1651 - 1714
The stonecutter Frère Jacques
Jacques de Beaulieu (1651-1714) was born in the small hamlet of Etendonnein, Burgundy of very poor parents. Initially, he served in the army, as a trooper in the French Cavalry, but at some point met an itinerent Italian lithotomist called Pauloni. Beaulieu joined him and learned his method of cutting for the stone, fistula and hernia. He began to travel around France treating patients in one place before moving on to the next village.
Images of Frère Jacques
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At about the age of 40, Jacques took on the practices and dress of a monk and took the name Frère Jacques. Although he never actually joined any religious order, he dressed as a Récollet Franciscian Friar but with a large hat rather than a cowl, wearing slippers rather than sandals on his feet. However, it appears he did indeed lead a humble life, eating little and taking only a few coins as a fee, to enable him to repair his instruments and slippers.
In 1697, encouraged by a priest he had operated on, he went to Paris. Initially, and perhaps understandably, he was turned away from Hôpital de la Charité. However, with a letter of introduction from Notre Dame he approached Achille de Harlay comte de Beaumont (1639 - 1712), President of the Parliament of Paris. He ordered the surgeons to test Frère Jacques, so a cadaver was prepared with a bladder stone placed suprapubically. Jean Méry (1645 – 1722), surgeon to the Hôtel Dieu, dissected the cadaver after Frère Jacques had cut out the stone perineally. Initially, Méry reported a clean cut between the ischio-cavernosus and bulbo-cavernosus. However, a few days later Jacques was tested on two more cadavers, a young boy’s and a woman’s. Méry now found he had sliced through the urethra of the boy and opened the vagina of the woman. As a result, he retracted his support but this decision was probably taken for financial and/or political reasons – the established surgeons did not want a new operation, or indeed surgeon, to surplant their well-paid methods.
Frère Jacques took his practice to the Royal Court at Fontainebleau and, after a successful operation on a shoemaker’s apprentice, gained some support, including that of the King, so he continued operating there. He later returned to Paris with the Court and the surgeons were once again obliged to test him.
An enquiry was set up the following Spring, in the Archbishop’s palace, to decide if Frère Jacques could operate. Despite the surgeons’ warnings, he was granted rights to operate at La Charité and the Hôtel Dieu. Unfortunately, his bold skill was no match for his lack of anatomical knowledge. Of 60 patients cut, 25 died, 13 were cured but the remaining 22 remained in hospital crippled.
He left Paris - and then France - and eventually ended up in Amsterdam where he was well received and observed by Johannes Jacobus Rau (1668 - 1719) the famous anatomist. Rau studied Frère Jacques’ method and, applying his anatomical knowledge, standardised it.
In 1700, Frère Jacques was invited back to Paris by the Royal physician Guy-Crescent Fagon (1638 – 1718). He had Jacques instructed in anatomy, to enable him to understand where he was cutting and what to avoid. He also changed his old large round sound to a groved one to increase the acuracy of his cut. Now with anatomical knowledge and a method improved by his mentors, his success rate hugely improved. He continued to travel Europe until at least 1713 when he finally returned home and died at around the age of 70, still living the humble life of a poor monk.
The true historical details of Frère Jacques' life are complicated by reports, stories and biographies biased by both his friends and his enemies. Although he was an itinerent lithotomist, he clearly had some skill, but his lack of anatomical knowledge led to a high morbidity and mortality. He did, however, bring a new technique of perineal lithotomy that was picked up by surgical masters such as Rau in Amsterdam, Georges Mareschal (1658 – 1736) of Paris and William Cheselden (1688 – 1752) of England.
As a result, lateral lithotomy became the standard open technique for removing bladder stones until the end of the 19th century.
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