Urolithiasis pp 269-283 | Cite as

Fictitious Stones and Sir William Osler

  • Michael E. Moran


Introduction and Objective

Stone disease has for some reason that is not quite clear attracted both the prankster as well as the malingerer. The people who suffer from acute stone colic present with those who seek nothing more than narcotics. The term Munchausen’s disease was coined to describe the patient’s who seek surgery for some psychopathologic gain. William Osler who is considered by many to be the greatest physician of the twentieth century wrote the standard book of medicine for almost 30 years, The Principles and Practice of Medicine, which discussed stone disease.


Osler’s textbook and references to his life and times were used to formulate his thought processes on urolithiasis. In addition he passed his first stone while still the chief at Johns Hopkins and attempted to pass off a stone from his walkway on his former resident and young staff physicians, Dr. Thomas B. Futcher, who subsequently wrote the case up, perhaps the first documented case of a fictitious stone, but assuredly not the last.


This is a review of Osler’s views on urolithiasis, his own sufferings and thoughts on this malady. His use of narcotics, treatment of narcotic addicts, which he had firsthand knowledge from treating his colleague, William Stewart Halstead. In addition, various forms of hypochondriacs and the psychological ramifications of chronic illness affected an increasingly broad group of people including Charles Darwin and Florence Nightingale. How the relationship of chronic suffering affects the relationship in stone disease is historically relevant.


The development and impact of fictitious or psychologically significant fictitious stone disease affects the management of patients and is reviewed with incidence, cost to society, and the medical ramifications. Finally, one peculiar group of stone formers is presented, those with foreign bodies that serve as a nidus for further stone growth and result in significant potential harm and even death.


Urolithiasis history fictitious stones Robert Burton Friedrich Sertürner Colic Opioids Sir William Osler Munchausen’s Disease Hypochondria Charles Darwin Florence Nightingale Jack London Wirt Bradley Dakin Egerton Yorrick Davis 


