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+The Project Gutenberg EBook of History of Circumcision from the Earliest
+Times to the Present, by Peter Charles Remondino
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: History of Circumcision from the Earliest Times to the Present
+       Moral and Physical Reasons for its Performance
+
+Author: Peter Charles Remondino
+
+Release Date: October 21, 2007 [EBook #23135]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK HISTORY OF CIRCUMCISION ***
+
+
+
+
+Produced by Bryan Ness, LN Yaddanapudi and the Online
+Distributed Proofreading Team at https://www.pgdp.net (This
+file was produced from images generously made available
+by The Internet Archive/Million Book Project)
+
+
+
+
+
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+
+
+No. 11 IN THE PHYSICIANS' AND STUDENTS' READY REFERENCE SERIES
+
+
+HISTORY OF CIRCUMCISION FROM THE EARLIEST TIMES TO THE PRESENT.
+
+MORAL AND PHYSICAL REASONS FOR ITS PERFORMANCE, WITH A HISTORY OF
+EUNUCHISM, HERMAPHRODISM, ETC., AND OF THE DIFFERENT OPERATIONS
+PRACTICED UPON THE PREPUCE.
+
+BY
+
+P. C. REMONDINO, M.D.
+(JEFFERSON),
+
+Member of the American Medical Association, of the American Public
+Health Association, of the San Diego County Medical Society, of the
+State Board of Health of California, and of the Board of Health of the
+City of San Diego; Vice-President of California State Medical Society
+and of Southern California Medical Society, etc.
+
+[Illustration]
+
+PHILADELPHIA AND LONDON:
+F. A. DAVIS, PUBLISHER.
+1891.
+
+Entered according to Act of Congress, in the year 1891, by
+F. A. DAVIS,
+In the Office of the Librarian of Congress, at Washington, D.C., U.S.A.
+
+
+Philadelphia Pa., U. S. A.:
+The Medical Bulletin Printing House,
+1231 Filbert Street.
+
+[Illustration: HEBRAIC CIRCUMCISION]
+
+
+
+
+PREFACE.
+
+
+In ancient Egypt the performance of circumcision was at one time limited
+to the priesthood, who, in addition to the cleanliness that this
+operation imparted to that class, added the shaving of the whole body as
+a means of further purification. The nobility, royalty, and the higher
+warrior class seem to have adopted circumcision as well, either as a
+hygienic precaution or as an aristocratic prerogative and insignia.
+Among the Greeks we find a like practice, and we are told that in the
+times of Pythagoras the Greek philosophers were also circumcised,
+although we find no mention that the operation went beyond the
+intellectual class. In the United States, France, and in England, there
+is a class which also observe circumcision as a hygienic precaution,
+where, from my personal observation, I have found that circumcision is
+thoroughly practiced in every male member of many of the families of the
+class,--this being the physician class. In general conversation with
+physicians on this subject, it has really been surprising to see the
+large number who have had themselves circumcised, either through the
+advice of some college professor while attending lectures or as a result
+of their own subsequent convictions when engaged in actual practice and
+daily coming in contact both with the benefits that are to be derived in
+the way of a better physical, mental, and moral health, as well as with
+the many dangers and disadvantages that follow the uncircumcised,--the
+latter being probably the most frequent incentive and determinator,--as
+in many of these latter examples the operation of circumcision, with its
+pains, annoyances, and possible and probable dangers, sink into the most
+trifling insignificance in comparison to some of the results that are
+daily observed as the tribute that is paid by the unlucky and unhappy
+wearer of a prepuce for the privilege of possessing such an appendage.
+
+There is one thing that must be admitted concerning circumcision: this
+being that, among medical men or men of ordinary intelligence who have
+had the operation performed, instead of being dissatisfied, they have
+extended the advantages they have themselves received, by having those
+in their charge likewise operated upon. The practice is now much more
+prevalent than is supposed, as there are many Christian families where
+males are regularly circumcised soon after birth, who simply do so as a
+hygienic measure.
+
+For the benefit of these, who may congratulate themselves upon the
+dangers and annoyances that they and their families have escaped, and
+for the benefit of those who would run into these dangers but for timely
+warning, this book has been especially written. To my professional
+brothers the book will prove a source of instruction and recreation,
+for, while it contains a lot of pathology regarding the moral and
+physical reasons why circumcision should be performed, which might be as
+undigestible as a mess of Boston brown bread and beans on a French
+stomach, I have endeavored to make that part of the book readable and
+interesting. The operative chapter will be particularly useful and
+interesting to physicians, as I have there given a careful and impartial
+review of all the operative procedures,--from the most simple to the
+most elaborate,--besides paying more than particular attention to the
+subject of after-dressings. The part that relates to the natural history
+of man will interest all manner of people. I regret that the tabular
+statistics are not to be had, but in this regard we must use our best
+judgment from the material we have on hand; at any rate, I have tried to
+furnish a sufficiency of facts, so that, unless the reader is too
+overexacting, he will not find much difficulty in arriving at a
+conclusion on the subject.
+
+P. C. REMONDINO, M.D.
+
+SAN DIEGO, CALIFORNIA, 1891.
+
+
+
+
+CONTENTS.
+
+
+                                                        PAGE
+
+PREFACE,                                                 iii
+
+INTRODUCTION,                                              1
+
+CHAPTER I.
+ANTIQUITY OF CIRCUMCISION,                                21
+
+CHAPTER II.
+THEORIES AS TO THE ORIGIN OF CIRCUMCISION,                28
+
+CHAPTER III.
+SPREAD OF CIRCUMCISION,                                   34
+
+CHAPTER IV.
+CIRCUMCISION AMONG SAVAGE TRIBES,                         42
+
+CHAPTER V.
+INFIBULATION, MUZZLING, AND OTHER CURIOUS PRACTICES,      46
+
+CHAPTER VI.
+ATTEMPTS TO ABOLISH CIRCUMCISION,                         63
+
+CHAPTER VII.
+MIRACLES AND THE HOLY PREPUCE,                            70
+
+CHAPTER VIII.
+HISTORY OF EMASCULATION, CASTRATION, AND EUNUCHISM,       82
+
+CHAPTER IX.
+PHILOSOPHICAL CONSIDERATIONS RELATING TO EUNUCHISM AND
+MEDICINE,                                                105
+
+CHAPTER X.
+HERMAPHRODISM AND HYPOSPADIAS,                           117
+
+CHAPTER XI.
+RELIGIO MEDICI,                                          134
+
+CHAPTER XII.
+HEBRAIC CIRCUMCISION,                                    143
+
+CHAPTER XIII.
+MEZIZAH, THE FOURTH OR OBJECTIONABLE ACT OF SUCTION,     150
+
+CHAPTER XIV.
+WHAT ARE THE BENEFITS OF CIRCUMCISION?                   161
+
+CHAPTER XV.
+PREDISPOSITION TO AND EXEMPTION AND IMMUNITY FROM
+DISEASE,                                                 183
+
+CHAPTER XVI.
+THE PREPUCE, SYPHILIS, AND PHTHISIS,                     187
+
+CHAPTER XVII.
+SOME REASONS FOR BEING CIRCUMCISED,                      200
+
+CHAPTER XVIII.
+THE PREPUCE AS AN OUTLAW, AND ITS EFFECTS ON THE GLANS,  206
+
+CHAPTER XIX.
+IS THE PREPUCE A NATURAL PHYSIOLOGICAL APPENDAGE?        217
+
+CHAPTER XX.
+THE PREPUCE, PHIMOSIS, AND CANCER,                       226
+
+CHAPTER XXI.
+THE PREPUCE AND GANGRENE OF THE PENIS,                   236
+
+CHAPTER XXII.
+THE PREPUCE, CALCULI, AND OTHER ANNOYANCES,              248
+
+CHAPTER XXIII.
+REFLEX NEUROSES AND THE PREPUCE,                         254
+
+CHAPTER XXIV.
+DYSURIA, ENURESIS, AND RETENTION OF URINE,               275
+
+CHAPTER XXV.
+GENERAL SYSTEMIC DISEASES INDUCED BY THE PREPUCE,        284
+
+CHAPTER XXVI.
+SURGICAL OPERATIONS PERFORMED ON THE PREPUCE,            302
+
+NOTES TO TEXT,                                           323
+
+WORKS AND AUTHORITIES QUOTED,                            336
+
+INDEX,                                                   339
+
+
+
+
+INTRODUCTION.
+
+
+This book is the amplification of a paper, the subject of which was, "A
+Plea for Circumcision; or, the Dangers that Arise from the Prepuce,"
+which was read at the meeting of the Southern California Medical
+Society, at Pasadena, in December, 1889. The material gathered for that
+paper was more than could be used in the ordinary limits of a society
+paper; it was gathered and ready for use, and this suggested its
+arrangement into book form. The subject of the paper was itself
+suggested by a long and personal observation of the changes made in man
+by circumcision. From the individual observation of cases, it was but
+natural to wish to enlarge the scope of our observation and comparison;
+this naturally led to a study of the physical characteristics of the
+only race that could practically be used for the purpose. This race is
+the Jewish race. On carefully studying into the subject, I plainly saw
+that much of their longevity could consistently be ascribed to their
+more practical humanitarianism, in caring for their poor, their sick, as
+well as in their generous provision for their unfortunate aged people.
+The social fabric of the Jewish family is also more calculated to
+promote long life, as, strangely as it may seem, family veneration and
+family love and attachment are far more strong and practical among this
+people than among Christians, this sentiment not being even as strong in
+the Christian races as it is in the Chinese or Japanese. It certainly
+forms as much of a part of the teachings of Christianity as it does of
+Judaism, Buddhism, or Confucianism, only Christians, as a mass, have
+practically forgotten it. The occupation followed by the Jews also in a
+certain degree favors longevity, and the influence on heredity induced
+by all these combined conditions goes for something. But it is not alone
+in the matter of simple longevity--although that implies
+considerable--that the Jewish race is found to be better situated.
+Actual observations show them to be exempt from many diseases which
+affect other races; so that it is not only that they recover more
+promptly, but that they are not, as a class, subjected to the loss of
+time by illness, or to the consequent sufferings due to illness or
+disease, in anything like or like ratio with other people.
+
+There is also a less tendency to criminality, debauchery, and
+intemperance in the race; this, again, can in a measure be ascribed to
+their family influence, which even in our day has not lost that
+patriarchal influence which tinges the home or family life in the Old
+Testament. Crimes against the person or property committed by Jews are
+rare. They likewise do not figure in either police courts or
+penitentiary records; they are not inmates of our poor-houses, but, what
+is also singular, they are never accused of many silly crimes, such as
+indecent exposures, assaults on young girls; nor do they figure in any
+such exposures as the one recently made by the _Pall Mall Gazette_.
+
+After allowing all that, which we can, in its fullest limit, to
+religion, family, or social habit, there is still a wide margin to be
+accounted for. This has naturally let the inquiry, followed in the
+course of this book, into a careful review of the Jewish people; into
+their religion and its character, its relation to other creeds, and to
+the world's history; into their many wanderings, and into the
+dispersion, and we have even been obliged to follow them into the midst
+of the people among whom they have become nationed, to try, if possible,
+to find the cause of this racial difference in health, resistance to
+disease, decay, and death. It has been necessary, in following out the
+research, to give a condensed _résumé_ of the religious, political, and
+social condition of the Jewish commonwealth, which, although in a state
+of dispersion, still exists. I need offer no apology for the extended
+notice this has received in the course of the book. We read with
+increasing interest either Hallam or May, Buckle or Guizot, through the
+spasmodic, halting, retrograding, advancing, erratic, aimless, and
+accidental phases that England has plowed through, from the days of
+goutless, simple, and chaste, but barbarian England of the Saxons, to
+the present civilized, enlightened, gouty, "Darkest England" of General
+Booth; and, after all is said and done, we are no wiser in any practical
+resulting good. We simply know that the English people, so to speak,
+have, as it were, gone through the figures of some social aspects, as if
+dancing the "Lancers," with its forward and back movements, gallop,
+etc., and have finally sat down, better dressed and better housed, but
+in an acquired state of moral and physical degeneration. The Briton of
+Queen Victoria is not the Briton of Queen Boadicea, either morally or
+physically. On the other hand, the system of sociological tables adopted
+by Herbert Spencer would have but little to record for some six thousand
+years--either in religion, morals, or physique--as making any changes in
+the history of that simple people which, in the mountainous regions of
+Ur, in distant Armenia, started on its pilgrimage of life and racial
+existence; in one branch of the family--that of Ishmael--the changes to
+be recorded are so invisible that its descendants may really be said to
+live to-day as they lived then. So that I do not feel that I need to
+apologize for the space I have given to this subject in the course of
+the book. The causes that make these racial distinctions should be of
+interest alike to the moralist, theologist, sociologist, and to the
+physician.
+
+Ecclesiastical writers and moralists, as well as writers of fiction or
+dramatizers, can write on anything they please, and it is eagerly taken
+up and read by the people generally, either of high or low degree,
+alike; and somehow these people seem never to require an apology on the
+part of the author, for having attempted rapes, seductions, or even
+unavoidable fornication committed through the leaves of the story, or
+having it imaginably take place between acts on the stage. But if the
+physician writes a book touching anything connected with the generative
+functions, and with the best intent and for the good of humanity, he is
+expected to make some prefatory apology. He is supposed to address a
+public who all of a sudden have become intensely moral and extremely
+sensitive in their modesty. Why things are thus I cannot explain. They
+are so, nevertheless. From the time that the celebrated Astruc wrote his
+treatise on female diseases, near the end of the seventeenth
+century,--who felt compelled by the extreme modesty of the people in
+this particular--but who, outside of medicine, were about as virtuous as
+the average Tabby or Tom cats in the midnight hour--to write the chapter
+touching on nymphomania in Latin, so as not to shock the morbidly
+sensitive modesty of the French nobility, who then enjoyed _Le Droit de
+cuissage_,--down through to Bienville, who wrote the first extended work
+on nymphomania, and Tissot, who first broached the subject and the
+danger of Onanism, all have felt that they must stop on the threshold
+and "apologize." Tissot, however, seemed to possess a robust and a plain
+Hippocratic mind, and as he apologized he could not help but see the
+ridiculousness of so doing, as in the preface to his work we find the
+following: "Shall we remain silent on so important a subject? By no
+means. The sacred authors, the Fathers of the Church, who present their
+thoughts in living words, and ecclesiastical authors have not felt that
+silence was best. I have followed their example, and shall exclaim, with
+St. Augustine, 'If what I have written scandalizes any prudish persons,
+let them rather accuse the turpitude of their own thoughts than the
+words I have been obliged to use.'"
+
+For my part, I think that people who can go to the theatre and enjoy "As
+in a Looking-Glass," and witness some of the satyrical or billy-goat
+traits of humanity so graphically exhibited in "La Tosca," with evident
+satisfaction; or attend the more robust plays of "Virginius" or of
+"Galba, the Gladiator," with all its suggestions of the Cæsarian
+section, and the lust and the fornications of an intensely animal Roman
+empress, without the destruction of their moral equilibrium or tending
+to induce in them a disposition to commit a rape on the first met,--I
+think such people can be safely intrusted to read this book.
+
+And as to the reading public, there are but few general readers who
+could honestly plead an ignorance of the "Decameron," Balzac, La
+Fontaine, "Heptameron," Crébillon _fils_, or of matter-of-fact Monsieur
+le Docteur Maitre Rabelais,--works which, more or less, carry a moral
+instruction in every tale, which, like the tales of the "Malice of
+Women," in the unexpurged edition of the literal translation of the
+"Arabian Nights," contains much more of practical moral lessons, even if
+in the flowery and warm, spiced language of the Orient, than any
+supposed nastiness, on account of which they are classed among the
+prohibited. To these, and the readers of Amelie Rives's books, or other
+intensely realistic literature, I need not imitate the warning of
+Ansonius, who warned his readers on the threshold of a part of his book
+to "stop and consider well their strength before proceeding with its
+lecture." Metaphorically speaking, the general theatre-going, or modern
+literature-reading public, can be considered pretty callous and morally
+bullet proof. I shall therefore make no apology.
+
+Some fault may, perhaps, be found with some of the occasional style of
+the book, or with some of the subjects used to illustrate a principle.
+To the extremely wise, good, and scientific, these illustrations were
+unnecessary; this need hardly be mentioned; and the passages which to
+some may prove objectionable were not intended for them, either with the
+expectation of delighting them or with the purpose of shocking them.
+These passages, they can easily avoid. This book, however, was written
+that it might be read: not only read by the Solon, Socrates, Plato, or
+Seneca of the laity or the profession, but even by the billy-goated
+dispositioned, vulgar plebeian, who could no more be made to read cold,
+scientific, ungarnished facts than you can make an unwilling horse drink
+at the watering-trough. Human weakness and perversity is silly, but it
+is sillier to ignore that it exists. So, for the sake of boring and
+driving a few solid facts into the otherwise undigesting and unthinking,
+as well as primarily obdurate understanding of the untutored plebeian, I
+ask the indulgence of the intelligent and broad-minded as well as the
+easily inducted reader. Cleopatra was smuggled into Cæsar's presence in
+a roll of tapestry; the Greeks introduced their men into Troy by means
+of a wooden horse; and the discoverer of the broad Pacific Ocean made
+his escape from his importunate creditors disguised as a cask of
+merchandise. So, when we wish to accomplish an object, we must adopt
+appropriate means, even if they may apparently seem to have an entirely
+diametrically opposite object. The Athenian, Themistocles, when wishing
+to make the battle of Salamis decisive, was inspired with the idea of
+sending word to the Persian monarch that the Greeks were trying to
+escape, advising him to block the passage; this saved Greece.
+
+There is a weird and ghostly but interesting tale connected with the
+Moslem conquest of Spain, of how Roderick, the last of the Gothic kings,
+when in trouble and worry, repaired to an old castle, in the secret
+recesses of which was a magic table whereon would pass in grim
+procession the different events of the future of Spain; as he gazed on
+the enchanted table he there saw his own ruin and his country's and
+nation's subjugation. Anatomy is generally called a dry study, but, like
+the enchanted brazen table in the ancient Gothic castle, it tells a no
+less weird or interesting tale of the past. Its revelations lighten up a
+long vista, through the thousands of years through which the human
+species has evolved from its earliest appearance on earth, gradually
+working up through the different evolutionary processes to what is
+to-day supposed to be the acme of perfection as seen in the
+Indo-European and Semitic races of man. Anatomy points to the
+rudiment--still lingering, now and then still appearing in some one man
+and without a trace in the next--of that climbing muscle which shows man
+in the past either nervously escaping up the trunk of a tree in his
+flight from many of the carnivorous animals with whom he was
+contemporary, or, as the shades of night were beginning to gather
+around him, we again see him by the aid of these muscles leisurely
+climbing up to some hospitable fork in the tree, where the robust habits
+of the age allowed him to find a comfortable resting-place; protected
+from the dew of the night by the overhanging branches and from the
+prowling hyena by the height of the tree, he passed the night in
+security. The now useless ear-muscles, as well as the equally useless
+series of muscles about the nose, also tell us of a movable, flapping
+ear capable of being turned in any direction to catch the sound of
+approaching danger, as well as of a movable and dilated nostril that
+scented danger from afar,--the olfactory sense at one time having a
+different function and more essential to life than that of merely noting
+the differential aroma emitted by segars or cups of Mocha or Java, and
+the ear being then used for some more useful purpose than having its
+tympanum tortured by Wagnerian discordant sounds. Our ancestors might
+not have been a very handsome set, nor, judging from the Neanderthal
+skull, could they have had a very winning physiognomy, but they were a
+very hardy and self-reliant set of men. Nature--always careful that
+nothing should interfere with the procreative functions--had provided
+him with a sheath or prepuce, wherein he carried his procreative organ
+safely out of harm's way, in wild steeple-chases through thorny briars
+and bramble-brakes, or, when hardly pushed, and not able to climb
+quickly a tree of his own choice, he was by circumstances forced up the
+sides of some rough-barked or thorny tree. This leathery pouch also
+protected him from the many leeches, small aquatic lizards, or other
+animals that infested the marshes or rivers through which he had at
+times to wade or swim; or served as a protection from the bites of ants
+or other vermin when, tired, he rested on his haunches on some mossy
+bank or sand-hill.
+
+Man has now no use for any of these necessaries of a long-past age,--an
+age so remote that the speculations of Ernest Renan regarding the
+differences between the Semitic race of Shem and the idolatrous
+descendants of Ham, away off in the far mountains and valleys of Asia
+lying between the Mediterranean Sea and the Euphrates, seem more as if
+he were discussing an event of yesterday than something which is
+considered contemporary with our earlier history,--and we find them
+disappearing, disuse gradually producing an obliteration of this tissue
+in some cases, and the modifying influence of evolution producing it in
+others; the climbing muscle, probably the oldest remnant and legacy that
+has descended from our long-haired and muscular ancestry, is the best
+example of disappearance caused by disuse, while the effectual
+disappearance of the prepuce in many cases shows that in that regard
+there exists a marked difference in the evolutionary march among
+different individuals.
+
+There is a strange and unaccountable condition of things, however,
+connected with the prepuce that does not exist with the other vestiges
+of our arboreal or sylvan existence. Firstly, the other conditions have
+nothing that interferes with their disappearance; whereas the prepuce,
+by its mechanical construction and the expanding portions which it
+incloses, tends at times rather to its exaggerated development than to
+its disappearance. Again, whereas the other vestiges have no injury that
+they inflict by their presence, or danger that they cause their
+possessors to run, the prepuce is from time of birth a source of
+annoyance, danger, suffering, and death. Then, again, the other
+conditions are not more developed at birth; whereas the prepuce seems,
+in our pre-natal life, to have an unusual and unseen-for-use existence,
+being in bulk out of all proportion to the organ it is intended to
+cover. Speculation as to its existence is as unprolific of results as
+any we may indulge in regarding the nature, object, or uses of that
+other evolutionary appendage, the appendix vermiformis, the recollection
+of whose existence always adds an extra flavor to tomatoes, figs, or any
+other small-seeded fruits.
+
+We may well exclaim, as we behold this appendage to man,--now of no use
+in health and of the most doubtful assistance to the very organ it was
+intended to protect, when that organ, through its iniquitous tastes, has
+got itself into trouble, and, Job-like, is lying repentant and sick in
+its many wrappings of lint, with perhaps its companions in crime
+imprisoned in a suspensory bandage,--what is this prepuce? Whence, why,
+where, and whither? At times, Nature, as if impatient of the slow march
+of gradual evolution, and exasperated at this persistent and useless as
+well as dangerous relic of a far-distant prehistoric age, takes things
+in her own hands and induces a sloughing to take place, which rids it of
+its annoyance. In the far-off land of Ur, among the mountainous regions
+of Kurdistan, something over six thousand years ago, the fathers of the
+Hebrew race, inspired by a wisdom that could be nothing less than of
+divine origin, forestalled the process of evolution by establishing the
+rite of circumcision. Whether this has been beneficial or injurious to
+the race will be, in a measure, the object of the discussion in this
+book.
+
+One object of this book is to furnish my professional brothers with some
+embodied facts that they may use in convincing the laity in many cases
+where they themselves are convinced that circumcision is absolutely
+necessary; but, having nothing in their text-books to back up their
+opinion with, their explanations are too apt to pass for their mere
+unfounded personal view of the matter. If the patient, or the parents of
+the patient, ask the physician for his authority, he is at a loss, as
+there is nothing that deals with the subject in any extended manner; so
+that this book has been written in as plain English as the
+subject-matter could possibly allow, so that non-professionals could
+easily read and understand it. I have often felt the need of such a
+work; people can understand emergency or accident surgery, military
+surgery, or reparative surgery, but such a thing as surgery to remedy a
+seemingly medical disease, or what might be called the preventive
+practice of surgery, is something they cannot understand. First, and not
+the least, among the incentives to skepticism on this subject is the
+unwelcome fact of a surgical operation, which, no matter how trivial it
+may seem to the surgeon, is a matter of considerable magnitude to the
+patient, his parents, or friends; there are risks, pain, worry,
+annoyances, and expenses to be undergone,--considerations which, either
+singly or unitedly, often lead one to reason against the operation, even
+when otherwise convinced of its need or utility.
+
+The hardest to convince are those, however, who insist on having a
+four-and-a-half-foot-gauge fact driven through their two-foot-gated
+understanding, without it ever occurring to them that the gate, and not
+the fact, is the faulty article, Some of these gentry are very
+unconvincible. They at times remind one of that description given by
+Carlyle in regard to one of the Georges, who found himself, when Prince
+of Wales, leading an army in Flanders, and actually engaged in a
+battle. His Royal Highness was on foot, and was seen standing facing the
+enemy, with outstretched legs, like a Colossus of Rhodes, impassive and
+stolid,--the very impersonification of Dutch courage and aggressiveness.
+There he stood, unconscious whether he was at the head of an army or
+single attendant; he might be overridden and annihilated, overturned and
+expunged, but there he would most assuredly stand and fall, if need be;
+overwhelming squadrons, by their impetus and weight, might ride him down
+and crush him; but one thing was most certain, this certain fact being
+that he never could be made to retreat or advance, as no impression from
+front or rear could convince him of the necessity of either.
+
+Then, there is our statistical friend, who cannot discriminate between
+the exception and the rule by any common-sense deductions. He must have
+all the authentic, carefully-compiled statistics before he can allow
+himself to form any opinion. As long as there is the smallest fraction
+of a decimal unaccounted for in a mathematical way, this individual is
+inconvincible. These men pride themselves upon being methodically exact;
+they express their willingness to be convinced if you can present
+acceptable proofs; but, trying to present simple rational proofs to
+these individuals is considerably like presenting a meal of boiled pork
+and cabbage to a confirmed and hypochondriacal dyspeptic,--it only
+increases their mental dyspepsia.
+
+Had Columbus waited to discover America, or had Galileo waited to
+proclaim the motion of the earth, until authorized to a serious
+consideration of the matter by properly-tabled statistics, they would
+have waited a long, long time; and, it may be added, the inconveniences
+that attend the proving of a negative will so interfere with the proper
+arrangement of statistical matter which relates to the prepuce and
+circumcision that, before such tables could be satisfactorily and
+convincingly constructed, time and the evolutionary processes that
+follow it will bid fair to completely remove this debatable appendage
+from man. It may be at a very far-distant period that this evolutionary
+preputial extinction will take place,--probably contemporary with the
+existence of Bulwer's "Coming Race,"--but not at a too remote period for
+the proper and satisfactory tabulation of the statistics.
