Pius X (1835-1914): the last gouty pope

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Corresponding author:
Natale Gaspare De Santo
Salita Scudillo 20,
80131, Napoli
E-mail: NataleGaspare.Desanto@unicampania.it

 

Abstract

Gout is a common, complex, systemic and well-studied form of chronic inflammatory arthritis in adults. It is due to the deposition of sodium monourate crystals in peripheral joints and periarticular tissues driven by hyperuricemia. Gout is the oldest recorded inflammatory arthritis to affect humankind, with roots stretching back to 2460 BC. It is known as “the rich man’s disease”, “the patrician malady”, “a disease of plenty”, “disease of kings”, “disease of Western Society”, and also “a life-style disease”. Few studies have addressed the problem of gout among popes, affluent people who usually live longer than their contemporaries and are among the most scrutinized persons. Pius X (1835-1914) was the last pope with gout.

Gout seems to have affected 26 out of 265 popes (9.81%) from Saint Peter to Benedict XVI (34-2013 AD). The first was Gregory I Magnus, who was pope in the years 590-604, the last was Pius X, who reigned from 1903 to 1914 at age 79. Their age at death was 71.7 ±9.2 years (Mean ± SD). All popes were elderly men, some had voracious appetites and/or were wine drinkers. Several were sedentary and obese, while others were sober eaters, who took long walks or went riding. Chiragra (arthritic pain in the hands), podagra (arthritic pain in the big toe) and renal stone disease were among the most frequent disturbances.

The causes of death, due to CKD, strokes and infections are discussed along with the fact that gout disappeared from the Vatican Palace on August 22, 1914. However, in accordance with the Theory of Epidemiological Transition, gout seems likely to become a problem for the general population, increasingly adopting unhealthy lifestyle choices, in the absence of a correct education.

Keywords: gout, popes, Pius X, renal death, death due to infection, death due to stroke

Introduction

Gout is a chronic, painful, non-infectious, non-lethal disease associated with crystal deposition of uric acid, when uric acid concentration exceeds 6.8 mg/dl plasma. The kidneys may cause hyperuricemia – the prevalence of which increases in the old and very old, – but are also the target of hyperuricemia (renal stones, renal disease and its progression). Hyperuricemias are due to either renal overload, renal underexcretion or a combination of both; renal overload may be due to overproduction by dietary purines, endogenous purine synthesis, purine breakdown and purine salvage [1–6]. Gout, known also as the “patrician malady” and the “disease of distinction” [7,8] is the oldest recorded inflammatory arthritis to affect humankind, with roots stretching back to 2640 BC [9].

Popes by definition belong to the most affluent class and their lifespan is longer than their contemporaries. In fact, a total of 51 pontiffs reigning in the years 1493 to 2005 lived to a mean age of 63.9 years and died an average of 10.0 years after being enthroned [10]. We have studied the narratives around popes, from Saint Peter to Benedict XVI [11–15], and demonstrated a high prevalence of gout. In a recent review [16] we identified a total of 25 gouty popes: 14 out of 25 (58%) had risk factors; 5 out of 25 (25%) had comorbidities; 21 out of 25 (84%) were unable to perform their duties; 8 out of 25 (32%) died of stroke; 12 of them (68%) had renal disease; 12 out of 17 (70.6%) underwent a renal death. Renal disease did not affect age at death [16].

This paper focuses on the last gouty pope, Pope Pius X. His death has been traditionally but wrongly attributed, even by us, to acute pneumonia. The present study now points out that his death was most likely linked to uremia, due to lasting gout, the final straw being acute pulmonary infection.

 

Historical case report – Pius X (1835-1914), Pope (8/4, 1903-8/22,1914)

Pius X (Figure 1), born Giuseppe Melchiorre Sarto on June 2, 1835 at Reise (Province of Treviso), was ordained priest in 1858 and, in the same year, became parish priest. Later he was nominated bishop of Mantua (1884), cardinal and patriarch of Venice (June 1893) and elected Pope on August 4, 1903; he reigned until August 22, 1914. A renowned orator, he is remembered for his expertise in sacred music and for hiring Lorenzo Perosi for the Choir of the Sistine Chapel, for his antimodernism and the refusal of science, for the letters sent to European powers to avoid the First World War, and for the wide pastoral care and the love for the poor. In his last will and testament wrote “born poor, lived poor, want to die poor”. Roger Aubert, the Belgian historian Roger Aubert (1914-2009) has defined Pius X as the greatest reformer of the internal life of the Church after the Council of Trent [17].

