Józef Dietl ( ), outstanding internist and reformer of the medical sciences, and his contribution to nephrology

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1 Section Department of Internal Medicine and Nephrology, Provincial Hospital, Wloclawek - Poland Historical Section, Polish Society of Nephrology - Poland ORIGINAL ARTICLE JN EPHROL 26( DOI: /jn Józef Dietl ( ), outstanding internist and reformer of the medical sciences, and his contribution to nephrology Janusz Ostrowski 1,2, Bolesław Rutkowski 2,3 1 Third Department of Internal Medicine and Nephrology, Provincial Hospital, Wloclawek - Poland Third 2 Historical Section, Polish Society of Nephrology, Gdańsk - Poland Historical 3 Department of Nephrology, Transplantation and Internal Medicine, Medical University, Gdań sk - Poland Introduction The works of Vesalius gave the 16 th century the nickname of the age of anatomy and, in a similar pattern, the 19 th century can be referred to as the age of pathology. Some of the major representatives of the new model in medicine based on pathological anatomy, medicinal chemistry and an in-depth examination of the patient were Czechs Karl von Rokitansky and Josef Škoda from Vienna, cofounders of the Second Vienna School of Medicine, which was characterized by therapeutic scepticism and scientific radicalism. The Polish physician Józef Konrad Dietl, involved in the creation of the School s manifesto, was their student and coworker. Prof. Józef Dietl was an outstanding Polish internist, and his remarkable achievements in the fields of pulmonology, balneotherapy, rheumatology and nephrology, combined with his contribution to the development of medical sciences in general, put him among the most renowned doctors of the 19 th century in Europe (1, 2). Biography and scientific achievement Józef Dietl was born on 24 January 1804 in the village of Podbuże, Austria-Hungary-annexed Galicia. His father, Franciszek, was an Austrian clerk, and his mother was Anna Kulczycka. He attended schools in Sambor, Tarnów and Nowy Sącz, where he graduated from the secondary school. After his father s death in 1819, being in a dire financial situation he started giving private lessons to pay for his further education. Initially, he intended to go in for a career in the military, yet following his mother s advice he gave up this idea, and in 1821 he set out for Lviv to start a 3-year course in philosophy in the Department of Philosophy of the University of Lviv, which was obligatory for anybody wishing to continue their education at the university, no matter what the faculty of their choice was. Since there was no medical department at the University of Lviv, Dietl moved to Vienna in He graduated from the Medical Department in 1829, and later the same year, he obtained the title of Doctor of Medicine following his dissertation: Dissertatio inauguralis medica sistens quedam circa medicinae securitatem. Next he started work in the Faculty of Detailed Natural History at the University of Vienna headed by Prof. Johan Scherer. Later, unsuccessfully, he applied for a position as professor at the University in Padua. In 1841 he became a senior doctor, and then the director of a new hospital in Vienna. Dietl s life was changed following his meeting with Karl von Rokitansky and Josef Škoda. Together with these famous 2 figures, he became the cocreator and ideologist of the so-called Second Vienna School of Medicine, heavily relying on pathoanatomy, medicinal chemistry and an in-depth physical examination of the patient. Dietl s work titled Praktische Wahrnehmungen nach den Ergebnissen im Wieder Krankenhause, published in 1845, became the school s manifesto. In 1846, financed by the authorities, Dietl travelled widely around Europe and outside it to learn about the organization and treatment of patients in top hospitals. His invalua- S Società Italiana di Nefrologia - ISSN

2 JN EPHROL 26( ble findings were included in reports published between 1850 and 1853, which were later put together in his work titled Kritische Darstellung europäischer Krankenhäuser, published in Vienna in This was the first work on hospital hygiene to be published in Germany, and is still highly valued by experts in the field today (3-6). While working in Vienna, he published one of his most significant works, in which he expressed his critical opinion about bloodletting in cases of pneumonia, a therapy in use since Hippocrates and Galen and up to the late 19 th century. In 1852, the work was translated into Polish by Paweł Grzywiński and Jan Ulichowski and published as O upuście krwi w zapaleniu płuc ze stanowiska kliniczno-fizjologicznego (On bloodletting in pneumonia from a clinical and physiological point of view). The opinion presented by Dietl in this work was far more radical than that of his predecessor s Pierre Louis, the first critic of the method back in Dietl quoted statistical data which clearly indicated higher levels of mortality in patients subjected to bloodletting as opposed to those who did not undergo such treatment (7). In 1851, he arrived in Krakow, where after some struggle, he took over from Prof. Józef Brodowicz as the head of the Medical Department and Clinic of the Jagiellonian University, where he remained until In the period he was also the head of the Department of Pathological Anatomy. During his 14 years of work in the Krakow clinic, he particularly emphasized the importance of pathological anatomy. Moreover, he conducted analytical, chemical and microscopic research and widely applied and popularized percussion and auscultation as routine elements of physical examination. A significant increase in the number of beds in the clinic was his next remarkable success. Being a representative of the Second Vienna School of Medicine and a believer in the scientific diagnosis simple therapy principle, Dietl tended to express scepticism toward the commonly applied methods of treatment. The above principle was popularized in the journal Przegląd Lekarski (Doctor s Review), which was cocreated by him. This was also where he published his cyclical articles titled Aforyzmy kliniczne na ścisłym badaniu osnute (Clinical aphorisms based on detailed examination). It is worth mentioning that the journal is still published today. In the Krakow period, he rejected the existence of the disease called the plica polonica (Polish plait) proving that it was not a general disease of the organism and that it did not display any cause-and-effect relation to any diseases accompanying its appearance. At that time he took up the sciences of climatotherapy and Fig. 1 - Photograph of Prof. Józef Konrad Dietl ( ). - Krakowpleas (reprinted with permission from Jagiellonian Library in Krakow). balneotherapy in Poland, thus adding to the development of a new specialty balneology, and to the emergence of numerous Polish spas, which, in his opinion, were in no way inferior to other renowned European resorts in terms of climate and the therapeutic properties of their waters. These opinions were presented in his work titled Remarks on the Efficiency, Application and Management of Domestic Spas. It is for this reason that Dietl is regarded as the father of the Polish balneology. Dietl s scientific achievements are remarkable, with over 140 pieces of writing, 100 of which are medical works, especially on balneology, published in Polish, German, Latin, French and Russian (8-10). In 1856 he was appointed dean of the Me Società Italiana di Nefrologia - ISSN S51

