|Circumcision and phimosis in eighteenth century France|
Did Louis XVI’s phimosis really cause the French Revolution?
A few points on circumcision in eighteenth century France
In the latest rewrite of his familiar list of “compelling” reasons as to why boys must not be allowed to keep their foreskins , Brian Morris makes the daring claim that Louis XVI, King of France 1754-93, was prevented from consummating his marriage to Marie Antoinette by his “tight foreskin”, and was obliged to submit to circumcision so that he could perform his marital duties. This assertion is presented as one of the numerous reasons why circumcision is “a biomedical imperative” for the 21st century.
This old story is one of the many anecdotes recorded as “compelling reasons” for circumcision by the notoriously unreliable circumcision evangelist Peter Charles Remondino, who wrote in the 1890s that the King “was afflicted by a congenital phimosis which prevented the flow of semen from properly discharging itself”. But even a fanatic such as Remondino was forced to concede that that there was no truth in the circumcision rumours, for even if it had been suggested, Louis refused to submit to the operation. Instead, according to Dr Remondino, he worked on dilating his foreskin manually, with such success that he soon fathered three children. 
There has been much speculation as to why Louis and Marie took eight years to produce an heir. Explanations offered have included their strict religious educations, their traumatic childhoods, the extreme youth of the two spouses, and the condition of the King’s foreskin. A reliable review of the case is provided by the Greek urologist George Androutsos, who concludes that there is no evidence that Louis was circumcised, but suggests that he was probably late in reaching puberty and also that he might have had an associated persistent phimosis or a short frenulum (frenulum breve) that made intercourse difficult. If so, it is possible that the problem was corrected by a very mild surgical intervention, involving no more than nicking the strands of tissue that tethered the foreskin, and not by amputating anything from the royal person.  This would have been similar to the limited operation for phimosis later recommended by the French sexual health authority Philippe Ricord, and practised in England by William Acton.  There is no firm evidence that Louis ever had any kind of surgery on his penis, but if he did have an operation, this is the most likely contender.
Morris seems vaguely aware as to the absence of evidence in favour of this anecdote, for the only citation he provides is to his own website, where he goes so far as to insinuate that Louis’ phimosis caused the French Revolution.
There are many fascinating historical aspects involving circumcision or lack thereof. For example, some argue that the latter may have precipitated the French Revolution. Marie Antoinette, 12th daughter of the Emperor and Empress of Austria, much hated by France, married the future Louis XVI in 1770 at the age of 14. By 18, still immature and lacking in intellectual interests, she became queen.
Louis XVI suffered from phimosis (tight foreskin) that prevented successful intercourse. As a result Antoinette was deprived of the responsibilities of motherhood, which might have matured her. She indulged in lavish amusements, balls, plays and receptions that pandered to her childish fantasies, even building a model dairy farm “dolls house” at Trianon. Her enemies accused her of bankrupting France. In a secret visit to France her brother, Emperor Joseph II, reprimanded her and also persuaded Louis to get circumcised. This was 8 years after their marriage. Although she subsequently bore 3 children, the damage had been done. The rest is history, the Revolution took place, and both were executed in 1793. 
Who those mysterious “some” may be, in the vague phrase “some argue that …”, is not revealed.
As Androutsos has shown , there was nothing secret about Joseph’s visit to France, and there is not the slightest possibility that the King was circumcised, yet Morris repeats this far-fetched story in his article. Even if he is unable to read French, the barest knowledge of the history of medically rationalised circumcision would have been enough to tell him that the notion of the King of France getting circumcised was implausible. The earliest mention of circumcision as a medical or health related procedure comes in the early eighteenth century, in a quackish book on venereal disease by John Marten – the same entrepreneurial pox doctor who bears much of the responsibility for launching the masturbation phobia on the Western world.  But even then the operation was only suggested for adults who experienced serious problems, and there is no evidence that the procedure was widely, or ever, performed.
Circumcision not seen as medical procedureIt would have been a most extraordinary thing if the King of France – His Most Christian Majesty – had consented to being circumcised, and if we consider how circumcision was viewed in eighteenth century France we can readily appreciate how preposterous the suggestion really is. In eighteenth century Europe circumcision was almost unheard of as a medical procedure, and insofar as it was known at all, it was understood as a religious rite performed by Jews, Muslims and certain African cultures, some of which practised circumcision of women as well. An authoritative statement of how Louis XVI’s contemporaries regarded circumcision is provided by the famous Encyclopedie compiled by Denis Diderot and the Comte d’Alembert in the years 1751 to 1765.
The entry for Circumcision states unequivocally:
Circumcision, noun (Theol.) religious ceremony among Jews and Mohammedans. It consists in the cutting of the foreskin of males who must or who want to profess the Jewish or Muslim religion.
