In memoriam: Professor Franciszek Kokot

In memoriam Professoris Francisci Kokot medici magni

Professor Franciszek Kokot (Figures 1 and 2) passed away on January 24, 2021. The tragic pandemic of COVID-19 claimed the life of a highly skilled physician, one of the truly great internists of the 20th century, and one of the most prominent Polish physicians of all times. Prof. Kokot was a reputable scientist with a great intuition who persistently carried out research on pathophysiological phenomena of several disorders, and was a mentor to many generations of physicians. He was a role model in diligence and perseverance as well as regularity that was difficult to imitate.

Prof. Kokot was born on November 24, 1929, in Olesno Śląskie (Poland) in a family of Silesian farmers. Olesno Śląskie, before World War II, was located in Germany (under the German name Rosenberg) as part of the Upper Silesian Province (Provinz Oberschlesien). He attended the primary school in his home city, and after the war, graduated from a Polish high school in Lubliniec in 1948. In the same year, he was admitted with the first group of students to the newly founded Medical University of Silesia (then, Medical Academy in Rokitnica Bytomska). While a student, Franciszek Kokot was working as a laboratory technician at the Department of General Chemistry, and since September 1, 1951 as a junior assistant at the Department of Pharmacology. He graduated with honors on December 22, 1953, and became an assistant at the Department of Pharmacology (Prof. Józef Jeske). Additionally, in 1953, he became a volunteer at the 3rd Department of Internal Medicine, chaired by Prof. Kornel Gibiński. In February 1957, Franciszek Kokot left the Department of Pharmacology and obtained a full-time post of assistant at the 3rd Department of Internal Medicine. In 1957, he received his specialty in internal medicine (the 1st degree). Also in March 1957, he was granted the PhD degree after the presentation of his thesis on renal function under condition of artificial hibernation in animal model (Prof. Józef Hano, a supervisor). Franciszek Kokot obtained the 2nd degree of certification in internal medicine in 1958. In 1963, he was awarded with a habilitation—the highest-rank university examination in Poland (and other European countries) confirming scientific qualification of the candidates to be appointed university professor. His habilitation thesis focused on the mechanism of activity of mercurial diuretic agents. Three years later (in 1966) he became head of the Nephrological Division at the 3rd Department of Internal Medicine. He was granted the title of associate professor in 1969, and full professor in 1982. In 1975, he became head of the newly established Department of Nephrology of the Medical University of Silesia. The unit was renamed as the Department of Nephrology, Endocrinology and Metabolic Diseases in 1997. Prof. Kokot was head of the department until his retirement in 2000, but was working at the department until 2016.

Prof. Kokot published almost 1600 papers. He authored the first paper in 1954 and his last publication appeared in print in 2020. It is impossible to review and summarize all his research achievement. In brief, his early works focused on pharmacology, subsequently he significantly contributed to medical enzymology. Prof. Kokot supervised an excellent biochemical laboratory and elaborated several assays, both biochemical and radioisotopic. He was a pioneer in research on the renin–angiotensin–aldosterone system. A number of his investigations focused on various endocrine and metabolic alterations in patients on a long-term extracorporeal dialysis. He authored significant papers on the mechanism of hypertension, eclampsia, and endocrine abnormalities, including investigations of calcium homeostasis.

Shortly after graduation, Prof. Kokot became a member of the Polish Society of Internal Medicine. Still as a young physician, he was awarded the first prize from the society for his research activity in 1957. In 1968, he was elected the president of the Silesian Division of the Polish Society of Internal Medicine and held the post until 1970. In the same year, he was elected a member of the Executive Board of the Polish Society of Internal Medicine. In 1976, he became the vice-president of the Society. He was chairman of the Nephrological Section of the Polish Society of Internal Medicine (1973–1976).

The Polish Society of Internal Medicine honored Prof. Kokot with the highest Society award, the honorary membership, in 1995. He was also awarded with a medal from the society. In 2006, Prof. Kokot was awarded with the Centenary Medal of the Polish Society of Internal Medicine as well. He participated in a number of congresses and meetings of the society. In 2004, he delivered an opening lecture at the 35th Congress of the Polish Society of Internal Medicine in Katowice. The lecture presented his life path and development of his scientific discoveries, and due to its very personal nature, it is fondly remembered by the participants of this conference. Unforgettable are the lectures which he delivered almost annually at the National Educational Conferences of the Polish Society of Internal Medicine. In 1997, he delivered the opening lectures at the Third Central European Congress of Internal Medicine in Wisła. His lecture opened the 5th Polish-Slovak Conference on Internal Medicine in 2004 in Wysowa.

Prof. Kokot participated in an international movement of internists. He was a member of the International Society of Internal Medicine (since 1969) and in 1976, was elected a foreign member of the Society of Internal Medicine of the German Democratic Republic.

It is hard to overestimate the contribution of Prof. Kokot to education of several generations of internists in Poland. He was an author and editor of a number of fundamental handbooks of internal medicine. His handbook Internal medicine (“Choroby wewnętrzne”) was edited 8 times, always in updated editions (1979–2004). For many medical students in Poland, the handbook was the main introduction to internal medicine. The monographic handbook Internal medicine (“Interna”) in 3 volumes appeared in print in 2002 and was edited by Franciszek Kokot and Włodzimierz Januszewicz. The second edition was published in 2006 as part of the Golden Series commemorating the Centenary of the Polish Society of Internal Medicine with preface written by the president of the society.

