Jędrzej Śniadecki ( ) and his flirtation with nephrology

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1 SePold ORIGINAL ARTICLE JN EPHROL 26( DOI: /jn Jędrzej Śniadecki ( ) and his flirtation with nephrology Bolesław Rutkowski 1,2, Janusz Ostrowski 2,3 1 Department of Nephrology, Transplantation and Internal Medicine, Medical University, Gdańsk - Poland 2 Historical Section, Polish Society of Nephrology, Gdańsk - Poland Historical 3 Third Department of Internal Medicine and Nephrology, Provincial Hospital, Wloclawek - Poland Introduction Spanning the period from the late 17th to the late 18th century, the Enlightenment, referred to as the age of reason or the age of philosophers, proved to be a period of breakthroughs for European culture and science. It was based on the belief that it was human reason that served as the means of discovering the truth about the world and man. The most notable figures of the Enlightenment were France s Montesquieu, Voltaire, Denis Diderot and Jean Jacques Rousseau, Britain s David Hume and Germany s Emmanuel Kant. Although the ideals of the Enlightenment spread in Poland somewhat later in the 1740s and lasted until the mid-19th century, they brought about a dynamic development of science, education and culture resulting in Poland becoming the first European country to create and adopt a constitution. All of these developments came to an abrupt halt with Poland falling victim to 3 subsequent acts of partition of its territory. The key scientific and educational representatives of the era in Poland included Stanisław Konarski, Hugo Kołłątaj, Stanisław Staszic and the Śniadecki brothers Jan and Jędrzej. Jędrzej Śniadecki was also the most distinguished figure in the field of medicine and chemistry. Biography and scientific achievement Jędrzej Śniadecki was born on 30 November 1768 in Żnin, Greater Poland. His father, Jędrzej Śniadecki Senior, was a land owner and a graduate of Lubrański College in Poznań, and his mother was Franciszka Giszczyńska. Jędrzej Śniadecki Jr was the youngest of the 4 siblings. His education started in a renowned monastery-run school in the neighboring town of Trzemeszno and was continued in the famous Nowodworski Secondary School in Krakow, where he was taken care of by his elder and already-famous brother Jan. He completed the secondary school with distinction, receiving a diligentae (for diligence) medal from King Stanislaw August Poniatowski. Then he studied physics and mathematics at the Main Crown School in Krakow where he encountered 2 outstanding chemists, Jan Jaśkiewicz, the first Polish professor of chemistry, and Prof. Franciszek Scheidt. After a year, he moved to the Medical Faculty from which he graduated in The same year, he went to study in Pavia, Italy, where he obtained his PhD in medicine and philosophy. At that time, Pavia, along with Paris, was a leading center for chemical research in Europe. It was in Italy that Śniadecki met the great names of the time, including the pioneers in the field of electricity, Galvani and Volta, the anatomist Antonio Scarpa, the physiologist Lazzaro Spallanzani and the clinical doctor Jan Piotr Franek. After his stay in Italy, he was planning to continue his education in Paris with Antoine Lavoisier, but the social unrest of the French Revolution (Lavoisier himself was guillotined) made him move to Edinburgh in 1793, which in the late 18th century was one of the intellectual centers of Europe and home to a number of renowned scientists and thinkers of the era. In Scotland, Śniadecki trained with the famous chemist Joseph Black, the anatomist Alexander Monro and the internist Andrew Duncan. After this, he went to Vienna for 6 months, where he came into contact with the representatives of the First Vienna School of Medicine. Then, in 1796 he arrived in Volhynia where he accepted the position of family doctor and married Konstancja Mikułowska. In 1797, he was appointed professor of chemistry at the Principal School of the Grand Duchy of Lithuania in Vilnius (later Vil- S Società Italiana di Nefrologia - ISSN

