Famous Stone Patients and Their Disease Michael E. Moran Capital Region Urologic Surgeons, Albany, NY USA Abstract: The fact that stone patients have endured much throughout the ages and that prior to our current era, when the ultimate horror, "being cut for the stone" was the only alternative to the repeated episodes of colic, should be recalled from time to time. Urolithiasis has affected humanity throughout the ages and has been indiscriminate to those lives it touched. A full accounting of those who have suffered and recorded their agonies is beyond the scope of this investigation; however, even a partial accounting is valuable for present day physicians who care for those with stone disease. For the present work, the historical accounts of stone disease literature were scrutinized for individual sufferers who could be cross-referenced from other sources as legitimately afflicted by stones. Only those patients that could be documented and were (or are) well known were included, because the internet is now a verdant repository of thousands of "not so well knowns." Reliable historical data was found for a variety of persons from the pre-Christian era to the present, including those remembered as philosophers and scientists, physicians, clergy, leaders and rulers, entertainers, athletes and fictitious/Hollywoodtype individuals. Verified accounts of famous stone formers were chosen for this paper, and are presented in chronological order. The list of urolithiasis sufferers presented here is undoubtedly incomplete, but it is not through lack of trying that they are missing. Most often, the suffering do so silently, and that is always allowed. Keywords: urolithiasis, history PACS: 01.01.00; 01.65.+g; 87.19.Xx

INTRODUCTION The literature is strewn with the flotsam and jetsam of diatribes regarding the cause and effects of urolithiasis. But in the final accounting of disease, human beings contract each episode and suffer individually. An investigator deals with statistics, and patient lists generate clinical series. Often overlooked is the individual. It is almost impossible to write a scientific paper any longer about an individual without crossing the threshold of impropriety or now federal legislation concerning HIPAA violation (Health Insurance Portability and Accountability Act of 1996, public law 104-191). Yet the individual is the unique endpoint of all discussions of disease, the final common denominator between treatment and outcome. So it behooves those whose mission it remains to become knowledgeable about stone disease to have at least passing knowledge of a catalog of the only patients one can discuss outside of these realms of impropriety and Federal jurisdiction: those who suffered in the historic past. Our society has already bypassed the acceptable boundaries of this indiscretion for a more tabloid notoriety. This represents an attempt at scholarly, chronologic listing of famous urolithiasis sufferers. CP900, Renal Stone Disease, 1" Annual International Urolithiasis Research Symposium, edited by A. P. Evan, J. E. Lingeman, and J. C. Williams, Jr. © 2007 American Institute of Physics 978-0-7354-0406-9/07/$23.00

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METHODS The Internet and historical literature regarding urolithiasis provides the student of history a list of famous stone sufferers. Any cross-referenced confirmation of these patients' stone sufferings were then traced. If there is identified confirmatory information from secondary sources, they were included in this list. Recognizing that the list, no matter what details could be found, is likely to be incomplete, this author leaves additions to the list to fall upon the shoulders of others in the future. The particular emphasis of the present search was upon science writing and articles from the past, as the modern current literature suffers from the society-imposed necessity to make anonymous the identity of present-day stone sufferers. In this article, there will be no emphasis on the suffering or treatment of these people. The purpose is to just generate a single list, as comprehensive as possible, of famous stone patients.

RESULTS The following table represents a verified list of famous stone patients. They are classified by the category or profession that each individual would be most identified. Some well-known stone patients, such as Ben Franklin, could be listed in several categories, but only one was chosen here. (For example, Franklin is listed as a physician, because of his particular medical interests in stone disease.) In addition, within each classification, persons are listed in chronological order.

CONCLUSIONS From the very earliest records, humans have been plagued by urolithiasis. There are no known ancient manuscripts that document individuals who have suffered, but the first known instance comes to us from Diogenes Laertius regarding the philosopher, Epicurus [2]. His stone disease would result in loss of life. Some histories describe that the stone disease itself had affected the outcomes of wars, as in the case of Napoleon III [3]. Others have had their suffering transformed into miraculous cures requiring sainthood (Saint Henry of Bavaria, Fig. 1). Some have taken the desperate route of surgical lithotomy and lived to tell about it (Pepys and Marshall). Some suffered enough to brave the knife, but were not so lucky, like Leopold of Belgium. Stones have afflicted the poor, the evil, the wealthy and the most devout without discrimination (Fig. 2, Pope Innocent XFs stone, 1689). Stone sufferers have publicly aired their sufferings, which represent a literary legacy that has seldom been mentioned at stone meetings (see my paper on this elsewhere in this Proceedings, pp. 402-405). Some writers have brazenly described their suffering from colic in magazines such as Esquire or in reference to their works (Alan Ginsberg and Richard Selzer). The notion of the stone patient's suffering has most recently become a somewhat cause celebre might be illustrated by the fictional characters that have been cropping up on sitcoms and TV shows, including Kramer from Seinfeld and Joey from Friends.