His health has been described as good until the end of his days and his death ascribed to “acute tracheitis, bronchitis, infection-inflammation of the lower left lung lobe”, a disease of acute onset followed by rapid worsening. He was under the care of Andrea Amici (1870-1920), archiater and chief of medical services in the Vatican, and of Ettore Marchiafava (1847-1935), professor of pathology at the University La Sapienza in Rome. His disease lasted from Saturday August 15 (he celebrated the last mass) to the night of August 20, 1920. The course was characterized by a worsening fever that, in his last hours, peaked at 40°C and was associated with dyspnea [18-20].

Figure 1: Picture of Pope Pius X (1835-1914), October 1903, from Herder Verlag, Freiburg im Breisgau: Die katholischen Missionen (digitally colored). Image in the public domain, https://commons.wikimedia.org/wiki/File:Pius_X,_by_Francesco_De_Federicis,_1903_(retouched,_colorized).tif

However, we now know that Giuseppe Sarto, since his early years of priesthood, had suffered from gout, which flared painfully from time to time and was tolerated by him. As a pope, for obvious state reasons, he was forced to frequent health checks and restrictive dietary impositions [21]. The disease flared up in August 1920 and was associated with chest pain, fever, nephritis (uncurable at that time). The disease extended to the bronchial tree and caused the pneumonia that killed him [22]. So, the diagnosis was pneumonia, heart failure, pericarditis and uremia due to gout.

He was beatified in 1951 by Pius XII. As far as we know, he was the last gouty pope and after him the disease was never again associated with the papacy.

 

Discussion

Recent studies have defined gout as a “papal disease” [16]. Pope Pius X is the last in the list of 26 gouty popes of the Catholic Church between the years 590-1914 (Table 1). Gout affected 9.77% of all popes and he was the 18th out of 26 (69.3%) gouty popes to die of a renal cause. The disease left him, like 22 out of 26 (84.6%) other popes, unable to perform his duties.

No. Popes Family name Start of pontificate End of pontificate Inhability to perform Renal/non renal death** Age of death
1 St Gregory I Anici 9/3, 590 3/12, 604 yes Non-renal 64
2 Sisinnius NK 1/15, 708 2/4, 708 yes Non-renal 58
3 Sergius II Sergio 1/2 844 1/17 847 yes Non-renal 57*
4 Boniface VI NK 4/5, 896 4/20 896 Non-renal NK
5 Honorius IV Giacomo Savelli 4/2, 1285 4/3, 1297 yes Non-renal 77*
6 Boniface VIII Benedetto Caetani 12/24, 1294 10/11, 1303 yes Non-renal 73
7 Clement VI Pierre Roger 5/7, 1342 12/6, 1352 Non-renal 62
8 Nicholas V Tommaso Parentucelli 3/6, 1447 3/24, 1455 yes Renal 58
9 Callistus III Alonso de Borja 4/8, 1455 8/6, 1458 yes Renal 80
10 Pius II Enea Silvio Piccolomini 8/19, 1458 8/15, 1464 yes Renal 66
11 Sixtus IV Francesco della Rovere 8/9, 1471 8/12, 1484 yes Renal 70*
12 Pius III Francesco Todeschini Piccolomini 9/22, 1503 10/18, 1503 yes Renal 64
13 Julius II Giuliano della Rovere 11/1, 1503 2/21, 1513 Non-renal 70
14 Julius III Giovanni Maria del Monte 2/7, 1550 3/23, 1555 yes Non-renal 68
15 Marcellus II Marcello Cervini degli Spannoni 4/1, 1555 4/30, 1555 yes Renal 54*
16 Pius IV Giovanni Angelo Medici di Marignano 12/25, 1559 12/9, 1565 yes Renal 66
17 Clement VIII Ippolito Aldobrandini 1/30, 1592 3/3, 1605 Renal 70*
18 Gregory XV Alessandro Ludovisi 2/9, 1621 7/8, 1623 yes Renal 69
19 Innocent X Camillo Pamphilj 10/4, 1644 1/7, 1655 yes Non-renal 80
20 Clement X Lorenzo Altieri 4/29, 1670 7/22, 1676 yes Non-renal 86
21 Innocent XI Benedetto Odescalchi 9/21, 1676 8/12, 1689 yes Renal 78
22 Innocent XII Antonio Pignatelli 7/12, 1691 9/28, 1700 yes Non-renal 85*
23 Clement XII Lorenzo Corsini 7/12, 1730 2/6, 1740 yes Renal 88*
24 Benedict XIV Prospero Lorenzo Lambertini 8/17, 1740 5/3, 1758 yes Renal 83*
25 Pius VIII Francesco Saverio Castiglioni 3/31, 1829 11/30, 1830 yes Non-renal 69
26 Pius X Giuseppe Melchiorre Sarto 8/4, 1903 8/20, 1914 yes Renal 79
All popes 84.6% 50% Renal 71.9 ±9.2#
Table I: Gouty popes (no. 26). Data for popes nos. 1-25 in reference no.16. (* affected by stroke; ** presumed Renal/Non Renal death; # Mean ±SD; NK = not known).