2 JN EPHROL 26( nius University and Medical-Surgical Academy) (Fig. 1). Jędrzej Śniadecki made efforts to establish a scientific and research center, with Polish as the language of instruction. A new building for chemical education and research was erected and equipped with state-of-the-art facilities for the performance of research in chemical analysis at the top European level. He retired in 1822 and left the Faculty of Chemistry to settle in his village estate in Bołtupia. However, 5 years later, in 1827, he again accepted the position of head of the medical clinic at the Medical-Surgical Academy. Jędrzej Śniadecki died in Vilnius on 11 May 1838 and was buried in the neighboring town of Horodniki (modern Belarus) next to his wife, Konstancja Mikułowska, who had died before, in He had 3 children: Józef, Ludwika and Zofia. The last married Michał Baliński, a historian, journalist, biographer and publisher of Jan and Jędrzej Śniadecki s works. Śniadecki s funeral was attended by about 20 thousand people (1-9). Śniadecki was renowned for his activities in the fields of chemistry, biology, medicine and journalism. As early as 1800, he published 2 volumes of the first textbook of chemistry, titled The Beginnings of Chemistry, dealing with both inorganic and organic chemistry (10). The work included the foundations of Polish chemical terminology, which was valid in the Polish chemical literature until the 1970s, and some nontypical Polish names of the chemical elements such as wodór (hydrogen), węgiel (carbon), krzem (silicon) and siarka (sulfur) are still in use today. The second volume of the work includes the division of urine depending on the time it takes to extract it from the system (drinks urine, food urine and blood urine), as well as the characteristics of the composition and physiochemical properties of urine. Śniadecki also presented the mechanism behind the creation of urinary tract stones, their shape and chemical composition. According to him, the most common chemical compositions of urinary tract stones are uric acid, ammonia uranium, tricalcium phosphate, magnesium ammonium phosphate, calcium oxalate and others. He also presents the possibilities for treatment of renal calculus, especially of the bladder type, with the use of lye and acid, having examined the composition of the sediment directly through the bladder. In June 1808, he published his work on a new metal, the element discovered in crude Siberian platinum, which he called west (11). Nevertheless, this discovery failed to be confirmed by the French Institute of Science. Forty years later, the Russian chemist Carl Claus extracted the last element of the platinum family ruthenium. In 1907, having compared west and ruthenium again, it was discovered that the 2 metals shared as many as 9 out of 13 tested properties. Although the issue is still controversial, it is no longer possible to test the same sample of ore which was tested by Śniadecki, which would be Fig. 1 - Prof. Jędrzej Śniadecki (courtesy of the Jagiellonian Library). decisive. The most famous representatives of Śniadecki s school of chemistry included: Jan Fryderyk Wolfgang, a professor of pharmacy at the University of Vilnius; Ignacy Fonberg, Śniadecki s successor in the Faculty of Chemistry; Jerzy Skrodzki, a professor of physics at the University of Warsaw; Michał Oczapowski, a pioneer of agricultural studies in Poland; Wincenty Homolicki, a professor of physiology at the University of Vilnius; and Ignacy Domeyko, rector of the University of Santiago, Chile. To honor Jędrzej Śniadecki s contribution to Polish chemistry, the Polish Chemical Society issued a medal featuring his portrait, the highest scientific honor presented by this organization (12-13). Jędrzej Śniadecki s opus magnum was the original and groundbreaking work Teorya Jestestw Organicznych (The theory of organic beings) published in 1804, (14) in which he describes the unique feature of living organisms, which is continuous metabolism and exchange of energy with the surrounding environment. In Śniadecki s opinion, human nature can be approached and examined from the point of view of anatomy, organic chemistry and physiology. Only 2013 Società Italiana di Nefrologia - ISSN S41

3 Rutkowski and Ostrowski: Je drzej Śniadecki and nephrology the combination of these elements can result in the emergence of real medicine. One of Śniadecki s contemporaries a professor of physiology, Johannes Müller from Berlin expressed the following opinion regarding this work: An outstanding, alas unknown work in my opinion this is the first philosophical foundation of the scientific system in medicine. (15) Teorya Jestestw Organicznych was translated into German twice (in 1810 and 1821) and into French in 1823 (16). For many years, it remained the basic textbook at German and Russian universities. Teorya Jestestw Organicznych constituted the summary of the total scope of knowledge of nature, a genius s attempt to describe the physiological aspect of life (17-21). Śniadecki also made no small contribution in significant medical discoveries. In 1805, in Vilnius he published his work On the Physical Upbringing of Children (O fizycznym wychowaniu dzieci) (22). It can be assumed that this outstanding work derived from the activities of the Commission of National Education. The work was aimed at presenting the methods of child upbringing to shape their bodies properly, taking care of both the physical and mental development of the young. The work was of high edifying value for biologists, physiologists, hygienists and educationalists. In the second edition of the work, which came out in 1822, Śniadecki proposed for the first time a method of rickets treatment with sunbathing, which later appeared as treatment with vitamin D. The British scientist T.A. Palm reached the same conclusion only in 1890, and yet he is cited as the author of the discovery. It was the works by Włodzimierz Mozołowski, published in the journal Nature in 1939 to commemorate the 100th anniversary of Śniadecki s death, and by Michael Holick of Boston University Medical Center that brought back recognition of Śniadecki s discovery by the international world of medicine (21, 23-29). Contribution to nephrology It is worth realizing that throughout his work in Vilnius, Jędrzej Śniadecki remained a practitioner. This was true both during his 25 years as head of the Faculty of Chemistry, and during his nearly 12 years as head of the Clinic at the Medical-Surgical Academy. Numerous works written by Śniadecki include those concerning nephrology, with 2 that are of particular interest for nephrologists: O zatrzymaniu uryny z przyczyny kamienia jednej tylko nerki (On retention of urine caused by stones in one kidney only) published in the Pamiętniki Towarzystwa Lekarskiego Wileńskiego (Memoirs of the Vilnius Doctors Society) in 1818, and Szczególny przypadek zatrzymania uryny (Ischuria), podany przez dra Karola Hastings (The London Medical and Physical Journal, June [sic] 1829) (A particular instance of urine retention (ischuria) quoted by Dr. Charles Hastings (The London Medical and Physical Journal. June 1829)) published in Dziennik Medycyny, Chirurgii i Farmacyi (the Journal of Medicine, Surgery and Pharmacy) in 1830 (30-32). Both works include very detailed accounts of a common malfunction of the urinary system renal calculus and the associated obstructive nephropathy leading to the development of uremia, made complete with a post mortem description. In the papers, he also suggested the treatment methods offered to patients in accordance with the level of knowledge at that time. It seems relevant to note that these were among the first such descriptions in the European medical literature, made at the same time as Richard Bright s work in nephrology which was widely regarded as pioneering (33-35) (Fig. 2). In the works mentioned above, Śniadecki touches upon the problems concerning what we might call today the renorenal reflux, his views on the place of urine production and the methods of treatment of the described ailments. In the first work, on anuria caused by kidney stone in 1 kidney only, he describes his observations made during an autopsy concerning the total damage to the kidney suffering from the disease, and the unchanged condition of the healthy kidney, as well as the completely unclogged ureter. What was intriguing for Śniadecki was the fact that the healthy kidney had failed to produce urine as it should have according to the general rules of the functioning of the organ. To explain this phenomenon he proposed that in cases of it being impossible to remove the stone, a reverse motion appears in the system the so-called motus peristalticus. In his opinion, the reverse movement was caused by an increased sensitivity of the urinary tract, inflammation or higher nervous activity. He also explained that similar instances of a reverse motion could be observed in the lymphatic and capillary vessel system. Of course, one cannot expect Śniadecki to have been aware of the detailed renal innervation and the impact of the sympathetic nervous system on the functioning of kidneys (36-38). The existence of such dependence was neglected for a number of years, and it was only with the experimental and clinical work conducted in the last quarter of the 20th century that a detailed definition was made of the role of the autonomous nervous system in this area and the establishment of the existence of the renorenal reflux (39, 40). What does, however, cause amazement and inspire respect is his ability to hypothesize the existence of such reflux despite having no possibility whatsoever of testing it on an experimental basis. What is more, it was a remarkable accomplishment to suggest for the first time ever that excitation of the nervous system can play a role in this phenomenon. S Società Italiana di Nefrologia - ISSN

