Marais’ most famous character piece is ‘Le Tableau de L’Operation de la Taille’ in which the music describes vividly an agonising operation to extract a bladder stone. Marais himself underwent lithotomy (stone removal) surgery in 1720 aged 64 years, and the composition which was published in 1725, almost certainly depicts his own experience.  In this period, before the discovery of anaesthesia, patients were tied down to the operating table with silken ropes and often held down by the surgeon’s assistants.  The stone was removed by a lateral perineal approach, with surgeons attempting to perform the operation within minutes. The tableau describes virtually in real time the fear and trembling of the patient on entering the ‘cutting’ room, his resolve to go through with the procedure, the intense pain of the incision, the use of forceps to remove the stone from the bladder neck, a frightening flow of blood, and finally an exhausted return to bed. 

In the second part ‘Les Relevailles’ - the patient’s recovery is recounted, happily. It is thought that Marais’ own procedure was carried out by a court lithotomist. The identity of the surgeon is unknown but generations of the Collot family were surgeons to the court at Versailles and frequently performed stone surgery on court members. Original speculation that the procedure was carried out by the travelling lithotomist Jacques Beaulieu (sometimes known as Frère Jacques of nursery rhyme fame) - a recognised exponent of the lateral perineal technique - is now thought unreliable as Bealieu died prior to 1720. Marais seems to have come through the dramatic operation successfully and without harm or side effects, as he returned to perform and compose music at Versailles for a further 5 years. He retired aged 69 years in 1725, handing on his court position to his son, and died aged 72 years in 1728. 

This writing was experimental and highly innovative so would have been startling and disturbing for audiences to hear in the 1720s¹. But the music faithfully renders the fear, distress and intense pain of the procedure.  The second part ‘Les Relevailles’ is in the uplifting and joyful key of E major. It describes the recovery of the patient (‘relevailles’ was a term also used for the period of ‘lying in’ after the birth of a child) and the piece ends on a positive optimistic note – the patient has been delivered of a stone, and cheated death!

This was no small achievement in the sixteenth, seventeenth and eighteenth centuries. Hippocrates recommended never operating on the bladder as felt the risk of death was inevitable, but the high prevalence of bladder stones at this time and recurrent misery they caused from pain and frequent infections hastened the development of the practice of lithotomy. Early mortality rates were extremely high confirming Hippocrates’ fears, which is not surprisingly in view of the lack of understanding of infection risk, not to mention the intense physiological stress and pain of surgery carried out without anaesthesia. At the time of Marais’ surgery expert lithotomists had mortality rates of around 6-12%, but in the hands of itinerant charlatan lithotomists mortality could be a high as 50% and complications such as wound abscess, incontinence and infertility were not uncommon.

Allemande Asthmatique (1717) 

This is the second piece by Marais from his Book 4 for Viol which has medical connotations. ‘Allemande’ is a movement from a dance suite like a ‘gigue’ or ‘sarabande’, and is taken from Suite d’un Gout Étranger (Suite in a Strange/Foreign Style). In his composition Marais evokes a staccato panting sound from the chest with erratic pauses as in a person struggling to breathe. The transcription for flute adds intensely to the breathiness of the notes. Remarkably the composition precedes Rene Lannec’s invention of the stethoscope by a century, and chest percussion wasn’t practiced until introduced by Auenbrugger in 1761, so the interpretation of chest sounds reflects Marais’ own observations. Marais had a son Sylvain who died early but no evidence has been found to suggest that either Marais or his son experienced asthmatic symptoms. 

French medicine in the early 1700s, like its counterpart in the United Kingdom remained strongly influenced by Galen’s teaching.  Physical examination of the patient was limited to taking the pulse and examining the urine, with the intention of balancing the four humours. The term ‘asthma’ was not new in the seventeenth and eighteenth century, and dates from Greek era, denoting panting or effortful breathing. Hippocrates used the term to denote a symptom, whereas Galen in the second century AD linked the symptom to bronchial obstruction. But it was John Floyer (himself an asthmatic) in his 1698 account ‘A Treatise of the Asthma’ who developed the concept of periodic bronchospasm and indicated there may be an inherited element². Floyer’s treatise (there is a copy in our Heritage library at RCP) was translated into French but not until after the Marais’ piece was written, so in French court circles at the time the term ‘l’asthmatique’ would probably have referred to a ‘chesty’ person. 

Anita K Simonds

Harveian Librarian

Recorded performances of both pieces are visible as part of the exhibition Patient Voices, on view on the 1st floor of the RCP, Monday to Friday, 9am to 5pm, until 23 July 2027.

References

1.Hannaford Goddard P.H, Goddard J.C. Marin Marais: Fiddling with bladder stones. Urology news January/February 2-25 Vol 29 no 2 2025.

2. Sakula A. Sir John Floyer’s A Treatise of the Asthma (1698). Thorax 1984;39:248-254.

Photography of musicians by Inka Stafrace, RCP AV team.