Francisco Díaz (1527-1590), forefather of urology
We often talk about urology being the oldest surgical specialty but who was the first urologist? One candidate is the Spanish surgeon Francisco Diaz (1527 – 1590).
Francisco Diaz was an eminent doctor and surgeon of the Spanish renaissance, during the time of the galenic humanist movement that took place in 16th century Spain. This “Century of Gold” was the period of the great Spanish literature of Cervantes, Lope de Vega and Francisco de Quevedo, but also of equally impressive medical writers such as Francisco López de Villalobos, Luis Lobera, Francisco Vallés, Dionisio Daza, Bartolomé Hidalgo, Andrés Laguna and of course Francisco Díaz.
The importance of Francisco Diaz resides in the fact that he was an academic doctor, not an empirical surgeon, dedicated to treating diseases of the urinary tract and to promoting the medical education of physicians, surgeons and barbers in this field. He was born in Alcalá de Henares. Cardinal Francisco Jiménez de Cisneros, confessor of Elisabeth of Castille and later delegate Spanish ruler before the arrival of Charles V to Spain, transformed Alcalá into one of the most important European university cities during the 16th and 17th centuries. Francisco Diaz, the son of a merchant, studied in the university of Alcalá. He became Bachelor of Arts in 1548 and of Medicine in 1551 and doctorated in 1555. He was appointed Professor of Philosophy, a study superior to Medicine, and took part in the board of “Doctors, Masters and Regents” of the university between 1556 and 1558. He was married to María de la Flor Medrano, with whom he had six children. After gaining his medical degree, he travelled to Valencia with Luis Collado and Pedro Ximeno, both disciples of Andreas Vesalius, to learn the art of medical dissection. His aim was to get an appointment as professor of Anatomy in the university of Alcala, but this post was offered to Luis Collado instead. Realising the difficulties of promoting himself in Alcalá and of building a fruitful surgical practice in a city with plenty of empirical barber-surgeons (one of whom was Rodrigo de Cervantes, father of the author Miguel de Cervantes), he decided to leave Alcalá. He again failed a contest for surgeon to the court hospital in Valladolid, losing out to Dionisio Daza, who had served in the army of Charles V with Vesalius, however, he did then secure the position of city surgeon with the Council of Burgos in 1559, to practice surgery in Hospital de la Concepción. Burgos was an important city of 12,000 that dominated the export of wool from Castille to the Flemish territories. The artistic and economic development of the city was however, truncated by a terrible bubonic plague epidemic in 1565. Diaz’s wife and youngest daughter died of plague and he decided to return to Alcalá.
A year later, he married Mariana de Vergara with whom he had three more children. His service in Burgos and his friendship with Cristobal de Vega and Francisco Vallés, both professors in Alcalá and doctors to Philip II, secured a position for Diaz with the King in 1568. Thanks to his great knowledge and ability to treat urinary diseases he was conferred the title of surgeon to his majesty in 1570, a position he held until he died in 1590. With the privilege of being court doctor, Diaz published his first book in Madrid in 1575, “Compendio de chirurgia” based on the dialogues between a doctor and a medical empiric who wanted to understand the principles of surgery. His teaching strategy is evident throughout the book, written in four parts: anatomy, swellings, fresh wounds and old sores (ulcers). The book presents hospital practice of his time and many tips on how a surgeon with a religious background and full respect to human suffer must behave. The book is a beautiful humanistic work published in vernacular Spanish language, but contains no reference to urologic knowledge except for the anatomy.
His dedication and experience to the diagnosis and treatment of renal, bladder and urethral disease was reserved for a second master work, also in Spanish, entitled “Tratado nuevamente impresso de todas las enfermedades de los riñones, vexiga y las carnosidades de la verga y urina, dividido en tres libros” [A newly printed treatise on all diseases of the kidneys, bladder, fleshiness of the penis and urine, in three volumes]. The first book describes sands, stones, inflammation and other renal diseases; the second one is about sands, stones and sores in the bladder and the third one, the most innovative, presents a very practical perspective on fleshiness and calluses in the exit of the penis. Diaz uses more than a thousand medical terms in old Spanish of which approximately one third are newly used, most of them invented by him as he translated from Latin and Greek. Interestingly half of the new terms he applies are still in use today in modern Spanish.
Several surgical instruments included are of his own invention; like the modified civet with a cutting point (scissoring instrument) that he used to perform blind urethrotomy, for use when “candles covered with a flesh-eating ointment” (caustic bougies) failed to treat urethral fleshiness (strictures or possibly obstructing prostatic tissue). When describing the cutting of the stone he presented many instruments beautifully depicted. Although he followed Marianus Sanctus classic description in De lapide, published in 1540, he controversially claimed that lithotomy was not an Italian, but a Spanish invention.
Francisco Diaz has been compared to the famous French surgeon Ambroise Paré (1510-1590) due to their similar time frame, for using woodcut prints to represent surgical instruments and in their descriptions of how to perform interventions. However, Diaz was not a practical surgeon like Paré, he was much more a philosopher and scholar. His books are very humanistic, with many anecdotes of famous characters including emperor Charles V and his noblemen. He described, for example, how he performed the autopsy of his respected professor of Medicine Fernando de Mena who died in 1585 of sepsis due to an embedded stone. The knowledge of Diaz regarding botany and pharmacy is immense and his books are full of references to Classical and Arabic authors. He really tried to establish a career of academical dedication to the treatment of urinary diseases. Diaz was himself a poet and friend of Lope de Vega and Miguel de Cervantes (author of Don Quixote), the latter calling him “Spirit of Apollo” in one of his laudations.
In Spain, the Francisco Diaz medal is the most important award given every year by Asociación Española de Urología and Francisco Diaz has been studied by many scholars, although not enough in non-Spanish languages. With his fine 1588 publication, he can reasonably be considered to be one of our first urologists.
This page was added to the EAU Museum of Urology by Javier Angulo and Jonathan Goddard, it is based on an article previously published in Urology News, Angulo J, Goddard JC, Francisco Díaz (1527-1590), forefather of urology, Urology News, 28(3), 2024
First page of “Tratado nuevamente impresso de todas las enfermedades de los riñones, vexiga y las carnosidades de la verga y urina”, printed in Madrid in 1588.
Detail of the scissoring instrument, used as the first urethrotome.