The mean age at death of the 26 popes listed in Table I was 71.7 ±9.7 years and no difference was found between the age at death of popes who died of a renal cause and those who died of a non-renal cause. Pius X died from an acute infectious disease, which is always a risk for a gouty person. In fact, compared to the general population, gout patients have an increased association with all-cause disease mortality, especially attributed to cardiovascular diseases, cancer, and infectious diseases [23].

In a study by Vargas-Santos et al. [24] enrolling 19,497 people with a new diagnosis of gout and 194,947 controls, a strong association was found between gout and risk of death due to renal disease. Furthermore, a study by Spaetgen et at. [25] investigated the risk of various types of infections (pneumonia and urinary tract infection), and infection-related mortality in patients with gout using data from the UK Clinical Practice Research Datalink. Their study was the first evaluating the risk of community-acquired infections in patients with gout versus matched controls. Gout was associated with a 34% increased risk of pneumonia. Also, in a national study across the United States [26], the most common infection was pneumonia (52%) in 1998-2000 and sepsis (52%) in 2015-2016. Older age was associated with a greater risk.

There is a strong suspicion, still to prove, of an association between lung infection and the lung dysfunction described in uremia for the first time in 1932 by Ehrich and McIntosh in 3 patients with Bright’s disease [27]. They believed that some toxic or metabolic factor resulted in edema and congestion with “formation of an exudate which failed to resorb and then went on to organization” [27], a dysfunction that has been extensively studied in recent years. A restrictive dysfunction, associated with gravity of CKD, was disclosed by Mukai et al. [28], whereas Zoccali et al. [29] have shown, by systematically applying chest ultrasound in ESRD patients, that hidden or clinically manifest lung congestion is exceedingly frequent in this population an may be detected at a preclinical stage.

Gout, probably the first known non-communicable disease, might not represent in principle the best candidate to be discussed in terms of “Theory of Epidemiologic Transition”. This theory was advanced in a landmark paper by Abdel R. Omran [30] after infectious diseases were conquered [31] after World War II and degenerative and “man-made diseases” started emerging. Using demographical tools, Omran analyzed the changing patterns of population age distribution in relation to changes in mortality, fertility, life expectancy, causes of death. He identified 3 ages in humankind: the age of famine and pestilence (life expectancy <30 years), the age of “receding pandemics” (life expectancy 30-50 years), and the “age of degenerative diseases and man-made disease” (life expectancy >50 year). The theory has been updated frequently, and finally poverty (initially neglected) has been taken into consideration along with incomes and education [30–36].

