Conocimiento de las enfermedades urogenitales en la obra de Gaspar Casal, «Historia natural y médica del Principado de Asturias» (1762) / Knowledge of the urogenital diseases in the work of Gaspar Casal, «natural and medical history of the Principality of Asturias» (1782)

OBJETIVO: Gaspar Casal (Gerona 1680, Madrid 1759) realiza la mayor parte de su obra médica en Oviedo, donde vive treinta y cuatro años, antes de volver a Madrid como médico de la Real Cámara. Fruto de su trabajo en Asturias es el libro póstumo «Historia natural y médica del Principado de Asturias» (Madrid, 1762), considerado el mejor exponente de la medicina española del siglo XVIII, y donde se describe por primera vez el «mal de la rosa», más tarde llamada pelagra o avitaminosis B. MÉTODOS: Estudio de la vida de Gaspar Casal y análisis de su única obra «Historia natural y médica del Principado de Asturias», especulando sobre el conocimiento de las enfermedades nefro-urológicas y genitales que se deduce de este texto. RESULTADOS: Casal conoce y trata la litiasis renal, que relaciona en unas ocasiones con las dolencias articulares y la gota, y en otras con la abundancia de comida y la vida sedentaria. Otras enfermedades acompañadas de poliuria y edemas que describe, son compatibles con el diagnóstico actual de nefritis infecciosa o degenerativa. Utiliza en pocas ocasiones el sondaje vesical en los casos de estranguria y anuria, incluye posiblemente en el término de «iscuria renal o supresión alta» a algunos enfermos con anuria y a otros con retención de orina, aunque también usa el término «iscuria vesical» para estos últimos. Los síntomas disuria-estranguria y hematuria, los trata sólo con terapia empírica, y se intuye en su texto que para los cirujanos locales no era habitual el alivio de estos síntomas mediante el sondaje uretral. Atiende una epidemia de paperas, con orquitis en los varones, que trata mediante sangrías, aunque se mostró contrario al abuso de las mismas. Sólo ocasionalmente hace tratar quirúrgicamente ciertas enfermedades testiculares. CONCLUSIONES: «Historia natural y médica del Principado de Asturias» refleja el espectro de las enfermedades que en la primera mitad del siglo XVIII ocupaban el trabajo de un médico, a saber, las derivadas de las carencias alimentarias, infecciosas, parasitarias y las degenerativas y vásculo-cerebrales en personas añosas. Desde el punto de vista nefro-urológico, es muy interesante comprobar el conocimiento en esa época de la enfermedad litiásica y de los síntomas del tramo urinario inferior, tratados al modo recomendado por los clásicos, con tratamiento físico y preparados empíricos, pocas veces con sondaje; y, en menor medida, los resultados del tratamiento médico de las orquitis y el tratamiento quirúrgico de algunas lesiones testiculares (AU)

OBJECTIVES: Gaspar Casal (Gerona, 1680, Madrid, 1759) made most of his medical work in Oviedo (Asturias, Spain), where he lived for thirty-four years, before his return to Madrid as a doctor for the Royal House. Fruits of this work is the book «Natural and medical history of the Principality of Asturias» (Madrid, 1762), considered the best exponent of the Spanish medicine of the 18th century, and where the «disease of the rose», known later as pellagra or hypovitaminosis B, was first described in. METHODS: Study of the life of Gaspar Casal and analysis of «Natural and medical history of the Principality of Asturias», speculating on the knowledge about nephro-urologic and external genitalia diseases that can be deduced from the text. RESULTS: Casal knows and treats kidney lithiasis, relating it either to joint diseases and gout, or to dietetic excess and sedentary life in some of his patients. Other diseases coursing with poliuria and oedemas, are compatible with the nowadays diagnosis of infectious or degenerative nephritis. He rarely uses a bladder catheter for cases of stranguria and anuria, probably including some patients with anuria and others with urinary retention in the term «renal ischuria or high suppression», although he also uses the term «vesical ischuria» for the last ones. He treats the symptoms disuria-stranguria and haematuria, with empiric therapy, and, as it may be deduced from the text, some local surgeons didn't use or know to alleviate those symptoms with urethral catheterisation. He attends an epidemics of mumps, with orchitis in male patients, that were treated with bloodletting, although he stood against the misuse of phlebotomy in several diseases. Only occasionally he orders surgical treatment for several testis diseases. CONCLUSIONS: «Natural and medical history of the Principality of Asturias» reflects the spectrum of diseases that conforms the day-to-day working schedule of a Spanish family doctor in the beginning of the 18th century, that is to say: diseases resulting from dietary shortage, infective, parasite, degenerative and vascular-cerebral diseases in older patients. From the nephro-urologic point of view, it is very interesting to read about the knowledge on stone diseases and lower urinary tract symptoms, that were treated as recommendedby the classic authors, with physical therapy and empiric formulas, rarely with bladder catheterization. To a lesser degree, the results of the medical treatment of orchitis and the surgical treatment of some testis diseases are also depicted (AU)

[Pierre J. Desault and the birth of nephrology 1785-1795]. / La néphrologie naît avec Pierre J. Desault en 1785-1795.

Desault's genius and methods opened up a new field, the pathology of those medical conditions which afflict the urinary apparatus. Though he was a surgeon and therefore an anatomically based clinician, his most important discoveries were in pathological physiology, the polyuria of atrophic kidneys, the fatal dehydratation which follows the various forms of polyuric diabetes, and the oligo-anurias which follow excess water loss from the gut, the lungs ... etc. In the last two conditions the kidneys might look normal and therefore might be presumed normal. If Desault's work had survived this physiological eruption into renal disorders would have been the first decisive step of modern nephrology. His message, though excellent, was delivered too soon and on barren soil, to poorly educated physicians who paid little attention. But then, one has to remember that Desault was just a surgeon!