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The Lure of Medical History October, 1930 GIROLAMO FRACASTORO-STRATMAN-THOMAS 739 functionless right ureter. Ureterogram demonstrated I am not convinced that mild inflammatory proc- a normal ureteral outline, the upper end, however, esses, without distension, can be depended upon as was blunted and showed no pelvis. The left kidney a cause of this ureteral pain. I think that the dilata- and ureter were normal. On March 11, 1925, a right tion of the ureter for the purpose of studying its ureterectomy was done. The ureter appeared soft and effect upon the pain should be a helpful guide, before normal throughout and no change in the wall could extirpation of the ureter is considered. be demonstrated macroscopically. Microscopically the ureter showed very little except edema and polymor- phonuclear infiltration of the wall with some loss of WILLIAM E. STEVENS, M. D. (608 Flood Building, San mucosa. Culture and microscopic examination of Francisco).-Doctor Michelson's interesting paper smears were negative for bacteria. The patient has calls attention to an unusual condition, ureteral pain had no pain in the right side since, although she has after nephrectomy in the absence of demonstrable had symptoms referable to a ureteral stricture on the pathology of the ureter or other urinary organs. left side. I have never seen a similar case. The disappearance COM MENT of the pain following ureterectomy seems to indicate The reason that more cases of this kind are the presence of some pathologic condition of the ureter, the diagnosis of which was impossible with not operated upon, is due, I believe, to the gen- the methods of examination available at this time. eral conception that pain in the reno-uteral tract A case I saw in consultation a short time ago is is from back pressure due to obstruction. The interesting in this connection. The patient was a kidney being removed and urine no longer se- young girl who entered the hospital complaining of creted, there is no back pressure and pain in the right lumbar region and the upper and the cause lower right abdominal quadrants. The family his- of pain must be looked upon as extra-ureteral. tory was negative. She had been treated fourteen Therefore, according to this way of thinking, months before for pain in the right lumbar region removal of the ureter would give no relief. accompanied by pus in the urine. Her temperature, pulse, urine and blood count were normal. Tender- Nevertheless, it is not improbable that the in- ness was somewhat greater on deep palpation at Mc- flammatory reaction is due to infection, carried Burney's point. Pyelography revealed an enlarged by the lymphatics around the ureter. One must right kidney pelvis. Indigo carmine injected intra- venously appeared at the left ureteral orifice in five also bear in mind the sensitiveness of the parietal minutes, but none could be detected on the right side peritoneum, to which the ureter is attached, and in one-half hour. Further examination was refused. not overlook the fact that any inflammatory con- Following a provisional diagnosis of appendicitis dition of the ureter may react on this membrane. her doctor removed an appendix not definitely patho- logical. Notwithstanding the abnormal condition of In both the cases to which I have alluded, the the upper urinary tract the lumbar and abdominal pain was the deciding symptom. And the fact pain disappeared following the appendectomy. In that pain was present when there was no back view of the findings treatment directed toward the urinary tract would have been justifiable but probably pressure, and disappeared upon resection of the no ureter, shows definitely that pain in like cases, improvement would have resulted. even where the kidney is still present, is not due exclusively to back pressure. THE LURE OF MEDICAL HISTORY CON CLUSION In cases where, after nephrectomy, pain is pres- GIROLAMO FRACASTORO (1478-1553) ent, apparently along the line of the ureter, and this pain is severe and persistent-after elimina- AND SYPHILIS* tion of other possible causes, removal of the By W,. K. STRATMAN-THOMAS, Ph. D., M. D., ureter should be seriously considered. D. T. M. AND H. 490 Post Street. New York City DISCUSSION OUR hundred years ago (in August ANDERS PETERSON, M. D. (1136 West Sixth Street, 1530), Los Angeles).