3 Ostrowski and Rutkowski: Józef Dietl - contribution to nephrology Fig. 2 - Journal page with Dietl s article in 1864 concerning Dietl s crisis (16). S Società Italiana di Nefrologia - ISSN

4 JN EPHROL 26( dical Department, the position which he was to hold without interruption for the next 5 years until 1861, when by an almost unanimous decision he was elected rector of the Jagiellonian University in Krakow. In his inaugural speech, he emphasized that the university was not merely an academe for Krakow and Galicia, but rather an educational hub for the whole territory of Poland. Within just 1 year he managed to attract a number of outstanding scientists who came to work in Krakow, including the famous anatomist from Göttingen, Professor Ludwik Teichman. As rector, Dietl demanded more autonomy for the university and introduced the position of assistant professor, which he promoted in his voluminous article On the Institution of Assistant Professors in General and at the Jagiellonian University in Particular. He was also very active in raising funds for the completion of the construction of the Jagiellonian Library. In 1862 he resigned from his position as rector, yet continued his scientific, social and patriotic activities. On 14 September, Emperor Franz Joseph of Austria signed a decree which removed Dietl from the department without stating any reason for this decision (11-13) (Fig. 1). Following his unexpected retirement, he intensified his political and administrative activity, as a result of which he was elected mayor of Krakow twice. By general consent he is regarded as one of the best mayors of the city ever, immensely adding to its future development. Being the kind of man he was, he became a living legend. His portrait painted by the great Jan Matejko was displayed in the clinic previously headed by him. Józef Dietl died in Krakow on 18 January 1878 following a long, severe illness (rheumatoid arthritis). The funeral, attended by tens of thousands of people was financed from the city budget, and his body was buried in the Rakowicki cemetery in Krakow. To commemorate and honor Krakow s finest son, one of the principal streets in the city was given his name. Later, in 1928, to mark the 50 th anniversary of Dietl s death, a memorial book edited by Władysław Szumowski, the renowned Polish medical historian, was published (14). Finally, in 1938, 60 years after Dietl s death, his monument, by the famous sculptor Xawery Dunikowski, was erected in the vicinity of the town hall (15). Contribution to nephrology The wide scope of his medical activities also covered the borderline between nephrology and urology. In 1864, in Wiener Medizinische Wochenschrift, he published his work titled Wandernde nieren and deren einklemmung Floating kidney and their incarceration (16). The work described in great detail his 3-year experience in the Krakow clinic, concerning nephroptosis, a pathological condition which may result in urinary retention, renal colic, hydronephrosis and kidney damage. The condition known as Dietl s crisis is commonly accompanied by severe renal, lumbar or abdominal pain; fever; tachycardia; cold sweats; nausea and emesis and even collapse. In such cases, Dietl recommended conservative treatment based on taking an appropriate body position, using band aids and corsets. In cases of prolonged pain, he recommended taking a horizontal body position and exerting pressure on the lower pole of the floating kidney, enabling its correct repositioning. The term Dietl s crisis is still commonly used by nephrologists, and notably by urologists around the world (16-20) (Fig. 2). Summary Prof. Józef Dietl lived in partitioned Poland, which arguably did not make his activities any easier. However, his great mind, legendary devotion to work and organizational talents made him hugely successful in all walks of life as a doctor, university rector and mayor of Krakow. Whatever his activities were, it always seemed that he was the right man in the right place. Prof. Józef Dietl was an outstanding Polish internist, and his achievements, especially in the field of pulmonology, balneology, rheumatology and nephrology, as well as his contribution to the development and reforming of the medical sciences, place him among the greatest doctors of the 19 th century in Europe. Financial support: No financial support. Conflict of interest: None declared. Address for correspondence: Janusz Ostrowski, MD, PhD Provincial Hospital Third Department of Internal Medicine and Nephrology Ul. Wieniecka 49 PL Włocławek, Poland ostryjan@poczta.onet.pl 2013 Società Italiana di Nefrologia - ISSN S53

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