Museum examines history of urology Renovated Didusch formally reopens

November 07, 1998|By Frank D. Roylance | Frank D. Roylance,SUN STAFF

Repeat after me: "I am thankful for my urologic health. And if my tender parts are ever stricken, I will thank my lucky stars that I am living in the late 20th century."

If you cannot say these things, you must make an appointment to visit the William P. Didusch Museum of the American Urological Association, on North Charles Street in Baltimore.

It will teach you a lesson.

"The 'good old days' were rough," said the museum's curator, Dr. Rainer M. Engel, a practicing urologist who just completed a four-year renovation of the museum, which opened in 1972. It formally reopened at ceremonies last night.

The museum's two large rooms bristle with two centuries of urologic instruments. The impossibly long and spiky metal probes, scopes and blades illustrate, with excruciating eloquence, the specialty's long, tortuous search for the best cures for obstructions and other troubles of the urinary tract.

They range from some knee-buckling contraptions from the 18th and 19th centuries, through a long series of once-scoffed-at advances, to blessedly slender and flexible instruments, and noninvasive "shock-wave" therapies used today.

"I hope in particular that the young [physicians] who come in here will see that research does at times lead to dead ends," Engel said. "But simply because your medical community does not think you're doing something worthwhile, that is not necessarily the last word. Against all odds, people have made tremendous differences."

The Didusch was named for the famous Johns Hopkins medical illustrator who was its first curator. His startlingly detailed

artwork is part of the collection.

Urology, it turns out, goes back thousands of years -- for as long as man has been troubled by bladder stones, kidney stones, prostate disease and other afflictions that block the free flow of urine from the body.

The object was always the same: to reopen the plumbing and get the urine flowing again before it backs up and kills you.

One of the first solutions was the catheter, a hollow tube inserted into the urethra to the bladder.

"The original catheters were actually the hollow stems of plants, mostly likely of the onion family," Engel said. Later, they were made of silver.

The museum has a replica of a catheter made from tightly coiled silver wire. Invented in 1782 by (who else?) Benjamin Franklin for the relief of his brother, it was inserted with the aid of a stiff silver "stylet." It slipped inside the springy coil and kept it stiff enough to get where it was going.

"I would dread the idea of having this thing put into me," Engel said. "But it worked."

Bladder and kidney stones are rock-hard accumulations of crystalline minerals. They form and grow as a consequence of an imbalanced diet, inadequate urine drainage or infection. Left alone, they cause inflammation, bleeding, urinary blockage, terrible pain and, eventually, kidney failure and death.

The Didusch displays one the size of a woman's fist, shaped like the kidney it eventually destroyed and displaced. "God, it gives you chills to look at that," Engel said.

For millenniums, desperate patients sought out "stonecutters" for relief. They were often itinerants who specialized in cutting open the bladder to remove the stones.

Hippocrates, in his famous Fourth-century B.C. physician's oath, forswears the procedure, leaving it to "such men as are engaged in this work."

There were no anesthetics, only alcohol, opium and strong men or a stout chair with leather straps to hold the patients down.

The stonecutters relied on experience and skill to slice into the bladder, find and remove the stone. They depended on great speed to minimize the loss of blood.

"There were some stonecutters who could do this in less than a minute," Engel said. Women and children sometimes survived. Adult men usually bled to death from the vessels around their prostate glands.

People had a choice, Engel said, "between death [from urinary blockage] and an operation -- an operation that didn't necessarily guarantee you would live."

Progress began in the 1820s. Frenchman Jean Civiale and others began to invent tools that allowed them to enter the bladder without surgery. The thickness of pencils, they barged through the urethra into the bladder. Through them, doctors slipped tiny grippers.

Operating blindly, they would grope about until they caught something hard. Then they either withdrew it or crushed it. It was up to the patient to flush out the pieces.

Because the stones were often too hard to crush with the strength of their hands, doctors invented versions with handles they could whack with a mallet.

The instruments eventually gave doctors their first look at what they were doing. It was a narrow window, illuminated by candles, mirrors and, in 1887, a tiny light bulb.

Later tools and materials permitted doctors to expand their view, whittle away at offending tissues and get out fast. New understandings and technologies since then have produced treatments and equipment that avoid most intrusions into the body.

"What a change," Engel said. "And am I glad I'm living now and not then."

Information: Didusch museum, 410-727-1100 or www. amuro.org/museum/.

Pub Date: 11/07/98

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