  1. 1.
    Donne J. Devotions upon emergent occasions. In: The works of John Donne with a memoir of his life. London: Parker; 1839.Google Scholar
  2. 2.
    Huxley A. Brave new world. London: Chatto and Windus; 1932.Google Scholar
  3. 3.
    Dick PP. Do Androids dream of electric sheep? New York: Doubleday; 1968.Google Scholar
  4. 4.
    Scott R. Blade Runner. Burbank, CA: Warner Brothers Pictures; 1982.Google Scholar
  5. 5.
    Homer. The Odyssey (Murray AT, Trans.). Loeb Classical Library Volumes. Cambridge, MA; 1919.Google Scholar
  6. 6.
    Brownstein MJ. A brief history of opiates, opioid peptides, and opioid receptors. Proc Natl Acad Sci USA. 1993;90:5391–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Ball P. The Devil’s Doctor: Paracelsus and the world of Renaissance magic and science. New York: Farrar, Straus, and Giroux; 2006.Google Scholar
  8. 8.
    Goerig M, Schulte am Esch J. Friedrich Wilhelm Adam Sertürner- the discover of morphine. Anas Intensivmed Notfall Schmer. 1991;26(8):492–8.CrossRefGoogle Scholar
  9. 9.
    Noble T. Claude Bernard, the first systems biologist, and the future of physiology. Exp Physiol. 2008;93(1):16–26.PubMedCrossRefGoogle Scholar
  10. 10.
    Weijlard J, Erikson AE. N-allylnormorphine. J Am Chem Soc. 1942;64:869–70.CrossRefGoogle Scholar
  11. 11.
    Osler WO. The principles and practice of medicine. New York: Appleton & Co.; 1892.Google Scholar
  12. 12.
    Roland CG. The formative years of the American Osler Society. In: Barondess JA, Roland CG, editors. The Persisting Osler III. Malabar, FL: Krieger Publishing; 2002.Google Scholar
  13. 13.
    Moran ME. Famous stone patients and their disease. In: 1st international urolithiasis symposium, American Institute of Physics; 2007. p. 412–6.Google Scholar
  14. 14.
    Golden RL, Roland CG. Sir William Osler. An annotated bibliography with illustrations. San Francisco, CA: Norman Publishing; 1988.Google Scholar
  15. 15.
    Bliss M. William Osler: a life in medicine. New York, NY: Oxford University Press; 1999.Google Scholar
  16. 16.
    Cushing H. The life of Sir William Osler (2 volumes). Oxford: Clarenden Press; 1925.Google Scholar
  17. 17.
    Futcher TB. Dr. Osler’s renal stones. Arch Intern Med. 1949;84(1):40.CrossRefGoogle Scholar
  18. 18.
    Moran ME, Das S, Rosenberg SA. Sir William Osler’s perceptions of urolithiasis and the case of the indigo calculus. J Endourol. 2005;19(10):1157–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Golden R. William Osler, urolithiasis, and ‘God’s own medicine. Urology. 2009;74(3):517–21.PubMedCrossRefGoogle Scholar
  20. 20.
    Moran ME. Labouring under the stone: a literary legacy of lithiasis. In: 1st international urolithiasis symposium, American Institute of Physics; 2007. p. 402–6.Google Scholar
  21. 21.
    Barondess JA. A case of empyema: notes on the last illness of Sir William Osler. Trans Am Clin Climatol Assoc. 1975;86:59–72.PubMedGoogle Scholar
  22. 22.
    Golden RL. A history of William Osler’s the principles and practices of medicine. Montreal: Osler Library McGill University; 2004.Google Scholar
  23. 23.
    Burton R. The anatomy of Melancholy, what it is: with all the kinds, causes, symptoms, prognostickes, and several cures of it. In: Three maine partitions with their several sections, members, and subsections. Philosophically, medicinally, historically, opened and cut up. London: Crips and Lloyd; 1621.Google Scholar
  24. 24.
    Madan F. Robert Burton and the anatomy of melancholy. Papers by Sir William Osler, Edward Bensly, S. Gibson and F.R.D. Needham. Oxford: Oxford Bibliographical Society; 1926.Google Scholar
  25. 25.
    Evans B, Mohr GJ. The psychiatry of Robert Burton. New York: Columbia University Press; 1944.Google Scholar
  26. 26.
    Freud S. The Freud Reader. In: Gay P, editor. New York: W.W. Norton; 1995.Google Scholar
  27. 27.