This is relevant and makes the theory suitable to explain the high prevalence of gout in popes and the low, but slightly increasing, prevalence in the general population. The data shall be discussed in terms of lifestyles, income and education. It has been shown that affluent and educated people also adopt immoderate lifestyles causing non-communicable diseases associated with morbidity and mortality [30–36]. However, these people, when made aware of the risks, often agree to modify their lifestyles choices, whereas poorer, uneducated people do not. Thus, the latter group tends to experience the morbidity and mortality of the disease (third transition phase) at the time when rich well-educated individuals achieve protection [36].

By applying the above concepts to gout (Figure 2), we can say that popes before 1915 had a high prevalence of gout due to lifestyles choices causing it. These were later corrected through education and gout disappeared. Thus, in 2021, gout has no room in the apostolic palaces. At the same time, poor people, because of undernutrition, working conditions, and frequent movements back and forth from the workplace, were “protected” from gout, and therefore, before 1915, the prevalence of gout was zero. After World War II the general population has become sedentary, while the availability of proteins and the abuse of spirits, wines and other alcoholic beverages, as well as beverages rich in glucose, has sharply increased. Therefore, in the USA, Italy and France, the blood concentration of uric acid has been slightly but steadily increasing; the prevalence of gout is still minimal, but increasing, and will continue to do as long as education fails to encourage healthier lifestyles.

Lifestyles causing and preventing gout
Figure 2: Lifestyles causing and preventing gout, and trends in the prevalence of gout in popes and general population before 1915 and in 2021

Acknowledgements

We thank for the English revision Joseph Sepe MD, Professor of Biological Sciences, University of Maryland Global Campus, USA and Adjunct Professor – Department of Mathematics and Physics University of Campania, Luigi Vanvitelli, Naples, Italy.

 

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The use of Water for the treatment of Kidney Disorders

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Athanasios A. Diamandopoulos

Diamandopoulos Athanasios

Corresponding Author:
Prof. Diamandopoulos Athanasios
Hon Professor EKPA,
Louros Foundation for the History of Medicine, Athens
E-mail address: 1453295@gmail.com
Tel +00 302610641364 Mobile phone+00306974026198

 

Abstract

The treatment of end stage renal failure is always based on the use of water. Both the artificial kidney machine and peritoneal dialysis use a huge amount of water, either in its pure condition (the RDT) or as the main ingredient in PD solutions. As these modalities are rather modern for an article on the history of the topic, we will skip them and proceed to the discussion of more ancient methods, correlating them with more recent times. Recent for us means from the 9th century onwards. The structure of this article was inspired by the Polka dance, originally a Czech dance and a genre of dance and music familiar throughout Europe and the Americas. It is still practiced in many countries and widely in Poland.
In this paper we present extracts from the works of Plato, Hippocrates, Aristophanes, Galen, Pliny the Elder, Paulus Aegineta, Rufus, Alexander, Avicenna with their views on mineral waters in general and their application on renal diseases. Gout and lithiasis figure prominently and were the more prominent indications for that mode of treatment. We followed the evolution of their ideas in time and compared them with the current use of hydrotherapy in various Spas with emphasis on the ones from Central and Eastern Europe.
We conclude that the popularity of hydrotherapy for treating kidney disorders was alternatively increasing and decreasing over centuries, resembling the Back and Forth steps of Polka

Keywords: Hydrotherapy, mineral waters, lithiasis, gout, Galen, Avicenna

Ci spiace, ma questo articolo è disponibile soltanto in inglese.

Introduction

The treatment of end stage renal failure is always based on the use of water. Both the artificial kidney machine and peritoneal dialysis use a huge amount of water, either in its pure condition (the RDT) or as the main ingredient in PD solutions. As these modalities are rather modern for an article on the history of the topic, we will skip them and proceed to the discussion of more ancient methods, correlating them with more recent times. Recent for us means from the 9th century onwards. The structure of this article was inspired by the Polka dance, originally a Czech dance and a genre of dance and music familiar throughout Europe and the Americas. It is still practiced in many countries and widely in Poland. Thus, let us consider this structure of the lecture as a tribute to our host country. Polka can be very bouncy and upbeat. Try going Back in the Past and Going Forth in squares, and Front and again. Similarly, we will present various practices and theories about the use of baths for renal ailments back in the past, we will follow their abandonment and then will we witness going forth to their revival.

