The royal fistula that changed the face of surgery
WARNING: The following article describes in detail a pioneering medical operation that took place in the 17th century. Readers also sensitive to matters of hygiene are warned that the patient in question is said to have bathed only twice in his life. He is considered one of France’s great kings.
NEXT time you have an abscess lanced, your hemorrhoids treated or an ingrown toenail removed, please spare a thought for one Charles-François Felix. I am sure it will make you feel much, much better.
Monsieur Felix, a barber-surgeon performed one epic operation that changed the face of surgery, and also thankfully for Monsieur Felix and his family, the royal derriere of King Louis XIV.
King Louis' bottom first came to prominence on January 15, 1685 when the Royal physicians discovered a swelling in the king's anal area. This they duly noted in the carefully-kept daily record of the king's health.
By February 18 an abscess had formed and by May 2 a fistula* appeared.
Enemas and poultices were unsuccessful. The king couldn't ride or sit comfortably on the throne, or in fact anywhere. He was suffering from a most royal pain in the rump.
Personal hygiene at this time was almost non-existent. The Church had proclaimed public bathing led to immorality, promiscuous sex and disease.
Physicians pronounced that water carried disease into the body through the skin. Even washing one’s face was dangerous. It caused inflammations and weakened eyesight.
King Louis XIV is said to have only bathed twice in lifetime. He found bathing a disturbing act, as did Queen Isabel I of Spain who also confessed to having only two baths; on the day of her birth and the day of her marriage.
Despite the powdered wigs, the heavy perfumes and the sachets of scented herbs concealed in clothing, the royal presence in the Palace of Versailles could often be smelt before it was heard.
A Russian ambassador to France noted that His Majesty Louis XIV "stunk like a wild animal."
The king himself would often open a window, so that his courtiers would not be overcome by his bodily stench, perhaps somewhat exacerbated around this time by his rear end swelling.
As Patrick Süskind writes in the marvellous first chapter of Perfume:
In the period of which we speak, there reigned in the cities a stench barely conceivable to us modern men and women. The streets stank of manure, the courtyards of urine, the stairwells stank of moldering wood and rat droppings, the kitchens of spoiled cabbage and mutton fat; the unaired parlors stank of stale dust, the bedrooms of greasy sheets, damp featherbeds, and the pungently sweet aroma of chamber pots. The stench of sulfur rose from the chimneys, the stench of caustic lyes from the tanneries, and from the slaughterhouses came the stench of congealed blood. People stank of sweat and unwashed clothes; from their mouths came the stench of rotting teeth, from their bellies that of onions, and from their bodies, if they were no longer very young, came the stench of rancid cheese and sour milk and tumorous disease. The rivers stank, the marketplaces stank, the churches stank, it stank beneath the bridges and in the palaces. The peasant stank as did the priest, the apprentice as did his master’s wife, the whole of the aristocracy stank, even the king himself stank, stank like a rank lion, and the queen like an old goat, summer and winter.
But back to the king’s bum…
While definitely not a believer in baths, the king did like a regular enema. Records state he had some 2000 enemas, none of which reduced the swelling and pain of his anal fistula.
In desperation the king and his royal doctors sent for the hero of our story, barber-surgeon Charles-François Felix.
Barber-surgeons were barbers by profession who also performed blood-letting, teeth extraction, and other minor operations.
Physicians rarely cut into a living human body. This job was left to barber-surgeons. One can only imagine the stress and panic of Monsieur Felix when presented with the royal derriere and a royal decree to cut open the king.
He wisely asked for six months to prepare the operation. Under royal patronage he procured about 75 men from the prisons and countryside; most of them, at least at that point in time, in relatively good health. He then went to work, cutting and slicing, on three or four guinea pigs per week, of course with no anaesthesia and no antibiotics. Many didn’t survive. With each bloody operation he developed and refined his two surgical instruments for his royal rendezvous with fate.
The ‘royally curved’ scalpel, which looks like a delicate hand-held scythe (faucille) and the retractor, which defies description, can be viewed today by curious visitors at the Palace of Versailles.
On November 18, 1686, at 7 o'clock in the morning, Monsieur Felix operated on the king. Present were Madame de Maintenon, (Louis’ mistress whom he later married), his son the Dauphin, his confessor, his physicians, and his Minister of State. And, of course, one rather stressed barber-surgeon, who was undoubtedly familiar with the work of Moliére, whose character Beralde in Le Malade Imaginaire observed:
Medicine is only for those who are fit enough to survive the treatment as well as the illness.
The operation was a success. The king was sitting up in bed within a month and was back on his horse within three months.
The royal court was delirious with joy. Fistulas were fashionable and something to be celebrated. The more devoted courtiers developed fake fistulas and took to wearing swathes of bandages around their buttocks, known as le royale, in homage to the king’s bandaged rear end.
The more fanatical royal devotees demanded the same operation from the barber-surgeon.
Monsieur Felix did not pick up his famed royal scalpel or another scalpel again. He received money, lands and a title; Charles-François Félix de Tassy.
The courage of both Monsieur Felix and the King gave a newfound respectability to surgeons. On December 18, 1731, the king’s grandson, Louis XV opened the Royal Academy of Surgery, now known as the National Academy of Surgery. There you will find this portrait of Charles-François Felix with the caption: Louis XIV's first surgeon.
* a fistula is an abnormal connection between an organ, vessel, or intestine and another structure. Fistulas are usually the result of injury, infection or inflammation.