+
+The ideas of the etiology and pathological processes through which we
+journey,--from a condition of health and good feeling to one of disease,
+miserable feeling, and death,--as described in, or rather as they
+control the sentiment and policy of, this work, are such as have been
+followed by Hutchinson, Fothergill, Beale, Black, Albutt, and
+Richardson, so that if I have totally ignored the old conventional
+systems, with their hide-bound classification of diseases to control the
+etiology, I have not done so without some reliable authority. In
+studying the etiology of diseases we have, as a rule, been content to
+accept the disease when fully formed and properly labeled, being
+apparently satisfied with beginning our investigation not at the initial
+point of departure from health, but at some distant point from this, at
+the point where this departure has elaborated itself, on favorable
+ground, into a tangible general or local disease. As truthfully observed
+by T. Clifford Albutt: "The philosophic inquirer is not satisfied to
+know that a person is suffering, for example, from a cancer. He desires
+to know why he is so suffering,--that is, what are the processes which
+necessarily precede or follow it. He wishes to include this phenomena,
+now isolated, in a series of which it must necessarily be but a member,
+to trace the period of which it must be but a phase. He believes that
+diseased processes have their evolution and the laws of it, as have
+other natural processes, and he believes that these are fixed and
+knowable." To do this, the physician must travel beyond the beaten path
+of etiology as found in our text-books. He must follow Hutchinson in the
+train of reasoning that elucidates the pre-cancerous stage of cancer, or
+tread in the path followed by Sir Lionel Beale, in finding that the
+cause of disease depends on a blood change and the developmental defect,
+or the tendency or inherent weakness of the affected part or organ; to
+fully appreciate the inherent etiological factors that reside in man,
+and which constitute the tendency to disease or premature decay and
+death, we must also be able to follow Canstatt, Day, Rostan, Charcot,
+Rush, Cheyne, Humphry, or Reveille-Parise into the study of the
+different conditions which, though normal, are nevertheless factors of a
+slow or a long life. We must also be able to appreciate fully the value
+of that interdependence of each part of our organism, which often, owing
+to a want of equilibrium of strength and resistance in some part when
+compared to the rest, causes the whole to give way, just as a flaw in a
+levee will cause the whole of the solidly-constructed mass to give way,
+or a demoralized regiment may entail the utter rout of an army. As
+described by George Murray Humphry, in his instructive work on "Old
+Age," at page 11:--
+
+"The first requisite for longevity must clearly be an inherent or inborn
+quality of endurance, of steady, persistent nutritive force, which
+includes reparative force and resistance to disturbing agencies, and a
+good proportion or balance between the several organs. Each organ must
+be sound in itself, and its strength must have a due relation to the
+strength of the other organs. If the heart and the digestive system be
+disproportionately strong, they will overload and oppress the other
+organs, one of which will soon give way; and, as the strength of the
+human body, like that of a chain, is to be measured by its weaker link,
+one disproportionately feeble organ endangers or destroys the whole. The
+second requisite is freedom from exposure to the various casualties,
+indiscretions, and other causes of disease to which illness and early
+death are so much due."
+
+In following out our study of diseases, we have been too closely
+narrowed down by the old symptomatic story of disease; we have too much
+treated surface symptoms, and neglected to study the man and his
+surroundings as a whole; we have overlooked the fact that there exists a
+geographical fatalism in a physical sense as well as the existence of
+the influence of that climatic fatalism so well described by Alfred
+Haviland, and the presence of a fatalism of individual constitution as
+well, which is either inherited or acquired. The idea that Charcot
+elaborates, that, as the year passes successively through the hot and
+the cold, through the dry and the wet season, with advancing age the
+human body undergoes like changes, and diseases assume certain
+characteristics, are also points that are overlooked; and nowhere is
+this latter view seen to be more neglected than in the relations the
+prepuce bears to infancy, prime and old age, as will be more fully
+explained in the chapters in this book which treat of cancer and
+gangrene. Admitting that Haviland has exaggerated the influence of
+climate as an etiological factor in its specific influence in producing
+certain diseases; or that M. Taine claims more than he should for his
+"Thèorie des Milieux," or influence of surroundings; or that Hutchinson
+has drawn the hereditary and pedigreeal fatherhood of disease too
+finely; it must also be admitted that the solid, tangible truths upon
+which these authors have founded their premises are plainly visible to
+the most skeptical; the architectural details of the superstructure may
+be defective, but the foundation is permanent.
+
+From the above outline it will be easier for the reader to follow out
+the reasons, or the whys or wherefores, of the views expressed on
+medicine in the course of the book; and, although I do not wish to enter
+the medical field like a Peter the Hermit on a new crusade, to lure
+thousands into the hands of the circumcisers, nor, as a new Mohammed,
+promise the eternal bliss and glory of the seventh heaven to all the
+circumcised, I ask of my professional brothers a calm and unprejudiced
+perusal of the tangible and authentic facts that I have honestly
+gathered and conscientiously commented upon from my field of vision,
+which will be plainly presented in the following pages. I simply have
+given the facts and my impressions: the reader is at liberty to draw his
+own conclusions.
+
+If I have been too tedious in the multiplication of incidents in support
+of certain views, I must remind the reader that the verdict goes to him
+who has the preponderance of testimony, and that many a lawsuit is lost
+from the neglect, on the part of the loser, to secure all the available
+testimony. Having brought the subject of circumcision before the bar of
+public opinion, as well as that of my professional brother, I would but
+illy do justice to the subject at the bar, or to myself, not to properly
+present the case; as it was remarked by Napoleon, "God is on the side of
+the heaviest artillery," and he who loses a battle for want of guns
+should not rail at Providence if, having them on hand, he has neglected
+to bring them into action.
+
+The reasons for the existence of the book will become self-evident as
+the reader labors through the medical part of the work. Our text-books
+are, as a class, even those on diseases of children as a specialty,
+singularly and unpardonably silent and deficient on the subject of
+either the prepuce and the diseases to which it leads, or circumcision;
+and even our surgical works are not sufficiently explicit, as they deal
+more with the developed disease and the operative measures for its
+removal than on any preventive surgery or medicine. Our works on
+medicine are equally silent, and, although from a perusal of the latter
+part of the book the prepuce and circumcision will be seen to have
+considerable bearing on the production and nature of phthisis, this
+subject would, owing to our strabismic way of studying medicine, look
+most singularly out of place in a work devoted to diseases of the lungs
+or throat. Owing to this poverty of literature on the subject, and that
+the library of the average practitioner could therefore not furnish all
+the data relating to it that the profession have in their possession, a
+book of this nature will furnish them the required material whereupon to
+form the basis of an opinion on the subject.
+
+To argue that the prepuce is not such a deadly appendage because so many
+escape alive and well who are uncircumcised, would be as logical as to
+assume that Lee's chief of artillery neglected to properly place his
+guns on the heights back of Fredericksburg. He had asserted, the night
+before the battle, that not a chicken could live on the intervening
+plateau between the heights and the town. On the next day, when these
+guns opened their fire, the Federals were unable to reach the heights,
+while many men were for hours in the iron hail-sweeping discharges of
+that artillery that mowed them down by whole ranks, and yet the majority
+escaped alive. We take the middle ground, and, while admitting that many
+escape alive with a prepuce, claim that more are crippled than are
+visibly seen, as, like Bret Harte's "Heathen Chinee," the ways of the
+prepuce are dark and mysterious as well as peculiar.
+
+A discussion of the relative merits of religious creeds, when considered
+in relation to health, has been, from the nature of the subject of the
+book, unavoidable. Modern Christianity but very imperfectly explains why
+this rite was either neglected or abolished. Frequent reference is made
+to what Saint Paul said and did, but, as Saint Paul was not one of the
+Disciples, it is inexplicable wherefrom he received his authority in
+this matter, seeing that the Disciples themselves had no new views on
+the subject. To the student who prefers to study his subject from all
+its aspects, the question naturally arises, "Where, when, and why came
+the authority that abolished this rite?" There is one probable
+explanation, this being that Paul, who was the real promulgator of
+Gentile Christianity, had to establish his creed among an uncircumcised
+race; although, as we shall see, devotees have not scrupled to sacrifice
+their virility in the hope of being more acceptable to God and to be
+better able to observe His commandments, and others, in their blind
+bigotry, have not objected to sitting naked on sand-hills, with a
+six-inch iron ring passed through the prepuce, it is very evident that
+the Apostle Paul's good sense showed him the uselessness of attempting
+to found the new creed, and at the same time hold on to the truly
+distinctive marking of Judaism among Gentiles, the Hebrew race being
+those among whom he found the least converts, as even the Disciples and
+Apostles in Palestine disagreed with him. In the words of Dr. I. M.
+Wise, it was impossible for the Palestine Apostles, or their flock,
+either to acknowledge Paul as one of their own set or submit to his
+teaching; for they obeyed the Law and he abolished it; they were sent to
+the house of Israel only, and Paul sought the Gentiles with the message
+that the Covenant and the Law were at an end; they had one gospel story
+and he another; they prophesied the speedy return of the Master and a
+restoration of the throne of David in the kingdom of heaven, and he
+prophesied the end of the world and the last day of judgment to be at
+hand; they forbade their converts to eat of unclean food, and especially
+of the sacrificial meats of the Pagans, and he made light of both, as
+well as of the Sabbath and circumcision. In the attempted reconciliation
+that subsequently took place in Jerusalem at the house of James, the
+Jacob of Kaphersamia of the Talmud, Paul was charged by the synod of
+Jewish Christians "with disregarding the Law, forsaking the teachings of
+Moses, and attempting to abolish circumcision." He was bid to recant and
+undergo humiliation with four other Nazarenes, that it might be known
+that he walked orderly and observed the Law; Paul submitted to all that
+was demanded.
+
+This, in short, with the exception of the sayings of Paul on the
+subject, which are all secondary considerations, is really all that
+there is relating to the abolishment of circumcision by the Christians.
+The real Disciples and Apostles believed in Jesus with as much fervor as
+Paul, but it is singular that they who were with the Master should
+always have insisted on the observance of the Law, while Paul as
+energetically insisted on its abolishment.
+
+From these premises, I have seen fit to inquire into the relative merits
+of the three religions practiced by what we call the civilized nations,
+as they affect man morally, physically, and mentally. I have given the
+facts, my impressions, and reasons for being so impressed; from these,
+the reader can easily see that religion has more to do with man's
+temporal existence than is generally believed; its discussion is not,
+therefore, out of place in this book.
+
+Repetitions in the course of the work have been unavoidable. This is not
+a novel nor a work of fiction, and wherever the want of repetition would
+have been an injury, either to the proper representation of a fact or a
+principle, the repetition has not been avoided. In describing the
+operations, I had desired to avoid any too numerous descriptions, as
+that is confusing, but have thought it best to give a number, as the
+reader will thereby obtain the views of the different operators, the
+mode of the operation often being an index to the view of the operator
+in regard to the needs or utility of a prepuce. In the general plan of
+the work, I have adopted the idea and the historical relation carried
+out by Bergmann, of Strasburg, who included all the mutilations
+practiced on the genitals while discussing the subject of circumcision,
+they being, in the originality of performance, somewhat intimately
+connected; this also tends to make the subject more interesting as a
+contribution to the natural history of man,--something in which all
+intelligent persons are more or less interested.
+
+P. C. REMONDINO, M.D.
+SAN DIEGO, CALIFORNIA.
+
+[Illustration: EGYPTIAN CIRCUMCISION.
+
+(From Chabas and Ebers' description of the bas-relief found in the
+temple of Khons, near the great temple of Maut, at Karnac.)]
+
+
+
+
+CHAPTER I.
+
+ANTIQUITY OF CIRCUMCISION.
+
+
+If the ceremonials of the Catholic Church or the High Church
+Episcopalians carry us back into the depths of antiquity, or, as
+remarked by Frothingham, that the ceremonies of St. Peter, at Rome,
+carried him back to the mysteries of Eulesis, to the sacrificial rites
+of ancient Phoenicia, to what misty antiquity does not the contemplation
+of the rite of circumcision take us? The Alexandrian library, with its
+vast collection of precious records, could probably have furnished us
+some information as to its origin and antiquity; but Moslem fanaticism,
+with its belief in the all-sufficiency and infallibility of the Koran,
+was the destruction of that wonderful repository. We must now depend
+wholly on the relation of the Old Testament or on what has since been
+written by the Greek and Italian historians as to its origin and
+practices. The Egyptian monuments and their hyeroglyphics give us no
+information on the subject further back than the reign of Rameses II;
+while the oft-quoted Herodotus wrote some fourteen centuries after the
+Old Testament relation, and Strabo and Diodorus some nineteen centuries
+after the same chronicler. We have, therefore, in their chronological
+order, first, the relation of the Bible; then the Egyptian monuments and
+their revelations; and, thirdly, the information gathered by Pythagoras,
+Herodotus, and other philosophers and historians. To these three
+sources we may add the misty mixture of tradition and mythological
+events, whose beginnings as to period of time are indefinite. These are
+the sources from which we are to determine the origin and antiquity as
+well as the character of the rite.
+
+Voltaire found in the subject of circumcision one that he could not
+satisfactorily make enter into his peculiar system of general
+philosophy. For some reason, he did not wish that the Israelites should
+have the credit of its introduction; were he to have admitted that, he
+would have had to explain away the divine origin of the rite,--something
+that the Hebrew has tenaciously held for over thirty-seven centuries.
+Voltaire thought it would simplify the subject by making it originate
+with the Egyptians, from whom the Hebrews were to borrow it. To do this
+he adopted the relation of Herodotus on the subject. His treatment of
+the Jewish race, however, brought out a strong antagonism from those
+people to his attacks, and in a volume entitled, "Letters of Certain
+Jews to Monsieur Voltaire,"--being a series of criticisms on his
+aspersions on the race and on the writings of the Old Testament (written
+by a number of Portuguese, German, and Polish Jews then residing in
+Holland[1]),--they proved conclusively that the Phoenicians had borrowed
+the rite from the Israelites, as they (the Phoenicians) had practiced
+the rite on the newborn, whereas, had they followed the Egyptian rite,
+they would have only circumcised the child after its having passed its
+thirteenth year,--these being the distinctive differences between the
+Jewish and Egyptian rites.
+
+Luckily, in the small temple of Khons, which formed an annex to the
+greater temple of Maut, at Karnac, there was found a _bas-relief_,
+partly perfect, which goes far toward giving light on the subject of
+Egyptian circumcision. The upper part of the sculpture was so defaced
+that the upper portions of four of the five figures were destroyed, but
+the lower portions were so perfect in every detail as to furnish a full
+history of the age of the candidates for the rite and the manner of its
+performance. It is further interesting from the fact that it establishes
+also the time during which the rite was so performed. M. Chabas and Dr.
+Ebers argue, from the founder of the temple having been Rameses II, that
+the sculpture refers to the circumcision of two of his children. The
+knife appears to be a stone implement, and the operator kneels in front
+of the child, who is standing, while a matron supports him in a kneeling
+posture, and she holds his hands from behind him.[2] In this
+_bas-relief_ we can see the great difference that existed between the
+two forms of the operation, that of the Hebrews being performed, as a
+rule, on the eighth day after birth, while in the _bas-relief_ they are
+ten or twelve years old.
+
+Although tradition and mythology veil past events in more or less
+obscurity, they do, in regard to circumcision, furnish considerable
+explanatory light on matters which would be otherwise hard to reconcile.
+Circumcision has been performed by the Chippeways, on the Upper
+Mississippi, and its modifications were performed among the Mexicans,
+Central Americans, and some South American tribes of Indians, as well as
+among many of the natives dwelling among the islands of the Pacific
+Archipelago. There is a tradition, mentioned by Donnelly in connection
+with the sunken continent of Atlantis, that Ouranos, one of the
+Atlantean kings, ordered his whole army to be circumcised that they
+might escape a fatal scourge then decimating the people to their
+westward.[3] This tradition tells us that the hygienic benefits of
+circumcision were recognized antediluvian facts, as it also points out
+the way by which circumcision traveled westward across to the Western
+World. As Donnelly has pointed out, many of the Americans possessed not
+only traditions, habits, and customs that must have come from the Old
+World, but the similarity of many words and their meaning that exists
+between some of the American languages and those of the indigenous
+inhabitants that have still their remains in spots on the southwestern
+shores of Europe--the ancient Armorica whose colony in Wales still
+retains its ancient words--leaves no room for doubt that at one time a
+landed highway existed between the two worlds. The Mandans, on the Upper
+Missouri, have many words of undoubted Armorican origin in their
+vocabulary,[4] just as the Chiapenec, of Central America, contains its
+principal words denotive of deity, family relations, and many conditions
+of life that are identically the same as in the Hebrew,[5] the name of
+father, son, daughter, God, king, and rich being essentially the same in
+the two languages. It must have been more than a passing coincidence
+that gives the Mandans some of their most expressive words from the
+Welsh, or that gave to Central America many cities bearing analogous
+names with the cities of Armenia.[6] Canadian names of localities, as
+well as those of the Mississippi Valley, denote the French origin of
+their pioneers, as well as the names of Upper California denote the
+nationality and creed of its first settlers. So that there is nothing
+strange in asserting that American civilization and many of the customs
+as found in the fifteenth century by the early Spanish discoverers were
+nothing more than the remains of ancient and modified Phoenician
+civilization, among which figured circumcision.
+
+Dr. A. B. Arnold, of Baltimore, argues that, with the present state of
+our anthropological knowledge and the material that research has been
+able to furnish, we need no longer be surprised to find customs, laws,
+and morals, among nations living in regions of the world widely apart
+from each other, which betray an identity of origin and development, and
+that beliefs and institutions, whether wise or aberrant, grow up under
+apparently dissimilar circumstances, circumcision forming no
+exception.[7] Dr. Arnold leaves too much to chance. It is hardly likely
+that the similarity that existed between the architecture of the
+Phoenicians and the Central Americans, as evinced in their arches; in
+the beginning of the century on the 26th of February; the advancement
+and interest taken in astronomical science; the coexistence of pyramids
+in Egypt and Central America; that five Armenian cities should have
+their namesakes in Central America, should all be a matter of accident.
+The historiographer of the Canary Islands, M. Benshalet, considers that
+those islands once formed a part of the great continent to its west;
+this has been verified by the discovery of many sculptured symbols,
+similar in the Canaries and on the shores of Lake Superior, as well as
+by the discovery of a mummy in the Canaries with sandals whose exact
+counterparts were found in Central America.[8] A compound word used to
+signify the Great Spirit being found identical in the Welsh and Mandan
+languages, each requiring five distinct sounds to pronounce, words as
+intricate as the passwords of secret societies, can hardly be said to be
+the result of chance.[9] There must, at some remote period, have existed
+some communication between the ancestors of these Missouri Mandans and
+the shores of ancient Armorica; the ancestors of these Mandans may have
+then been living farther to the east; they even may have then been a
+tribe of since lost Atlantis; but the analogy, not only in regard to the
+word just mentioned,--_Maho-peneta_, of the Welsh and Mandan,--but in
+the similarity of the pronouns of both languages, and the existence of
+the idea of the counterpart of the sacred white bull of the Egyptians
+being found among the Dakotas, or Sioux, all point to the fact that
+these people, in common with the rest of the Americans, originally came
+from the East; from whence came their languages, manners, customs,
+rites, and what civilization they possessed, among which circumcision
+has, through the mist of centuries, held its own in some shape or other.
+
+That some terrible catastrophe occurred to divide the hemispheres is
+evident; the Western World remaining stationary in its civilization and
+retaining the customs and rites of the times as evidence of their
+origin. With this view of the case, the existence of circumcision as
+found among the inhabitants of the West can easily be traced to its
+origin among the hills of Chaldea. The ancient traditions and
+mythological relations of the Egyptians in regard to the great nation to
+the West are amply verified by the deep-sea soundings of the
+"Challenger," the "Dolphin," and the "Gazelle," which plainly indicate
+the presence of a submarine plateau that once formed the continent of
+Atlantis, whose only visible evidence above the waves of the boisterous
+Atlantic is the Azores and the remains of Phoenician civilization among
+the Americans.
+
+Professor Worman, of Brooklyn, scouts the idea that circumcision was
+ever connected in any way or that it originated in any of the rites
+connected with phallic worship.[10] Bergmann,[11] of Strasburg,
+however, not only claims circumcision to be a direct result of phallic
+worship, but looks upon the rite as something that has been reached by
+what may be termed a gradual evolutionary process of manners, customs,
+and society, from the time of what is termed the hero-warrior period of
+traditional history, when war and the clashing of shields and sword or
+spear were the main delights and occupations of man. It is strange to
+note what difference must have existed between these hero-warriors in
+regard to their ideas of manliness; some were brutal and fiendish,
+whilst others were magnanimous. McPherson, the historiographer of early
+Britain, cannot help but contrast the superior manliness of the heroes
+of Ossian in his graphic description of the ancient Caledonians, when
+compared to the brutality of Homer's Greek heroes. The traditions upon
+which Bergmann undertakes to found the origin of the rite of
+circumcision are all connected with the inhuman and brutish passions
+that animated our barbarous ancestry. The first incident given is the
+Egyptian traditional tragedy, which was, in all probability, the initial
+point of that phallic worship which, with increasing debauchery,
+assisted in the final demoralization of Rome and Greece, after its
+introduction into those countries.
+
+
+
+
+CHAPTER II.
+
+THEORIES AS TO THE ORIGIN OF CIRCUMCISION.
+
+
+We are told that in battle man looked upon the vanquished as unfit to
+bear the name of man, looking upon the weakness or want of skill which
+contributed to their defeat as something effeminate. The victor then
+proceeded by a very summary and effective mode, done in the most
+primitive and expeditious manner, to render his victim as much like a
+female as possible to all outward appearances; this was accomplished by
+a removal at one sweep of _all_ the organs of generation, the phallus
+being generally retained as a trophy,--a practice which was also carried
+into effect with dead enemies, to show that the victor had vanquished
+_men_. It has been the practice from time immemorial for a victor to
+carry off some portion of the body of his victim or defeated enemy, as a
+mark or testimony of his prowess; it was either a hand, head or scalp,
+lower jaw, or finger. The carrying off of the phallus or virile member
+was considered the most conclusive proof of the nature of the
+vanquished, and, as it established the sex, it conferred a greater title
+to bravery and skill than a mere collection of hands or scalps, which
+would not denote the sex. In conformity with this custom, we find that
+Osiris, when he returned to Egypt and found that Typhon had fomented
+dissension in his absence, being vanquished by the latter in the
+conflict that followed, was dismembered and cut into pieces, the
+followers of Typhon each securing a piece and Typhon himself securing
+the phallus or generative member. Isis, the spouse of Osiris, seems in
+turn to have secured the control of government, and, having secured all
+the pieces of the dissected Osiris except the phallus,--Typhon having
+fled with that, and, according to some traditions, having thrown it into
+the sea,--Isis ordered that statues should be constructed, each to
+contain a piece of the unfortunate Osiris, who should thereafter be
+worshiped as a god, and that the priesthood should choose from among the
+animals some one kind which should thereafter be considered sacred. The
+phallus which was missing was ordered special worship, with more marked
+solemnities and mysteries; from this originated the phallic worship and
+the sacredness of the white bull, Apis, among the Egyptians, which was
+chosen to represent Osiris.
+
+By gradual evolution and the progress of society, the cultivation of the
+ground and the need of menials, warriors found some other use for their
+prisoners taken in strife besides merely cutting off the phallus as a
+trophy; these prisoners began to have some intrinsic value. From this a
+change came about; the warrior instinct, however, still claimed that the
+vanquished, even if a slave, should still convey or carry some sign of
+servitude. The original idea of the ablation of the phallus was to
+emasculate the victim; investigation developed the idea that the same
+object could be accomplished by castration, an operation which also
+finally reached a tolerable state of perfection through different stages
+of evolution, it first being performed by a complete removal of the
+whole scrotum and contents. This operation, with the ignorance of the
+times in regard to stopping hæmorrhage, was, however, accompanied by a
+large mortality, and it finally evolved into the simple removal of the
+gland, or its obliteration by pressure or violence. Bergmann conveys the
+idea that circumcision was at one time the indestructible marking and
+the distinctive feature of the slave, the mind of the period not being
+able to emancipate itself from the idea that the genitals must in some
+manner be mutilated, not being able to conceive any other degrading mark
+of manhood which barbarians felt they must inflict on slaves.
+
+The generally accepted idea in regard to the physical mutilation of
+captives taken in war, or that some token from the body of the
+vanquished must be carried off by the victor, has not only the support
+of tradition and monumental sculptured evidence, but its practice is
+still in vogue among many races. Among the ancient Scythians, only the
+warriors who returned from the battle or foray with the heads of the
+enemy were entitled to a share in the spoils. Among the modern Berbers
+it is still a practice for a young man, on proposing marriage, to
+exhibit to his prospective father-in-law the virile members of all the
+enemies he has overcome, as evidence of his manhood and right to the
+title of warrior. The Abyssinians and some of the negro tribes on the
+Guinea coast still follow the custom of securing the phallus of a fallen
+foe. However barbarous this practice may seem, its actual performance is
+only secondary, the primary motive being that the warrior wished to
+prove that he had been there, engaged in actual strife, and that his
+enemy had been overcome. The writer remembers that, after one of the
+battles in the West during the late war, many letters arrived in his
+locality with pieces of the garments or locks of the hair of the
+unfortunate Confederate general, Zollikoffer, who had been slain in the
+battle; a disposition in the warrior, seemingly still existing, such as
+animated the old Egyptians. On an old Egyptian monument,--that of
+Osymandyas,--Diodorus noticed a mural sculpture, a _bas-relief_
+representing prisoners of war, either in chains or bound with cords,
+being registered by a royal scribe preparatory to losing either the
+right hand or the phallus, a pile of which is visible in one corner of
+the foreground; from this sculpture we learn that the practice was not
+only an individual performance, but that it was a national usage among
+the Egyptians as well, who subjected, at times, their vanquished foes to
+its ordeal in a wholesale but business-like manner.
+
+Bergmann argues that the Israelites were given to like practices, and
+cites the incident wherein David brought two hundred prepuces--as
+evidence of his having slaughtered that number of Philistines--to Saul,
+as a mark of his being worthy to be his son-in-law. He argues that,
+whereas many have made that Old Testament passage to read "two hundred
+prepuces," it should have read "two hundred virile members" which David
+and his companions had cut off from the Philistines, the word _orloth_
+meaning the virile member, and not the prepuce. That Israelitish
+circumcision could have originated from either phallic worship or any of
+the hero-warrior usages is untenable as a proposition, as regards the
+living prisoners, and is contrary to the monotheistic idea which ruled
+Israel, or to the benign nature of their God. The strict opposition of
+the religion of Judaism to any other mutilation except that of the
+covenant is also antagonistic to the views advanced by Bergmann, as it
+is well known that even emasculated animals were considered imperfect
+and unclean, and therefore unfit to be received or offered as a
+sacrifice to their deity. No emasculated man was allowed to enter the
+priesthood or assist at sacrifices. The whole idea of Judaism being
+opposed to such mutilations, their observance of circumcision and its
+performance can in no way have developed from either phallic or other
+warlike rites or usages; but we must accept its origin as a purely
+religious rite,--a covenant of the most rigid observance, coincident in
+its inception with the formation of the Hebraic creed in the hills of
+Chaldea.
