LITHOTOMY. 



Frere Jacques put his patientsunder no preparatory treat- 

 ment before the operation ; he placed them on the edge of 

 a table, with a pillow under their heads, and with their legs 

 and thighs bent and feparated from each other, in fnch a 

 way, that their heels approached their buttocks. He did 

 •not bind his patient, in this pollure ; but made lome llrong 

 . alTiflants ho'd them. Then, having introduced into the 

 bladder a round, iolid, ungrcovcd ftaif, he took a long nar- 

 row knife, and made an oblique incifion in the perineum, 

 along the internal part of the tubcrofity and ramus of the 

 jfchinni, cutting from below upwards. In this way, he 

 cut all tlie parts which prefented tli.-mfelves, without taking 

 out tiie ftafT. He now introduced his finger into the wound, 

 in order to afcertain the fuuation of llie itone, and enlarged 

 the in'.ernal opening with an inllrument much like a fcratch- 

 ing knife, but which only had one cutting edge. On this 

 inllrument, which he called his conductor, he pafied the 

 forceps into the bladder. The folld ftaff was then with- 

 drawn from the urethra, and the calculus extrafted. Laltly, 

 fome linen dipped in a mixture of oil and wine was applied 

 to the wound, and the operator took final leave of his pa- 

 tients, te'ling them, that the operation was done, and that 

 God would complete the cure. 



Frere Jacques' fuccefs at Fontainbleau changed the pub- 

 lic opinion fo much in his favour, that it was determined to 

 let him o;"-rate, in the enfuing fpring, on the patients in 

 the Hoiel D'.eu and La Chaiite. He was direfted, how- 

 ever, to make fome previous triaU of his method upon the 

 dead fubjed in the prefence of Meiy, who was ordered to 

 ■furiiifli a report on the matter. Mery's firft declaration 

 was qu'te favourable to Frere Jacques, as it ftated, that the 

 neck and b idy of the bladder were cut inftead of being 

 dilated, as they were in the ordinary method at that time ; 

 that as tlie ftcne was extracted at the wideft part of the 

 arch of the pubes, the fympt.ims were likely to be milder ; 

 and, among other circumilances, that the internal parts were 

 lefs ex])ofed to be torn and bruifed. Mery thought Frere 

 Jacques' inltruments not fo eligible as thofe in previous 

 ufe, and pariicularly objeftcd to the ftafF, which, having no 

 groove, fei-ved as a very indifferent guide to the knife. 



Under Mery's infpeftion, Frere Jacques made further 

 trials of the new method on dead bodies, and a fecond re- 

 port, dra.vn up by the former, wa^ much lefs propitious 

 than that which had been previouily delivered. Bat nei- 

 ther this cirjumftance, a^or fome untor'.unate operations 

 which Frere Jacques had lately performed at Verfailles and 

 Paris, led to a rejeiiion of the ne^v plan ; for forty-two 

 ftone patients, in the Ho el Dieu, and eighteen in La 

 Charite, were now put under his care. Nothing could 

 furpafs the general eagernefs to fee him operate. There 

 was not a phvfician, iiur a furgeon, who was not proud of 

 being his atfiilant. In ihort, fo vail was the concourfe 

 of fpeclators, or rather, 'of thofe who willied to be fueh, 

 that guards were found neceffary to preferve order. Of 

 the above fixty patients, twenty-three died. Only thirteen 

 were perfetily cured, and even in fome of thefe the wound 

 is faid to have afterwards brok:-n out again. The other 

 trtentv-four remained in the hofpitals ; fnme with an incon- 

 tiriense of urine ; others with fiftulie; and all in a reduced 

 ftate, from «hich they are laid to have, never recovered. 

 On exa.-nining the bodies of the deceafsd, it appeared that, 

 in fome inilanoes, the fundns of the bladder was wounded, 

 while ii others, the neck of this vifcus was entirely fepa- 

 rated from the urethra i that, in women, the vagina was 

 conft^ntly pierced in two oppofite places ; that, in both 

 fexes, the reituni was frequently opened ; and that, in all 

 cafes, the parts were terribly liacked, in conl'equence of no 



guide for the knife, and no conductor having been em-» 

 ployed. 