The entry continues with a lengthy discussion of Jewish practice, followed by an explanation of why the Church Fathers rejected the procedure and banned it among Christians. It then adds that the various other peoples that practise circumcision inherited the rite from the Jews:
The origin and use of circumcision among peoples other than the Hebrews, is easy to demonstrate, but all have derived it from Abraham and his descendents. Ishmael driven from the house of the patriarch communicated it to the people of which he was the father, that is, the Ishmaelites and to the Arabs. From these peoples, it was transmitted to the Saracens, to the Turks, and to all the peoples who profess the doctrine of Mohamed. 
In the most up to date and comprehensive encyclopaedia in the world at that time, and one which made special efforts to include all the latest scientific and medical advances, the entry for circumcision makes no mention of the operation as any kind of medical, therapeutic or health-related procedure.
It is of interest, however, that the Encyclopedie’s entry for Prepuce actually says very little about the anatomy or physiology of the penis, but launches immediately into a discussion of circumcision as a hygienic measure desirable in hot climates:
It is more than apparent that the method of circumcising, practiced so universally in the Orient, that it is necessary to consider it less as an act of religion than as a means of keeping the part clean and of hindering the diseases that originate in these regions due to the retention of mucosity supplied by glands that are underneath the prepuce. The same author adds that he has seen Orientals, who, having large swollen prepuces, were frightened to see a mucosity issuing forth, which undoubtedly would not have been there had it not amassed between the prepuce and the glans. It is without doubt this problem among others that the divine legislator of the Jews had in mind to prevent when making a law of circumcision. 
We see here the beginning of two biomedical myths that still maintain their grip on certain dusty corners of the modern health empire: first, the myth that there are glands (usually identified as Tyson’s Glands) on or under the foreskin – and the related myth that sub-preputial moisture is harmful;  secondly, the myth that ritual circumcision as practised by the ancient Hebrews and some Arabs (and later by the Muslims) had its origin in the need to keep the penis clean. (Some travellers, on the other hand, claimed that the foreskins of the people in Middle Eastern regions grew so long that they had to be cut in order to permit impregnation.) There is no truth in either of these stories. There are no glands under the foreskin. Ritual circumcision as practised in the ancient Middle East did not arise from hygienic motives. 
Medical materialismThe fact that the entry for Prepuce differs from the entry for Circumcision reflects the different authors – the latter by a priest (who would be expected to give the traditional religious explanation), the former by the Chevalier de Jaucourt, who was an enthusiastic party to the Encyclopedists’ secularising project. Although they knew little about the anatomy of the penis or the origins and significance of the customs of non-Western peoples, they were determined to give secular and rationalist explanations for strange customs, not the traditional religious explanations that assumed the existence and agency of a supernatural being. Something as bizarre and counter-intuitive as genital mutilation might be explained as a command from the Deity, but if you were trying to take the Deity out of modern life, you had to find another explanation for something so apparently irrational.
Hence the health argument: adapting the Comte de Montesquieu’s account of different social structures and customs arising from differing climatic conditions in his sociological study, L’Esprit des Lois, the Encyclopedists assumed that the custom of circumcision in the desert regions familiar to them was not result of a divine command, but of a rational appreciation of the inconvenience or even the unhealthiness of a foreskin in such torrid conditions. They explained the practice of female circumcision, also common in these regions, in similar terms. They had not done enough research in either anthropology or physiology to make reliable pronouncements on either the functions of the foreskin or the culture of non-European peoples, but they knew enough to advance their ideological project: to “disenchant the world” by providing secular explanations for phenomena previously attributed to the will of the deity. This "medical materialism" (cooking up "health" reasons for customs really deriving from cosmology and social structure), as Mary Douglas calls it in Purity and Danger, has been a fruitful source of confusion and error in both anthropology and medicine and has given rise to many folk myths.
PhimosisThe secularising mission of the French Enlightenment also meant that the Encyclopedie was willing to entertain the possibility of circumcision as a treatment for persistent phimosis in adults, though medical opinion at the time was divided as to the necessity for what was still regarded as a dangerous operation that resulted in an embarrassing disfigurement. As Androutsos reports, leading French surgeons such as Pierre Dionis and Dr Moreau were against it, on the grounds that the problem usually resolved itself (through manipulation and usage), and that surgery was always risky and often left a messy and unaesthetic result. Men valued their foreskin as a sexually dynamic and aesthetically pleasing component of their genitals, and they were not to going to part with it unless it was absolutely necessary. 
The situation had not changed very much by the early nineteenth century. In Charles Pancoucke’s massive Dictionnnaire des Sciences Medicales (1812-20), circumcision is defined as follows:
Circumcision, noun, circumcisio, peritome of the Greeks. Very ancient operation that is only rarely performed for surgical reasons and which is almost always performed for religious or political motives.
Speculating as to the rationale of the rite, the entry expressed clear awareness that circumcision reduced sexual sensation when it stated that losing one’s foreskin was a sacrifice of something precious:
Perhaps the idea of sacrificing to god a part of the organ that is most important to man, from that which enables him to enjoy the only form of immortality to which he has the right to partake, may have played a role in the institution of this bizarre operation.