+
+What Herodotus or Pythagoras may have written concerning the practice
+among the Egyptians was written, as already remarked, some nine
+centuries after Moses had recorded his laws; Moses himself having come
+some centuries after Abraham. Herodotus is quoted as representing that
+the Phoenicians borrowed the practice from the Egyptians, in support of
+the theory that Egypt was the central nucleus from whence the practice
+started, and not that it traveled toward Egypt from Phoenicia. The
+difference in the ages, already mentioned, at which the rite was
+practiced--that of Phoenicia and Israel being at one time
+identical--shows that the testimony of Herodotus in this one particular
+was the result of faulty judgment, as we find the people who have
+borrowed the practice from the Egyptians, as well as their descendants,
+closely follow their practice in regard to the age at which the
+operation should be performed. Another evidence of the strictly
+religious nature of the rite, as far as the Hebrews are concerned, lies
+in the fact that, with all their skill in surgery and medical
+sciences,--they being at one time the only intelligent exponents of our
+science,--they never made any alteration or improvement in the manner of
+performing the operation. It is evident that even Maimonides, a
+celebrated Jewish physician of the twelfth century, who furnished some
+rules in regard to the operation, was held under some constraint by the
+religious aspect of the rite. As a summary of this part of the subject,
+it may be stated that the Old Testament furnished the only reliable and
+authentic relation prior to Pythagoras and Herodotus. From its evidence,
+Abraham was the first to perform the operation, which he seems to have
+performed on himself, his son, and servants,--in all, numbering nearly
+four hundred males; he then dwelt in Chaldea. In absence of other as
+reliable evidence we must accept this testimony in regard to its origin,
+causes, and antiquity.
+
+Voltaire, in his article on circumcision in his "Philosophical
+Dictionary," seems more intent on breaking down any testimony that might
+favor belief in any religion than to impart any useful light or
+information. He bases all his arguments on the book "Euterpe," of
+Herodotus, wherein he relates that the Colchis appear to come from
+Egypt, as they remembered the ancient Egyptians and their customs more
+than the Egyptians remembered either the Colchis or their customs; the
+Colchis claimed to be an Egyptian colony settled there by Sesostris and
+resembled the Egyptians. Voltaire claims that, as the Jews were then in
+a small nook of Arabia Petrea, it is hardly likely that, they being then
+an insignificant people, the Egyptians would have borrowed any of their
+customs. To read Voltaire's "Herodotus" is somewhat convincing, but
+Voltaire's "Herodotus" and Herodotus writing himself are two different
+things, and the book "Euterpe" says quite another thing from what M.
+Voltaire makes it say. A perusal of Voltaire and a study of his Jewish
+critics on this subject, as found in the "Jews' Letters to Voltaire,"
+will convince any reader that as to circumcision M. Voltaire is an
+unreliable authority.
+
+
+
+
+CHAPTER III.
+
+SPREAD OF CIRCUMCISION.
+
+
+From Chaldea, then, in the mountains of Armenia and Kurdistan, the
+practice of circumcision was, in all probability, first adopted by the
+Phoenicians, who finally relinquished the Israelitish rite as to age of
+performance and exchanged it for the Egyptian rite. From Phoenicia its
+spread through the maritime enterprises of this race to foreign parts
+was easy. Egypt was the next place to adopt its practice; at first the
+priesthood and nobility, which included royalty, were the only ones who
+availed themselves of the practice. The Egyptians connected circumcision
+with hygiene and cleanliness; this was the view of Herodotus, who looked
+upon the rite as a strictly hygienic measure. History relates of the
+existence of circumcision among the Egyptians as far back as the reign
+of Psammétich, who ruled toward the end of the sixth century B.C. The
+practice must then have been of a very religious and national nature, as
+we are told that Psammétich, having admitted some noted strangers, whom
+he allowed to dwell in Egypt without being circumcised, brought himself
+into great disfavor among his subjects, and especially by the army, who
+looked upon an uncircumcised stranger as one undeserving of favors.
+During the next century Pythagoras visited Egypt, and was compelled to
+submit to be circumcised before being admitted to the privilege of
+studying in the Egyptian temples. In the following century these
+restrictions were removed, for neither Herodotus nor Diodorus, who
+visited the country, were obliged to be circumcised, either to dwell
+among the people or to follow their studies. There is one curious habit
+that is mentioned in connection with the rite of circumcision among
+these people, this being its relation to the taking of an oath or a
+solemn obligation. Among the Egyptians the circumcised phallus, as well
+as the rite of circumcision, seemed to be the symbol of the religious as
+well as of the political community, and the circumcised member was
+emblematical of civil patriotism as well as of the orthodox religion of
+the nation. To the Egyptian, his circumcised phallus was the symbol of
+national and religious honor; and as the Anglo-Saxon holds aloft his
+right hand, with his left resting on the holy Bible, while taking an
+oath, so the ancient Egyptian raised his circumcised phallus in token of
+sincerity,--a practice not altogether forgotten by his descendants of
+to-day. It was partly this custom of swearing, or of affirming, with the
+hand under the thigh, by the early Israelites, that caused many to
+believe that their circumcision was borrowed from the Egyptians,
+especially by M. Voltaire, who insists that it was the phallus that the
+hand was placed on, and that the translation has not the proper meaning,
+as given in the Bible.
+
+Among the Arabs it was the practice to circumcise at the age of thirteen
+years, this being the age of Ishmael at his circumcision by his father,
+Abraham. The Arabs practiced circumcision long before the advent of
+Mohammed, who was himself circumcised. Pococke mentions a tradition
+which ascribes to the prophet the words, "Circumcision is an ordinance
+for men, and honorable in women." Although the rite is not a religious
+imposition, it has spread wherever the crescent has carried the
+Mohammedan faith. Uncircumcision and impurity are to a Mohammedan
+synonymous terms. Like the Abyssinians, the Arabs also practice female
+circumcision,--an operation not without considerable medical import, as
+will be explained in the medical part of the work. This practice is also
+common in Ethopia. Some authorities argue, from this association of
+female circumcision among the Southern Arabs, Ethiopians, and
+Abyssinians, that they did not derive their rite from the Israelites;
+but there is not much room for doubt but that the operation came down to
+the Arabians from Abraham through his son Ishmael. Considering the
+occupancy of Syria, Arabia, and Egypt by the French, and the intercourse
+with these countries by the British, it is surprising that the
+profession in the early part of the present century had not full
+information regarding the nature and objects of female circumcision as
+practiced in these countries. Delpesh observes, in relation to the
+Oriental practice, that his information was too vague to determine
+whether it was the nymphæ or the clitoris that were removed, or whether
+it was only practiced in cases of abnormal elongations of these parts.
+M. Murat, however, writes at length on the subject, very intelligently,
+as well as Lonyer-Villermay, who, writing in the same work with Delpesh,
+thinks it is certainly the clitoris that is removed.[12] In Arabia, the
+trade or profession of a _resectricis nympharum_ or she-circumciser is
+as stable an occupation with some matrons as that of cock-castration or
+caponizing is the sole occupation of many a matron in the south of
+Europe. It is related by Abulfeda that, in the battle of Ohod, where
+Mohammedanism came very near to a sudden end by the crushing defeat of
+the prophet and his followers, Hamza, the uncle of the prophet, seeing
+in the opposing ranks a Koreish chief, whom he knew, thus called out:
+"Come on, you son of a she-circumciser!" As Hamza was among the slain,
+it is most likely that he met his death from the hands of the chief,
+whose mother really followed that occupation. So extensive is the
+practice, that these old women sometimes go through a village crying out
+their occupation, like itinerant tinkers or scissors-grinders.
+
+The present ceremonies attending the performance of the rite among the
+Arabians are well described by Dr. Delange, a surgeon of the French
+army, as witnessed by him in the province of Constantine, in Algeria.
+
+With these Arabs, circumcision is performed on a whole class, so to
+speak, at the same time, regardless of the trifling differences in their
+ages. It is preceded by feasting, the total length of the feast being
+for eight days. For the first seven days, all the Arabs of the quarter
+where the candidates for circumcision reside dress in their best. The
+poor have their mantles and clothes carefully washed, and the rich deck
+themselves out in their gold and silver brocaded vests and pantaloons.
+During these seven days there is general rejoicing, and the Arabs spend
+most of this time in the village street, racing, firing guns, or
+engaging in sham battles between the different camps, during which one
+carries the green, or sacred banner, which is supposed to render the
+bearer invulnerable. The battle ends by the standard-bearer being fired
+at by all parties, and falling, but quickly rising again and waving the
+flag in token of its protecting power. The Arabs now adjourn to another
+public place, where the notables and strangers are furnished seats on
+carpets; here a dance to the music of tumtums and the singing of
+invisible females takes place, the dancers being only males.[13] In the
+evening the women sing, to which the men listen in silence, this concert
+being kept up until midnight. On the seventh day, the women, decked out
+in their best, and with all their personal ornaments, accompanied by all
+the young men, armed with their guns and pistols, repair to the
+extremity of the oasis, where they gather plates of fine sand. With this
+sand they return to the village, where it is exposed overnight to the
+glare of the full moon on the terraces of the house. This last day
+closes with a grand banquet, given by the rich whose children are about
+to be circumcised, to which all the people are invited.
+
+The next morning all the relatives of the candidates repair to the house
+where the rite is to be performed; the women going up into the second
+floor, wherefrom they can look down into the court from a porch screened
+with lattice-work, without themselves being seen. The men gather
+together on the ground-floor, together with the operator and his
+assistants and the children about to be circumcised, who are dressed in
+yellow, silken gowns. The child to be operated upon is seated in a pan
+of sand, while an assistant fixes his arms and holds the thighs well
+separated from behind. The circumciser then examines the prepuce, the
+glans, and removes any sebaceous collection. This done, a compress with
+an aperture to admit of the passage of the glans is slipped over the
+organ; a small piece of leather, some six centimetres in diameter, with
+a small hole in the centre, is now used, the free end of the prepuce
+being drawn through the aperture; a ligature of woolen cord is then tied
+on to the prepuce next to the front of the leather shield, and, the
+knife being applied between the thread and the leather, the prepuce is
+removed at one sweep; the mucous inner layer is then lacerated with the
+thumb-nails and turned back over to join the other parts. The surface is
+then sprinkled with _arar_ or _genevriere_ powder and dressed with a
+small cloth bandage, the subsequent dressings consisting of _arar_
+powder and oil. During the operation the women in the gallery keep up an
+unearthly music by means of tumtums, cymbals, and all the kettles and
+saucepans of the neighborhood, which are brought into requisition for
+the occasion. This music is accompanied with songs and chants, each
+woman striking out with an independent song of her own, either
+improvised or suggested by the occasion. This not only serves to drown
+the cries of the children, but it must, in a manner, assist to draw them
+away from the immediate contemplation of their sufferings. The prepuces
+are now gathered together and carried to the end of the oasis, where
+they are buried with ceremony and rejoicings. This circumcision only
+takes place once in three or four years, and the children are from four
+to eight years of age; of fifteen circumcised at the feast witnessed by
+M. Delange, only two had passed their eighth year.
+
+In a very interesting old book,[14] "The Treaties of Alberti Bobovii,"
+who was attached to the court of Mohammed IV, published with annotations
+by Thomas Hyde, of Oxford, in 1690, there is a description of the
+Turkish performance of the rite which leads one to infer that they
+circumcised the children quite young: "Et cum puer præ dolore exclamat,
+imus ex duobus parentibus digitis in melle ad hoc comparato os ei
+obstruit; cæteris spectatoribus acclamantibus. O Deus, O Deus, O Deus.
+Interim quoque Musica perstrepit, tympana et alia crepitacula
+concutiuntur, ne pueri planctus et ploratus audiatur." Bobovii says that
+the age at which circumcision is performed is immaterial provided the
+candidate is old enough to make a profession of faith,--which, however,
+is made for him by the godfather,--in the following words: "There is no
+God but God, and Mohammed is his Prophet," or, as rendered by our
+author, "Non esse Deum nisi ipsum Deum, et Mohammedem esse Legatum
+Dei." To which he adds that the child must not be an infant, but that he
+must be at least eight years of age. Like to the Arabs, the Turks
+celebrated the occasion by feasts, plays, and a general good time; the
+child was kept in bed for fifteen days to allow complete cicatrization
+to take place. The circumcision was performed with the boy standing.
+
+Michel Le Feber, writing in 1681,[15] speaks of the tax levied on the
+Christians by the Turks, that they, the Christians, may enjoy liberty of
+conscience, and observes that, circumcision not being compulsory among
+the Turks, it often led to trouble and annoyances, as many of the Turks
+evaded the operation. The tax-gatherers in Turkey are very industrious,
+and, as being circumcised was, as a rule, sufficient evidence of not
+being a Christian, he often witnessed on the streets scenes wherein
+strangers, arrested by these tax-collectors, were compelled to show
+their circumcision as an indisputable sign of their exemption from the
+tax. He also relates that in their zeal for converts to Mohammedanism
+the Turks often resorted to presents to induce Christians to embrace
+their faith. While in Aleppo, he saw a Portugese sailor, who, through
+presents, had forsaken his religion, but who had repented in the most
+emphatic manner when brought to face circumcision. Finding entreaties in
+vain, the Cadi ordered the immediate administration of a stupefying
+draught, and the sailor was then seized and circumcised without further
+ceremony.
+
+In cases where the new Mohammedan is reasonable and submits like a hero,
+the ceremonies are more elaborate. Le Feber relates that if the
+candidate is a man of note or wealth he is mounted on a horse and
+exhibited all over the city; he is dressed in the richest of Turkish
+robes and in his hand he holds an arrow with the point directed to the
+sky; he is followed by a great concourse of people, some dressed in
+holiday attire and others in fantastic costumes; and general feasting
+and enjoyment is the rule over the course of the march, where all the
+people run to swell the crowd. If the man happens to be a poor man, he
+is simply hurriedly marched about on foot, with a simple arrow in his
+hand pointed skyward, to distinguish him from ordinary mortals; before
+him a crier proclaims in a loud voice that the new religionist has
+ennobled himself by professing the faith of the prophet in this solemn
+manner. A collection for his benefit is taken up among the booths and
+shops, which is mostly appropriated by the conductor, circumciser, and
+his assistants, after which he is circumcised without further ado.
+
+The same author describes the operation as performed on the young Turks
+and the accompanying ceremonies. They differ in some respects from those
+employed in circumcising a convert. The parents of the child give a
+feast in proportion to their means, to which are invited the relatives
+of the family and personal friends; if of the upper ranks, he is
+promenaded about the town to the music of drums and cymbals, dressed in
+rich attire; two warriors lead the procession with drawn swords, and a
+troop of females who sing songs of joy bring up the rear; the procession
+now and then stops, when the two gladiators in the front indulge in a
+fierce set-to, hacking at each other in the most determined and
+murderous manner, but so studiedly shammy that neither is injured; on
+the return to the house, the child, who is usually eight or ten years of
+age, is bound hand and foot to prevent his causing any injury to
+himself, laid on a bed, and circumcised with a razor, the operation
+being performed either by a surgeon or the chief of a mosque.
+
+
+
+
+CHAPTER IV.
+
+CIRCUMCISION AMONG SAVAGE TRIBES.
+
+
+E. Casalis,[16] who, in the capacity of missionary, for a very long time
+resided among the Bassoutos, tells us that among that nation the
+operation is performed at the age of from thirteen to fifteen years. The
+ceremony is gone through once in three or four years. So important an
+event is it considered by the Bassoutos that they date events from one
+of these observances, as the Romans dated events from a certain
+consulship, or the Greeks from an Olympiade. At the time fixed, all the
+candidates go through a sham rebellion and escape to the woods; the
+warriors arm and give chase, and, after a sham battle, capture the
+insurgents, whom they bring back as prisoners, amidst dancing and great
+rejoicings, which are the preludes to the feast. The next day the huts
+of mystery (_mapato_) are erected, where, after the circumcision, the
+young men are to reside for some eight months, under the tutorship of
+experienced teachers, who drill them in the use of the spear, sword, and
+shield, teaching them to endure hunger, thirst, blows, and all manner of
+hardships; prolonged fasts and cruel flagellations being regarded as
+pastimes between the exercises. The severity of the regulations may be
+judged from the fact that the instructors have a right to put to death
+any one who may try to escape from these ordeals. The women are
+rigorously excluded from these camps, but the men are allowed to visit
+them, when they have the privilege of assisting the teachers by adding
+additional blows and precepts to the backs of the unlucky candidates.
+After eight months of such training, the young men are oiled from head
+to foot and dressed in a garment, and are now given the name which they
+are to bear for the rest of their lives. The _mapato_, or mystery hut,
+is now burned to the ground and the young men return to the village. The
+maternal uncle of the youth here presents him with a javelin for his
+defense, and a cow that is to furnish him with nourishment. Until the
+time of his marriage, the newly circumcised dwell together; their duties
+being of a menial character, such as gathering wood and attending to the
+flocks and droves.
+
+M. Paul Lafargue looks upon circumcision among the negro races as being
+a rite commemorating their advent to manhood; Livingstone, who has also
+observed the above, related incidents in relation to the performance of
+_boguera_, or circumcision, among the Bassoutos, believes that with them
+the rite has a purely civil significance, being in no way connected with
+religion.
+
+Among many of the African tribes the young maids have an ordeal
+approaching to circumcision that they must pass when near the age of
+thirteen, this rite bearing precisely the same relation regarding their
+entrance into the state of womanhood that male circumcision denotes the
+entrance into manhood on the part of the males among the Bassoutos. At
+the appointed time the maids are gathered together and conducted to the
+riverbank; they are placed under the care of expert matrons. They here
+reside, after having undergone a kind of baptism; they are maltreated,
+punished, and abused by the old women, with a view of making them hardy
+and insensible to pain; they are also schooled in the science and art of
+African household duties. Among the Gallinas of Sierra Leone, in
+addition to the other observances, the clitoris of the young maid is
+excised at midnight, while the moon is at its full, after which they
+receive their name by which they are to be known through life. The
+initiation of each sex into these mysteries is exclusively for the sex
+engaged, and it would be as fatal for a man to steal into the camp of
+the women during the performance of these ceremonies as it would be
+fatal for a woman to enter a _mapato_ where the young men are undergoing
+their ordeal. After their initiation into womanhood, the maids live by
+themselves, similarly to the young men, until they marry.
+
+Lafargue relates that among the Australians circumcision is held in such
+importance that tribes at war will suspend all hostilities and meet in
+peace during the observance or performance of the rite. Here, again, we
+have a repetition, with a slight variation, of the practices of the
+Bassoutos,--something which gives some countenance to the hero-warrior
+idea of the origin of circumcision advanced by Bergmann. The Australian
+warriors go through a mimic battle, and, after a series of combats,
+finally capture the boys aged about from thirteen to fourteen years,
+whom they bear away amidst the cries and lamentations of the mothers and
+other female relatives, who, in their excess of grief, mutilate
+themselves by cutting gashes into their thighs, so that they bleed
+profusely. The boys are, in the meantime, carried to some out-of-the-way
+place, where an old man, perched on a tree or some rising ground,
+through the means of a musical instrument made of a deal-board and human
+hair, announced that the rite is in process of performance, so that
+neither women nor children might approach. Tufts of moss are placed in
+the axilla and on the pubis, to represent puberty, and among some tribes
+the skin of the penis is divided to the scrotum with a stone knife,
+while others content themselves with simply making a circular incision,
+which removes the prepuce, after the Jewish manner, the excised portion
+being placed as a ring on the median finger of the left hand. The
+circumcised then takes himself to the hills or woods, and there remains
+until healed, carefully guarding himself against the approach of any
+female. After this the third part of the ceremonies takes place: the
+godfather of the youth opens a vein in his own arm, the circumcised
+youth is placed on all-fours, and an incision is made from the neck down
+as far as the lumbar region, and the blood of the godfather is made to
+flow and mingle with that of the godchild; this being in reality a
+bloody baptism, and a near relation to the blood-compacts of the Arabs.
+
+The Malays, as well as the men of Borneo, are circumcised. The Battos
+likewise perform the rite. Among the Islanders they sometimes ligate the
+prepuce so that it drops off. Among the Battos the same object is
+reached by small bamboo sticks, between which the prepuce is fastened.
+In New Caledonia and Tidshi the boys are circumcised in their seventh
+year. The Tonga Islanders split the prepuce on the dorsum with a piece
+of bamboo or of shell. In the Marquesas and Sandwich Islands the
+operation is superintended by the priests.[17]
+
+
+
+
+CHAPTER V.
+
+INFIBULATION, MUZZLING, AND OTHER CURIOUS PRACTICES.
+
+
+It seems a matter of controversy as to whether the Mexicans did or did
+not circumcise their children. That they had a blood-covenant is
+admitted by the historians, as well as the fact that this blood was
+taken from the prepuce; but that the prepuce was actually removed is
+something that is not agreed upon by all authorities. Las Casas and
+Mendieta state that it was practiced by the Aztecs and Totonacs, while
+Brasseur de Bourbourg found traces of its practice among the Mijes. Las
+Casas states that on the twenty-eighth or the twenty-ninth day the child
+was presented to the temple, when the high-priest and his assistants
+placed it upon a stone and cut off the prepuce, the excised part being
+afterward burnt in the ashes. Girls of the same age were deflowered by
+the finger of the high-priest, who ordered the operation to be repeated
+at the sixth year; and once a year, at the fifth month, all the children
+born during the year were scarified on the breast, stomach, or arms, to
+denote their reception as servants of their god. Clavigero, on the other
+hand, denies that circumcision was ever practiced. It was customary in
+Mexico, according to most authorities, to take the children while
+infants to the temple, where the priests made an incision in the ear of
+the females, and an incision in the ear and prepuce of the males.[18]
+
+Grotins and Arias Montan at one time advanced the idea that the western
+coast of South America was peopled by some mutinous sailors from the
+fleets of King Solomon, who, in their endeavor to go away far enough to
+be out of reach, were driven by winds and chance to the Peruvian coast.
+Others have imagined that some of the lost tribes of Israel found their
+way eastward to America, by the way of China, to the Mexican coast. The
+same ideal tradition has made the lost tribes the fathers of the
+Iroquois Nation in the northeastern parts of the United States. An
+author, who will be quoted in another part of this work, scouts the idea
+that the rite, as performed in America, had any connection or common
+origin with the rite performed in Asia and Africa; but, true to his
+theory of the climatic causes of the origin of circumcision, he
+maintains that it originated here as it did elsewhere, being a
+performance born of climatic necessity. He is, however, dissatisfied
+with Father Acosta for not being more explicit in relation to the _modus
+operandi_ of the Mexican circumcision. The want of being explicit, and
+its consequences in this particular regard, may be inferred from a
+"Diatribe on Circumcision," by a Mr. Mallet, in an encyclopædic
+dictionary of the last century, in which Mr. Mallet informs his readers
+that Mexicans were in the habit of _cutting off the ears and prepuces_
+of the newly born. Herrera and Acosta agree with Clavigero in asserting
+that the Mexicans simply _bled_ the prepuce. Pierre d'Angleria and other
+contemporary writers are as emphatic in asserting that in the island of
+Cosumel, in Yucatan, on the sea-board of the Gulf of Mexico and on the
+Florida coast, they have observed circumcision by the complete removal
+of the prepuce with a stone knife. The Spanish monk, Gumilla, relates
+that the Saliva Indians of the Orinoco circumcised their infants on the
+eighth day. These Indians also included the females in the observance
+of the rite. The same author tells us of the barbarous and bloody
+performances, in relation to the rite, of the nations on the banks of
+the Quilato and the Uru, as well as those dwelling along the streams
+that empty into the Apure. The same is said of the Guamo and of the
+Othomacos Indians; according to Gumilla, many of these Indians, in
+addition to the rite of circumcision, inflicted a number of cuts on the
+arms, legs, and over the body, to a degree that amounted to butchery,
+the child being reserved for this inhuman treatment until the age of ten
+or twelve years, that he might, by his greater powers of resistance and
+of recuperation, stand some chance of escaping alive from the ordeal.
+The friar mentions that in 1721 he found a child dying from this
+treatment, the wounds having become gangrenous and the child dying of
+pyæmia; prior to the operation the children were stupefied with some
+narcotic drink, and were insensible during its performance.[19]
+
+Besides circumcision, the Americans practiced several other operations
+that bore an analogy to the operation of infibulation, a procedure
+common to the Orient and to early Europe, and so ancient that, like
+circumcision, its source is in the misty clouds of antiquity. It
+consisted in introducing a large ring, either of gold, silver, or iron,
+through an opening made into the prepuce, the free ends being then
+welded together. Females were treated likewise, the ring including both
+labia. In some countries an agglutination of the parts induced by some
+irritant or a cutting instrument answered the purpose among females.
+Dunglison mentions that the prepuce was first drawn over the glans, and
+then that the ring transfixed the prepuce in that position; that the
+ancients so muzzled the gladiators to prevent them from being enervated
+by venereal indulgence. The ancient Germans lived a life of chastity
+until their marriage, and to their observance of a chaste life can be
+attributed the superior physical development of the race, as both males
+and females were not only fully developed, but were not enervated by
+either sexual excess or inclinations before having offspring, which were
+necessarily robust and healthy. To obtain the same results in a nation
+given to indolence and luxury, and lax in its morality, some physical
+restraint was required, and we therefore find the practice of
+infibulation coming from the warm countries to the East. The ancients
+not only infibulated their gladiators to restrain them from venery, but
+they also subjected their chanters and singers to the same ordeal, as it
+was found to improve the voice; comedians and public dancers were also
+restrained from ruining their talents by the means of infibulation. In
+an old Amsterdam edition of Locke's "Essay on the Extent of the Human
+Understanding," there is a quotation from the voyages of Baumgarten,
+wherein he states having seen in Egypt a devout dervish seated in a
+perfect state of nature among the sand-hillocks, who was regarded as a
+most holy and chaste man for the reason that he did not associate with
+his own kind, but only with the animals. As this was by no means an
+uncommon case, it led the Greek monks, in Greece and Asia Minor, to
+resort to every expedient to protect their chastity; in some of the
+monasteries not only were the monks muzzled by the process of
+infibulation, but they even had rules that excluded all females, either
+human or animal, from within their convent,--a habit that still prevails
+among many of the convents of the Orient to this day,--that on Mount
+Athos especially, omitting the infibulation of the ancients.