The ill fuccefs of Frere Jacques' operations did not pro- 

 duce fimilar fcntiments in every mind. Felis and Fagon, 

 in France, thought that his method had merit, and that, 

 when improved in particular points, which they fuggeftcd, 

 it might be made far fuperior to any other mode of cutting 

 for the ilone. Frere Jacques profited fo much by their 

 advxe, that, in 1 699, he operated on about fixty perfans, 

 moil of whom got quite well. He fpent the enfuing winter 

 at Verfailles, as an inmate with Fagon; and there repeat- 

 edly praCtifcd lithotomy on the dead fubjeft. Duvcimey 

 diffected the bodies, and though he found Frere Jacques' 

 method far preferable to the apparatus major, which was 

 then the only other plan in ule, he was of opinion with 

 Mery, " that the ftaft would be .better with a groove, as 

 its round and foHd form was ill fuited for the guidance of 

 the knife." Frere Jacques, ever ready to receive inftruc- 

 tion, loft no time in adopting the improvement. He had 

 new ilaffs conlbudled, and continued to employ them the 

 reft; of his life. 



In the fpring of 1 70 1, this celebrated lithotomifl cut 

 thirty-eight patients for the ilone at Verfailles. Thefe all 

 recovered. Fagon, who was afflidled with the difordcr, 

 could not refolve to put himielf under the care of the new- 

 operator ; but was operated upon and cured by Marcchal. 

 Frere Jacques, fomewhat piqued at this circumitance, quit- 

 ted Verfailles, with the intention of never returning thither; 

 but, in 1702, he was induced to re-vifit the place at the in- 

 ftance of the Marfhal de Lorges, who was afRitled with the 

 ftone, and under whofe roof were lodged twenty-two poor 

 patients with calculi. Thefe were all operated upon with 

 fuccefs ; but the Marflial, whofe bladder contained fun)j;ous 

 excrefcences, and leven Imall flones, the extraclion of which 

 was tedious, died the day after fuhmitting to the opera- 

 tion. In confequence of this accident, Frere Jacques de- 

 termined to go into Holland. Here his fuccefs mull have 

 been very confiderable ; for he was thrice engraved ; and 

 at Bruffels, whither he was fent by the magiftrates of Am- 

 fterdam, a medal was llruck in honour of him, with this 

 infcriplion : Pro feyuatls civiliis. The motto of one of the 

 engravings is the toUosving pafiage from Cicero : JEari, 

 quia non omnes canvakfcunt, jion iddrco ars nulla medicina cjl. 

 This alludes to the many hoilile criticifras which had been 

 iflued againft him. 



In 1712, Fi ere Jacques, being fixty years of age, re- 

 turned to Befangon, his native place, where he foon after- 

 wards died. 



While he was at Amfterdam, his mode of operating had 

 been obferved by the famous Raw, who at once perceived, 

 that the method was infinitely preferable to the apparatus 

 major, and who, after fome trials on the dead fnbjed^, put 

 it in practice on the living.- Raw's fuccefs exceeded every 

 thing heard of before : befidcs extracting the Ilone with the 

 utmoil eafe, he cured all his patients wi'hout oxce: tion. 

 His reputation fpread every wiiere. Surgeons flocked from 

 all parts to Amllerdam, in order to fee him operate and 

 receive his inftruftions. He cared not how many fp--ftators 

 he had ; but no one could prevail on him to divn'ge the 

 particulars of his plan. To every folicitation on this point, 

 his ufual reply was, " Celfum legitote," which feems to hint, 

 that he was in the habit of cutting the fame parts as were 

 divided in the ancient operation of the apparatus vninor. 

 It is afferted, that he cut for t'ne Hone 1540 patients, and 

 (what is almo (I incredible) they are all Hated to have re- 

 covered, fo that there was never any opportunity of dilfedf- 

 jng the bodies of any of his patients. 



It 