Discussion

The article starts the discussion with a general view on the therapeutic properties of baths.

Back in the past:

As the use of water treatments combines mythical, religious, medical and social characteristics, it has been a point of discussion since antiquity. We read in Plato’s Cratylus that: “(…) and should be accepted one name only for the god (Apollo) being the god of music, or arching, oracles and of medicine (…) [as] the same tools are used by doctors and oracles like baths and sprinkling with water, as there is a common goal: A person’s soul and body purification” (1).

 

Going forth, the revival:

Today, ritual purification through water can be found in the religious ceremonies of Jews, Muslims, Christians, Buddhists, and Hindus. These ceremonies reflect the ancient belief in the healing and purifying properties of water. With time, various qualities of natural waters were considered, or advertised, as beneficial for health.

 

Back in the past:

Plutarch (1st cent. AD): “Which pain, which abstinence, which drug did solve any disease as quickly as a bath taken timely?” (2) Galen (1st/2nd cent. AD): “When there is an increase of impurities the best purgation is via phlebotomy, then baths and fasting (3) and when these are neglected many ailments appear”. (4) And further on: “Who doesn’t remember his (Kointos’) scorn of warm and cold and dry and wet baths, now he announces names of baths without which no treatment is achieved” (5). Rufus of Ephesus (1st/2nd cent. AD) repeats the above: “(…) if the patients suffer by an abundance of bad humours, they benefit from (…) warm baths (6).

Natural springs had been classified according to their physical properties. Hippocrates had already commented that: “The next worst will be those whose springs are from rocks–for they must be hard–or from earth where there are hot waters, or iron is to be found, or copper, or silver, or gold, or sulphur, or alum, or bitumen, or soda” (7). A more detailed classification was made by Pliny the Elder (1st cent. AD) in his famous Natural History. He himself was a fervent advocate for bathing as his nephew Pliny the Younger states “In the country, the only time he took from his work was for his bath, and by bath I mean his actual immersion, for while he was being rubbed down and dried he had a book read to him or dictated note” (8). Also Paulus Aegineta (7th cent. AD) elaborated on the topic (9). According to Galen, natural waters could also be classified in accordance to their temperature: “The so-called natural springs in some places have a pleasant temperature; in others these are boiling or lukewarm, while the cold ones are everywhere” (4).

 

Going forth, the revival:

Similarly, nowadays a variety of natural waters is widely advertised as good for health, as we can see from extracts of various pamphlets for spas in Central and Eastern Europe:

  1. The Yeisk resort, on the coast of the Azov Sea, is famous for its healing waters containing hydrogen sulphide (…). The main therapeutic factors of the resort are the unique and rare in the content of iron, mineral waters surpassing in some characteristics all known springs in the world (10).
  2. Carbonaceous: Naturally carbonated waters. Stimulate the appetite and digestion when drunk, increase the digestive secretions of the stomach, pancreas and intestines (11).
  3. Sulphur-containing water reduces gastric secretion, helps digestion, and treats lazy bowels. Less mineralized waters are used for treating calculus (kidney stones) and urinary tract infections (12).
    Apart of the variations of waters, baths and bathing always took place in beautiful scenic landscapes and in buildings with works of art.

 

Back in the past: 

Romans took this to the extreme, building huge imperial bath complexes full of mosaics, statues, paintings and other luxuries. In many ways, these were similar to community centers. Because the bathing process took so long, conversation was necessary. Many Romans would use the baths as a place to invite their friends to dinner parties, and many politicians would go to the baths to convince fellow Romans to join their causes. The thermae had many attributes in addition to the baths. There were libraries, rooms for poetry readings, and places to buy and eat food. The modern equivalent would be a combination of a library, art gallery, mall, restaurant, gym, and spa (13). Baths were a site for important sculptures; among the well-known pieces recovered from the Baths of Caracalla are the Farnese Bull and Farnese Hercules and the larger-than-life early 3rd century patriotic figures somewhat reminiscent of Soviet Socialist realism works (now in the Museo di Capodimonte, Naples). There were also famous artistic works in the baths of Constantinople (14, 15). Later, Avicenna in his Canon of Medicine in the 10th century elaborated on: The bath-rooms: Temperature of air in different rooms (temperate, warm, hot, and cool); mural decorations (16).