+
+Readers living in the climates of extreme ranges and of seasonal change
+cannot understand the physical temptations that beset mortals in certain
+climates, any more than they can imagine the faultless condition of the
+climate itself. The subject of climatic influences will be more fully
+discussed further on; but climate, as a factor of habits and usages in
+one part of the world, that are incomprehensible to those living in
+others, plays a part that is but little appreciated or understood;
+whether it be the question of diet, dress, or custom, climate exerts its
+influence in no uncertain manner. As Sulpicius Severus remarked to the
+Greek monks, when they accused the Gaulish monks with voracity and
+gluttony, "That which you of Greece consider as superfluous, the climate
+of Gaul renders into a positive necessity." So of all physical needs and
+passions,--they are subject to a similar law. Those who have read Canon
+Kingsley's small work on the "Hermits of Asia, Africa, and Europe" will
+appreciate the above remarks; and it may be incidentally mentioned that
+his description of the climate that is common to the hilly country
+bordering on the eastern half of the Mediterranean Sea gives as vivid
+and as graphic a description of the physical condition of the climate
+and of its effects as can well be written. It occurs in the life of the
+hermit Hilarion, and the description given relates to his last home in
+the ruins of an old temple, situated on a cliff in the island of Cyprus,
+where the air is so invigorating that "man needs there hardly to eat,
+drink, or sleep, for the act of breathing will give life enough." The
+work gives the best insight also into origin and causes that led to
+monachism, as well as it tells the benefit that the condition conferred
+on humanity, showing a phase in the march of civilization that is but
+little understood.
+
+But, to return to the subject of infibulation, which has, in a manner,
+necessitated this digression from the main topic. Thwing[20] informs us
+that in ancient Germany woman was considered the moral equal of man, and
+that woman might traverse the vast stretches of country unprotected and
+unharmed. Woman never held such a position in the Oriental countries;
+neither has man, under the sub-tropics, a like self-command as shown by
+those ancient Gauls. So that, with the advent of Christianity and the
+moral revolution that followed, primitive methods, either inflicted on
+others or self-inflicted, were adopted to insure a chaste life.
+Infibulation was known, as already stated, for centuries, and in those
+rude times it seemed as the most natural and effective mode of
+accomplishing the object. It was not as barbarous an operation as
+emasculation on the male, as it only temporarily interfered with his
+functions.
+
+In the Old World the practice is still performed in various manners. In
+Ethiopia, when a female child is born the vulva is stitched together,
+allowing only the necessary passage for the needs of nature. These parts
+adhere together, and the father is then possessed of a virgin which he
+can sell to the highest bidder, the union being severed with a sharp
+knife just before marriage. In some parts of Africa and Asia, a ring, as
+before stated, transfixed the labia, which, to be removed, required
+either a file or a chisel; this is worn only by virgins. Married women
+wear a sort of muzzle fastened around the body, locked by means of a key
+or a padlock, the key being only in the possession of the husband. The
+wealthy have their seraglios and eunuchs, that take the place of the
+belt and lock. Another method is a mailed belt worn about the hips, made
+of brass wire, with a secret combination of fastenings, known only to
+the husband. In the museum in Naples are to be seen some of these
+belts, studded with sharp-pointed pikes over the abdominal part of the
+instrument, which was calculated to prevent even innocent familiarity,
+such as nest-hiding, to say nothing of greater evils.
+
+In the "Les Femmes, Les Eunuchs, et Les Guerrieres du Soudan," Col. Du
+Bisson mentions a very peculiar custom invented by the careful jealousy
+that is inseparable from harem life. He had noticed that many of the
+harem inmates, contrary to the general Oriental custom, were allowed to
+go about unattended by the usual guard of eunuchs, but that they walked
+in a painful, hesitating, and impeded manner. This walk was not the
+conventional, short, shuffling step that peculiarity of dress and
+shoe-wear imposes on the Japanese beauty, nor the willowy, swaying gait
+produced in the Chinese beauty by the lack of a sufficiency of foot;
+neither could it be ascribed to the presence of the ancient jingling
+chain of bells which induced the mincing steps of the virgins of
+Judea,--an invention which confined the lower limbs within certain
+limits by being worn just below the knees, and calculated to prevent the
+rupture of the hymen by any undue length of step or violent exercise;
+hence a tinkling noise and a mincing step always denoted a virgin. In Du
+Bisson's cases, however, virgins were out of the question; they might be
+the victims of enforced continence, but a Soudanese harem contains no
+virgins. On inquiry he learned that the very peculiar and unmistakably
+painful gait was due to the fact that each woman carried a bamboo stick,
+about eight inches in length, three inches or more being inserted in the
+vagina so as to effectually fill the opening, the balance projecting
+beyond, between the thighs of the person; this bamboo stick, or guardian
+of female virtue, was held in place by a strap with a shield that
+covered the vulva, the whole apparatus being strapped about the hips and
+waist, and the whole being held in an undisplaceable position by a
+padlock. This was affixed to the woman whenever she was allowed outside
+the harem grounds, being placed in position by the eunuch, who carried
+the key at his girdle. In such a harness virtue can be considered
+perfectly safe; even safe from any mental depredation or revolution, as,
+with the plug causing such uncomfortable sensations, it is perfectly
+safe to infer that the imagination could not be seduced by any Don
+Juanic or other Byronic unvirtuous revelry. The physical ills that this
+contrivance must cause are necessarily without number, as the instrument
+is not as lightly constructed as our modern stem pessaries; but to the
+Oriental who can replace a woman at any time and who prizes the
+virginity, continence, and chastity of his slaves, even if enforced,
+more than their health or their lives, these are matters of secondary
+importance. In the Soudan there are no divorce courts, hence the
+probable necessity of the apparatus, and, as the woman is not obliged to
+wear it unless she chooses to go out unattended, it can hardly be
+considered as a compulsory barbarity. In the United States such a
+practice might do away with considerable divorce proceedings.
+
+Celsus gives a detailed description of the manner of infibulating as
+practiced among the Romans. According to this authority, it was employed
+by them on the youth attending the public schools, as well as upon the
+actors, dancers, and choristers, who were sold to the directors of the
+plays and spectacles. In the cabinet of the Roman College there are to
+be seen two small statues representing two infibulated musicians, which
+are remarkable for the excessive size of the ring and the leanness of
+the persons to which they are attached. The mode of applying this ring
+did not differ much from the usual method of preparing the ear for
+pendants.[21]
+
+Among the Greek monks mentioned, the infibulation serves a manifold
+purpose; it not only is a sure badge of chastity, but its weight and
+size is very often increased so as to render it an instrument of
+penitence, and considerable rivalry exists at times in this regard.
+Virey notices that the Hindoo bonze, or fakir, at times submits to
+infibulation at the same time that he takes his vows of eternal
+chastity. This ring is at times enormous, being sometimes six inches in
+diameter; so that it is a burden. These saints are held in great esteem
+and veneration.
+
+Nelaton, in the sixth volume of his "Surgery," mentions the case of a
+man who presented himself at Dupuytren's clinic with a tumefied,
+thickened, and somewhat dilapidated and ulcerated prepuce; this prepuce
+had worn a couple of golden padlocks for five years, a woman having thus
+infibulated his organ.
+
+In an elaborate work on the subject of circumcision,[22] de Vanier du
+Havre relates, on the authority of M. Martin Flaccourt, that with the
+Madécasses the children are circumcised on the eighth day after birth;
+and that in some portions of the country the mother swallows the removed
+portion of the prepuce, while in others the father loads the prepuce in
+some form of fire-arm, which is afterward fired in the air. In the
+neighborhood of Djezan, in Arabia, as reported by M. Fulgence Fresnel in
+the _Revue de Deux Mondes_ of 1838, courtship and matrimony are not so
+great social events as they are with our society beaux. The occasion is
+probably considered social enough by the rest of the invited guests, but
+it can hardly be called an agreeable episode in the life of the groom.
+Those whose bashfulness prevents them from contracting marriage in
+civilized communities can have the consolation of knowing that in
+far-off Arabia, among the fierce followers of the conquerors of Spain
+and of the Eastern Empire, they have sympathizing fellow-sufferers whom
+the conventionalities of the country deter from rushing into matrimony.
+In this region, circumcision is performed on the adult at the time of
+his candidacy for matrimonial bliss. A more inauspicious occasion could
+not possibly have been chosen, unless as in another Mohammedan tribe,
+who circumcise the bridegroom on the day after his marriage and sprinkle
+the blood that falls from the cut onto the veil of the bride. The bride
+is present, and the victim is handed over to what might be called the
+executioner of the holy office, who proceeds to circumcise the victim in
+what might be called its utmost degree of performance and barbarity.
+This attention does not stop at the pendulous and loose prepuce. He
+devotes himself to the skin of the whole organ; beginning at the prepuce
+he gradually works backward, removing the whole skin of the penis--a
+flaying alive, and nothing more. Should the victim betray any sign of
+weakness, or allow as much as a sigh or groan to escape him, or even
+allow the muscles of the face to betray the fact that he is not
+immensely enjoying the occasion, the bride elect at once leaves him for
+good, saying that she does not wish a woman for a husband. A large
+proportion of the male population annually die from this operation. So
+that the Arabs of the Djezin can be likened to those spiders who lose
+their life while in the act of copulation,--the female making a dinner
+from off the male,--only the spider is said to die a happy death, while
+that of the Arab is one of misery.
+
+Margrave and Martyr have recorded a very peculiar practice common among
+some South American tribes: A kind of a tube is fastened onto the
+prepuce by means of threads of the _tacoynhaa_, the latter being the
+bark of a certain kind of a tree. Cabras brought one of the natives, so
+muzzled, to Lisbon, on the return from his first voyage. Some tribes
+were observed to wear an apparatus like the old-fashioned
+candle-extinguisher, the virile member having been forced into this
+receptacle, which was strapped about the loins.
+
+The travelers Spix and Martius found the practice of circumcision of
+both sexes in the region of the upper Amazon River and among the Tuncas.
+Squires mentions a curious custom of the aborigines of Nicaragua. They
+wound the penis of their little sons and let some of the blood flow on
+an ear of corn, which is divided among the assembled guests and eaten by
+them with great ceremony.
+
+On the fifth day after birth it is the custom among the Omaha Indians of
+North America to christen the infant, the child being stripped and
+spotted with a red pigment; considerable ceremony accompanies the
+act.[23]
+
+Among the cannibals of Australia, Lumholtz[24] observed a practice that
+seems to have no analogue in the wide world, either as an operation or
+in regard to its purposes. About ninety-five per cent. of the children
+are subjected to the ordeal. This is no less than the formation of an
+artificial hypospadias; this abnormality is formed through the penis
+into the urethra, near its junction with the scrotum; the wound is about
+an inch in length and is made with a flint knife which serves for no
+other purpose; the edges of the wound are burned with a hot stone, and
+the wound is subsequently kept open by the introduction of a small piece
+of wood, which, on healing, leaves a permanent opening. These cannibals
+undoubtedly are inspired by some Malthusian spirit which impels them
+thus to functionally eunuchize themselves in one sense, as during
+copulation the seminal discharge flies out backward through this
+opening, being thereby a most effectual check on further procreation. By
+some, this practice has been attributed to the unreliability of the
+seasons in regard to food-production; but Lumholtz observes that where
+the practice is most in vogue--among the tribes to the west of the
+Diamantina River and west and north of the Gulf of Carpentaria--the
+food-supply is not deficient, the region being full of rats, fish, and
+vegetables. All the tribes are not subject to the practice of the
+operation at the same time of life; in some, the hypospadias is not
+produced until in adult life and after the person has married and has
+become the father of one or two children, when he must submit to the
+requirements of the law; the operation seems to be invested with some
+civil or religious significance, as a palisade or stockade of trees is
+placed around the place where it is performed. A native, aged about
+twenty years, informed Lumholtz that the operation was performed because
+the blacks did not like to hear the children cry about the camp, and,
+further, that they were not desirous of having many children; this
+native had not yet become a father and had not yet been subjected to the
+operation. The natives were observed to be fat and in good physical
+condition.
+
+There is something mysterious in this operation. It can easily be
+conceived how circumcision might at times have been suggested by its
+spontaneous and natural performance without any assistance from man.
+Cullerier reports one case of partial circumcision through the means of
+an accident happening to a painter. The man was at work on a ladder,
+with a small bucket of paint hooked into one of the rounds above him;
+through some means the bucket lost its hold and in falling struck the
+penis on its dorsum with such force that the prepuce was cut through on
+a parallel with the corona of the glans for fully two-thirds of its
+circumference, the glans slipping through the opening and gathering in a
+fleshy bunch underneath the frenum. This man carried this abnormality
+for some years, when, desiring to marry and seeing that this appendage
+would be as much of an impediment as one of the huge rings worn by the
+Hindoo devotee, he applied to Cullevier for advice, who promptly removed
+it with the knife.[25] The writer has seen three cases, during his
+practice, of spontaneous circumcision, all resulting from phymosis as a
+secondary affection to venereal disease. The first case occurred when he
+first entered into practice; it was in a young, stout, and full-blooded
+man with a violent gonorrhoea. There was much swelling and tumefaction
+of the whole organ, which seemed to be very rebellious to all treatment.
+At one of his morning visits he was horrified to observe a transverse,
+livid mark at what seemed to be the middle of the organ; by noon this
+had gained ground to the right and left and there was no mistaking that
+it meant nothing less than mortification. Never having seen a case, the
+natural uncomfortable conclusion was that, through some cause or other
+or the natural result of excessive congestion, the man was about to lose
+one-half of his organ; and Burnside at Fredericksburg was in no greater
+state of suspense and uncertainty with the fate of the Army of the
+Potomac on his hands than the writer must acknowledge he was with this
+man and his organ apparently liquefying under his treatment. The
+surprise can be better imagined than described when, on the following
+morning, the glans made its appearance safe and sound out of its
+imprisonment, and at right angles with the organ there hung the prepuce,
+thick and as large and as long as the penis itself, inflammatory deposit
+and infiltration having brought it to that shape and consistence; the
+glans became completely uncovered; the parts gathered underneath, where,
+in the course of some weeks, they had shrunk to the size of a walnut,
+which was afterward removed by the knife. In this case, as in the other
+two cases observed, the corona was very prominent and acted as an
+internal tourniquet by its upward pressure, the line of demarkation
+being on the dorsum in the three cases noted.
+
+That such cases would suggest circumcision is not only probable but
+possible, as it would point out the manner of performing the operation;
+but, in the cases of the Australian savages, who performed an artificial
+hypospadias on themselves for a specific purpose, requiring a knowledge
+of the anatomical relation of the parts as well as of their
+physiological functions, it is hard to speculate how the operation was
+first suggested or how it came at first to be performed. As a Malthusian
+agent it is certainly an operation of the highest merit, and it should
+be introduced, by all means, in the United States, where the wealth and
+luxury in which the people dwell is fast drifting them toward the same
+whirlpool that engulfed Rome, which was preceded by a dislike to have
+children. Whenever the writer sees the poor anæmic, broken-down victim
+of many miscarriages, he cannot help but feel that, if the laws of the
+Damiantina River savages were enforced on their husbands, it would be a
+blessing to the poor women without materially injuring the husbands,
+who, in case of need of a re-establishment of the functions of
+procreation, might be fitted with a vulcanite plate for the
+occasion,--something like our cleft-palate patients are supplied with a
+plate that enables them to articulate.
+
+It was the custom among the Hottentots, when first discovered or known
+to the whites, to remove one of their testicles. This was supposed to
+enable them to run more swiftly and to be lighter-footed in the race.
+The real reason, afterward found, was a mixture of pure humanitarianism
+and Malthusianism boiled down to Hottentot ethics. With them a monorchid
+was not supposed to beget twins; when twins are born in the family, the
+mother generally smothers the female, if one happens to be such; if not,
+then the feeblest of the two is sacrificed. In their migratory and
+nomadic life the mother finds it impossible to either carry or care for
+the two children. The male Hottentot, rather than have any avoidable
+infanticide in his family, or that his wife should go through and suffer
+the annoyance and pangs of an unnecessary and unprofitable pregnancy,
+generously has one testicle removed; this is something that the ordinary
+civilized white man would not do, even if his legitimate wife and all
+his outside concubines were to have twins or triplets every nine months;
+so that, even as strange as it may appear, civilization must need go to
+the wild Bushmen in search of that grand old Quixotic chivalry that was
+in ancient times always ready to sacrifice itself for the welfare of
+woman.
+
+The old Greek and Roman statues, representing the gods and athletes of
+ancient Greece and Rome, are a puzzle to many, owing to the diminutive
+and phimosed virile organ that the artists have attached to them. Galen
+represents that the disuse of the organ by the athletes was the cause
+of its undeveloped form, and that as the organ of these did not figure
+in the worship of Venus, or participate in the festivals of Bacchus, but
+was used solely and simply for micturating purposes, impotence was often
+the result, citing the case of a patient who came to consult him for an
+obstinate priapism resulting from venereal excess, who met, in his
+anteroom, an athlete who was being treated for the opposite condition,
+due to the too rigid continence to which he had been for years
+subjected. Acton does not believe that continued continence has that
+effect, quoting Dr. Bergeret, who had long been physician to a number of
+religious societies, as saying that he had never seen serious troubles
+of the organs of generation in these communities, which denotes that if
+they indulged in proper fasting and prayer they were in the same
+condition of flaccid impotence as the athlete in Galen's anteroom. Louis
+VII, of France, tried fasting and prayer in connection with rigid
+continence, and, as a result, his wife, Queen Eleonore, was divorced
+from him and married Henry II, of England, who had not been continent.
+Hence, we see that the old sculptors, whether wishing to represent
+Jupiter or Plato, Æsculapius or Mars, a strongly knit and muscular frame
+was desired, an athlete, gladiator, or soldier being used as a model;
+the small, puerile, funnel-prepuced organ belonged to all these muscular
+or well-trained classes, was a natural appendage, as enforced continence
+and the most absolute chastity was the rule, to enforce which they even
+resorted to infibulation. This enforced continence often resulted in
+impotence, even before the prime of life was passed, accompanied by an
+inevitable atrophy of the male organ, with the resulting prepuce in the
+shape in which it is found in a boy of from eight to twelve years,
+precisely as they are found on the statues. How faithful the sculptors
+and artists were to nature and life in their representations can well be
+imagined by a critical examination of the Apollo Belvidere, where the
+difference of the scrotal position that exists between the right and
+left testicles is carried out to the minutest anatomical detail. In our
+age it is hard to conceive why their most masculine men should be
+deified, and all their gods represented as the most perfect of bodily
+development, while at the same time the finest physical specimens of
+manhood were doomed to a life of the most rigorous continence. It is
+also astonishing that all this should be done not from any principle or
+consideration of morality or virtue, but simply as a means subservient
+in producing at its maximum the highest degree of physical development
+and endurance.
+
+
+
+
+CHAPTER VI.
+
+ATTEMPTS TO ABOLISH CIRCUMCISION.
+
+
+Probably no rite or practice of a custom has been such a long-standing
+bone of contention as circumcision; nor does the Sphynx surpass this
+relic of bygone ages in mystery. From time immemorial its practice has
+been the subject of disputes, and its literature finds oftentimes its
+friends and foes ranged side by side. At one time a noted Israelite and
+Voltaire, the scoffer of Judaism, may be consulted on the question as to
+whether Israelite or Egyptian is entitled to priority as to its original
+practice with a like answer; and, again, Christians are found who, after
+a careful investigation, will accord this to the Israelites. In Rome,
+the persecuted Hebrew was stopped on the street and compelled to show
+the mark of circumcision, that he might be taxed, and in Turkish parts
+the Christian was subjected to the same indignity to enable the
+tax-gatherer to harvest the impost which he paid for his liberty of
+conscience and not being circumcised. When the monkish missionaries of
+the Catholic faith first entered Abyssinia, they were shocked to find
+their converts insisting on their time-honored practice of circumcision;
+and later, when the Propaganda sent its own missionaries, they were
+scandalized to see Christians practicing what they looked upon as an
+infidel rite; and nothing but the most earnest confession of faith, with
+the assurance that the rite of circumcision was only a physical remedy,
+and that in their conscience it in no wise possessed any religious
+significance, and that neither did they, in any sense, hold it in any
+connection with the sacrament of baptism, permitted these Abyssinians to
+save themselves from excommunication. Later still, when an Abyssinian
+bishop was present in Lisbon, the clergy of the city refused him the
+right of celebrating the sacrifice of the holy mass in the Cathedral of
+Lisbon, on the ground that he, having been circumcised, was no better
+than a heretic. The Abyssinian Christians still practice the rite at the
+present day.
+
+The Turks, although very fanatical and greater proselyters than the
+Christians of Rome, seem now and then to relax in favor of general
+utility, as we find Bajazet II writing to the Pope, Alexander VI,
+supplicating his Holiness to confer a cardinal's hat on the Archbishop
+of Arles as a special favor to the Turkish emperor, as he knew that the
+archbishop _had a secret leaning toward Mohammedanism_. As the clergy of
+those days, from the Holy Father down, were more politicians than
+followers of the humble Nazarene, the heaven of Mohammed had probably
+more attractions for their taste than the ideal Christian paradise, and
+it is possible that the good archbishop would have submitted to a
+cardinal's hat and circumcision at the same time to secure the good
+things of this world and of those in the world to come. History also
+relates that his most Christian majesty, Henry III, of France, as a
+relaxation to the interminable squabble between two Christian religious
+factions which were rending France, and which in the end cost him his
+life, actually wrote a letter to the Sultan, asking the favor to be
+allowed to stand as godfather at the circumcision of his son. When it is
+remembered that the godfather at a Turkish circumcision has to make a
+strong profession of Moslem faith and the answers as sponsor for the
+child, and must promise that the child will be faithful to the Koran and
+Mohammed, it will be seen that, however much the lower levels of
+humanity may quarrel over trifles, the heads of the people easily
+accommodated themselves to any existing circumstances. Friar Clemens
+might as well have let such a liberal-minded monarch live, as any of the
+existing churches could easily have got along with him.
+
+On the other hand, we have the remarkable tenacity to custom and habit
+in this regard, as exhibited by the Moslems, who, although having
+neither ordinance nor authority for its performance, either in their
+law, creed, or in any order from their prophet, still no more zealous
+circumciser exists than the son of Islam, who exacts from all proselytes
+the excision of the prepuce. Mohammed was circumcised in his boyhood,
+and, although he did not order its performance to his followers, he did
+not see fit to proscribe a custom so general to the Arabians, where the
+greater development of the prepuce probably renders circumcision a
+necessity. From the same reason it is easy to perceive why the rite has
+found such general observance among the Africans, who are as noted for
+long and leathery prepuces as for their slim shanks. One author, writing
+in 1772, in a work entitled "Philosophical Researches on the Americans,"
+treats the subject in a very intelligent manner. His arguments are both
+ingenious and plausible. This author looks upon circumcision as of
+purely climatic origin in its inceptive causes. From a careful survey of
+the natural history of man in his general distribution over the globe,
+he finds that circumcision may be said to be restricted to within
+certain boundaries of latitude, equidistant on both sides of the line.
+No circumcised people have ever inhabited northern regions, and the bulk
+of the circumcised races are found within certain climates. From this
+reasoning it is easy to see why the rite should lose its standing under
+certain climatic conditions, unless bolstered up by some religious
+significance, as it is equally easy to foresee why it should flourish
+elsewhere, even without any religious backing or ordinance. It is well
+known that in Ethiopia and the neighboring countries, excrescences and
+elongation of either the prepuce or nymphæ are as probable as the
+existence of an enlarged thyroid gland or goitre among the inhabitants
+of some of the valleys of Switzerland or of those of the Tyrol.
+According to the author of the treatise just quoted, circumcision would
+be nothing more than a remedy to repair the evils that a faulty
+construction of the human body developed in certain climatic conditions.
+
+With the Israelites it is observed as a religious rite, although they
+are not strangers to the physical benefits that circumcision confers
+upon them; the fact that even where no prepuce exists, as sometimes
+happens, the circumciser nevertheless goes on with the rite, being
+satisfied with drawing a few drops of blood from the skin near the
+glans, stamps the operation essentially as being a religious rite.
+Persecutions have signally failed to suppress its performance by those
+of the Hebrew faith. Beginning with the decree of Antiochus, 167 B.C.,
+which consigned every Hebrew mother to death who dared to circumcise her
+offspring, they have not ceased to suffer in defense of their rite.
+Adrian, among other repressive measures, forbade circumcision; under
+Antonine this edict was still enforced, but he afterward recalled it and
+gave to the Hebrews the right of observing their religious rites. Marcus
+Aurelius, however, revived the edict of Adrian. Heliogabalus, who
+ascended the Roman throne in the year 218 A.D., was himself circumcised.
+During the reign of Constantine all the laws that interfered with
+Hebraic rites were renewed, with the addition that any Hebrew who should
+circumcise a slave should suffer death. Under the sway of Justinian, in
+the sixth century, the persecutions against these people were so
+oppressive that a Hebrew was not allowed to raise or educate his own
+child in the faith of his fathers. In the seventh century, the augurs
+having prophesied the ruin of the Roman Empire by a circumcised race to
+the emperor Heraclius, the persecutions were renewed against these
+unfortunate people. In this century, Hebrews refusing baptism suffered
+banishment and confiscation of all their property; they were obliged to
+renounce the Sabbath, circumcision, and all Hebraic rites if they wished
+to remain. About this period the success of the Saracens induced
+persecutions of the Hebrews in Spain, where their children were taken
+away from them that they might be raised in the Christian religion. In
+the fifteenth century they suffered the greatest persecution and
+martyrdom at the hands of the Spanish Inquisition. The persecutions
+above cited were national and governmental persecutions levelled
+directly at the Jewish nation and creed; the persecutions that they
+momentarily suffered at other times had no signification beyond the
+exhibition of popular spite and fury, but those above cited were moves
+calculated to extirpate the creed, if not the people, from off the face
+of the globe. If repressive measures are of any avail, circumcision as
+an Hebraic rite should now have no existence. Its present existence and
+observance show a vitality that is simply phenomenal; its resistance and
+apparent indestructibility would seem to stamp it as of divine origin.
+No custom, habit, or rite has survived so many ages and so many
+persecutions; other customs have died a natural death with time or want
+of persecution, but circumcision, either in peace or in war, has held
+its own, from the misty epochs of the stone age to the present.
