Quirino Maggiore
January 1, 1933 - September 2, 2017
Professor Quirino Maggiore passed away on September 2nd, 2017. He was my master and mentor and I owe him the passion for clinical care and research and the attention to social and ethical aspects inherent to the medical profession. He was a great physician, a curious, creative investigator, an inspiring educator and a just man.
Professor Maggiore was an all-round internist and a formidable diagnostician. With him leading, the discussion of clinical cases at the bedside or during clinical meetings was a rigorous intellectual exercise that required 360 degree assessment of possible alternative hypotheses. In the 1970s, the science of clinical diagnosis was still at an early phase of development. Yet, he did not leave anything to approximation and simplistic deductions. His diagnostic exercise was intrinsically Bayesian and he discouraged superficial application of prêt-à-porter algorithms which he felt simplistic in most cases. His insight into suspecting the disease was formidable. I remember several cases in which, without any positive evidence of the disease he suspected, his acuity and ability to contextualize clinical data led him to bring forward definitive diagnostic tests that might have seemed unjustified by available clinical data.
Beyond the academic context in Pisa where he was educated, his methodological formation was Anglo-Saxon. He absorbed modern clinical methodology mostly during a fellowship in London at the Royal Free Hospital Liver Unit then led by Dame Sheila Sherlock. There he met Stanley Shaldon, who inspired him on the application of home haemodialysis. Shaldon also became his role-model for a frank approach to the scientific debate. Professor Maggiore's interventions at meetings and congresses were always punctual, acute and, whenever he perceived the necessity, unconditionally critical but always respectful of the interlocutor. As a clinical investigator he was gifted with great creativity. His interests were vast and spanned from immunopathology to dialysis technology. The intuition to apply a hypothermic stimulus to increase vascular stability during dialysis, or plasma cooling in the extracorporeal circuit for the removal of immune complexes in cryoglobulinemia and the very formulation of the low protein diet remain among the most innovative advancements in the first three decades of the history of modern nephrology.
Professor Maggiore was uncompromising in situations where he felt that the protection of the most serious and fragile patients was not properly guaranteed. In the early 1980s, he resigned from the direction of a prestigious nephrology unit of a large academic hospital that was being developed because it was unacceptable to him that the managerial and the academic leadership of the same hospital had not placed the organization of an emergency department as an absolute priority. He was a great raconteur and listening to his narratives of places and people within and outside academia was an engaging and fascinating experience. He has maintained a solid and warm relationship with his staff over the years. Far beyond the professional context, among the ethics he transmitted to his colleagues and fellows, I believe that the human respect and the intellectual and moral honesty are the most notable ones. By his example, he made clear that apologizing when wrong is an imperative both in the professional and in the everyday life. In the mid-1970s, when Italian medicine was still ossified in baron-like professional relationships, he did not hesitate to apologize to his young collaborators even for minor dissonances.
Professor Quirino Maggiore is part of the noblest history of modern nephrology. He will be missed by his beloved wife Marta and by his children Elena, Giulia and Umberto and other family members and by the nephrology community at large.
Prof. Carmine Zoccali
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