 

Going forth, the revival:

The use of public baths declined during the Middle Ages, partially revived in the 16th century and reached its peak in the 19th. To limit the search only to France, we quote six novels from Philip Albou’s article on “Taking waters in the French literature” (17). Namely, 1. Michel de Montaigne (1533 – 1592) who compares the particular manners of taking water in France, Germany and Italy in 16th century. 2. Gui Patin (1602 – 1672), the famous Senior of the Faculty of Medicine of Paris, declared to be very perplexed as to the effectiveness of water, going on to declare: “the waters make more cuckolds than they do cure patients!”; 3. The account of Madame de Sévigné (1626 – 1696), from her famous Letters, on taking waters in Vichy in 1676; 4. Thermal treatment (without effect…) of the extinction of voice of Nicolas Boileau (1636 – 1711) at Bourbon-l’Archambault in 1687; 5. The portrait of Irene (alias Madame de Montespan) found in the “Caractères” of Jean de la Buyère’s (1645 – 1696); and finally, 6. An extract of the novel Mont-Oriol by Guy de Maupassant where he evokes the cynical and financial aspects of the creation of a thermal place in the centre of France during the 19th century. The latter, though cynical, explains in part the frenzy of building huge hotels and other buildings in that era to accommodate the well-off’s desire for cure and recreation. Focusing on the subject of this article, we notice an echo of the bath decorations of the past in the modern trend of the last two decades, as more designers and operators recognize the healing benefits of positive distractions, natural views, and daylight within their care environments (18).
Having dealt in brief as an introduction with the general ideas of the benefits of bathing both in the past and in modern times, we will focus now on our central theme that is the use of waters for kidney problems.

 

Back in the past:

Hippocrates (5th cent. BC): The very cold water minimizes and eliminates the tumours and pain of gouty attacks. (19) He also commented on the impact of the quality of drinking water on stone formation: “Men become affected with the stone, and are seized with diseases of the kidneys, strangury, sciatica, and become ruptured, when they drink all sorts of waters, and those from great rivers into which other rivulets run, or from a lake into which many streams of all sorts flow” (5) Galen: For renal diseases you should consume a light diet and very frequent baths. Because drinking too much water is contraindicated in renal disease while purification via the skin is desirable (20). Plutarch refers to the gouty attack of Sulla, the Roman general, who according to Strabo hurried himself to the medicinal waters of the Aedipsos Baths, at the island of Euboea in Central Greece (21). Paul of Aegina (5th cent. AD): “(…) for retention of urine: add a fifth part of heated oil to the water. Such a bath is highly anodyne” (9). Alexander warns on the over-prescription of hot or cold baths for treating renal problems and suggests moderation (22). Hydrotherapy in Byzantium was a strong therapeutic agent for many ailments, including acute nephritis and attacks of gout (23). Avicenna (10th cent. AD): “(…) On the presentations of the urinary stone. Know that when the stone enlarges in the kidney it hinders the urine, causes intolerable pain, and may lead to mental confusion from pain. Each occasion of the pain is called an episode (the pain is intermittent). During the episode of pain the patient should sit in a tub of warm water in which the leaves of cabbage…” (24).

Generally, in antiquity methods for alleviation of pain from kidney stones consisted of (…) baths and warm clysters that were sometimes medicated (25). Hence, even the comic play writer of the 5th cent BC Aristophanes has Dionysus suffer from kidney pains, because of overtiredness, to beg Zeus to permit him to run to the public bath for relief (26).