+
+There is something pathetic and soul-appealing in contemplating the
+early Christians forced to worship in the catacombs of Rome, hunted like
+wild animals in their subterranean burrows, and then given the choice of
+making offerings to the heathen gods or being thrown into the arena as
+prey to wild beasts; so are we stirred when we think of the Spanish Jew,
+who had made Spain his home for centuries, being driven into exile in
+such droves that no country could receive them; we see them perishing of
+hunger by the thousands on the African coast, and dying of starvation on
+the quays of the ports of civilized Italy. That many, through all these
+trials, were forced to embrace other religions is not astonishing. In
+Spain apostacy was to no purpose, as the Inquisition could not be
+expected to split hairs in regard to an apostate Jew, when it sent the
+best of Gothic blood, raised in the Catholic faith, to the _auto da fé_
+or the scaffold,--the rack respecting neither faith nor profession that
+fell into its clutches. In milder persecutions, however, he escaped by
+outwardly conforming to the demands of his oppressors and history tells
+us of the circumcisions secretly performed on the dead Jew, that the
+spirit of the law of their fathers might be carried out.
+
+In other cases, threatened exile, confiscation, or exorbitant taxation
+drove them to adopt every possible expedient to eradicate the sign of
+their Israelitism and make attempts to reform a prepuce. The first
+attempts in this line were made during the reign of Antiochus, when a
+number of Hebrews wished to become as the people about them who were not
+persecuted--_fecerunt cibi præputia_. This is no easy operation, and in
+later times by the aid of appliances, both in Rome and in Spain, they
+undertook to cause the skin to recover the glans. Martial, in speaking
+of the instrument used in Rome, a sort of a long funnel-shaped copper
+tube in which the Hebrew carried his virile organ, terms it _Judæm
+Pondum_, the weight of which, by drawing down the skin, was supposed in
+time to draw it down far enough to answer the purpose. The apostle Paul,
+in his epistle to the Corinthians, refers to these practices when he
+says, "Was any one called being circumcised, let him not be
+uncircumcised." The operation of reforming a prepuce, or of obliterating
+the marks of circumcision, does not appear to have been a success.
+
+The writer had one experience that was interesting. On one occasion he
+advised circumcision for the relief of a reflex nervous disease, in a
+tall, athletic Austrian sailor from the Adriatic; although the nature of
+the operation was explained to the man, he evidently did not appreciate
+its full nature and importance until a sweeping cut with a scalpel left
+the excised prepuce in the operator's hand. Most Adriatic sailors have
+sailed up the Bosphorus and are more or less familiar with both the
+Greek and Turkish nations; the latter they despise with gusto, "_porchi
+di Turci_" being the affectionate appellation they bestow on their
+national neighbors. No sooner did he perceive the real condition of
+affairs than he began to beat his head, saying that he was disgraced
+forever, as he never would dare to associate with his countrymen again,
+as he would be liable to be taken for a _porcho di Turco_; his frenzy
+increased to such a pitch that to spare any unpleasantness it was deemed
+advisable to replace the prepuce, which was done accordingly, the man
+making a tolerable good recovery, as far as the grafted prepuce was
+concerned. It required a secondary operation to overcome some
+cicatricial contraction, and, on the whole, he had a very serviceable
+prepuce; but, what was more to the point, it prevented his ever being
+mistaken for a Turk.
+
+
+
+
+CHAPTER VII.
+
+MIRACLES AND THE HOLY PREPUCE.
+
+
+What strange fancies have circled themselves about the subject of
+generation or its organisms during the different stages of moral
+civilization since the world has existed! The efforts in this regard
+among different creeds have been something peculiar. Neither Mohammedans
+nor Hebrews--both zealous circumcisers--ever went to the lengths reached
+by Christian churches and their followers in some particulars concerning
+this rite; this being especially strange when it is considered that the
+new creed was the one that abolished the rite and through which the Jews
+suffered such cruel and unjust persecutions. The early Christian Church
+celebrated and continues to celebrate the Feast of Circumcision, and
+history relates some strange events in connection with this
+circumcision. Having abolished and repudiated the rite, it would seem
+inconsistent that it should celebrate its performance on any occasion
+and consider such an event sufficiently memorable that its occurrence
+should excite the veneration of the church and be the means of exciting
+the pious zeal of the faithful. The strangest events in this connection
+are still more mysterious and incomprehensible, if not amusing, the only
+excuse for the occurrence being the greedy thirst for relics of any and
+all kinds that in the middle ages pervaded Europe.
+
+At some remote period--in the thirteenth or fourteenth century--the
+abbey church of Coulombs, in the diocese of Chartres, in France, became
+possessed in some miraculous manner of the holy prepuce. This holy
+relic had the power of rendering all the sterile women in the
+neighborhood fruitful,--a virtue, we are told, which filled the
+benevolent monks of the abbey with a pardonable amount of pride. It had
+the additional virtue of inducing a subsequent easy delivery, which also
+added to the reputation and pardonable vanity of the good monks. This
+last virtue, however, we are told, came near causing the loss to the
+abbey of this inestimable prize, for, as a French writer observes, a too
+great reputation is at times an unlucky possession; at any rate, the
+royal spouse of good and valiant King Henry V--he of Agincourt, whom
+England waded up to its knees in the sea at Dover to meet on his return
+from that campaign--had followed the example of all good dames and was
+about to give England an heir. Henry then governed a good part of
+France. Having heard of the wonderful efficacy of the relic of Coulombs,
+he early one morning threw the good monks into consternation by the
+arrival at the convent gate of a duly equipped herald and messenger from
+his kingship, asking for the loan of the relic with about as much
+ceremony as Mrs. Jones would ask for the loan of a flat-iron or saucepan
+from her neighbor, Mrs. Smith. The queen, Catherine of France, was of
+their own country and Henry was too powerful to be put off or refused;
+there was no room for evasion, as the holy prepuce could not be
+duplicated; so the poor monks with the greatest reluctance parted with
+their precious relic, entrusting it into the hands of the royal envoy,
+which wended its way to London, where it in due time, being touched by
+the queen, insured a safe delivery. Honest Henry then returned the relic
+to France; but so great was its reputation that royalty caused a special
+sanctuary to be erected for its reception, and a full period of
+twenty-five years occurred before the monks of Coulombs again regained
+possession of their prize, during which period the population of the
+neighborhood must have suffered from the natural increase of sterility
+and the physicians must have reaped a rich harvest owing to the
+increased difficulty and complications of labor induced by the absence
+of the relic. On its return, the relic was found to have lost none of
+its virtues, and the good people and monks were all correspondingly made
+happy; in 1870, when the writer was in France, it was still working its
+miracles. Balzac found ample facts to found his famous "Droll Stories"
+without straining his imagination.
+
+So great an attraction was not to go without attempted rivalry or
+imitators; hence we find in the "Dictionary of Moreri," edition of 1715,
+in the third volume, at page 108, that several other establishments
+claim the honor of a like relic,--namely, the Cathedral of Puy, in
+Velay; the collegial church of Antwerp; the Abbey of our Saviour, of
+Charroux; and the Church of St. John Lateran, in Rome. All of these have
+had very adventurous histories. The Abbey of Charroux was founded by
+Charlemagne in 788, and among the relics with which that monarch endowed
+the abbey the principal one was a fragment of the holy prepuce. This
+abbey enjoyed great reputation, and indulgences were granted by Papal
+bull to all those who assisted at the adoration of the relics. In the
+internecine wars of the sixteenth century the abbey fell into the hands
+of the godless and heretical Huguenots and the holy relic disappeared.
+In 1856, while some workmen were at work demolishing an ancient wall on
+the abbey site, they discovered some relic cases. The bishop was at once
+notified, who immediately proceeded to investigate, when, lo and
+behold! there, sure enough, was a piece of desiccated flesh, with marks
+of coagulated blood; nothing more or less than the lost prepuce--long
+lost, but now found. It was placed in charge of the Ursuline Sisterhood,
+where it has remained ever since undisturbed, except by a controversy in
+regard to the propriety of the relic, in which the good bishop ambled
+about in the most ambiguous manner, the only clearly defined portion of
+his dissertation being the one wherein he laments "the decadence of that
+truly Christian spirit which animated the laity of the middle ages with
+a radiant zeal. A piety also pervaded those gentle Christians of former
+times, who were possessed of a religious instruction which determined
+for them the tenets of the creed and its practices,--a happy state or
+condition of affairs, which prevented the intelligence of the faithful
+from wandering into the sloughs of unprofitable skepticism." This
+settled the question as to the propriety of the prepuce being converted
+into a miracle-working relic; at least, as far as the good bishop was
+concerned.
+
+It would be an injustice not to mention the other shrines in detail
+after the prominence that has been given to the abbeys of Coulombs and
+Charroux; so the history of another will be given. We are not told just
+how the Church of St. John Lateran in Rome first became possessed of
+_its_ holy prepuce, but it nevertheless had one; also the only authentic
+one in existence, like all the others. It disappeared at one of the
+periodical sackings that Rome has repeatedly suffered at the hands of
+Goth, Vandal, or Christian. This time it was the soldiery of the eldest
+son of the church--- Charles V--who did the sacking; it was in the year
+1527, a soldier--probably some impious, heathenish mercenary--broke into
+the holy sanctuary of the church and stole therefrom the box that
+contained the holy relics, among them the holy prepuce. These impious
+wretches, as a rule, came to grief in short order; hence we are told
+that this mercenary and sacrilegious soldier was compelled to secrete
+his box, when only a short distance from Rome, where the box remains and
+the mercenary wretch disappears, probably carried off bodily by the
+devil, as he deserved. Thirty years afterward the box is discovered by a
+priest, who, ignorant of its contents, carries it to the lady on whose
+domain it was found. On being opened it was found to contain a piece of
+the anatomy of Saint Valentine, the lower jaw of Saint Martha, with one
+tooth still in place, and a small package upon which the name of the
+Saviour was inscribed. The lady picked up the package, when immediately
+the most fragrant odor pervaded the apartment, being exhaled by the
+miraculous packet, while the hand that held it was seen perceptibly to
+swell and stiffen; investigation proved it to be the holy prepuce stolen
+by the miscreant mercenary from St. John Lateran. It is related that in
+1559, a canon of the church of St. John Lateran, impelled by a worldly
+curiosity untempered by piety, undertook to make a critical examination
+of this relic, in the process of which, to better satisfy himself, he
+had the indiscretion to break off a small piece; instantly the most
+dreadful tempest broke over the place, followed by crashing peals of
+thunder and blinding flashes of lightning; then a sudden darkness
+covered the country, and the luckless priest and his assistants fell
+flat on their sacerdotal noses, feeling that their last hour had
+arrived.[26]
+
+Wonderful and miraculous cures are performed at these shrines, and some
+of the cures are of a nature that would baffle the intelligence of the
+most learned mind to ascertain the intricate and devious way that
+nature must at times journey to accomplish some of these changes. The
+writer well remembers seeing, in the Church of Corpus Christi, in
+Turin,[27] a long hall, covered, from marble pavement to ceiling, with
+votive tablets, after the manner inaugurated in the old temples of
+Greece. Modern votaries have the advantage of being able to record their
+cure, safe venture or escape from peril, by means of faithful
+representation of the event in painting or drawing, as the material and
+art is more common now than in the days of ancient Greece, who recorded
+its cures by simple inscription in laconic terms. Modern medicine labors
+under the disadvantage of presuming that the people are endowed with an
+intelligence that was unknown to ancient or mediæval people, when, in
+fact, the people are as credulous and as subject to imposition as they
+were in the earlier centuries of the present era. With all its supposed
+superior intelligence, there is no fatter pasture for quacks and
+impostors than that presented by the people of the United States.
+Whenever I see the poor, intelligent, broad-minded physician struggling
+along, barely able to procure for himself the necessaries required to
+maintain himself with proper books and appliances, while the itinerant
+quack or dogmatic practitioner rolls in undeserved affluence, I question
+the wisdom of our ethical code. Braddock, at the Monongahela, scorned to
+have his regulars, who had fought under Marlborough and Eugene, break
+ranks before a lot of breech-clouted savages, and take shelter that the
+nature of the ground and the trees could afford, thinking it an unfit
+action for men who had faced the veterans of Louis XIV on many a
+hard-fought European field. I sometimes think that if _our_ regulars
+were, for only a season, to follow the example of the provincial
+militia at that battle, it would be better for the country, the people,
+science, and last, but not the least, for the profession. The theory
+that we should not counsel with quacks is altogether mischievous and
+fallacious, although right and rigidly orthodox in its intent; were we
+to counsel and meet these gentry, we should expose their ignorance and
+assumption, and we should not be exposed to the charge of jealousy and
+of fear to meet them in consultation. I remember on one occasion a
+client went to a lawyer for advice as to how he might dispossess some
+parties who had some adverse claim to some property which he owned,
+after due deliberation and a protracted siege of the house, in the vain
+hope of gaining admittance; the lawyer advised his client to go and nail
+up all exits and fasten them in, which had the effect of driving them
+out. So with our profession--we should not neglect an opportunity of
+meeting a quack in consultation, regardless of the nature of the case;
+it is the only way to nail them up; as it is, we have simply chained up
+the shepherd-dog and given the wolves full play.
+
+The French Guards at Fontenoy, who out of courtesy refused to fire first
+on the English, may have been very ethical and chivalrous, but they were
+very foolish, as the English discharge nearly swept them from the field,
+and but for the Irish Brigade, who knew no ethics, Louis XV would in all
+likelihood have followed the example of King John, who, after Crecy,
+visited England for a season. A disregard of ethics gave Copenhagen to
+Lord Nelson, who insisted on looking at Admiral Parker's signal to
+withdraw from action with his sightless eye, which could not see it. A
+fear of disregarding ethics lost to Grouchy the chance of assisting
+Napoleon at Waterloo. In our strife against ignorance and quackery the
+profession should follow the general plan of action usually adopted by
+Lord Nelson--lie alongside of whom you can and sink or capture your
+enemy; let each man do his duty; never mind any general plan. A reverse
+to this mode of fighting invariably lost the battle to the French and
+Spaniards, who were, as a rule, all tied up in ethical red tape. Our
+profession is broad, intelligent, and fearless; we do not profess any
+exclusive dogma, and should not, therefore, exclude persons; as a large
+ship throws its grappling-irons on to its adversary, we should always
+seek an opportunity to meet these gentry when practicable. As it is, we
+have placed them on the vantage-ground of appearing as being persecuted;
+our ethics need circumcising in this regard, and the prepuce of
+exclusion should be buried in the sands of the desert.
+
+Moreover, we often are apt to learn something from even the most
+ignorant of these men. Rush investigated the nature of a cancer-cure by
+not refusing to meet and talk with one of this kind;[28] Fothergill
+learned from an old, unlicensed practitioner that there was a knowledge
+important to the physician beyond that picked up in the pathological
+laboratory or the study of microscopy; and that the practiced eye of an
+otherwise unlearned man could detect that there were general physical
+signs that negatived the unfavorable prognosis suggested by the presence
+of tube-casts.[29] It is related of Sir Isaac Newton, that while riding
+homeward one day, the weather being clear and cloudless, in passing a
+herder he was warned to ride fast or the shower would wet him. Sir Isaac
+looked upon the man as demented, and rode on, not, however, without
+being caught in a drenching shower. Not being able to account for the
+source of information through which the rustic had gained his
+knowledge, he rode back, wet as he was, to learn something. "My cow,"
+answered the man, "always twists her tail in a certain way just before a
+rain, your Worship, and she so twisted it just before I saw you."[30]
+Although twisting cow-tails do not figure in his "Principia," it is very
+probable that such a lesson was not without its remote effects on a mind
+like Newton's. A spider taught a lesson to one of Scotland's kings; so
+that one man may learn something from another.
+
+Professor Letenneur, of the Medical School of Nantes, in his "Causerie à
+propos de la Circoncision," mentions that the Convent of Saint
+Corneille, in Compiègne, claims to possess the identical instrument with
+which the Holy Circumcision was performed. Such a holy relic must have
+been unusually potential in performing many miracles.
+
+In this connection it will not be amiss to notice the lapping over that
+the old phallic worship and idea has made on the new religions. It is
+also as interesting to observe how the human mind still leans toward
+observances and ideas which are believed to belong to a solely pagan
+people. Hargrave Jennings, in a chapter devoted to phallic worship among
+the ancient Gauls, gives many interesting and curious examples, the
+first example that he notices being that of Saint Foutin (from whom the
+very expressive French word "_foutre_" is taken). Foutin was the first
+Christian bishop of Lyons, and after his death, so intimately was
+priapic worship intermingled with the religion or theology of the Gauls,
+that somehow the memory of St. Foutin and the old, dethroned Priapus
+became commingled, and finally the former was unconsciously made to take
+the place of the latter. St. Foutin was immensely popular. He was
+believed to have a wonderful influence in restoring fertility to barren
+women and vigor and virility to impotent men. It is related that, in the
+church at Varages, in Provence, to such a degree of reputation had the
+shrine of this saint risen, it was customary for the afflicted to make a
+wax image of their impotent and flaccid organ, which was deposited on
+the shrine. On windy days the beadle and sexton were kept busy in
+picking up these imitations of decrepit and penitent male members from
+the floor, whither the wind wafted them, much to the annoyance and
+disturbance of the female portions of the congregation, whose devotions
+are said to have been sadly interfered with. At a church in Embrun there
+was a large phallus, which was said to be a relic of St. Foutin. The
+worshippers were in the habit of offering wine to this deity,--after the
+manner of the early Pagans,--the wine being poured over the head of the
+organ and caught underneath in a sacred vessel. This was then called
+"holy vinegar," and was believed to be an efficacious remedy in cases of
+sterility, impotence, or want of virility.
+
+Near the city of Bourges, at Bourg Dieu, there existed, during the Roman
+occupation of Gaul, an old priapic statue, which was worshipped by the
+surrounding country. The veneration in which it was held and the
+miracles with which it was accredited made it impolitic as well as
+impossible for the early missionaries and monks to remove it; it would
+have created too much opposition. It was therefore allowed to remain,
+but gradually changed into a saint,--St. Guerluchon,--which, however,
+did not detract any from its former merit or reputation. Sterile women
+flocked to the shrine, and pilgrimages and a set number of days of
+devotion to this saint were in order. Scrapings from this statue infused
+in water were said to make a miraculous drink which insured conception.
+Similar shrines to this same saint were erected at other places, and we
+are told that the good monks, who must have had an intense and lively
+interest in seeing that the population was increased, were kept busy
+supplying the statues with new members, as the women scraped away so
+industriously, either to prepare a drink for themselves or for their
+husbands, that a phallus did not last long. At one of these shrines, so
+onerous became the industry of replacing a new phallus to the saint,
+that the good monks placed an apron over the organ, informing the good
+women that thereafter a simple contemplation of the sacred organ would
+be sufficient; and a special monk was detailed to take special charge of
+this apron, which was only to be lifted in special cases of sterility.
+By this innovation the good monks stole a march on their brothers in
+like shrines in other localities, such as those of St. Gilles, in
+Brittany, or St. Rene, in Anjou, where the old-fashioned scraping and
+replacing still was in vogue. Near the seaport town of Brest, in
+Brittany, at the shrine of St. Guignole, the monks adopted a new
+expedient. They bored a hole through the statue, through which a phallus
+was made to project horizontally; as fast as the devotees scraped away
+in front the good monks as industriously pushed forward the wooden peg
+that formed the phallus, so that it gave the member the miraculous
+appearance of growing out as fast as scraped off, which greatly added to
+its reputation and efficacy. The shrine continued in great vigor until
+the middle of the last century. Delaure mentions a similar shrine at
+Puy, also in France, which existed up to the outbreak of the French
+Revolution. The scrapings in this case were immersed in wine, and the
+guardians of the statue saw to it that no amount of paring or scraping
+should remove from the saint any of that appearance of vigor or
+virility which his great reputation demanded, this being done by a
+similar procedure as followed at the church near Brest, one of the
+attendants having been sent to investigate into the marvelous growth of
+the Brest phallus.
+
+
+
+
+CHAPTER VIII.
+
+HISTORY OF EMASCULATION, CASTRATION, AND EUNUCHISM.
+
+
+For the earliest records in regard to emasculation we must go back to
+mythological relations. In the old legendary lore of ancient Scandinavia
+or of Germany, the loves and hatreds of their semi-mythological heroes
+and heroines space over many romantic incidents before reaching a
+culmination. The swiftly flowing Rhine, with its precipitous banks,
+eddies, and rapids; the broad and more majestic Danube or Elb; the broad
+meadows and Druidical groves on its hilly slopes and stretches of dark
+and gloomy forest,--all conspired to people the fancy with elfs, gnomes,
+fairies, and goblins, who were more or less intermingled in all the
+episodes that engaged their semi-mythological heroes. This helped to
+fill in all their deeds with entertaining incidents; their halls and
+castles were made necessary accessories by the rigors of the climate, as
+well as were the beery feasts and carousals with the inspiration of
+monotonous song also rendered necessaries by the same element; hence, we
+have various incidents, either entertaining or exciting, connected with
+their legendary tales, acting like periods of intermission between their
+love scenes, spites, hatreds, murders, and general cremations. From such
+material and such opportunities it was comparatively easy for Wagner to
+construct the thrilling and interesting incidents that compose his opera
+on the legend of the Nibelungenlied.
+
+The Grecian landscape and topography does not permit of such richness of
+romantic incidents or details, any more than the love-making of the
+unfortunate spider who is devoured by his spidery Cleopatra at the end
+of his first sexual embrace could furnish any incidents for one of
+Amelie Rives's spirited novels; so that neither minstrel nor bard have
+recorded the details of the first emasculating tragedy, which from all
+accounts was a kind of an Olympian Donnybrook-fair sort of a
+paricidal-ending tragedy.
+
+Unfortunately, Homer was not there to describe the event, or we might
+have had a Wagnerian opera with its Plutonic music to illustrate all its
+incidents; or even a Virgil could have made it into interesting verses;
+but, as it is, we must content ourselves with the laconic recitals that
+have been handed down by tradition, and, as all the Greek performances
+of those days were marked by an intense decisiveness, with an utter lack
+of circumlocution, it is probable that there was not much to relate
+beyond the bare facts.
+
+In Smith's "Dictionary of Greek and Roman Biographies and Mythology" we
+find it related that Uranos, or Coelus, was the progenitor of all the
+Grecian gods. His first children were the Centimanes; his next progeny
+were the Cyclops, who were imprisoned in Tartarus because of their great
+strength. This so angered their mother, Gäa, that she incited her
+next-born children, the Titans, into a rebellion against their father,
+Uranos. In the general turmoil that followed Uranos was deposed, and, so
+that he would be incapable of begetting any more children, Saturnus, the
+youngest of his sons, with a sickle made from a bright diamond,
+successfully emasculated poor old Uranos. The records are not clear
+whether the operation only included the penis, or the scrotum and
+contents, or whether, like the Turkish or Chinese _taillè à fleur de
+ventre_, Saturnus made a clean sweep of all the genitals; it is
+probable that he did, however, as the members fell into the sea, and in
+the foam caused by the commotion from their contact with the element
+Venus was born. Meanwhile, the blood that dripped from the wounded
+surface caused the Giants, the Furies, and the Melian nymphs to spring
+into life. Uranos is also represented as being the first king of
+Atlantis; so that the first eunuch was a god and a king, more
+unfortunate than any of Doran's heroes, in his "Monarchs Retired from
+Business," because he was more effectually retired from business than
+any monarch that Doran records.
+
+After this the practice seems to have been adopted in a general way; and
+the fact that the future proceedings of men and things on earth do not
+much interest these unfortunate members of society in any great degree,
+interest in worldly affairs and testicles seemingly having been as
+intimately connected in those early and remote days as with us of the
+present, it very naturally followed that this disinterestedness, as well
+as the docility and pliability which emasculation engenders, first
+suggested their use as servants or in position of trust, as a eunuch,
+having no incentive either to run away or to embezzle, would naturally
+be a valued and trusted servant. In the days of eunuchism there were no
+defaulting bank, city, or county cashiers,--a circumstance which would
+suggest that such a condition should form one of the qualifications for
+eligibility to such offices, the very opposition to any such proposal
+that the class would make showing in itself the benefits that would
+follow such an innovation, as it would show that the class is not
+possessed with that total spirit of abnegation requisite in the
+guardians of public funds. The requirement might be extended to
+bank-presidents with benefit, if some Cincinnati episodes are any
+criterion. It is safe to assume that the bank that could advertise, in
+connection with its attractive quarterly or semi-annual statement, that
+the president and cashier were properly attested and vouched-for eunuchs
+would find in the public such a recognition of the fitness of things
+that the patronage it would receive would soon compel other banks to
+follow the example. The procedure might, with national benefit, be
+extended as an ordeal to our legislators at the national capitol, as it
+would do away with the particular influential lobby so graphically
+described in Mark Twain's "Gilded Age." These things or ideas are merely
+thrown out as suggestions to be used by those who write those
+interesting articles in the _Forum_, or the _North American_ or
+_Fortnightly Reviews_, on government and social reforms, as a perusal of
+the many articles written in that direction will convince any one that,
+from a practical psychological view of the matter, they are sadly
+deficient. To make those articles effective the reflex impressions made
+by the animal on the psychological and moral nature of man should not be
+neglected.
+
+Semiramis, whose beauty and many accomplishments, assisted by the
+murders of several of her husbands by the hand of the succeeding one,
+had this subject in hand in a far more practical manner than it is
+generally forced on the understanding; hence we see that she was the
+first to introduce the use of eunuchs in the capacity of servants as
+well as in official positions in and about the palace, as well as
+trusting some of the positions of the highest importance to the class.
+From her epoch, eunuchism has become an inseparable attendant on
+Oriental despotism, and has so continued to the present day. Like yellow
+fever, phthisis, and some diseases, as well as many other social
+afflictions and customs, eunuchism does not seem to flourish beyond
+certain degrees of north and south latitudes,--a fact that probably
+assisted Montesquieu to arrive at the conclusion that climate was a
+powerful factor in all things.
+
+Bergmann, of Strasburg, quotes the ancient traditions, wherein it is
+stated that man was taught the art of castration by the brute creation.
+The hyena is cited as having so instructed man by the habit it exhibited
+of castrating its infant males in removing the testicles with its teeth,
+the habit being instigated by a jealousy, for fear of future competition
+in the exercise of the procreative act on the part of the young males.
