cutting for the stone in seventeenth-century bruges Johan J. Mattelaer
bladder stones and lithotomists The presence of stones in the bladder is associated with a wide range of complaints, causing patients acute pain and severe difficulty in urinating (Fig. 20). Bladder stones are especially prevalent in times of poverty and malnutrition, with a diet low in protein – especially meat or fish – as was the case in the seventeenth century. There is evidence in Flanders from as early as the tenth century of barber-surgeons operating to remove bladder stones. We know that Count Arnold the Elder (919–964) suffered from a bladder stone and consulted a number of lithotomists, but that fear ultimately prevented him from going through with the procedure. Many ‘cutters for the stone’ travelled from town to town: only later did larger cities appoint their own ‘sworn lithotomists’. These travelling surgeons sometimes gave themselves elaborate titles: many were simultaneously steensnijder ende oculist (cutter for the stone and optician) or threw in obstetrics too (steensnijder, oculist ende woutmeester) or even steen ende houtsnijder, oculist en woutmeester (cutter for the stone and wood, optician and obstetrician). In
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response, surgeons’ guilds and civic authorities in Flanders began to supervise and regulate the activities of itinerant lithotomists. Numerous bylaws were announced in this regard from the seventeenth century onwards. The surgical method for removing a bladder stone changed little between the Roman era and the late sixteenth century. Two assistants gripped the patient’s legs as he sat on a table (known in Flemish hospitals to this day as the steensnedeligging or ‘stone-cutting position’). The surgeon inserted his left index finger into the patient’s anus in order to feel the stone and to press it downward against the perineum (Fig. 21). A probe held by a third assistant was inserted into the patient’s ureter. The surgeon made an incision in the perineum below the
anus until he made contact with the stone. The incision was then dilated and the stone removed by forceps. The procedure was performed with no anaesthesia other than a little alcohol and a sponge impregnated with mandrake solution. The most common postoperative complications were bleeding and infection, and also fistula formation, where the wound did not close and the patient continued to lose urine through the opening.
cutting for the stone in bruges The earliest known lithotomy in Bruges was performed in 1270 by Pierre dou Leene, li maistre le tailla (‘master cutter’) on a certain Jan vander Beurse. The lithotomist was assisted by his son, by Maistre Simons, le mire de Bruges, and
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