[The Somovillas: a family of lithiasis surgeons from Rioja. Chronology of their trajectory in Arnedillo, 16th Century]

In the second middle of the XVI century lived in Arnedillo Juan and Francisco Somovilla, booths "maesse". The names of his wives were Anna Garcia and Iomar de Oña. The brothers of Juan and Anna were Mardia, Diego baptised on 20 of june of 1566, and Iñigo. Juan Somovilla passes away on 22 of December of 1574. His brother made the testament. We think that Juan was the surgeon that we contracted by Felipe II, instead of Francisco. Francisco Díaz talked about Arnedillo, as an important thermal baths in the treatment of the kidney diseases, in his text. If Arnedillo was a centre of treatment of urinary disease, the Somovilla family could learn here the surgery of bladder litiasis.

[History of surgical instruments. 9. Surgical instruments and development of surgical technique of lithotomy incision]

Lithotomy, i.e. the surgical method of cutting for stone in the bladder, belongs to the oldest and, due to the high risk, most notorious operating techniques. Records of stone-cuttings date as far back as Ancient Greece. The first detailed description of the procedure and instrumentation of lithotomy is to be found by Celsus (1. century AD). The patient in the lithotomy position, the neck of the bladder is approached by a median incision of the perineum. Celsus is also the first to mention special stone-hooking instruments ("uncus") to aid in extracting the bladder-stones. Medico-historical development lead to constant changes in the technique as well as in the instrumentation, since the lack of analgesia and anaesthesia necessitated quick operations of only a few minutes. A key step in the progress of operation was the introduction of so-called path-finders and directing probes in the 16th century. The opening of the bladder from the perineal incision was now accompanied by the simultaneous admission of a metal catheter into the bladder via urethra, thus providing the "Lithotomist", through manual control of the catheter, with an enhanced orientation towards the position of urethra and bladder. At that time, the dissection was conducted bluntly and without direct view of the situation, i.e. without an exact representation of the structures to be separated. Thanks to the improved instrumentation, the instruments could now be guided along a probe directly into the bladder, thus alleviating the tedious search for the opening after changing instruments, all the while with an agitated, pressing patient. Famous names in the development of the lithotomy with an perineal incision are the medical doctor Mariano Santo (around 1488-1564), the barber-surgeon Frère Jacques de Beaulieu (1651-1719) and later Johann Jakob Rau M.D. (1668-1719). Only later, to avoid injury to the perineum, the suprasymphyseal approach ("Sectio alta") was adopted (primarily by Pierre Franco 1556). Due to the construction of arrow-like probe by the barber-surgeon Frère Come (Jean Baseilhac [1703-1781]), which was pushed through the urethra into the bladder and up and above the symphysis, the danger of damaging or penetrating the peritoneum was greatly reduced. In the 19th century the upper lithotomy prevailed as the standard operating method over the perineal approach, known even by the ancient Greeks, but marked by its high complication rate. Since the end of the 19th century, however, the upper lithotomy in ist turn, has been nearly completely replaced by the cystoscopic transurethral lithotripsy.

[Surgery of bladder lithiasis in the 19th century]

In the nineteenth century, in France, the vesical lithiasis, that as almost vanished today, was frequent. In the middle of the century, the ancient methods of surgical exeresis, by perineotomy or abdominal cystotomy, left one place to a new technique, the removal of the calculus by the natural ways: the lithotrity.

[History of surgery in Preci better known as surgeons of Norcia]

This paper makes a small contribution to a more detailed knowledge of the history of Italian surgery. Few know that Italy can boast a category of surgeons who should be regarded as the world forebears of modern surgery. These skilled individuals are better known as "Norcini", a term which is often regarded as negative and contemptible. However, in practice, they came from Preci and were only called "Norcini" because their village formed part of the "contado" of Norcia. Preci still possesses a large collection of surgical instruments and other items which testify how the art of surgery developed from this small centre. Extensive research has led to the reconstruction of a general picture of this phenomenon and its influence in Italy and throughout the world. These surgeons were the only ones capable of operating gallstones, cataracts and inguinal hernia. They developed specific instruments and were the first to introduce cauterization and narcosis. The latter enabled them to overcome almost all the factors which limited surgery at the time, namely infection, pain and hemorrhage. This study attempts to explain how and why such skillful surgeons were to be found in such a small and isolated area of Umbria.

Frère Jacques Beaulieu: from rogue lithotomist to nursery rhyme character

PURPOSE

We discuss the history of Frère Jacques Beaulieu, a celebrated 17th century French lithotomist, and question the relationship of his name to a well-known nursery rhyme character.

MATERIALS AND METHODS

We reviewed historical reports about Beaulieu and his career as a lithotomist. Nursery rhyme interpretations were also reviewed.

RESULTS

Beaulieu was born in 1651 to a peasant family and learned the practice of lithotomy by apprenticeship. He was never formally ordained yet donned a monk habit and called himself Frère Jacques. He was the first person to use the lateral approach to perineal lithotomy and openly shared his surgical technique. His lithotomy procedure was observed by the high court in Paris on 3 separate occasions between 1697 and 1704. Unfortunately his patients had significant morbidity and mortality, and he was denied operating privileges. He performed approximately 5,000 lithotomies in 30 years and died in 1719 at age 68 years. The nursery rhyme "Frère Jacques" probably refers to a playful group of Jacobinic monks who often overslept. We found no direct association between Frere Jacques Beaulieu and the nursery rhyme character.

CONCLUSIONS

Beaulieu was an early urologist who was the first to describe the lateral approach to perineal lithotomy. Unlike other lithotomists of the 17th century, he openly shared his surgical techniques and stimulated others to refine the procedure. Regardless of the exact derivation of the nursery rhyme, the name Frere Jacques will always be remembered in song.

Autosurgery, 1816

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Hippocrates and urology: the first surgical subspecialty

Hippocrates, who is generally considered a focal point for the start of western medical tradition, left behind a corpus of medical writings that constituted the first recorded comprehensive health system. The pivotal point of the Hippocratic corpus was the Hippocratic Oath, which outlined the duties of healers of his school, but demarcated lithotomy as a practice that was off limits to his fellow physicians. Surgery for bladder stone, urology in essence, was thus the first specifically identified surgical subspecialty.

Sir Henry Thompson BT, the first English urologist

Sir Henry Thompson was a gifted Victorian. As a surgeon he achieved early recognition by successfully removing King Leopold of Belgium's bladder stone where two other eminent surgeons had failed. He was undoubtedly the most famous surgeon of his age, a position he was to occupy for some 30 years. As well as professional eminence he achieved success in an extraordinarily wide range of endeavours. He was an accomplished artist, exhibiting 12 times at the Royal Academy, a connoisseur and collector of china, a keen astronomer, an authority on diet and cooking and a pioneer advocate of cremation. He was interested in poultry-farming, market-gardening and photography. He published two novels sandwiched between a book on tumours of the bladder and another on the prevention of calculous disease, He was a celebrated host and his dinners--called 'Octaves'--at which he served eight courses to eight guests were legendary. To be invited meant one had 'arrived'. He was friendly with artists, scientists and men of letters--Huxley, Browning, Ray Lankester and Thackeray. At the age of 80 he bought himself a motor-car and 2 years later wrote a book on the anatomy of the motor-car engine. Sir Zachary Cope described him as a versatile Victorian, a fitting description of an extra-ordinarily gifted man. A commanding and slightly intimidating figure with little sense of humour, he achieved distinction in professional, artistic and social circles. Not only did he leave his mark on urology he left his mark on Victorian England.