+Another tradition attributes its origin to the castor. Bergmann here
+traces out the etymological relation existing between the name of the
+operation and that of the animal with that of a Greek verb that forms
+the root of _castrum_, or camp; _casa_, or house; _castigare_, to
+arrange; from whence also is traced _cosmos_, the world; _kastorio_, the
+Greek for wishing to build, and the Latin _kasturio_ having the same
+relative but a more imperative signification; _kastor_, signifying as
+loving to build; _castitiator_, Latin for architect, and _casticheur_,
+old French for constructor. The tale or tradition in regard to the
+self-mutilation inflicted by the castor is traced to the Arabian
+merchants who purchased the castoreum, which was imported from the
+shores of the Persian Gulf and from India. It was called, also, by the
+Arabs, _chuzyalu-l-bahhr_, or testicles from beyond the sea; or, in
+French, _testicules d'outre mer_. These terms and the tradition that the
+castor on being pursued, knowing the reason of the chase, was in the
+habit of tearing out his testicles and throwing them at his pursuers,
+were invented by these merchants to heighten the price and value of the
+article intrinsically, as well as to make it more interesting by this
+peculiar individuality of adventure. The Latins, believing and adopting
+the tradition as a matter of fact, coined the word _castorare_, or doing
+like the castor. Bergmann uses in this connection a number of terms in
+French to denote different forms or degrees of this mutilation which
+have no equivalents in English,--for instance, _chatrure_, as applied to
+animals, making also a distinctive difference between the meaning of the
+French words _castration_ and _chatrement_. Bergmann is a decided
+evolutionist as regards circumcision being evolved from prior forms of
+physical mutilation, as will be more fully explained in the next
+chapter; the shaving of the head of a conquered people by the Hindoos,
+or the shearing the royal locks of the ancient Frankish kings; the
+blinding of one eye of their slaves by the old Scythians, or crippling
+one foot by the division of a tendon in a captive by the Goths, he
+considers as on the same line with the idea that led to castration, the
+different forms of eunuchism, and circumcision.[31]
+
+From a purely materialistic and utilitarian view of the subject, he
+observes that what we call moral progress and civilization owe their
+advancement more to material interest and cold, selfish calculation than
+to any development of the humanitarian sentiments, and that neither
+morality nor justice has much to do with it. The evolution of the slave
+and the marks inflicted upon him by his fellow humans are the most
+emphatic evidences of the justness of the above proposition. The study
+of the subject is equally interesting when considered in connection with
+the evolutions of the Christian Church. In its divergence from Judaism
+and its beneficent laws, both social and moral, the Christian Church was
+but illy fit to cope with its persecutors of Pagan tendencies, or to
+enforce an unwritten law or code of morality or hygiene among an
+idolatrous, barbarous, and ignorant population such as it had to
+encounter. To its professors, the formation of that monachism which has
+been so much misunderstood and abused was but an inevitable
+condition.[32] These men had not the steady compass to guide them in the
+path that was possessed by the Jewish people. The martyrdom of Christ
+and many of his apostles, and the teachings of the early church, pointed
+to physical denials, castigations, humiliations, and sufferings as the
+only way to salvation; all pleasures were sin and all denials and pain
+were looked upon as steps to heaven. The climate pointed to sexual
+indulgence as the sum of all happiness, as can readily be inferred from
+the Mohammedan idea of heaven; so, with the early Christians who were
+born in the same climates, the denials of sexual pleasures were looked
+upon as the most acceptable offering that man could make to the Deity.
+Continence, celibacy, infibulation, and even castration were the
+conditions looked upon by many of these men as the only means of living
+a life on earth that would grant them an eternal life in the next. This
+view of the situation peopled the deserts with a lot of men dwelling in
+caves and in huts, living on such a scarce diet that they barely
+existed. That many went insane, and in their frenzy died while roaming
+in these solitudes, we have ample evidence. The tortures and impositions
+of the Pagan rulers also drove many to this life or death.
+
+Religious mania has caused many cases of self-mutilation, either to
+escape continued promptings and desires, or simply from a resulting
+species of insanity. Of the first, Sernin[33] reported to the Medical
+Society of Paris the case of a young priest who had castrated himself
+with the blade of a pair of scissors, and who nearly lost his life with
+the subsequent hæmorrhage. The writer saw an analogous case on board an
+American war-vessel, of which Dr. Lyon was surgeon, in the harbor of
+Havre, in the spring of 1871, the subject being the ship's cobbler, a
+religious fanatic, who was driven insane by self-imposed continence. We
+are not surprised, from the lack of intelligence of the times, the
+extreme but undefined views as to religion that then ruled men, that
+self-imposed castration should have been sanely considered and carried
+into effect by Origines and his monks. The Cybelian priesthood had
+formerly set the example in their Pagan worship, and when we are told
+that the monks of Mount Athos accused the monks of the convent of a
+neighboring island with falling away from grace, because they allowed
+_hens_ to be kept within the convent inclosure, we may well believe that
+Origines and his monks felt that they were gradually ascending in grace
+when they submitted to this sacrifice. As strange as it may sound,
+self-castration is still practiced by the Skoptsy, a religious sect in
+Russia. In justice to the Church, however, it must be said that she
+neither asked for nor did she sanction these performances, although she
+was not quick enough in asserting that she recognized the same law in
+regard to her presbytery that controlled that of the Hebraic priesthood.
+
+Eunuchism presents many contradictory conditions; eunuchs have not
+always been the fat and sleek attendants on Oriental harems as tradition
+and custom places them or would have us believe; neither does the loss
+of virility, in a procreative sense, seem to have always robbed them of
+their virility in other senses, as we find eunuchs holding the highest
+offices in the State under the reigns of Alexander, the Ptolemys,
+Lysimachus, Mithrades, Nero, and Arcadius. The eunuch Aristonikos, under
+one of the Ptolemys, and another, Narces, under Justinian, led the
+armies of their sovereigns. These are, however, exceptional cases; as a
+rule, the result is as we observe in the domestic animals,--loss of
+spirit, vim, and ambition. The Church recognized this result, and, while
+the Hebraic law excluded eunuchs from participating in the priesthood as
+being imperfect and unclean, the Church reproached Origines and his
+monks and excluded eunuchs from its presbytery on the ground that such
+beings lack the moral and physical energy requisite in a calling that is
+supposed to guide or lead men; moreover, there are many reasons for
+doubting that the ministers of state and the generals of the reigns
+above mentioned were actually eunuchs in the full acceptance of the
+word. Among the ancients there were several methods of performing the
+operations that made the eunuchs; some were more effectual than others.
+From the removal of _all_ the genitals, or the penis alone, or the
+scrotum and testicles, or removing only the testicles, down to
+compression or to distorting the spermatic vessels, or, as in the case
+of the Scythians, who often became eunuchs from bareback riding, as
+Hammond describes a eunuchism manufactured by our southwestern Indians
+of New Mexico and Arizona, are performances that left many degrees of
+eunuchism; as we find some eunuchs that not only contracted marriage,
+but engendered children. Voltaire mentions Kislav-aga, of
+Constantinople, a eunuch _à outrance_, with neither penis, scrotum, nor
+anything, who owned a large and select harem. Montesquieu, in his
+"Persian Letters," admits this class of marriages as being practiced,
+but doubts the resulting conjugal felicity, especially on the part of
+the wife. Potiphar's wife was one of these unfortunate wives; no wonder
+that she tore Joseph's cloak in her desire. Juvenal mentions that some
+eunuchs were held in high esteem by the Roman matrons; it possibly could
+have been some of this kind of a eunuch that led armies or ruled in the
+palaces. Among the sultans and Oriental potentates those who had every
+exterior evidence of virility removed, so as to be obliged to micturate
+through the means of a catheter, were considered the safest guards, as
+well as they were the highest-priced eunuchs, for in their manufacture
+fully 75 per cent. of those operated upon died as a result. It is
+related that the Caribs made eunuchs of their prisoners of war on the
+same principle that caponizing is resorted to for our kitchens,--the
+prisoners were easier to fatten and were more tender when cooked. The
+Italians allowed their children to be eunuchized for chorister purposes
+in church services, their soprano voices after this treatment being
+simply perfect. It was considered that, in the year prior to the papal
+ordinance of Pope Clement XVI forbidding the practice or the employment
+of eunuchs in choirs, four thousand boys, mostly in the neighborhood of
+Rome, were castrated for chorister purposes.
+
+In China eunuchs were in use during the reign of the Emperor Yen-Wang,
+in 781 B.C. The Chinese make their eunuchs by a complete ablation of all
+genitals. In India the followers of Brahma never placed their women in
+charge of eunuchs. In Italy it was customary to emasculate boys that
+they might grow up with the faculty of taking the female parts in
+comedies, their voices thereby assimilating to that of the other sex,
+this being on the same principle that the _basso-profundos_ were
+infibulated that they might retain their bass.
+
+Eunuchism resulting from an operation owing to disease has at times
+given queer and unlooked-for results, as, for instance, in the case of
+the old man that Sprengle mentions, in whom castration did not remove an
+inordinate sexual desire. Sir Astley Cooper mentions a case in his
+"Diseases of the Testes" that is somewhat unique. After castration Sir
+Astley's patient showed the following results: "For nearly the first
+twelve months he stated that he had emissions _in coitu_, or that he had
+the sensations of emission; that then he had erections and coitus at
+distant intervals, but without the sensation of emission. After two
+years he had excretions very rarely and very imperfectly, and they
+generally ceased immediately upon the attempt at coitus. Ten years after
+the operation he said he had during the past year been only once
+connected. Twenty-eight years after the operation he stated that for
+years he had seldom any excretion, and then that it was imperfect." In
+regard to the mortality from castration done in a professional manner
+and for disease, Curling, in his work on "Diseases of the Testis,"
+observes that he saw or performed some thirty operations without a
+death, and that in a table of like operations performed at the Hôtel
+Dieu, in Paris, it appeared that the mortality was one in four and a
+quarter.
+
+J. Royes Bell, in the sixth volume of the "International Encyclopædia of
+Surgery," has the following in regard to the practice among the
+Mohammedans in India: "Young boys are brought from their parents, and
+the entire genitals are removed with a sharp razor. The bleeding is
+treated by the application of herbs and hot poultices; hæmorrhage kills
+half the victims, and at times brings the perpetrators of the vile
+proceeding within the clutches of the law."
+
+The _taillè à fleur de ventre_ of the Chinese is a somewhat primitive
+procedure. According to Dr. Morache, in his account of China in the
+"Dic. Ency. des Sciences Médicales," the operation is as follows: "The
+patient, be he adult or child, is, previous to the operation, well fed
+for some time. He is then put in a hot water bath. Pressure is exercised
+on the penis and testes, in order to dull sensibility. The two organs
+are compressed into one packet, the whole encircled with a silk band,
+regularly applied from the extremity to the base, until the parts have
+the appearance of a long sausage. The operator now takes a sharp knife,
+and with one cut removes the organ from the pubis; an assistant
+immediately applies to the wound a handful of styptic powder, composed
+of odoriferous raisins, alum, and dried puffball powder
+(boletus-powder). The assistant continues the compression till
+hæmorrhage ceases, adding fresh supplies of the astringent powders; a
+bandage is added and the patient left to himself. Subsequent hæmorrhage
+rarely occurs, but obliteration of the canal of the urethra is to be
+dreaded. If at the end of the third or fourth day the patient does not
+make water, his life is despaired of. In children the operation succeeds
+in two out of three cases; in adults, in one-half less. Poverty is the
+cause which induces adults to allow themselves to be thus mutilated. It
+is said to be difficult to distinguish these last from ordinary Chinese
+men. Adult-made eunuchs are much sought after, as they present all the
+attributes of virility without any of its inconvenience."
+
+The study of the evolutionary moves or processes passed by eunuchism in
+its relation to music and the drama tends to rob these otherwise
+civilizing and enlightened arts of the aureoles of poetry and gentility
+with which they have been surrounded. From Bergmann we learn that the
+practice originated in the Orient, where female voices were held in
+higher esteem in singing, and where the profane songs that accompanied
+the dance were chanted by women. The Hebraic regulations permitted
+neither women nor eunuchs to sing in their temples. With the
+establishment of the early Christian Church in Oriental countries, more
+or less of the ancient Judaic customs were retained, and in addition a
+too literal interpretation of the words of St. Paul was adhered to,
+which said that women should not be _heard_ in the Church. The Oriental
+Church from these reasons long remained in a quandary; according to the
+ceremonials, it was deemed requisite to imitate as near as possible the
+voices of the angelic seraphims, and this could not be done by the
+rasping bass voices of the well-fed monks; women were out of the
+question in the then social stage of church evolution; so that at last a
+compromise was effected by admitting the eunuch, who could chant in a
+most seraphic soprano, as his prototype, the mendicant priests of
+Cybele, had done before him.
+
+Constantinople became the centre of learning for Greek music, and the
+fine soprano solos which now form the attraction of many of our modern
+churches were sung by the eunuchs. Eunuchs were not only the chief
+singers, but they cultivated the art into a science, and Constantinople
+furnished through this class the music-teachers for the world, as we
+learn that in 1137 the eunuch Manuel and two other singers of his order
+established a school of music and singing in Smolensk, Russia. There is
+no doubt but that in a moral sense, considering that women are generally
+the pupils, this was a most meet and an appropriate arrangement; for,
+as St. Alphonsus M. Liquori observed, man was a fool to allow his
+daughters or female wards to be taught letters by a man, even if that
+man were a saint, and, as real saints were not to be found outside of
+heaven, it can well be imagined how much more dangerous it might be to
+have them taught music and singing by a man not a eunuch,--elements
+which have a recognized special aphrodisiac virtue, as was well known to
+the ancient Greeks, who only allowed their wives to listen to a certain
+form of music when they (the husbands) were absent from home.
+
+There is not much room for doubt but that both morality and medicine
+have too much neglected the study and contemplation of the natural
+history of man, and relied altogether too much on the efficacy of church
+regulations and castor-oil and rhubarb. There are other things to be
+done besides simply framing moral codes and pouring down mandrake into
+the stomach; the old conjoined service of priest and doctor should never
+have been discontinued, as, by dividing duties that are inseparable,
+much harm has resulted. Herein dwelt the great benefit of the early
+practice of medicine among the Greeks, and to the physical understanding
+and supervision of human nature by the Hebraic law may be said that the
+creed owes its greatness and stability, and the Hebrew race its sturdy
+stamina. The wisdom of the Mosaic laws is something that always
+challenges admiration, the secret being that it did not separate the
+moral from the physical nature of man. Bain, Maudsley, Spencer, Haeckle,
+Buckle, Draper, and all our leading sociologists base all their
+arguments on the intimate relations that exist between the physical
+surrounding and the physical condition of man and his morality. Churches
+foolishly ignore all this.
+
+From Constantinople the fashion or custom gradually invaded Italy; and
+as Rome was the centre of the new religion, so it also became the centre
+of music, and Rome and Naples were soon the home of the eunuch devoted
+or immolated to the science of music. The eunuchs reached the height of
+their renown in music, as well as what might be termed their golden era,
+with the establishment of the Italian opera, in the seventeenth century.
+At this period all the stages of Italy were the scenes of the lyric
+triumphs of this otherwise unfortunate class, some of whom accumulated
+vast fortunes. In the following century, as has been seen, Clement XVI
+abolished the practice as far as the church was concerned, and in the
+present century the first Napoleon abolished the practice secularly and
+socially. Mankind cannot sufficiently appreciate the benefits it
+received from the results of the French Revolution; we are too apt to
+look at that event simply from the unavoidable means which an uneducated
+class--rendered desperate by long suffering and brutalization under an
+organized system of oppressive misrule--had adopted to remedy existing
+evils. After the dissolution of the Directory France cannot be said to
+have been in a state of anarchy, and the long and bloody wars with which
+Napoleon is usually blamed should rather be charged to that government
+and imbecile ministerial policy that lost to England the American
+colonies. The series of battles from Marengo to Waterloo are as much the
+creation of the cabinet of George III as those from Concord to Yorktown.
+Waterloo involved more than the simple defeat of Napoleon; it meant the
+defeat of moral and intellectual progress, as well as the suppression of
+the rights of man. The suppression of the Inquisition in Spain, and of
+eunuchism in Italy; the Code Napoleon; the Imperial highways of France;
+the construction of its harbors,--notably that of Havre; and the
+political and social emancipation of the Jews in France, Italy, and
+Germany are monuments to this great man that have not their equals to
+crown the acts of any other French monarch. Like the Phrygian monk who
+leaped into the arena in Rome to separate the maddened gladiators, and
+who was stoned to death by the angry and brutal mob of spectators whose
+amusement he stopped, Napoleon's work has had its results, in spite of
+Waterloo and St. Helena. The martyrdom of the poor monk caused an
+abolishment of the brutal sports of the Colosseum, which henceforth
+crumbled to pieces. Little did the people look for this result who
+trampled the monk under foot. Neither did Blucher, debouching on the
+English left with Bulow's battalions on the evening of Waterloo,
+foresee, some fifty years later, Prussia extending its hand to make a
+united Italy, which with Napoleon--who was by blood, nature, instinct,
+and education an Italian--had been the dream and ambition of his life.
+
+Eunuchism as a punishment is an old practice, as the ancient Egyptians
+inflicted it at times upon their prisoners of war; so it formed part of
+their penal code, and we are told that rape was punished by the loss of
+the virile organ; a like punishment for the same offense was in vogue
+with the Spaniards and Britons; with the Romans at different times and
+with the Poles the punishment was castration. The difficulty of proving
+the crime, as well as the ease with which the crime could be charged
+through motives of revenge, spite, or cupidity on innocent persons,
+should never have allowed this form of punishment to be so generally
+used as history relates that it was; rape being one of the most complex
+and intricate of medico-legal subjects, unless we take M. Voltaire's
+summary and Solomonic judgment, who relates that a queen, who did not
+wish to listen to a charge of rape made by one person against another,
+took the scabbard of a sword and, while she kept the open end in motion,
+asked the accuser to sheath the sword.
+
+Count Raoul Du Bisson, _Dedjaz de l'Abyssinie_, gives some very
+interesting information in regard to eunuchism in his work entitled "The
+Women, the Eunuchs, and the Warriors of the Soudan." Count Bisson has
+looked on the question from its moral, physical, and demographic
+stand-points, and, having seen eunuchism in its different aspects, from
+his landing at Alexandria and Cairo, down through his different
+expeditions into Arabia, the Soudan, and Abyssinia, his observations are
+well worth repeating.
+
+From a demographic and statistical view of the subject, its truly
+Malthusian results become at once shockingly and persistently
+prominent,--not alone in the interference that the condition induces in
+arresting any further procreation on the part of the unfortunate victim,
+but in the unparalleled mortality that, in the gross, is made necessary
+by the results of the operative procedures. The Soudan alone furnished,
+according to reliable statistics, some 3800 eunuchs annually, the
+material coming from Abyssinia and the neighboring countries, it being
+gathered by war and kidnapping parties, or by purchase, from among the
+young male population of those regions. These children are brought to
+the Soudan frontier and custom duties are there paid for their passage
+across the border, the duty being about two dollars per head. At
+Karthoum they are purchased by pharmacists, apothecaries, and others
+engaged in the manufacture of eunuchs, who generally perform simple
+castration; the mortality among these amounts to about 33 per cent.
+These simply castrated eunuchs bring about $200 apiece. The great eunuch
+factory of the country, however, is to be found on Mount Ghebel-Eter, at
+Abou-Gerghè; here a large Coptic monastery exists, where the unfortunate
+little African children are gathered. The building is a large, square
+structure, resembling an ancient fortress; on the ground-floor the
+operating-room is situated, with all the appliances required to perform
+these horrible operations. The Coptic monks do a thriving business, and
+furnish Constantinople, Arabia, and Asia Minor with many of their
+complete, much-sought-for, and expensive eunuchs. They here manufacture
+both grades,--those who are simply castrated and those on whom complete
+ablation of all organs has been performed, the latter bringing from $750
+to $1000 per head, as only the most robust are taken for this operation,
+which nevertheless, even at the monastery, has a mortality of 90 per
+cent.
+
+The manner of performing the operation is as barbarous and revolting as
+the nature of the operation itself, and the cruel and ignorant
+after-treatment is as fully in keeping with the whole. The little,
+helpless, and unfortunate prisoner or slave is stretched out on an
+operating-table; his neck is made fast in a collar fastened to the
+table, and his legs spread apart and the ankles made fast to iron rings;
+his arms are each held by an assistant. The operator then seizes the
+little penis and scrotum and with one sweep of a sharp razor removes all
+the appendages. The resulting wound necessarily bares the pubic bones
+and leaves a large, gaping sore that does not heal kindly. A short
+bamboo cannula or catheter is then introduced into the urethra, from
+which it is allowed to project for about two inches, and no attention
+is paid to any arterial hæmorrhage; the whole wound is simply plastered
+up with some hæmostatic compound and the little victim is then buried in
+the warm sand up to his neck, being exposed to the hot, scorching rays
+of the sun; the sand and soil is tightly packed about his little body so
+as to prevent any possibility of any movement on the part of the child,
+perfect immobility being considered by the monks as the main element
+required to promote a successful result. _It is estimated that 35,000
+little Africans are annually sacrificed to produce the Soudanese average
+quota of its 3800 eunuchs._
+
+When this immense sacrifice of life, the useless barbarity, and the
+really unnecessary needs of such mutilated humanity existing are fully
+considered, it would seem as if Christian nations might, with some
+reason, interfere in this horrible traffic, by the side of which
+ordinary slavery seems but a trifle. When we further consider that, in
+some instances, the child is also made mute by the excision of part of
+the tongue,--as mute or dumb eunuchs are less apt to enter into
+intrigues, and are therefore higher prized,--the barbarity, cruelty, and
+extremes of inhumanity that these poor children have to suffer cannot be
+overestimated. Neither must we be astonished at the stolid indifference
+that is exhibited by the eunuchs in after life to any or all sentiments
+of humanity, or that they should hold the rest of humanity in continual
+execration.
+
+Often-occurring accidents in harems make _complete_ eunuchs a
+desideratum. Bisson mentions that on one occasion he saw the chief
+eunuch of the Grand Cherif of Mecca--a large, finely-proportioned,
+powerful black--on his way to Stamboul for trial and sentence; he was
+heavily chained and well guarded. It appears that the eunuch had only
+been partly castrated, and that the operation had been performed during
+infancy; his testicles had not fully descended, so that in the operation
+the sac was simply obliterated, which gave him the appearance of a
+eunuch. In this condition he seemed to have kept a perfect control of
+himself and passions until made chief eunuch of the Cherif, who
+possessed a well-assorted harem of choice Circassian, Georgian, and
+European beauties. The _négligé_ toilet of the harem bath and the
+seductive influence of this terrestrial Koranic seventh heaven was too
+much for the warm Soudanese blood of the chief; his forays were not
+suspected until a blonde Circassian houri presented her lord and master,
+the Cherif, with a suspiciously mulatto-looking son and heir. A
+consultation of the Koran failed to explain this discrepancy, and
+suspicion pointed to the chief eunuch, who was accordingly watched; it
+was found that he had not only corrupted the fair Circassian, but every
+inmate of the harem as well. The harem was promptly sacked and drowned
+and the false eunuch shipped to the Sultan for sentence, the Cherif
+having the right to sentence and drown the harem, but having no such
+rights over such a high personage as the chief eunuch.
+
+There are physiological facts and pathological conditions brought forth
+for our contemplation, while investigating the subject of eunuchism in
+all its details, that cause us to feel that, after all, the old
+Hippocratic principle of inductive philosophy, upon which our study and
+practice of medicine is founded, with rational experience and
+observation for its corner-stone, is, even if commonplace, the only
+proper avenue of knowledge. To exemplify this proposition we have in
+this particular subject the practical observations and experience of M.
+Mondat, of Montpellier; in his interesting work on "De la Stérilité de
+l'Homme et de la Femme," published in 1840, he details some instructive
+information on the subject of eunuchs, giving some explanation as to why
+many simply castrated eunuchs are, like the much-prized eunuchs of the
+Roman matrons, still able to acquit themselves of the copulative
+function. He mentions that while in Turkey he studied the subject in its
+details, and, having found some of these copulating eunuchs, he secured
+some of the ejaculated fluid and subjected it to a careful examination.
+The discharge was lacking the characteristic seminal odor; it was in
+other respects, to the palpation especially, very much like the seminal
+fluid. He found that these eunuchs were much given to venereal
+enjoyment, but that either legitimate intercourse or masturbation, to
+which many were addicted, was apt to be followed by a marasmus ending in
+galloping consumption. Mondat personally knew the opera-singer Velutti,
+who died in London; Velutti was, when a child, castrated by his parents,
+having both testicles removed, being intended by his father, who had
+himself performed the operation, for the choir of the Papal Chapel at
+Rome. Velutti was as much of a favorite in his day as our present tenors
+and handsome actors. The admiration of the opposite sex was fatal to
+him; he formed a _liaison_ with a young English lady residing in London,
+and the resulting excesses in which he indulged quickly brought him to
+his grave. He was passionately fond of women and was able to acquit
+himself perfectly; at least, as far as the copulative act--barring
+fecundation--was concerned.
+
+In a previous part of this chapter I have alluded to the very
+appropriate arrangement which formerly existed when music-teachers were
+eunuchs, and that our higher circles of society would do well to employ
+eunuchized coachmen, especially if possessed of susceptible and elopable
+daughters; but, from the accounts given by Mondat, it would seem that
+they are not as safe as might at first be imagined. However, they could
+not be as dangerous as the chief eunuch of the Grand Cherif of Mecca and
+increase the population to the same extent; but I should judge that they
+might be a very demoralizing moral element if introduced into modern
+society. If eunuchs must be employed, it can easily be understood why
+the Turk and Chinese prefer the real, clean-cut article. The New York
+"Four Hundred" should make a note of this, as in their present thirst
+for European aristocratic notions, coats of arms and titles, there is no
+telling how soon they may cross over into Oriental customs and run a
+harem, in which case it would be sad to have them make any mistakes in
+the quality and ability of the eunuch.
+
+Dr. Gardner W. Allen has furnished the American profession with a
+faithful translation of the valuable work of Professor Ultzmann on
+"Sterility and Impotence." In this, we have a clear and intelligent
+dissertation that explains the above conditions, and I am only surprised
+that the observations of Mondat have not developed such explanations
+before, as the principle was fully explained in practice fifty years ago
+by the Montpellier physician. According to Ultzmann, there is a form of
+fecundating impotence in persons otherwise well provided with an
+apparent complete apparatus, an impotence which he terms _potentia
+generandi_. He states, however, that this form of impotence was not
+recognized until a few years ago, citing the fact that females have had,
+as a rule, to bear all of the blame for the unfruitfulness of the
+family, and that they have been accordingly subjected to all manner of
+operations, general and local treatment, even to being sent to watering
+places and sanatoria where red-headed male attendants are employed, to
+say nothing of the prayers, intercessions, pilgrimages, and novenas to
+the holy shrines, as mentioned in the chapter on the holy prepuce.