A special handbook was edited by Prof. Kokot under the title Differential diagnosis of symptoms and signs of disorders (“Diagnostyka różnicowa objawów chorobowych”). It was the third book of such kind in the history of Polish medicine after the book by Władysław Biegański and Edward Szczeklik. The book edited by Prof. Kokot had 3 editions in 1990, 1998, and in 2006. The last edition appeared as a book commemorating the centenary of the Polish Society of Internal Medicine. It is important to mention that Prof. Kokot was an author of a few chapters in the abovementioned book on differential diagnostics edited by Edward Szczeklik.

The issues of water-electrolyte and acid-base disturbances were reviewed for the first time in a form of a monograph published by Prof. Kokot and Jadwiga Kuska in 1965. Over the next years, Prof. Kokot expanded and updated subsequent editions. The following books appeared in print: On acid-base balance in health and disease (“O równowadze kwasowo-zasadowej w stanach fizjologii i patologii człowieka,” editions in 1965, 1966, and 1968), Disturbances of water-electrolyte and acid-base homeostasis (“Zaburzenia gospodarki wodno-elektrolitowej i kwasowo-zasadowej,” editions in 2001, 2007, 2013, and 2015) and Water-electrolyte and acid-base metabolism in health and disease (“Gospodarka wodno-elektrolitowa i kwasowo-zasadowa w stanach fizjologii i patologii,” editions in 1981, 1986, 1993, 1998, 2005, and 2010).

One cannot forget about other publications of textbooks and monographs that were read by generations of Polish physicians. As an example, there are 3 editions of the work Emergency conditions in internal diseases („Ostre stany zagrożenia życia w chorobach wewnętrznych”) which were edited by Prof. Kokot in 1998, 2000, and 2003.

For nearly half a century, Prof. Kokot was the author of chapters in significant Polish textbooks and monographs. Their list is very long and only selected examples can be given. It is enough to mention his participation in the creation of such significant works as Clinical enzymology (“Enzymologia kliniczna”) edited by Edward Szczeklik, which was one of the first monographs in the world of a new emerging area of clinical medicine, diagnostic enzymology (editions in 1967 and 1974). We also coauthored the work Enzymological diagnostics in clinical practice (“Diagnostyka enzymologiczna w medycynie praktycznej”) edited by Jerzy Krawczyński (1965). Other works prepared with the participation of Prof. Kokot include: Vademecum of management (“Vademecum terapii,” edited by Włodzimierz Brühl in 1975), Kidney diseases (“Choroby nerek,” edited by Tadeusz Orłowski in 1976), Clinical endocrinology (“Endokrynologia kliniczna,” edited by Walenty Hartwig, published in 1972 and edited in 1984).

Each year from 2005 new editions of the monumental textbook Internal medicine edited by Andrzej Szczeklik, now known under the title Szczeklik’s internal medicine (edited by Piotr Gajewski), are published. Prof. Kokot has been the coauthor and coeditor of this textbook continuously since 2005.

There is also a long list of foreign monographs that were translated into Polish and edited by Prof. Kokot. The most famous are several editions of Harper’s Biochemistry.

Prof. Kokot was a physician who understood internal medicine as it was understood by the first founders of this medical specialty. Internal medicine emerged from medicine not as another specialty narrowing its interests to specific systems or organs, but as a discipline representing a then--new approach to the issues of health and disease, primarily basing diagnostics and therapy on the pathophysiological understanding of phenomena occurring in the human body as a whole. The holistic approach to health and disease meant that internal medicine, despite the gradual division into subspecialities, from the beginning of its existence understands the patient as an entire integrated system.

In the first years of scientific work, Prof. Kokot conducted research in the field of basic science, had thorough pharmacological and biochemical knowledge, was creatively involved in laboratory diagnostics, and thus understood clinical procedure through the prism of biochemical and physiological phenomena. This trend includes his works on acid-base and water-electrolyte balance, metabolic studies in kidney diseases, works in hypertensiology, and numerous endocrinological works. The kidneys, as the organ responsible to a large extent for the homeostasis of the human body, have been the subject of his numerous investigations. However, he never lost a holistic view of the patient, and in this sense, he was a precursor of personalized medicine who always individualized the management of each patient. In the preface to Differential diagnosis of symptoms and signs of disorders, he wrote, “Only a good knowledge of the pathophysiology of disease symptoms enables the correct diagnosis in the shortest possible time, and with the least possible burden of application of additional procedures.”¹

As a teacher, he educated a large group of PhD students, some of whom became professors of medicine, and board-certified physicians. His knowledge and example influenced the formation of many generations of internists and medical students. It is difficult to overestimate the influence of his textbooks on the medical education in Poland over the last half century. In all his actions, Prof. Kokot was a man of great honesty and integrity. This was especially evident in his relationship with his patients. In an interview published in 1997, Prof. Kokot said, “Knowledge applied at the bedside gives great satisfaction. I have the advantage over laboratory researchers that I can use my theoretical knowledge in diagnostics and treatment. Nothing can replace the words of a patient who, on leaving the hospital, says ‘thank you, doctor, you saved my life.’ These are unique moments for me. (...) The greatest happiness of a human being is to give something to other people, even knowledge.”²

Prof. Kokot will remain remembered as an outstanding physician, an extremely hard-working scientist and a talented teacher, but those who got to know him closer will remember Prof. Kokot, above all, as a good man.