    Osler W. Aequanimitas with other addresses to medical students, nurses and practitioners of medicine. London: H.K. Lewis; 1904.Google Scholar
  28. 28.
    Darwin C. Diary of health, cited by R. Colp Jr, to be an invalid: the illness of Charles Darwin. Chicago: University of Chicago Press; 1977.Google Scholar
  29. 29.
    Anon. The late Charles Darwin. BMJ 1882;1:628.Google Scholar
  30. 30.
    Johnston WW. The ill health of Charles Darwin; its nature and relation to his work. New York: G.P. Putnam’s Sons; 1901.Google Scholar
  31. 31.
    Gould GM. Biographic clinics: the origin of ill-health of De Quincey, Carlyle, Darwin, Huxley, and Browning. Philadelphia, PA: P. Blakiston’s and Son; 1903.Google Scholar
  32. 32.
    Adler S. Darwin’s illness. Nature. 1959;184:1102–3.PubMedCrossRefGoogle Scholar
  33. 33.
    Winslow JH. Darwin’s Victorian Malady: evidence for its medically induced origin. Philadelphia: American Philosophical Society; 1971.Google Scholar
  34. 34.
    Dillon B. The Hypochondriacs. Nine tormented lives. New York: Faber & Faber; 2009.Google Scholar
  35. 35.
    Seymer L. Florence Nightingale, vol. 2. London: Faber & Faber; 1950.Google Scholar
  36. 36.
    Cited in Cook, E. T. The life of Florence Nightingale, vol. 1; 1913; p. 237.Google Scholar
  37. 37.
    Longfellow HW. Santa Filomena. Atl Mon. 1857;1(1):22–3.Google Scholar
  38. 38.
    Cook ET. The life of Florence Nightingale. London: Macmillan; 1913.Google Scholar
  39. 39. “The recording was made on 30th July 1890 to raise money for the impoverished veterans of the Charge of the Light Brigade. The full transcript of the recording says: ‘When I am no longer even a memory, just a name, I hope my voice may perpetuate the great work of my life. God bless my dear old comrades of Balaclava and bring them safe to shore. Florence Nightingale.’ In fact, there are two recitations; this second one having slightly altered wording to the first, which was presumably a practice session.”
  40. 40.
    Sinclair A. Jack: a biography of Jack London. New York: Harper & Row; 1977.Google Scholar
  41. 41.
    Huntington Library Archives. San Marino, CA.
  42. 42.
    Bomback AS, Klemmer PJ. Jack London’s chronic interstitial nephritis. A historical differential diagnosis. Pharos 2008;Winter:26–30.Google Scholar
  43. 43.
    Parran T. Prescription drug abuse. A question of balance. Med Clin North Am. 1997;81(4):967–78.PubMedCrossRefGoogle Scholar
  44. 44.
    Zednich AD, Hedges JR. Community-wide emergency department visits by patients suspected of drug-seeking behavior. Acad Emerg Med. 1996;3(4):312–7.CrossRefGoogle Scholar
  45. 45.
    Musto DF. William Osler and the first opioid epidemic. In: Barondess JA, Roland CG, editors. The Persisting Osler III. Malabar, FL: Krieger Publishing; 2002. p. 167–71.Google Scholar
  46. 46.
    Lambert A. Address of the President-Elect. JAMA. 1920;72:1767.Google Scholar
  47. 47.
    Osler W. Oedema of left lung-morphia poisoning. Montreal Gen Hosp Rep Clin Pathol. 1880;1:291–2.Google Scholar
  48. 48.
    Penfield W. Halsted of Johns Hopkins: the man and his problem as described in the secret records of William Osler. JAMA. 1969;210:2214–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Bliss M. Harvey Cushing: a life in surgery. Oxford: Oxford University Press; 2005.Google Scholar
  50. 50.
    Rowe TC. Federal narcotics laws and the war on drugs: money down a rat hole. Binghamton, NY: Haworth Press; 2006.Google Scholar
  51. 51.
    Pendergrast M. For God, country and Coca-Cola. New York, NY: Basic Books; 2000.Google Scholar
  52. 52.
    Meldrum ML, editor. Opioids and pain relief: a historical perspective, Progress in pain research and management, vol. 25. Seattle: International Association for the Study of Pain Press; 2003.Google Scholar
  53. 53.
    Gavin H. On feigned and factitious diseases, chiefly of soldiers and seamen, on the means used to simulate or produce them, and on the best modes of discovering impostors. London: John Churchill; 1843.Google Scholar