+Ultzmann observes that a man may be perfectly able to go through the
+procreative or, rather, the copulative act, even to the great
+satisfaction of all parties concerned, and yet be perfectly impotent; he
+even goes further, by observing that there are cases in which copulation
+may take place without any fluid whatever being ejaculated. He mentions
+two such cases at pages 87 and 116 of his book. In the first instance
+the ejaculated fluid is precisely as that observed in such cases as
+those of the eunuchs and of Velutti, mentioned by Mondat, and consisted
+of an azoöspermic discharge, made up mainly from the secretion of the
+seminal vesicles, the accessory glands of the urethra, the prostate, and
+Cowper's glands, as well as the discharge from the secretory glands
+distributed along the course of the urethral mucous membrane. Some of
+the cases of this form of impotence have exhibited wonderful copulating
+desire and power of endurance, and, even if unfecundating, they must be
+said to be better off than the victims of that other form of male
+impotence, the _potentia coeundi_ of Ultzmann, where, with a normal
+semen, either the power of erection or that of ejaculation may be
+entirely absent.
+
+
+
+
+CHAPTER IX.
+
+PHILOSOPHICAL CONSIDERATIONS RELATING TO EUNUCHISM AND MEDICINE.
+
+
+Eunuchism does not always subdue the animal passions; this is the view
+that the church took in connection with the emasculation of Origenes and
+his monks; the church here held that not only was it possible for them
+to still sin in heart or imagination, but that, even were the complete
+eradication of the sexual idea possible, they had by their act lost the
+main glory of a Christian,--that of successfully striving against
+temptation, and by a force born of triumphant virtue overcome all the
+wiles of the devil. It is related that among the eunuchs at Rome there
+were some who, having been made so late in life, still retained the
+power of copulation, although the final act of the performance was
+absent. Montfalcon relates that Cabral reported dissecting a soldier who
+was hanged for committing a rape, but who on dissection showed not the
+least trace of testicles, either in the scrotum or abdomen, although the
+seminal vesicles were filled with some fluid.[34] Sprengle, in his
+"History of Medicine," relates of the complete removal of both testicles
+from an old man of seventy years of age, on account of inordinate sexual
+desire, the operation having no perceptible effect in subduing the
+disease.[35] These cases are analogous to those exceptionable cases in
+which, after extirpation of the ovaries, both menstruation and
+fecundation have still taken place.
+
+Modern civilization and its unnatural mode of dressing inflict great
+harm on men by keeping these parts too warm and constricted. Much of
+the irritability of these organs, as well as their _decadence_ at an age
+some generation or two before the time when they should still possess
+all their virile attributes, can be directly attributed to this cause. A
+more intelligent way of dressing would result in less moral and physical
+wreckage, and require less galvanic belts and aphrodisiacs in men under
+fifty. If those who habitually swath their scrotums in the heavy folds
+of their flannel shirts, to which are superadded the cotton shirts,
+drawers, and outer clothes in which civilized man incases himself, would
+cast a backward eye into the dim and misty past, and see the priest of
+some of the old Pagan gods soaking the scrotum in hot water, and then
+gradually rubbing the testicles within, by gentle but firm friction, _to
+make the testicles disappear_, a process by which many of the heathen
+priests prepared themselves for the discharge of their sacerdotal duties
+and the strict observance of those rules of chastity and celibacy which
+they were henceforth to live up to, they would find _one_ explanation of
+why civilized man does not possess that vigor and retain that
+procreative power into advanced age that was one of the characteristics
+of our ancient progenitors in the days that breeches were as abbreviated
+as those now worn by the Sioux Indians. These are really but leggins,
+which run only to the perineum and are simply tied by outer points to a
+strap from each hip. Finely and comfortably cushioned chairs may be a
+luxury to sit on, but they will have, on the man who uses them in youth
+and in his prime, a wonderful sedative and moral influence later on,
+about as effectual as the miniature warm baths for the scrotum and
+gentle pressure to the testicles that were used by the heathen priests
+of old, who preferred a gradual disappearance of the glands to the too
+sudden and summary methods of the Cybelian clergy, who used a piece of
+shell and an elaborately-performed castration. According to Paulus
+Ægineta, this was a common practice of making eunuchs out of young boys
+in the Orient, the mortality being hardly any; whereas the _taillè à
+fleur de ventre_, the favorite method for making eunuchs for harem
+guards and attendants, and more suited to the jealous disposition of the
+Turk, has a mortality of three out of every four, according to Chardin,
+and of two out of every three, according to Clot Bey, the chief
+physician of the Pasha,[36] and of nine out of ten, according to Bisson.
+So prone to reach high offices were intelligent eunuchs that it is
+related that parents were at times induced to treat their boys in the
+manner above stated, that they might be on the highway to royal favor,
+honor, and rank; such is the ennobling tendency of Oriental despotism,
+polygamy, and harem life. On the same principle Europeans subjected
+their boys to a like operation to fit them for a chorister life or the
+stage, where fame and honor and wealth were to be found.
+
+Medicine has been the butt of wits and philosophers, as well as of the
+men who, from the profession, have gone into the ranks of literature.
+Smollet, himself a physician, gives us an insight into our wandering and
+erratic misapplication of our knowledge on therapeutics in "Peregrine
+Pickle," where the poor painter, Pallet, is believed to be a victim of
+hydrophobia. The learned opinion of the doctor, who explains the many
+and various reasons by which he arrives at his diagnosis, the various
+physical signs exhibited by the patient as being pathognomonic of the
+disease, and his final venture with the contents of the _pot de
+chambre_, as a diagnosis verifier, which he dashes in the patient's face
+in preference to ordinary water on account of the medicinal virtues
+contained in urine, which in the case seemed to him to have a peculiar
+therapeutic value, is something worth reading, however ludicrous it all
+sounds. There are few intelligent physicians but who have seen as
+ridiculous performances, in what might be called medical gymnasts, that
+equal, if not surpass, those of Smollet's doctor. Rabelais was also a
+professional brother, who, equally with Smollet, attempted to waken up
+the profession by his satires. Smollet was not only a physician, but in
+his early life had seen some very active and practical work, having
+participated in and been a witness to the ills and misfortunes that
+follow any attempts to "lock horns" with nature through ignorance of
+physical laws and preventive medicine,--having been a surgeon's mate in
+the fleet which assisted the land forces in the murderous and ill-fated
+Carthagena expedition which cost England so many lives, ignorantly and
+needlessly sacrificed to ministerial disregard of physical laws and its
+consequences,--lessons which, unfortunately, seem to have but little
+effect on cabinets, owing to their shifting _personelle_, England
+following up the disasters of Carthagena with the still greater blunder
+of the Walcheren expedition, where, out of England's small available
+physical war material, nearly forty thousand men were either left to
+fatten the swamps of Walcheren, or to wander through England in after
+years on the pension-list, physical wrecks and in bodily and financial
+misery.[37] Again, the same disregard, born of ignorance and red tape,
+crippled the British army in the Crimea, causing in its ranks the
+greatest mortality. It has seemed as if it would be of advantage if all
+the blunders, either philosophical or of statesmanship, committed by a
+cabinet, should be written in large letters of gold, to be hung in the
+council-halls of the nations, that similar blunders at least might not
+occur again.
+
+Dumas, in his "History of the Two Centuries" and his "History of the
+Century of Louis the XIV," gives some very interesting medical touches.
+Le Sage, in his "Adventures of Gil Blas," gives us food for speculating
+on medical philosophy in connection with the interesting subject of how
+to make the profession remunerative. Dickens's ideas of the doctor, as
+given in his works, are life touches. Witness his description of the
+little doctor who superintended little David Copperfield's advent into
+the world, or of Dr. Slammer of the army; they represent his view of the
+professional character. Fontenelle, probably, was right in ascribing the
+fact of his becoming a centenarian, and maintaining a stomach with the
+force and resistance that are the peculiar characteristics and
+attributes of a chemical retort, to the fact that when sick it was his
+practice to throw the doctor's physic out of the window as the doctor
+went out of the door, as in his day a man required the constitution of a
+rhinoceros and the stomach of an ostrich, with the external
+insensibility of a crocodile, to withstand the ordinary doctor of the
+period and his medications. Napoleon believed that Baron Larrey was the
+most virtuous, intelligent, useful, and unselfish man in existence; in
+fact, it is doubtful if any man of his time commanded from this truly
+great man so much admiration or respect, either for bravery, courage,
+intelligence, or activity, as the great and simple-minded Larrey. As
+observed by Napoleon of his bravest general,--poor Marshal Ney, the
+bravest of the brave, the rear guard of the grand army, the last man to
+leave Russian soil,--Ney was a lion in action, but a fool in the closet.
+All his generals had some great distinguishing characteristic, beyond
+which was a barren waste, a vacuity, but too apparent to a man of
+Napoleon's discernment. But the cool, unflinching bravery of Larrey,
+that did not require the stimulus of the fight or the phrenzy of strife
+to bring it to the surface and keep it alive; bravery and intelligence
+alike active under showers of shot and shell or in the thunders of
+charging squadrons; in the face of infective epidemics or
+contagiousness, walking about in these scenes in which his own life was
+as much at stake as that of the meanest soldier, with the same cool
+exercise of his intelligence that he exhibited in the organization and
+superintendence of his hospitals in the time of peace; always the same,
+untiring, unmurmuring, brave, studious, observing, unflinching in his
+duties, unselfish; whether in the burning sands of Egypt or in the snowy
+steppes of Russia, in the marshy plains of Italy or in the highlands of
+Spain, he always found him the same, and his notes and observations,
+from his first government service on the Newfoundland coast to his last,
+always showed him the same laborer and student in the field of medicine.
+And yet at St. Helena we find Napoleon refusing to take remedies for
+internal disease whose real nature was unknown, and only toward the end
+did he consent to take anything, and then only when seeing that the end
+was approaching, and more from a kindly desire to express his
+appreciation of the services of his attendants, and not to wound their
+feelings, than from any hope of assistance. Napoleon had not neglected
+the study of medicine any more than he had the study of every other
+science. This is evident from the instance related as taking place
+during the march of the grand army from the confines of Poland into
+Russia, in 1812, when dysentery became very prevalent, of his inviting
+several of his favorite guard to his own table, where he experimented
+on each particular grenadier with a specific form of diet, so as to
+determine its cause and possible remedy. He did not look upon our
+knowledge of pathology and our skill in diagnosis as being sufficiently
+advanced or perfect to make him feel but that a treatment for an obscure
+disease like his own would be pretty much a matter of guess-work.
+Charles Reade, in his "Man and Wife," shows an intimate knowledge of
+medical science where he philosophizes on the effects of an irregular
+life and of over-physical training. His logic is sound science. Defoe
+and Cervantes show a like intelligent insight as to medicine; and it was
+not without reason that Sydenham, the English Hippocrates, advised a
+student of medicine who entered his office as a student to begin the
+study of medicine by the careful study of "Don Quixote," remarking that
+he found it a work of great value, which he still often read. The works
+of Bacon and of Adam Smith on "Moral Sentiments;" the famous treatise on
+the "Natural History of Man," by the Rev. John Adams; the later works of
+Buckle, Spencer, Darwin, Draper, Lecky, and other robust wielders of the
+Anglo-Saxon pen, as well as the works of Montaigne, Montesquieu, La
+Fontaine, and Voltaire, are all works that the medical man could
+probably read with more profit than loss of time. In fact, either Hume,
+Macaulay, or any philosophical work on history will furnish to the
+physician additional knowledge of use in his profession. No physician
+can afford to neglect any study that in any manner adds to his knowledge
+of the natural history of man, as therein is to be found the foundation
+of our knowledge as to what constitutes health, and as to what are the
+causes that lead humanity to diverge from the paths of health into those
+of physical degeneracy and mental and bodily disease.
+
+We have in medicine many sayings which pass for truisms, which are,
+after all, misleading. We say, for instance, keep the feet warm and the
+head cool; this will not always either keep you comfortable or well, as
+we know that in neuralgias it is absolutely necessary, either for
+comfort or to get well, to keep the head warm. While so much stress is
+laid on the necessity of keeping the head cool, a thing a person is sure
+to look after whenever the head becomes uncomfortably warm, and to which
+can be ascribed but few ailments or deaths, we hear comparatively
+nothing about the thermometric condition of the perineum, which, from
+the varying temperatures in which it is at times plunged, produces more
+beginnings for diseases in the future, during youth and our prime, as
+well as it quite often causes the sudden ending of life in more advanced
+periods. People who carefully observe the rule of keeping their heads
+cool and their feet warm will stand with outspread legs and uplifted
+coat-tails with their backs to a blazing grate, and then, going outside,
+incontinently sit down on a stone or iron door-step, or, stepping into a
+carriage or other vehicle, they sit down on a cold oil-cloth or leather
+cushion, without the least knowledge of the harm or danger that they are
+liable to incur. They little dream of the prostatic troubles that lie in
+wait for the unwary sitter on cold places, ready to pounce upon him like
+the treacherous Indian lying in ambush,--troubles that carry in their
+train all the battalions of urethral, bladder, kidney disease and
+derangments, and subsequent blood disorganization, which often begin in
+a chilled perineum, and, in conjunction with the local disease that may
+result, end in handing us over to Father Charon for ferriage across the
+gloomy Styx long before our life's journey is half over. It is true,
+neither the savage of Africa or America nor the nomads of Asia are
+subject to any of these troubles; but with us, hampered with all the
+benefits of the dress, diet, habits, and luxuries of civilization, and
+with a civilized prostatic gland, it is quite otherwise. Herein, again,
+comes that connection between religion, morality, and medicine, that
+existed with so much benefit to mankind, but from which we of later days
+have, in our greater wisdom, seen fit to separate; although,
+inconsistently as it may seem, the present age has done more than any
+previous epoch in practically demonstrating the intimate and inseparable
+relation existing between the physical and moral nature of man. The
+persistent priapism which oftentimes results from riding with a wet seat
+and the inordinate morbid sensibility of the sexual organs that may
+result from the same cause or from spinal irritation are not to be
+allayed by any homily on morality or on the sanctifying attempts at
+keeping the animal passions under subjection, any more than will prayers
+or offerings to all the gods of Olympus restore the eunuchized, either
+through foolish civilized dress and customs or through excessive
+indulgence. We must mix medicine with our religion and make the clergy
+into physicians, or ordain our physicians into full-fledged clergymen.
+
+The science of medicine, or what might be called the natural ways of
+nature through its physical laws, is true to itself; the fault lies in
+our interpretation of its phenomena, which we fail to study with
+sufficient discriminative precision and nicety. We have repeatedly
+mistaken causes and results from this want of close observance and of
+precision, attributing results to causes which did not exist. As an
+example, when the early disciples of homoeopathy in ancient Palestine
+undertook to revive poor, old, withered King David, by putting him to
+bed with a young and caloric-generating Sunamite maid, when it was by
+like incontinent practices that he had brought himself to that state of
+decrepitude, it is plain that they misunderstood the principle.
+Boerhaave--who, as a true eclectic practitioner, followed these ancient
+and Biblical homoeopaths in their practice in a similar case, the
+subject being an old Dutch burgomaster, whom he sandwiched between a
+couple of rosy Netherland maids--also failed to grasp the true condition
+of the nature of things, or the true philosophical explanation. The
+exhalations from the aged are by no means an elixir of health or life to
+the young, and the fact that the young were apt to lose health by
+sleeping with the aged was wrongly attributed to their loss being the
+others' gain, and the result of its passing into the bodies of their
+aged companions, and not to its true cause,--the deteriorating influence
+to which they were subjected; and, further, when we analyze the subject
+still more, we can understand how a full-blooded and active,
+lithe-bodied, thin, and active-skinned Sunamite maid might and would
+impart caloric to King David; but, from our knowledge (not altogether
+practical) of the difference that exists between differently
+constitutioned and differently built maids in imparting caloric, and
+from our knowledge of the physique of the Netherland maids, who are cold
+and impassive, with a layer of adipose tissue that answers the same
+purpose as that of the blubber in the whale,--that of retaining heat and
+resisting cold,--we can well believe that the poor, shriveled
+burgomaster could receive but little heat, even when sandwiched between
+the two; but, on the contrary, he was, in fact, more liable to lose the
+little he had, unless we look at the subject in another light, and
+consider that sentiment that is common to both animals and men of
+spirit, a sentiment that has furnished the subject for more than one
+canvas in the hands of the true and sympathetic artist, as seen on the
+awakening and alert attitude of the worn-out and old decrepit war-horse,
+browsing in an inclosed pasture, as he hears from afar the familiar
+bugle-notes of his early youth, or some cavalry regiment with prancing
+steeds and jingling accoutrements, with bright colors and shining arms,
+going past the pasture, restoring for a time to the stiffening joints
+and dim eyes the suppleness and fire of bygone times, with visions of
+gallant charges and prancing reviews; or, how the same sentiment erects
+once more the bowed and withering frame of the old veteran, and once
+again fires his soul with the martial zeal of his prime as he sees the
+passing colors and active-stepping regiment which he followed in the
+bright sunshine and flush of his youth. Aside from these sentiments,
+which might possibly have inspired David and the Dutch burgomaster with
+an infusion of a new and transient good feeling, it is unquestionable
+but that some heated brickbats or stove-lids, curocoa jugs or old stone
+Burton ale-bottles filled with hot-water, would have been more effectual
+in imparting warmth than either Sunamite or Netherland maids.
+
+It is hard to reconcile the beliefs of some people or nations with their
+manners and customs. For instance, there is the Turk; when a Jew becomes
+a Mohammedan he is made to acknowledge that Jesus Christ, the son of
+Mary, is the expected Messiah, and that none other is to be expected;
+they know of Christ's speech on the cross, made to the repentant thief;
+they believe in a heaven full of houris, with large black eyes and faces
+like the moon at its full, in which all good Moslems are to have
+continual rejoicings, and yet they go on performing the most barbarous
+and inhuman forms of castration imaginable, which not only deprives its
+victims of their virility, but subject more than three-fourths of those
+operated upon to a painful death, and the remaining to a life of
+continual misery. Have these poor subjects no right to future bliss, or
+in what shape will they reach there? If the heavens of these eunuchisers
+were like the heaven of Buddhism, or, as the Chinese call it, the
+Paradise of the West, where, although all forms of sensual
+gratifications are to be enjoyed, no houris are to be supplied to the
+saints of Buddhism,--as even the women who enter this paradise must
+first change their sex,--we might understand that, the genitals not
+being needed in the eternal world, it might be considered a matter of
+small moment to compel a man to go through this short and transient life
+without them; but where a robust condition of the sexual organs is
+suggested as one of the heavenly requisites, it would seem as if the
+Turk would look upon the suffering, misery, and death that they cause,
+in connection with the inhuman mutilation they inflict, with horror.
+Doctrinal theology, whether in the East or West, is something
+incomprehensible.
+
+
+
+
+CHAPTER X.
+
+HERMAPHRODISM AND HYPOSPADIAS.
+
+
+There exists a class of human beings whose description is connected with
+the subject of this work. They date back to mythological times, and the
+confusion incident to the misapplication of names and the want of proper
+observation on the part of the narrators has tended to carry the
+uncertainty of their real existence to the present day. One reason that
+this part of the subject would be incomplete without their description
+is on account of the origin of their existence being intimately
+connected with eunuchism, being, in fact, an outgrowth of this
+condition; and any history of eunuchism would be but half told, without
+the additional information concerning these persons.
+
+Hermaphrodites, as stated, date back to mythology. Tradition tells us
+that Hermaphroditus, a son of Venus and Mercury, was educated by the
+Naiades dwelling on Mount Ida. At the age of fifteen years, he began his
+travels; while resting in the cool shades on the woody banks of a
+fountain and spring near Caira, he was approached by the presiding nymph
+of the fountain, Talmacis, who, becoming enamored of him, attempted to
+seduce him. Hermaphroditus, like Joseph, was the pattern and mirror of
+continence, and would not be seduced. Talmacis then, like Potiphar's
+wife, seized on the unlucky pattern of virtue, and prayed to the gods
+that they should so amalgamate poor Hermaphroditus to her body as to
+make them one. The prayer was heard on Olympus, and forthwith the two
+became one, but with the distinctive characteristics of each sex
+unchanged. Thus began that fabled race of the _androgynes_ of the
+ancients. Another tradition, which is probably correct, affirms that
+ancient Carnia, or Halicarnassus, was in those days the Baden-Baden of
+Asia Minor; that thither repaired all the victims of gluttony,
+debauchery, and general physical bankruptcy. Its name in ancient Caria
+denotes its seaside-resort location, Hali-Karnas-Sos meaning literally
+"Karnassus-by-the-sea," like Boulogne-sur-mer. The city was under the
+protection of Hermes and Aphrodite, whose temples were near each other.
+Human nature in the days of Halicarnassus did not much differ from human
+nature at Monte Carlo or Baden-Baden. The baths had a number of young
+and handsome eunuchs who waited on the old, debauched, and nervous
+wrecks, and the nymph who presided over the whole was Talmakis, a name
+derived from the salty nature of the springs which fed the baths; this
+nymph was worshiped as Aphrodite. Pederasty was one of the practices at
+these baths. From these conjoined conditions the place was said to be
+peopled with hermaphrodites,--meaning, at first, simply that they were
+under the protection of Hermes and Aphrodite; and latterly the name was
+attached to the passive agent in the pederastic art,--a name that has
+followed the class and crossed the ocean into the interior wilds of
+America, as in Powell's history of the manners and customs of the
+Omahas, an Indian tribe of the Missouri, we find that they at times
+practiced pederasty, the passive agent being called by the Indians an
+hermaphrodite, or double sexed.[38]
+
+The relations that from eunuchism led to pederasty are very easy of
+explanation. Eunuchism induces an effeminate form, softer body, and
+prevents the growth of the beard; the voice is softer and more
+melodious; and their timidity renders them also more effeminate,
+obedient, and dependent. The peculiar commingling of the female form
+with that of the male furnished to the sculptors the models for those
+wonderfully well-made forms which are yet to be seen, representing in
+statuary the forms of Androgynes and Hermaphrodites; that of the
+favorite eunuch of the emperor Adrian being remarkable for the symmetry
+of its form and grace of pose.
+
+Europe must have been astonished at the tales that were carried back by
+the early explorers and voyagers, in relation to the New World. The
+story of the immensity of the quantity of gold and silver, of great
+stores of hidden treasures, of the quantities of precious gems and
+priceless crystals was fully discounted when, from the Florida coast and
+the explorers of the Lower Mississippi, men returned with the tale that
+in the everglades and in the trackless forests, intersected by navigable
+sloughs, there dwelt a people half of whom were hermaphrodites. Neither
+the explorers nor their European historiographers seem able to have
+grasped the true state of affairs. Many believed in the actual existence
+of such numbers of these monstrosities, while others, arguing from what
+was then known regarding the extraordinary development of the nymphæ and
+clitoris, as well as of the great labia, of the women in the African
+regions, concluded that these supposed _androgynes_, or hermaphrodites,
+must be women, the dress assumed by these and the menial labors to which
+they were consigned assisting to favor this opinion. The early
+Franciscan missionaries to California found the men who were used for
+pederasty dressed as women.[39] Hammond mentions the practice as in
+vogue among the Indians of the southwest, which in a measure greatly
+resembled that of the ancient Scythians in its operation, the men being
+dressed as women, associating with women, and used for pederastic
+purposes during the orgies of their festivals. These men had previously
+been eunuchised by a process of continued and persistent onanism, which
+caused at the end a complete atrophization of the testicle.
+
+In regard to the great number of hermaphrodites observed in Florida and
+on the Mississippi, the accounts are only reliable as far as they were
+present in female garb and in an apparent state of slavery, being
+compelled to do all the menial labor of the villages and camps, besides
+being used for pederasty, no examination having been made by any
+traveler. Their lot was different from those described by Hammond in his
+work on "Male Impotence," where the whole transaction seems to have some
+sort of religious and civil significance. In Florida, however, they
+tilled the ground, extricated and carried off the dead during a battle,
+and did all the work generally, being used for beasts of burden and not
+allowed to cut their hair; but all authorities are silent or in complete
+ignorance as to whether they had suffered castration. Pere Lafiteau,
+however, gives an explanation which was in the last century considered
+ridiculous, but which, in the light that has been thrown on the
+existence of a former continent, and of the undisputable relation that
+must, some ages in the past, have existed between Phoenicia and Central
+America, seems a strongly probable solution of these customs. The Father
+accounts for the presence of these American _androgynes_ in the
+following manner: The Carribeans, or Caribs, were originally a colony
+from Carnia; with these colonists was brought over the worship of their
+Pagan gods of Caria and Phrygia; these two localities were the homes of
+the Cybelian priesthood, who dressed in female garb, as did the
+sacrificial priests of the Temple of Venus Urania. It is true that the
+Java or Floridian priest had nothing in common with the priests of
+Cybele or of Venus Urania; but, still, Lafiteau gave as lucid an
+explanation for the existence of these conditions as any of his
+contemporaries. Charlevoix observed the same practices among the
+Illinois, which he attributed as being due to some principle of
+religion. The Baron de la Hontan insists that the missionary,
+Charlevoix, was mistaken; that the persons whom he saw in female attire,
+whom he took to be men, were not men. Hontan asserts that they were
+veritable hermaphrodites. The missionaries were, however, correct, as
+what has since been observed confirms their opinion. M. du Mont, who
+ascended the Mississippi for a distance of nine hundred leagues, also
+reported meeting Indians at different places attended by these
+petticoated androgynes.[40]
+
+As strange as it may seem, many intelligent men were loth to part with
+their belief in the existence of these double-sexed individuals; the
+logic used by many of these insisters of hermaphrodism, although now
+very ridiculous, was no doubt sensible logic one hundred and fifty years
+ago. As a matter of curiosity, some of this reasoning will bear
+repeating. It is taken from a Latin edition of an ancient description of
+Florida, originally in the English, but translated into the Latin by the
+geographer, Mercator. In this book we find the roots of some of the
+myths that led Ponce de Leon and his steel-clad warriors to wander
+through Florida in a vain search of that spring or fountain of the
+waters of perpetual youth and of everlasting life which they were never
+to find. We there learn that, in the days of the good old Spanish
+knight, the inhabitants of Florida lived to a very old age, and that
+they did not marry until very late in life, as before that period it was
+very difficult to determine the sex of the individual.
