Dietl's Crisis: The Rise and Fall of Medical Eponyms

DIETL'S CRISIS: THE RISE AND FALL OF MEDICAL EPONYMS JOHN H. FELTS* Medical eponyms commemorate reporters of new findings and serve a mnemonic function because proper nouns can stand for involved processes or identify isolated observations. Most of our medical ones arose in the 19th century, as European investigators using new tools—stethoscopes, ophthalmoscopes, and microscopes—integrated seemingly random findings and defined natural histories of many diseases [1-5]. With increased understanding and characterization of diseases, the value of eponyms decreased , and they have been transformed through serial passage into historical markers. Their continued survival reflects their reporters' authority, and their clinical value even today. Fifty years ago medical literature was more densely populated with eponyms : ghosts of 19th-century physicians. For example, the 1947 edition of the medical text edited by Russell Cecil includes a description of "Dietl's crisis," an abdominal catastrophe attributed to abnormal descent of a kidney , usually the right, with varied symptoms [6]. Dietl's crisis had first appeared in editions of Principles and Practices ofMedicine published between 1892 and 1918. In these editions, William Osier described a syndrome manifested by acute abdominal pain, nausea, vomiting, fever, highly colored urine, and prostration, a syndrome which he called Dietl's crisis [7-10]. Such attacks, more common in frail, parous young women, were attributed to a wandering kidney, which in descent twisted on its pedicle and kinked the ureter. The many multi-authored texts in English which followed continued to consider Dietl's crises, often in terms little modified from Osier's, but finally in 1968 the crisis was excluded from Cecil's text. As recently as 1992 nephroptosis, defined as floating or wandering kidney , was listed in the International Classification ofDisease (ICD) and given the code number 593. One of the diagnoses given under nephroptosis is "other ureteric obstruction," Dietl's crisis, coded as 593.4 [H]. Yet beThe late Modesto Scharyj translated parts of Dietl's paper from Polish [15] and assisted the author with the translation of the report in German [16]. *3335 Paddington Lane, Winston-Salem, NC 27106.© 1999 by The University of Chicago. All rights reserved. 0031-5982/99/4204-1118101.00 Perspectives in Biology and Medicine, 43, 1 ¦ Autumn 1999 47 tween January 1981 and 30 April 1985, none of the 236 patients diagnosed as having "other ureteric obstruction" at the North Carolina Baptist Hospital had such a crisis, and veterans of the record room do not recall earlier codings during their years there. As might be expected, the diagnosis is not acceptable as a co-morbidity among Diagnostic Related Groupings (DRGs) . Since first looking into Cecil's text, I have searched for but never found a case. Neither medical texts nor the ICD give specific references for the phenomenon. So several questions arise in relation to this particular eponym . Who was Dietl? What actually is his crisis? How did it acquire eponymic stature? And what happened to it? JosefDietl (1804-1878) Josef Dietl was born in 1804 in Galicia, in Poland (then in the Austrian empire, now in Ukraine) , and attended the university at Lvov (Limberg) . Like many ambitious young men he studied in Vienna, the empire's scientific , cultural, and administrative center. He graduated in medicine from the University of Vienna, strongly influenced there by the leaders of the rising Viennese school, including the pathologist Karl Rokitansky, and the clinician Josef Skoda [2, 12]. Dietl's own chief, Franz Wilhelm Lippich, was a disciple of the French school, which pioneered physical diagnosis, correlating bedside and autopsy findings, and using Pierre Louis's new method of numerical analysis [2, 4, 5]. Strongly influenced by Rokitansky, Skoda, and Lippich, Dietl become a vigorous advocate of therapeutic nihilism: Medicine . . . cannot set itself the task of inventing elixirs of life, of performing miraculous cures, of banishing death . . . but of establishing a science of man or anthropology . . . derived from natural history, physics and chemistry ... to date we have ... no scientifically based therapeutics .... While die old school carried on therapy before engaging in research, the new school began researching in order ... to undertake therapy .... Our strength lies in knowledge, not in action. He succinctly stated his therapeutic outlook when he asserted that "only...