Itinerant Lithotomists.—For an unknown number of years preceding the sixteenth century it had been a well-established custom for members of the medical profession in France, and also, doubtless, in neighboring countries, to intrust—as the Hippocratic oath enjoined—all cases of stone in the bladder to expert lithotomists. Such special knowledge and skill were not easily acquired, and so it came about that there were very few individuals who were acknowledged to be experts and who were really capable of teaching the art, and these few guarded most carefully the knowledge which they had gained. During the period of time which we are now considering, certain members of the Collot and Pineau families were the most distinguished lithotomists in France, and the records show that in the year 1600 Jehan Paradis and Nicolas Serre petitioned the Government for official recognition of their special rights to enjoy a monopoly of operative work of this character. “We ask that you give orders that all poor patients who may apply to Hôtel-Dieu (the great city hospital of Paris) or to the Bureau-of-the-Poor for relief from stone in the bladder, be turned over to our care for proper treatment. The poor will receive this treatment gratis, and those who can afford to pay will be charged a very reasonable fee. And you will do well if you prohibit all other persons from meddling with such cases in any manner.” In a document bearing the date 1646 mention is made of four lithotomists—Philippe and Charles Collot, Jacques Girault and Antoine Ruffin—who had erected in the Faubourg Saint-Antoine, Paris, a building which was intended to serve as a hospital “in which, at any time during the entire year, those who are afflicted with stone in the bladder may be lodged, fed, nursed and subjected to proper treatment,—the poor without charge of any kind, and the well-to-do at a proper rate of remuneration.”
In Franco’s time (middle of the sixteenth century) cutting for stone in the bladder was by no means an uncommon operation, and was almost always performed by itinerant lithotomists (“inciseurs”). The Collots had, for many years, possessed almost a monopoly of this business. Laurent Collot, who was the first one of the family to engage in the work, was Royal Lithotomist in 1556, and handed down to his son all the knowledge on this subject which he had acquired through long experience. François Tolet was another of these popular lithotomists who flourished in Paris during the sixteenth and seventeenth centuries. He died in 1724 at the age of seventy-seven. His treatise on lithotomy, which was published in Paris in 1681, and subsequently passed through several editions, is said by Dezeimeris to contain the records of a large number of his own cases and to show clearly that he was a surgeon of sound judgment. No better treatise on this subject, he adds, was published during that period of the history of medicine.
In addition to those whom I have just mentioned there were two French monks who gained wide celebrity as operators for stone in the bladder, viz., Frère Jacques de Beaulieu and Frère Côme. The last-named belongs to the early part of the eighteenth century, and should therefore—in accordance with the plan which I have been following—not receive consideration in the present account; but, in view of the fact that these are the only two monks who, during the Renaissance and the period immediately following, gained conspicuous credit for the honorable and efficient service which they rendered, not merely to the science of medicine but also to the cause of humanity, I believe that I cannot do better than to place the two sketches together as if they both belonged strictly to one and the same period of time.
FIG. 26. FRÈRE JACQUES DE BEAULIEU.
Born in 1651 in the village of Létendonne, Franche-Comté, France.
(From the steel engraving in the treatise De la Taille Latérale par le Périnée, etc., by Pascal Baseilhac, nephew of Frère Côme, Paris, 1804.)
(a) Frère Jacques—or Brother James, who was born in 1561 at the village of Létendonne, near Lons-le-Saulnier, Central France,—learned the art of operating for stone in the bladder from an Italian surgeon named Paulony, and acted as his assistant or associate up to the time when he became a monk of the Order of Saint Francis—that is, of that branch of the Order which had its chapter house at Feuillants in Languedoc. He traveled about the country offering to treat gratuitously all persons affected with stone in the bladder who were willing to trust him, and he made it a rule, whenever such a thing was possible, always to operate in the presence of one or more physicians or surgeons. He was also ready at all times to give instruction to those who wished to learn his method of procedure. He never asked to be remunerated, but was always pleased to receive from his patients a written testimonial of what he had done for them. Out of the moneys which he received from the rich he retained only that which he required for his own support and for the purchase of such instruments as he from time to time required; the balance he distributed among the poor. He was very faithful in performing his religious duties, and he succeeded in gaining the good will and esteem of everybody with whom he had any dealings.
For a long time it was customary in France to credit Frère Jacques (Fig. 26) with the invention of the lateral method of operating for stone in the bladder. This, however, was an error, for Franco, on page 95 of E. Nicaise’s reproduction of the 1561 edition, describes this operation clearly. It must therefore have been invented a long time before Frère Jacques was born. The text (rendered into English) reads as follows: “... the incision should be made between the anus and the testicles, two or three finger-breadths to one side of the commissure or perinaeum [median line of the perinaeum].” This is said to be the earliest clear description of the first step of the lateral operation of which we have any knowledge.
In 1697, when Frère Jacques visited Paris, he had already attained wide celebrity as a lithotomist; the number of his successful operations—all of which had been performed according to the lateral method of procedure—having reached a grand total of several thousand. He therefore had a right to suppose that his visit would prove acceptable to the physicians of that metropolis; but the published account of this visit reveals plainly the fact that the surgeons of that city were not at all pleased that an itinerant lithotomist from one of the provinces should have the effrontery to request permission of the authorities to exhibit his method before the Medical Faculty of Paris. His request, however, was granted, and he was allowed to operate on a man, forty years old, at Hôtel-Dieu. He performed the operation before a large assembly of physicians, and, after the stone had been successfully extracted, the patient made a prompt recovery. A short time afterward he operated upon another patient at Fontainebleau in the presence of several physicians, one of whom was Monsieur Félix, the First Surgeon of the King, Louis the Fourteenth. In this case also, as well as in several later cases, Frère Jacques was entirely successful, and he now began to be treated by the public with marked consideration. But, in a short time, owing to the jealousy exhibited by a large clique of Paris surgeons, who were encouraged to pursue this course by Mery, the Head Surgeon of Hôtel-Dieu, Frère Jacques was finally forced to leave Paris. I cannot follow him on his further wanderings throughout Europe, from the leading cities of Holland, Belgium and Switzerland to Vienna and Rome. In 1716 he retired to Besançon and lived there quietly up to the time of his death in 1719. But even then his enemies—men to whom he had never done the slightest harm—did their best to destroy the last traces of his existence. A visit made to Besançon by one of his acquaintances not long after our Franciscan monk’s death, revealed the fact that his name had been erased from the church registry of deaths. The lateral method of operating for stone, which had been revived and thoroughly developed by him, still finds favor among the best surgeons of our own day; and the names of those mean-spirited men who tried so hard to injure him have long since passed into complete oblivion.