Nor was the dictionary unaware that circumcision often had unfortunate “complications”:
On the other hand, one cannot say that this operation is followed by no unfortunate accidents. The skin is the not only organ affected, and the vessels that run through it in this area are of such importance that cutting them might cause a haemorrhage that one could not stop easily and promptly.
Pancoucke did acknowledge that circumcision could be useful in cases of severe phimosis in adulthood, though it insisted that, while this condition could be an “inconvenience” to intercourse, it would not necessarily prevent it. If circumcision was performed, the entry continued, it was necessary to ensure that only the bare minimum of tissue be excised, just enough to allow the foreskin to retract easily when the penis is erect. 
ConclusionThese comments, along with the article by Androutsos, forcefully make the point that phimosis in late childhood or adolescence does not usually require surgery, and certainly does not require surgery as radical as circumcision. Persistent phimosis and frenulum breve in adulthood, however, do require intervention, and it’s interesting that the recommended procedure even in the eighteenth century, long before drugs were available, was a minimal slitting of the fibres of the foreskin that prevented retraction. These days the conditions can be easily cured by steroid cream or other minor surgery not requiring the amputation of any tissue.
In conclusion, we may state with confidence that Professor Morris is wrong on all counts. Louis XVI was not circumcised, and still managed to have children; circumcision was not regarded as a medical procedure in the eighteenth century, but as a religious rite; the marital difficulties of an eighteenth century monarch are not among the reasons why circumcision is “imperative” for the 21st century; phimosis is not a reason for prophylactic (precautionary) circumcision of infants, and is very rarely needed for therapeutic circumcision of children or adults. The preferred treatment for phimosis in these modern, scientific times is application of a topical steroid (usually betamethasone valerate), and if that fails there are other options that do not involve amputation. To imply that radical surgery is the only option is to live in the past. 
If an undergraduate history student had made claims as misleading as these in an essay he would have been marked down severely and might have been failed. Such nonsense would certainly never be accepted in a respectable history journal, and it comes as a surprise to find them published in a scientific publication such as BioEssays. If Professor Morris can retail a hoary old chestnut such as this as though it were a proven fact, can we really believe anything he says?
References1. Brian Morris, “Why circumcision is a biomedical imperative for the 21st century”, BioEssays, Vol. 29, November 2007
2. Peter Charles Remondino, History of Circumcision from the Earliest Times to the Present: Moral and Physical Reasons for its Performance, Philadelphia and London, F.A. Davis, 1891, pp. 201-2. Further information on Remondino on this site.
3. Androutsos G., Le phimosis de Louis XVI (1754-1793) aurait-il ete a l’origine de ses difficultes sexuelles et de sa fecundite retardee?. Prog Urol. 2002; 12(1):132-7. An English translation of this article is available on this site.
4. William Acton, A Practical Treatise on the Diseases of the Urinary and Generative Organs (in Both Sexes), 2nd edition, London, Churchill, 1851, pp. 77-78
6. John Marten, A Treatise of all the Degrees and Symptoms of the Venereal Disease, in Both Sexes, 6th edn, London, 1708, Facsimile reprint, New York, Garland, 1985. Discussed in Robert Darby, A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain (University of Chicago Press, 2005), pp. 41, 48-9; Angus McLaren, Impotence: A Cultural History (University of Chicago Press, 2007), chap. 4; Patrick Singy, “The history of masturbation” (Review of Thomas Laqueur, Solitary Sex: A Cultural History of Masturbation), Journal of the History of Medicine and Allied Sciences, Vol. 59, 2004, pp. 112-21
7. Abbe Edme Mallet, “Circumcision”, in Denis Diderot (1713-1784) and Jean d’Alembert (eds), Encyclopedie; ou Dictionnaire raisonne des sciences, des arts et des metiers. Paris: Briasson, 1751-1765, Vol. 3, pp. 458-462.
8. Louis le Chevalier de Jaucourt, “Prepuce”, Encyclopedie, Vol. 13, pp. 306-307
9. Van Howe RS, Hodges FM. The carcinogenicity of smegma: debunking a myth. J Eur Acad Dermatol Venereol 2006;20(9):1046-54.
10. Robert Darby, “The riddle of the sands: Circumcision, history and myth”, New Zealand Medical Journal, Vol. 118, 15 July 2005
11. Charles Panckoucke, Dictionnaire des Sciences Medicales (60 vols, Paris, 1812-22), Vol. 5, pp. 223-227.
12. For example, Van Howe RS. Cost-effective treatment of phimosis. Pediatrics 1998; 102(4)/e43. Rickwood AMK, Kenny SE, Donnell SC. Towards evidence based circumcision of English boys: survey of trends in practice. BrMedJ 2000;321:792-793. Berdeu D, Sauze L, Ha-Vinh P, Blum-Boisgard C. Cost-effectiveness analysis of treatments for phimosis: a comparison of surgical and medicinal approaches and their economic effect. BJU Int 2001; 87: 239-44; Ashfield JE, Nickel KR, Siemens DR, et al. Treatment of phimosis with topical steroids in 194 children. J Urol 2003;169(3):1106-8.