects from their experiments, have paved the way for the continuing advancement of medical science.

Eur Urol Suppl 2009;8(4):122