4 JN EPHROL 26( Fig. 2 - A-D) Journal pages of articles by Śniadecki: O zatrzymaniu uryny z przyczyny kamienia jednej tylko nerki (On retention of urine caused by stones in one kidney only) (25) and Szczególny przypadek zatrzymania uryny (ischuria podany przez dra Karola Hastings) (Particular instance of urine retention (ischuria) quoted by Dr. Charles Hastings) (26). A B C D In the other of the works cited above, Śniadecki wrote a detailed polemic discussion with some information included in the reference literature, calling upon works by Charles Hasting from England (The London Medical and Physical Journal, June 1829) (27), Dr. Falaschi (Journal Universel des Science Medicales, 1829, p. 513) and Mr. Arnold (Journal Universel des Science Medicales, 1828) (31, 32). He reiterates that urine is only produced in the kidneys, and flatly refutes the suggestions included in Arnold s work (1828) that urine could trickle from the ear, eye, chest wart, tip of the nose or stomach, treating them as completely ungrounded and contradictory to physiology. It seems interesting to note that for the clinical cases described, he administered the following medications and methods of treatment: sodium carbonate, pills of soap and bitter extracts, bathing, strenuous physical work, reduction in the intake of food, decent nourishment, application of Spanish flies, magnesium sulfate dissolved in camphor mixture, cupping on the back, plaster, laxating medications and quicksilver. Apart from bathing, physical workouts and dietetic treatment, all of the other methods have failed to remain as part of the modern therapy of kidney stones (41). Summary Jędrzej Śniadecki had a truly amazingly creative mind for his times. Some of his accomplishments and discoveries in the fields of chemistry, biology, medicine, sociology and hygiene were far ahead of his time, and are still valid today. He was among the greatest of the Enlightenment figures not only in Poland, but also in Europe. By general consent, he is regarded as the father of Polish chemistry and pediatrics, and his flirtation with nephrology confirms the depth and versatility of his perception and reasoning. Financial support: No financial support. Conflict of interest: None declared. Address for correspondence: Prof. Bolesław Rutkowski Medical University Department of Nephrology, Transplantation and Internal Medicine Dębinki Street 7 PL Gdańsk, Poland bolo@gumed.edu.pl References 1. Baliński M. Życie Jędrzeja Śniadeckiego: Nakład i druk Ernesta Günthera. Leszno i Gniezno; Jelinek J. Sławni Żninianie. Jędrzej Śniadecki Żnin: Miejska i Powiatowa Biblioteka Publiczna; Karpińska D, Szymański J. Gimnazjum Trzemeszeńskie z miastem w tle. Poznan: Wielkopolskie Muzeum Walk Niepodległościowych; Konieczyńska J, Żurawska E. Jędrzej Śniadecki Bibliografia w wyborze. Żnin: Powiatowa i Miejska Biblioteka Publiczna; Gawęda S. Studia akademickie Jędrzeja Śniadeckiego w 2013 Società Italiana di Nefrologia - ISSN S43

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