  54. 54.
    Asher R. Munchausen’s syndrome. Lancet. 1951;1:339–41.PubMedCrossRefGoogle Scholar
  55. 55.
    Raspe RE. Baron von Munchausen’s narrative of his marvellous travels and campaigns in Russia. New York: TY Crowell & Co.; 1902.Google Scholar
  56. 56.
    Kent JD. Munchausen’s syndrome and substance abuse. J Subst Abuse Treat. 1994;11(3):247–51.PubMedCrossRefGoogle Scholar
  57. 57.
    Hyler SE, Sussman N. Chronic factitious disorder with physical symptoms (Munchausen syndrome). Psychiatr Clin North Am. 1981;4:365–77.PubMedGoogle Scholar
  58. 58.
    Cai T, Pazzagli A, Gavazzi A, Bartoletti R. Recurrent renal colic in young people: abdominal Munchausen syndrome- a diagnosis not to forget. Arch Ital Urol Androl. 2008;80(1):39–41.PubMedGoogle Scholar
  59. 59.
    Heimbach D, Brühl P. Urological aspects of Munchausen’s syndrome. Eur Urol. 1997;31(3):371–5.PubMedGoogle Scholar
  60. 60.
    Mydlo JH, Macchia RJ, Kanter JL. Munchausen’s syndrome: a medico-legal dilemma. Med Sci Law. 1997;37(3):198–210.PubMedGoogle Scholar
  61. 61.
    Gluckman GR, Stoller M. Munchausen’s syndrome: manifestation as renal colic. Urology. 1993;42:347–50.PubMedCrossRefGoogle Scholar
  62. 62.
    Basu AA, Tandon SP, Goswami AK, Bapna BC. An Indian Munchausen with urologic symptoms (a case report). J Postgrad Med. 1987;33(4):213–6.PubMedGoogle Scholar
  63. 63.
    Ketabchi AA, Zadeh MRE, Parvaresh S, Moshtaghi-Kashanian GR. Opium dependency in recurrent painful renal lithiasis colic. Addict Health. 2012;4(1–2):73–8.Google Scholar
  64. 64.
    Walsh A. Renal colic. Br J Hosp Med. 1978;19(3):224–7.PubMedGoogle Scholar
  65. 65.
    Symons A. Selected writings. In: Holdsworth R, editor. London: Carcenet Press Limted; 1974.Google Scholar
  66. 66.
    Hansen GR. The drug-seeking patient in the emergency room. Emerg Clin North Am. 2005;23:349–65.CrossRefGoogle Scholar
  67. 67.
    Sharon E, Diamond HS. Fictitious uric acid urolithiasis as feature of Munchausen syndrome. Mt Sinai J. 1974;41:698–9.Google Scholar
  68. 68.
    Atkinson Jr RL, Earll JM. Munchausen syndrome with renal stones. JAMA. 1974;230:89.PubMedCrossRefGoogle Scholar
  69. 69.
    Gray CL, Krane CJ. Drug-seeking behavior in urolithiasis in the noncontrast computed tomography era: 2 cases. Urology. 1999;54(2):744.PubMedCrossRefGoogle Scholar
  70. 70.
    Geiderman JM. Keeping lists and naming names: habitual patient files for suspected nontherapeutic drug-seeking patients. Ann Emerg Med. 2003;41(6):873–81.PubMedCrossRefGoogle Scholar
  71. 71.
    Anonymous. Drug-seeker lists are dangerous at best, require tight administrative controls. ED Manage 2004;16(3):25–8.Google Scholar
  72. 72.
    Murphy TM. Chronic opioids for chronic low back pain- solution or problem? J Am Board Fam Pract. 1996;9(3):225–7.PubMedGoogle Scholar
  73. 73.
    Dakin WB. Urological oddities. Self published, Los Angeles; 1948.Google Scholar
  74. 74.
    Morgagni GB. The seats and causes of diseases investigated by anatomy. New York: Hafner; 1960.Google Scholar
  75. 75.
    Bean WB. William Osler: the Egerton Yorrick Davis alias. In: McGovern JP, Burns CR, editors. Humanism in medicine. Springfield, IL: Charles C. Thomas; 1973.Google Scholar
  76. 76.
    Tigertt WD. An annotated life of Egerton Yorrick Davis, M.D., an intimate of Sir William Osler. J Hist Med Allied Sci. 1983;38:259–97.PubMedCrossRefGoogle Scholar
  77. 77.
    Davis EY. Vaginismus. Med News (Philadelphia). 1884;45:673.Google Scholar
  78. 78.
    Davis EY. Extrauterine pregnancy changed to intrauterine pregnancy by electricity. Med News (Philadelphia). 1886;48:279.Google Scholar
  79. 79.
    Cullen TS. The gay of heart. Arch Intern Med. 1949;84:41–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Michael E. Moran
    • 1
  1. 1.American Urological AssociationWilliam P. Didusch Center for Urologic HistoryLinthicumUSA

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