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TABLE 1. Famous stone formers. Pre-Christian era El Amrah boy age 16 dated about 4800 B.C. (Prof. G. Elliott Smith in Hunterian Museum)[l] Epicurus (270 B.C.)[2] Philosophers/Scientists Erasmus of Rotterdam[3] Francis Bacon (and his brother) [5] Johan van Beverwijck [3] George-Louis Leclerc (Count of Buffon) Isaac Asimov [7]

Michel de Montaigne [4] Galileo Isaac Newton [6] Horace Walpole

Physicians Boerhaave Antonio Scarpa Thomas Linacre John Jones Sir William Osier [10]

Thomas Syndenham [8] Benjamin Franklin [9] William Harvey Philip Syng Physick [1] Richard Selzer [11] Clergy

Pope Innocent XI Pope Clement XI

John Wilkins

Leaders Henry II of Bavaria Peter the Great Oliver Cromwell John Marshall [1] John Hart (signer of the Declaration of Independence) King Leopold I of Belgium Lyndon Johnson John Prescott Artists/Entertainers Alan Ginsberg (poet) Gay Talese Suzanne Strempek Shea Bruce Springsteen Karl Pilkington Athletes Joe Mauer (baseball)

Frederick III (King of Saxony) Louis XIV Sir Kenelm Digby King George IV Napoleon Bonaparte Napoleon III Dennis Hastert (House Speaker)

Ava Gardner John Derek (husband of Bo) William Shatner Tito El Bambino John Wilkins

Fictitious TV/Movie Characters Kramer (6th episode of Seinfeld) Joey of Friends Al Swearengen in TV series Deadwood Muddy Waters in Family Guy Duckman (from the cartoon Duckman) Brock (TV series Reva)

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FIGURE 1. Sculpture of Henry II of Bavaria (by Riemenscheider, circa 1499-1513). Later canonized as St. Henry, he suffered from bladder stones and is said to have been cured in his sleep by St. Benedict, the figure at left, who is placing the stone in Henry's hand. The figure at the right is that of a doctor, sleeping. Wellcome Library, London; used by permission.

Figure 2. Drawing of the kidneys of Pope Innocent XI, who died of urolithiasis. The illustration was published in 1707 by Tommaso Alghisi. On the left is the right kidney, with the large stone marked as C; the letter E marks channels through the stone, which evidently carried what little urine was produced by the remaining renal tissue (A). The left kidney (on the right) shows similar structure, with the stone marked by B, and the channels through the stone by I. Wellcome Library, London; used by permission.

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Whatever the interest in urolithiasis at scientific meetings, the focus is rightly on pathophysiology, preventative strategies, incidence, therapeutics and surgery. But the lessons of the past should not be forgotten, and the legacy of the individual might yet be introduced by knowledge of those who have suffered. Famous stone sufferers do not lead us to knowledge that will change the disease, but their legacy should not be lost. REFERENCES 1. Ellis,H: A History of Bladder Stone. Blackwell Scientific Publ., Oxford, 1969. 2. Bitsori,M, Galanakis,E: Epicurus' death. World J £/ro/22(6):466-469,2004. 3. Engel,RM: De Historia Lithomiae. http://www.urolog.nl/urolog/php/content.php7docHithotomia &profmenu=yes 4. Healy,M: Journeying with the "stone": Montaigne's healing travel journal. Literature and Med 24(2):231-249,2006. 5. Winer,R: Comments on Francis Bacon's 1625 essay on a "...Regimen of Health." http://www.gesher.org/Articles/Health/Comments%20on%Bacon's%20Regimen%of 6. Ostad,E, Wise,GJ: Celestial bodies and urinary stones: Isaac Newton (1641-1727)- health and urological problems. BJULnternat 95:24-26,2005. 7. Asimov, I.: It's Been a GoodLife, Prometheus Books, Amherst, NY, 2002. 8. Dehurst,K: Dr. Thomas Sydenham, his life and original writings. Wellcome Institute, London, 1966. 9. Bliss,M: Sir William Osier. A Life in Medicine. Oxford University Press, Oxford, 1999. 10.Corner,GW, Goodwin,WE: Benjamin Franklin's bladder stone. J Hist Med All Sci Oct:361-377, 1953. 11. Selzer,R: Mortal Lessons: notes on the art of surgery. Simon and Shuster, NY, 1974.

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