 

Going forth, the revival:

In The Principles and Practice of Medicine, William Osler (1849–1919) commented on the topic: “Many patients find benefit from a stay at Saratoga, Bedford, Poland or other mineral springs in this country, or at Vichy or Ems in Europe” (27). In Central and Eastern Europe today, bath treatments for kidney diseases flourish. We present indicatively a few such places:

1) Czech Spas – Treatment of kidney and urinary tract diseases has a long tradition in Marienbad with the use of the god-given effects of natural carbon dioxide. The curative springs, in particular, the hypotonic mineral waters in the drinking cure, are the foundation of therapies for urologic and kidney illnesses in children, adolescents, men and women. Due to the cooperation with the dialysis centre Fresenius in Marienbad, it is possible with advance arrangements, to treat patients requiring a dialysis program (sic!). A fine example of the combination between alternative and high tech treatments based on commercial goals (28).
Czech Spas.

2) The Royal Spa hotel in Mariánské Lázně specialises in kidney and urinary tract treatment. Natural mineral carbon dioxide treatment in the form of both water and dry baths helps the vascular system widen and become more flexible. Carbon dioxide, which is absorbed through the body surface, stimulates receptors of even the tiniest capillaries in our body. It is also suitable for curing cysts, kidney stones and sand (lithiasis) or kidney hypofunction in connection with other chronic diseases (29).

3) In the Carpathian Basin in Central Europe, where Hungary is located, the crust of the earth is very thin, so these waters right from the core of the earth rise to the surface very easily. There are more than 200 thermal spas (…) used to cure kidney diseases. Most Hungarian spa resorts use their hot springs complimentary to regular medicinal methods in many type of diseases and conditions like skin diseases, (…) kidney diseases, neurological problems, etc. depending on the composition of their waters. In Hungary, spa treatments are covered by the Hungarian medical insurance plan and regularly prescribed by Hungarian doctors as part of natural rehabilitation protocols (30).

4) There are more than 1300 mineral sources in Slovakia, used as curative waters for (….) renal diseases. There are 21 thermal spas built on these mineral springs, usually divided in three groups according to type: Balneological spas, Climatic spas, mixed spas. The main focus of the “cure” is often drinking water from the spring (it usually tastes like medicine), but all of the spas listed also offer soothing soaks, medicinal massages!) and other restorative therapies, as well as swimming and other recreational opportunities in beautiful natural settings (31).

5) The oldest balneological centres in Russia are the resorts of Caucasian Mineral Waters. The waters in Zheleznovodsk at Stavropol Krai can heal the digestive system, the pancreas, and kidneys. (11) In the same area, the Mashuk Aqua-Therm hosts the only monument in the world commemorating enemas, unveiled in June 2008 (Figure 1). The 770-pound bronze statue stands nearly five feet tall and was created by a local regional artist named Svetlana Avakova. The use of enemas for treating uraemia has been well established since antiquity.

6) Treatment descriptions – Pühajärve Spa & Holiday Resort (…) for heart diseases, high blood pressure and kidney diseases. The discovery of the mineral springs in 1876 marked the beginning of the history of Rymanow-Zdroj. It specializes in the treatment of children with kidney diseases (32).
The main ways in which baths are useful in treating renal failure were perspiration and toxic substance elimination via the skin, which acted as a kind of dialysis membrane.

 

Back in the past:

Hippocrates: “We should then abstain from the cathartic methods performed from below (that is, diuretic drugs and enemas). The best of all though is to provoke diuresis and perspiration and get the patient walking” (33).

Aristotle (4th cen. BC): “And soon this (alien substance) is separated and discharged. And the latter when is discharged from below is called urine whereas when it is eliminated through the skin is called perspiration. Both are saline for the same reason” (34).

Rufus: “because it is good for them to be able to perspire if diuresis stops. The best of all is a steam bath in a small vat with the head coming out from the top, so that, while the rest of the body is being heated, one can breathe cool air” (35).

 

Going forth, the revival:

A Clinical/Historical paper we wrote tried to explain the beneficial role of perspiration in renal failure: “(…) Each human kidney has approximately 1.2 million nephrons. In other words, humans have as many nephrons as sweat-glands (…). The role of the skin as an excretory organ is also demonstrated by the fact that the sweat glands as well as the kidneys have receptors for aldosterone and ADH (…). We found a difference of 16 mg/dl in average blood urea between winter and summer months (mean winter urea 182 mg/dl, mean summer urea 166 mg/dl). These differences were statistically very significant (p<10-27). There was no significant difference in patient body weight between winter and summer months” (36). The following articles back our thesis:

Sauna baths in the treatment of chronic renal failure. 