-It has not occurred within my experi- Girolamo Fracastoro, the genial Veronese phy- ence that the ureter free from pathology has caused sician, astronomer and poet, published that most any disturbances following nephrectomy. On the con- interesting medical poem Syphilis sive Morbus trary, many pathological ureters are permitted to Gallicus. Dedicated to his remain at the time of nephrectomy, and only a few friend, the Cinquecento of these cause any disturbance. This, I think, is par- pagan, Cardinal Pietro Bembo, the poem surveys, ticularly true in cases of tuberculosis, where the ureter in the flowery pseudoclassical style of the period, is almost always involved in the tuberculous process. opinions on the origin, symptoms, and treatment In neither one of the two cases reported by Doctor of the disease now known by the name Fracastoro Michelson did the pathologist demonstrate any patho- gave to one of his poetical characters. logical entity. However, it is of interest that in Case 2 temporary relief was experienced by the patient Where Fracastoro got the word syphilis is not following dilatation of the ureter. This, to my mind, known. But that this name of the fictitious shep- did indicate that even though the kidney was removed herd, who Fracastoro says first contracted the ill- some distension of the ureter might well have been ness by defying the sun god, has become the responsible for the pain. common designation of the disease was not mere I have recently had such an experience with a man chance. The jolly Fracastoro deliberately gave upon whom a nephrectomy for stone had been done and some years previouslv who complained of pain * Edited for publication by Dr. S. V. Larkey and in the nephrectomized side. The urological examina- Professor C. D. Leake from notes and material prepared tion revealed several small calculi, lying in the lower by Dr. Stratman-Thomas while in London and Africa as end of the ureter, and this man actually experienced a Guggenheim Traveling Fellow, 1928-1930. * Itead before the California Medical History Seminar, a pain similar to renal colic, extending well up into at a luncheon in honor ofN Dr. and Mrs. Charles Singer of the kidney space. London, on August 19, 1930. 140 CALIFORNIA AND WESTERN MEDICINE Vol. XXXIII, No. 4 countrymen. He died in 1553 from apoplexy, and was buried in his beloved Verona. In 1555 the Senate of Verona commissioned Danese Cataneo to carve a lifesize statue of Fracastoro,2 which now adorns a narrow street arch near the Piazza dei Signori. Klebs has enter- tainingly described 2 another bust, presumably of Fracastoro, by this same Cataneo. Most of the representations of Fracastoro seem to have been taken from the woodcut portrait in his De Homo- I contricis (Verona, 1538), which is supposed to be the only authentic likeness made during Fracas- toro's life. There is, however, a portrait (No. 3949) in the National Gallery, London, which is supposed to be that of Fracastoro, and which is attributed to Francesco Torbido (1486-1545). While it portrays a slightly younger man than the woodcut, there is considerable similarity. The mole near the nose on the right side of the face, wvhich shows on the woodcut, is lacking in the painting. But in the Pitti Gallery (Florence) portrait,3 this mole appears on the left side of the face. Since the National Gallery portrait has not hitherto been published, enough interest attaches to it to reprocluce it here, with the woodcut, for comparison. THE POEM HIER ON Y MI ER AC After the usual flowery introduction, Fracas- Fig. 1-Wood-cut portrait of Fra.castoro in hiis Hoviocen- toro alludes to the belief that syphilis was brought trica, Venice, 1538. Supposed to be the only g-enuine likeness made during his life (1478-1553). to Europe from the New World. He says, as translated by Tate (1686): the cue in the poem itself. As translated in 1686 "Say, Goddess, to what Cause we shall at last by "England's worst poet laureate," Nahum Tate, Assign this Plague, unknown to Ages Past; the passage reads: If from the Western Climes 'twas wafted o'er, WVhen daring Spaniards left their native shore; A Shepherd once (distrust not ancient Fame) Resolv'd beyond th' Atlantick to descry, Possest these Downs, and Syphilus his Name. Conjectur'd Worlds, or in the search to dye. For Fame Reports this Grief perpetual there, He first wore Buboes dreadfull to the sight, From Skies infected and polluted Air: First felt strange pains and sleepless past the Night; From whence 'tis grown so Epidemical, From him the Malady receiv'd its name, Whole Cities Victims to its Fury fall; The neighboring Shepherds catcht the spreading Few 'scape, for what relief where vital Breath. Flame. The Gate of Life, is made the Road of Death?" Later, in the more critical discussion of the dis- It may be that the "Grief perpetual" referred ease in his pioneer treatise on infections, De con- to in the New World was yaws, difficult to dis- tagionibus et contagiosis miorbis (1546), Fracas- tinguish from syphilis, and endemic in the West toro consistently refers to the condition by the Indies. Columbus' sailors may easily have con- name given to it in his earlier poem, Syphilis. tracted this disease and returned with it to While Fracastoro is generally known because Europe.
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