Snyder D, Merrill JP, Trans Am Soc Artif Intern Organs. 1966; 12:188-92.

Sweating treatment for chronic renal failure. 

Lacher JW, Schrier RW. Nephron. 1978; 21(5): 255-9. “This removal of urea, water and salt suggests that sweating could be used to treat uraemia in conjunction with charcoal hemoperfusion”;

Stimulated sweating in chronic renal failure

Man in ‘t Veld AJ, van Maanen JH, Schicht IM. Br Med J. 1978 Jul 15; 2(6131): 172-3. “With hot baths and/or saunas the urea and creatinine in RDT patient falls”

Hot bath for the treatment of chronic renal failure

Ting Ye, Weiping Tu & Gaosi Xu, Ren Fail. 2014 Feb; 36 (1):126-30: “(…) Therefore, it offers an adjuvant alternative renal replacement method”.

Local application of footbaths for gout has been also suggested.

Back in the past:

Rhazes (9th cent. AD) stated that: “Two factors are involved in gout management via application of water to the feet; the temperature of the water and the time of application. Some patients with gout are advised to use extremely cold water during acute episodes, while others need to apply tepid or hot water (37).

Going forth, the revival:

Claridge in the 19th cent wrote: “A king’s councilor had suffered for six years with the gout (…) repeated cold foot-baths, after some days, caused the inflammation and redness to disappear (38). The method has a modern interpretation: In Foot Bath Therapy, warm water can promote blood circulation, and blood flow after a footbath can increase to 10~18 times above normal, which can improve patient metabolism and Qi-blood circulation. Besides, Foot Bath Therapy can improve the skin functions of mucosa absorption and skin penetration, which can promote the medicine ingredients to be absorbed into the blood (39). Basically, hot therapy is applied when there is no inflammation while cold therapy where there is inflammation/swelling. Contrast Hydrotherapy (CH) has been used for treating and preventing gout besides daily hydration.
The most exotic treatment is via magnetized water. Its ancestor was mesmerism. Practitioners were often known as magnetizers, rather than mesmerists. For about 75 years from its beginnings in 1779, it was an important specialty in medicine, and continued to have some influence for about another 50 years. Hundreds of books were written on the subject between 1766 and 1925. Today it is almost entirely forgotten. Magnetism dressed up as magnetized water, is the new frenzy for treating kidney ailments: In a 19th cent Commentary on Avicenna’s Canon, there is an implication of the impact of the radiation of the soil over the medicinal waters: “His statement contains an important truth. Certain spas and health- resorts (Carlsbad, Bath, Droitwich, Baden, Bourbonne-les-Bams, Is ancy Wiesbaden) owe their virtue not merely to the chemical composition of the water which is taken by the patients, but also to the locality itself. The radiations which pass outwards at those parts of the earth produce a beneficent influence upon them as they walk over the ground” (17). In a more recent article on the efficacy of naturally magnetized water on kidney function, we read: “(…) a daily regimen of 16 ounces of naturally magnetized water was shown to be significant in lowering urine pH, and promoting excretion of acids and toxic mineral salts suggesting an increased ability of the kidneys to remove toxic wastes from the body …” (40). In another similar article: “They had their patients drink bi-polar (treated with both North and South poles) magnetized water. This simple treatment was very effective in breaking up kidney and gall bladder stones into small enough particles to be passed through urine without any pain or danger to the patient (41).

 

Conclusions

Ancient and medieval practices on the use of water are reincarnated today in the more general urge for alternative, traditional, mythical treatments. They are those who look and make steps Back in the Past  to follow them, there are those who sternly stand for the technological approach turning their back to the past Moving Forwards. Nevertheless, both groups in their contrary movements meet harmoniously in the middle like groups dancing the famous Polka dance Podhale (Figure 2).

 

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