+
+From what has since been seen among the Indians, the probability is that
+these were really eunuchs, and probably in slavery, as the result of the
+fortunes of war, as their great number and servile condition will hardly
+admit of the belief that they belonged to the same tribe as their
+masters and oppressors. Pederasty was an old, very old practice, being
+mentioned before circumcision; it prevailed among many of the Orientals,
+and among the many peoples by whom the early Jews were surrounded, who
+were, according to the Old Testament, about as an immoral, dissolute,
+and bestial a set as one could well imagine. Their religions were
+nothing but a gross mixture of stupid superstition and blind idolatry,
+pederasty, fornication, and general cussedness. In the then state of the
+Jewish nation, to have allowed them to mingle freely with these people
+would have ended in having the Jews adopt all their customs and habits.
+The aim of the Jewish leaders was to prevent any too free intercourse of
+their people with these nations, that they might remain uncontaminated
+even while dwelling near them. To accomplish this it was necessary to
+raise a barrier that would be the distinguishing mark of the Jewish
+nation. Jahns, in his learned work on the "History of the Hebrew
+Commonwealths,"[41] lays down the idea that circumcision, as well as
+many articles in their laws,--which to us appear trivial,--were in
+reality intended to separate the Jews farther and farther from their
+idolatrous, bestial, and heathenish neighbors, while at the same time
+these same ordinances were intended to preserve a constant knowledge of
+the true and only God, and maintain their moral and physical health.
+
+Although hermaphrodism on a large scale, as an existing condition, was a
+matter of serious belief at the end of the eighteenth century, it has
+occupied no little attention in this. Courts have been called to decide
+on cases to invalidate marriages, or to decide the sex, more than once;
+and physicians are often asked the question, Do hermaphrodites really
+exist? Dr. Debierre, of Lyons, published in 1886 a valuable paper,
+entitled "Hermaphrodism Before the Civil Code: its Nature, Origin, and
+Social Consequences," which was published in the _Archives of Criminal
+Anthropology_ of Lyons, France. In this short but very concise treatise,
+Debierre gives us a complete review of the subject from mythological
+times to 1886. It must be quite evident to all that there exists no
+logical reasons why the sexual or generative organs should be exempt
+from, at times, being subject to variations from the normal, either
+through the commingling of two conceptions or of faulty development
+affecting other parts of the body,--conditions that go to form
+monstrosities. Debierre gives one peculiar case of a duplication of
+vagina and uterus in a girl of nineteen, the appearance of the parts and
+the septum between the vaginæ giving to the whole an appearance
+precisely similar to that of a double-barreled shot-gun. These
+monstrosities are as likely to happen as the different forms that
+affect--either by arrested development or some abnormality of excessive
+development--the head, which is a very prolific subject of anomalies.
+
+Hermaphrodism is a common attribute in the vegetable kingdom, where
+fixed habitation or position makes such a condition necessary; it is
+also common to many of our lower forms of animal life, and even in the
+human foetus the presence of the Wolfian bodies and the canal of Müller
+in the same individual attest a primitive case or condition of
+hermaphrodism. In other words, humanity begins its existence in a state
+of hermaphrodism. This condition is found up to the end of the second
+month of foetal life in the human being, in common with all mammals, as
+well as all the vertebrates, where, however, it is subject to variations
+as to time of development and limit of existence in the normal
+condition. In the chick, it is only after the fourth day that the
+genital gland begins to determine whether it will turn into an ovary or
+a testicle; in the rabbit it is on the fifteenth day, and in the human
+embryo on the thirtieth day. Hermaphrodism does not occur, however, from
+this at first uncertain state of affairs, but rather from subsequent
+developments of the external organs that by their abnormality of
+formation simulate one or the other sex, while the internal organs may
+belong without any equivocation of structure to its definite sex; as it
+has often happened that some of these cases, having been the subject of
+differences of opinion among experts during life, were, after death,
+unanimously assigned to one sex by all of the same experts, the organs
+readily defining the sex being completely of the one sex. As observed by
+Debierre, where the subject is really a female, even where the vagina or
+uterus is unperceived, the presence of the menstrual function or some
+physical disturbance at its stated periods are sufficient evidences, as
+a rule, by which to determine the sex. The case of Marzo Joseph, or
+Josephine, reported by Crecchio in 1865, had rudiments of an hypospadic
+penis ten centimetres in length and a prostate of the male sex, with a
+vagina 6 centimetres in length and 4 in circumference, ovaries,
+oviducts, and uterus of the female; it was not until her death, at the
+age of fifty-six, that her sex was fully determined. The case reported
+by Sippel in 1880, supposed to be a male from external evidences, was at
+death found to be a female. Guttmann reported a like case in 1882. The
+celebrated case of Michel-Ann Dronart is remarkable; this case was
+declared a male by Morand Pere and a female by Burghart, as well as by
+Ferrein; declared asexual or neutral by the Danish surgeon, Kruger; of
+doubtful sex by Mertrud. The case of Marie-Madeleine Lefort, to which
+Debierre devotes four figures, is full of interest. One of the figures
+is her portrait at the age of sixteen, and another is from her
+photograph at the age of sixty-five. She has a man's head in every
+particular of physiognomy and expression, having in the latter figure a
+full beard and the peculiar intellectual development of a male sage; she
+has the hairy breast of the man, with the mammary development of the
+female, and an abnormally-enlarged clitoris, which was often mistaken
+for the male organ. The vagina at its lower end was narrow, and the
+urethral aperture opened into it some distance from its outer opening;
+otherwise she was sexually a perfect woman, and menstruated regularly.
+Debierre quotes the case which Duval gives in his work on
+hermaphrodites, wherein a man asked for a dissolution of marriage,
+claiming that his wife had a male organ, which, although she was a woman
+in every other sense, prevented by its interference the consummation of
+the marriage act. The court had the case examined, when it was found
+that the erection of the clitoris, which was large, was enough to
+interfere as the husband had stated. It decreed that the young woman
+should have the objectionable and interfering member amputated, and on
+the refusal to have this done the marriage should be dissolved. She
+refused, and the divorce was consequently granted to the man.
+
+From the history of Marie Lefort, it can well be conceived how the
+popular mind, in ignorant times, could easily be imposed upon. Montaigne
+relates the history of a Hungarian soldier who was confined of a
+well-developed infant while in camp, and of a monk brought to a
+successful accouchement in the cell of a convent; while Duval reports
+the case of a priest in Paris who was found to be pregnant with child,
+who was in consequence imprisoned in the prison of the ecclesiastical
+court. These cases were strongly females in every sense, but with some
+male characteristic sufficiently developed, like in the case of Marie
+Lefort, to allow them to believe themselves men and to pass for such.
+
+On the other hand, males have had some female characteristics so well
+pronounced that they have passed for females. Debierre mentions a number
+of cases, to wit: Ambroise Paré reported such a case in his time;
+Ladowsky, of Reims, reports the case of Marie Goulich, who, up to the
+age of thirty-three, was believed to be a female, at which time the
+descent of the testicles removed all doubts as to sex. Sheghelner and
+Cheselden have reported analogous cases, and Girand's case--who was
+happily married to a man with whom he lived until the death of the
+husband, in which the only female attribute was a blind vagina, which,
+in his case, seems to have answered all purposes--was a most remarkable
+case. As a rule, the cases of males who have been mistaken for
+hermaphrodites have been cases of hypospadic urethræ in a greater or
+lesser sense of deformity.
+
+Debierre, however, mentions some cases of true hermaphrodism. He quotes
+a number of cases, the earliest being from the writings of Coelius
+Rhodigin, who claimed to have seen in Lombardy a case in which the
+organs of the two sexes were side by side; Ambroise Paré records that in
+1426 a pair of twins were born, joined back to back, wherein both were
+hermaphrodites. Among the many reporters that he quotes, he mentions
+Rokitansky, who reported a case in 1869, at Vienna, this being the
+autopsy of Hohmann, who had two ovaries and oviducts, a rudimentary
+uterus, and a testicle, with a sperm-duct containing spermatozoa. This
+individual menstruated regularly, and it is an interesting question as
+to what the result would have been had some of the spermatic fluid come
+in contact with some of the ovules that were periodically discharged.
+Hohmann had an imperforate penis and a bifide scrotum. Ceccherelli, who
+gives a more minute description of this interesting case, relates that
+Hohmann, who died at the age of forty, had menstruated regularly to the
+age of thirty-eight. The penis was imperforate but hypospadic, from
+whence came the urinary and spermatic discharges, and Hohmann could in
+turn copulate as either male or female. Odin is also quoted in relation
+to the case seen at the Hôtel-Dieu-de-Lyon, during the service of M.
+Bondet. The subject was aged sixty-three, and named Mathieu Perret. The
+case greatly resembled that of Hohmann, at the autopsy being found to be
+double sexed. So that, while most of the cases mentioned are fictitious
+and only apparent, the fact remains that the existence of true
+hermaphrodites is indisputable.[42]
+
+If the subject of either apparently or true hermaphrodism is one of
+unhappiness, and oftentimes of discomfort and misery, history relates
+that this unfortunate class has suffered additionally, from the laws and
+action of ignorant and barbarian times, as such freaks of nature must
+of necessity have occurred at all times; only in the then ignorant state
+of medicine and anatomy they must have been considered as occurring much
+oftener--every deviation from the normal being considered as
+hermaphroditic. Opmeyer relates that in excavating in the neighborhood
+of the capitol in Rome, the laborers discovered the bronze tables on
+which were inscribed the twenty-two laws of Romulus, termed by many
+historians "The Double Decalogue of Romulus." Article XV of this law, as
+well as Articles IX and X, seem to be directed against the life of these
+androgynes. In Roman history, however, we have an event which would seem
+to contradict that there existed any laws in actual force against this
+unfortunate class. It happened during the existence of the Punic wars,
+when the people were more or less laboring under fear and excitement,
+which would readily prepare them to accept any superstitious notion. It
+was during these times that three of these androgynes were known to
+exist in Italy. Titus Livius mentions that the existence of one of these
+was denounced during the consulships of C. Claudius Nero and of Marcus
+Livius. Etruscan soothsayers and seers were summoned to Rome, that they
+might consult the signs and the conditions of the constellations that
+accompanied the nativity of this hermaphrodite, or androgyne. These
+impostors, after a careful consultation of all attending circumstances,
+gave it as their opinion that the occurrence was an unfortunate
+impurity, and that it could only result to the disadvantage of Rome,
+unless she at once took steps to purify herself of such a monstrosity,
+with the conclusion that the androgyne should be first exiled from Roman
+soil, and then drowned in the depths of the sea. The unfortunate being
+was accordingly inclosed in a chest and put on board a galley, which
+put immediately to sea; when the vessel was out of sight of land the
+chest was thrown into the Mediterranean.[43]
+
+A hermaphrodite born in Umbria during the consulship of Messalus and C.
+Lucinius was condemned to death, as well as was the one born at Luna
+during the consulship of L. Matellus and Q. Fabius Maximus. Debierre
+states that in the reign of Nero this barbarous custom was discontinued,
+as this emperor admired these freaks of nature from their novelty, as it
+is related that his chariot was drawn by four hermaphroditic horses.[44]
+
+In connection with hermaphrodism it has been shown that the males who
+have been supposed to be so malformed were really, in most instances,
+but cases of hypospadias. It may not be uninteresting to observe that,
+while during nearly four thousand years circumcision has been practiced
+without the habit or condition ever having become transmissible or
+hereditary, hypospadias has shown a decided tendency to being
+transmitted. In Virchow's _Archives_, Lesser reports having treated
+eight subjects during one generation in a family.[45] Fodéré records the
+case of hypospadias reported by Schweikard, in a person of forty-nine
+years of age, whose urethral orifice was near the junction of the penis
+and scrotum, but who, nevertheless, had three fine children. The same
+author records the remarkable case reported by Hunter to the Royal
+Society of London, also so deformed, who successfully impregnated his
+wife by receiving the spermatic fluid in a warm spoon and immediately
+injecting it into the vagina.[46] Another interesting case is taken from
+_L'Union Médicale_ of August 26, 1856. It instances both the heredity
+connected with hypospadias and the peculiar circumstances under which
+impregnation at times takes place; it is reported by Dr. Trexel, of
+Kremsier, and is as follows: "On April 1, 1856, a newborn infant was
+brought to Dr. Trexel, that he might determine its sex. The father and
+mother were servants of a peasant. On an examination of the alleged
+father, he was found to have all the external characters of a male; the
+urethra, which was rather shorter than ordinary, but of large size, was
+imperforate; the scrotum was divided into two pouches, each containing a
+testicle. The apposed surfaces of the scrotal pouches were covered with
+a red skin, and the division extended through their entire length. At
+the root of the penis, in the anterior angle of these pouches, was an
+opening of the size of a lentil; this was the orifice of the urethra.
+The lower surface of the penis was grooved from the above-mentioned
+orifice to the end of the glans. There was no prepuce. Almost in a line
+behind the corona of the glans, and in the groove, were two elliptical
+openings, which readily admitted a large hog-bristle; there was a third
+smaller opening two lines from the orifice of the urethra. This man had
+always passed for a woman. He lay in the same room with the mother of
+the child; and they acknowledged having had frequent connection. The
+woman declared that she had had no commerce with any other man for three
+years, and the man did not deny this assertion. The idea of cohabitation
+with another man was further negatived by the circumstance that the
+infant had the same conformation of the genital organs as the father.
+How did fecundation take place? The three openings in the penis were
+probably the orifices of the excretory ducts of Cowper's glands. But
+might not these have been the openings of the ejaculatory ducts? It is
+to be regretted that Dr. Trexel did not examine these canals; their
+length and direction would have thrown light on the subject. The fact
+of fecundation may also be explained by supposing that during coition
+the posterior wall of the vagina supplied the place of the absent floor
+of the urethra, thus forming a complete canal. This is the most probable
+explanation."[47]
+
+The above case, as stated, had passed for a woman; these cases are by no
+means such rarities. The case of Marie Dorothee, mentioned by Debierre
+in his work, was as peculiar. Hufeland and Marsina had pronounced Marie
+a woman, while Stark and Martens pronounced her a man, and Metzger could
+not determine on the sex. The case of Valmont, noticed by Bouillaud and
+Manee, is on a par with that of Giraud, in which the party was married
+as belonging to one sex and where it was not until after death
+ascertained that the person belonged to the other sex. Valmont had a
+hypospadic urethra and penis; a scrotum without testicles; ovaries with
+the Fallopian tubes; a uterus opened into a vagina of two inches in
+length, which, gradually narrowing, ended in the male urethra, to which
+was attached a prostate gland. Valmont contracted marriage as a man and
+was not discovered to have been a female until the autopsy revealed her
+to be a woman. The relation does not state anything in regard to
+menstruation; so that her condition in that regard is unknown.[48]
+
+There has also been reported a number of cases in the male analogous to
+the double organed female mentioned by Debierre. Geoffrey St. Hilare
+reports a case where the penis was double, one being above the other,
+urine and semen flowing through both urethras. Gorè mentioned a like
+case to the Academy in 1844. Dr. Vanier (Du Havre) records the case
+reported by Huguier to the Academy, where the organs in the anatomical
+preparation which he exhibited were so anomalous that it was impossible
+to decide the sex. Aside from the medico-legal aspects that these cases
+present, there is an interesting Jewish theological question connected
+with them. The law is explicit as to circumcision; the cases presenting,
+if males, should be circumcised, but how to determine the sex where an
+autopsy alone will decide the question is not defined. It has been
+decided, in such cases where the presumption is that the child is of the
+male sex, that, like in cases of absence of prepuce, a suppositious
+circumcision should be performed, so that the covenant should be
+observed; this being in keeping with the sentiment shown by the Jews
+when persecuted by the Romans, or, later, by the Spaniards, who often
+were not able to circumcise until after death; but they never fail to
+comply with the covenant as far as it is possible.
+
+Cases are liable to occur, however, which, without leaving the question
+as to sex in doubt, if reasoned by exclusion, would not furnish any
+possible opportunity for circumcision. Such a case is reported in
+Virchow's _Archives_, vol. cxxi, No. 3; also in the _British Medical
+Journal_ of December 6, 1890, and in the _Satellite_ for January, 1891.
+It is one of congenital absence of penis. "Dr. Rauber records very
+briefly the case of a shoe-maker, aged 38, who complained of pain and
+trouble in the anus. On examining him, Rauber found a well-formed
+scrotum containing two testicles, each with a vas deferens and spermatic
+cord, but no trace of a penis. The urethra opened apparently into the
+anterior wall of the rectum. The man occasionally experienced sexual
+excitement, followed by an emission into the rectum. The burning pain
+complained of in the rectum and about the anus was due to the irritation
+caused by the urine. The man would not allow an ocular inspection of
+the interior of the rectum. Unfortunately, the details of this very rare
+condition are incomplete."
+
+It would be interesting to know where the seat of his sexual desire is
+situated, unless an aching testicle is such. I once knew a Spiritualist
+who claimed to feel the pains suffered by any friends with whom he was
+in sympathy; he once tried to argue with me that a certain lady
+patient--a warm personal friend of my questioner and a Spiritualist--had
+ovaritis, because he felt an intense burning pain in his _right ovarian
+region_ whenever he went near to her. I tried to reason with him that
+that pain should be in his right testicle, but he would insist on having
+the sympathetic pain in _his_ ovarian region.
+
+
+
+
+CHAPTER XI.
+
+RELIGIO MEDICI.
+
+
+Sir Thomas Browne, in his "Religio Medici,"[49] alludes to the scandal
+that is generally attached to our profession, we being accused of
+professing no religion. That this opinion is still prevalent at the
+present day is undeniable,--philosophers and physicians are believed to
+be atheists and non-religionists,--while, at the same time, by that
+strange contradiction that is so common, philosophers and physicians are
+the known and recognized sources of religions, such is the intimate
+relation existing between physical and moral hygiene. Confucius, the
+contemporary of Pythagoras, whose religion was said to be nothing more
+than the observance of a certain moral and political ethical code, and
+he who first formulated the text "that one should do unto others as one
+wishes others to do unto him," the founder of the Confucian religion,
+the orthodox religion of China, was a philosopher. Buddha, the founder
+of the second creed recognized in China, and which forms the religion of
+a great part of eastern Asia, was also a philosopher who was endeavoring
+to reduce the Brahminical religion to the simple principles of
+philosophical religion, based on morality. Moses not only was the
+greatest philosopher of his time, but also had an insight into medicine
+that to us of the present day is simply incomprehensible. The Great
+Master was both a philosopher and a physician, his disputes with the
+learned and his attention to the sick having given him the titles of
+Great Master and Divine Healer.
+
+To use the words of the "Religio Medici," the great body of the medical
+profession can, without usurpation, assume the name of Christians; for
+no monk of the desert convents of Asia Minor or religious knight of the
+middle ages, either in their care of the sick, or giving food and
+shelter to the weary, or protection of sword and shield to the oppressed
+pilgrim plodding his way to the Holy Land, were more deserving of the
+name of Christian than the medical man unwearily and unselfishly
+practicing his profession. To the true student of his art there is that
+in medicine which makes of the physician a practical Christian. Nor is
+there aught in medicine, either in its traditions, history, study, or
+practice, that in the lover of his art should ever make him anything but
+a philosophical and practical religionist. The physician, such as is
+actively engaged in the daily practice of his profession, instead of
+having no religion, is really a practical religionist, and, although he
+may subscribe to no outer ceremonial form or dogma, his life is such
+that a Confucian, a Buddhist, a Christian, or a Hebrew can behold in him
+the practitioner of the essence of either of their religions,--a
+conception carried out by Lessing, in his play of "Nathan the Wise,"
+where the Jew, the Saracen, and Crusader teach the impressive lesson
+that nobleness is bound by no confession of faith or religion; showing
+the principle that should guide true religion.
+
+The Rev. Dr. Townsend, of Boston University, has given a very
+interesting and intelligent relation of the connections that exist
+between medicine and the Old Testament, in the light of
+nineteenth-century science.[50] The article in question is interesting
+in its logical reasons as to why the Bible was inspired by a superior
+power, as well as in the comparisons it lays before us of the medicine
+of the Pagans and that of the Bible, during the early history of the
+world. After reviewing the false, crude, and senseless vagaries and
+superstitious notions that passed for medicine from the period of the
+Trojan war, in 1184 B.C., to the dissolution of the Pythagorean Society,
+500 B.C.--periods which existed after the writing of the books of
+Moses,--and the period between 500 B.C. and 320 B.C., or the philosophic
+era of medicine, during which flourished the father of our present
+system of medicine, an era of advancement, but which in our eyes is
+still full of errors and unscientific conclusions. From these two
+periods we span over centuries of darkness for science and medicine to
+the ages of Ambroise Paré and the more modern fathers of our art, who by
+perseverance finally extricated medicine from the mass of magical and
+superstitious rubbish which, like barnacles, had clung to it during its
+passage through the dark and ignorant ages. After this review our author
+turns to the Bible and discourses in this wise:--
+
+"Turning our attention to the Bible, we take the position that, though
+it was not designed to teach the science of medicine, still, whenever by
+hint, explicit statement, or commandment there is found in it anything
+relating to medicine, disease, or sanitary regulation, there must be no
+error; that is, provided the Bible, in an exceptional sense, is God's
+book. Now, what are the facts in this case? They are these: though the
+Bible often speaks of disease and remedy, yet the illusions, deceptions,
+and gross errors of anatomy, physiology, and pathology, as formerly
+taught, nowhere appear upon its pages. This, it must be acknowledged, is
+at least singular. But more than this: the various hints and directions
+of the Bible, its sanitary regulations, the isolation of the sick, the
+washing, the sprinkling, the external applications, and the various
+moral and religious injunctions in their bearing upon health are
+confessed to be in harmony with what is most recent and approved. To be
+sure, the average old-school physician of a century ago would have
+blandly smiled at our simplicity, had it been suggested to him that his
+methods would be improved by following Bible hints. 'What did Moses know
+about medical science?' would have been his reply. But Moses, judged by
+recent standards, seems to have known much, or, at least, to have
+written well."
+
+The above statement is a truthful relation of facts, from which it can
+well be conceived that even in the Bible the physician finds something
+to inspire him with the idea of its divine inspiration, as the very
+history of medicine, with which it is connected, and with which he is
+familiar, only lends him further support in that direction. Most
+intelligent physicians are also lovers of philosophical history. None is
+more entertaining than Rawlinson, either in his "Seven Great Monarchies"
+or his "Ancient Egypt." In his "Ancient Religions," in his concluding
+remarks, he observes as follows, in regard to the Hebraic religion: "It
+seems impossible to trace back to any one fundamental conception, to any
+innate idea, or to any common experience or observation, the various
+religions which we have been considering. The veiled monotheism of
+Egypt, the dualism of Persia, the shamanism of Etruria, the pronounced
+polytheism of India are too contrariant to admit of any one explanation,
+or to be derivative of one single source.... It is clear that from none
+of the religions here treated of could the religion of the ancient
+Hebrews have originated. The Israelite people, at different periods of
+its history, came and remained for a considerable time under Egyptian,
+Babylonian, and Persian influence, and there have not been wanting
+persons of ability who have regarded Judaism as a mere offshoot of the
+religion of one or the other of these three peoples. But, with the
+knowledge that we have now obtained of the religions in question, such
+views have been regarded as untenable, if not henceforth impossible.
+Judaism stands out from all other ancient religions as a thing _sui
+generis_, offering the sharpest contrast to the systems prevalent in the
+rest of the East, and so entirely different from them in its essence
+that its origin could not but have been distinct and separate.... The
+sacred books of the Hebrews cannot possibly have been derived from the
+sacred writings of any of these nations. No contrast can be greater than
+that between the Pentateuch and the 'Ritual of the Dead,' unless it be
+that between the Pentateuch and the Zendavesta, or between the same work
+and the Vedas.... In most religions the monotheistic idea is most
+prominent _at the first_, and gradually becomes obscured, and gives way
+before a polytheistic corruption.... Altogether, the theory to which the
+facts appear on the whole to point is the existence of a primitive
+religion, communicated to man from without, whereof monotheism and
+expiatory sacrifice were parts, and the gradual clouding over of this
+principle everywhere, unless it were among the Hebrews."[51]
+
+Medicine is indebted for its advancement to the Hebraic religion to a
+greater extent than is generally believed. In the early Christian
+centuries there existed three great creeds: the Christian, Hebraic, and
+Mohammedan. The Christian Church was in a perplexing condition. As
+observed by Draper,[52] it was impossible to disentangle her from the
+principles which had, at the beginning, entered into her political
+organization. For good or evil, right or wrong, her necessity required
+that she should put herself forth as the possessor of all knowledge
+within the reach of the human intellect. But the monk and priest were
+prohibited from studying medicine,[53] as by so doing the church saw
+that she would have to relinquish the spiritual control of disease were
+medicine a matter of scientific research; she preferred to hold on to
+her spiritual dominion, and let science slumber in darkness. On the
+other hand, the Mohammedans, recognizing the principle of fatalism in
+their religion, it was not to be expected that they should cultivate an
+art entirely opposed to that principle. In this state of affairs the
+Jewish physician, led by the teachings of his religion, alone presented
+the study of medicine in a scientific manner, and its practice and its
+result taught the Moslems that medical science placed it within the
+power of man to keep himself out of the grave, when either assailed by
+disease or laid low by the wounds of war. The Arabs were not slow to
+avail themselves of this discovery; and to the learning and skill of the
+Jewish physician, guided by the light of an intelligent Deity and a
+liberal religion, does medicine owe the existence of those able and
+learned Arabian physicians that flourished during the eleventh and
+twelfth centuries.
+
+There has been more or less of fault-finding in regard to certain rules
+and ordinances being sacramental, which, from the nature of things,
+should have been merely advisory or suggestive, as they pertained
+more to the hygienic welfare of the people than to the spiritual. Thus
+to reason, is neither philosophical nor in concert with our knowledge
+of the structure of man, and of the intimate relations that exist
+between mind and body, or of good health and good morals. The writer
+has seen violent catharsis produced by bread pills, after podophyllin,
+castor-oil, and phosphate of soda in the most generousdoses--administered
+as one would drop a letter in a mail-box--had completely failed; it is
+all in the manner and way we give a medicine or treat a disease. Certain
+narcotic and irritant poisons or powerful sedative agents have a
+physical action uninfluenced by the mind, but an intelligent physician
+is hardly supposed to drive at the small tack of disease with such
+powerful sledge-hammers. Charcot, recognizing the power of and availing
+himself of such a remedial agent as the pilgrimages to the Notre Dame de
+Lourdes, is an evidence of the intelligent and enlightened practitioner,
+who has learned, what the Bible taught, long, long ago, that human
+nature must be taken as it is found, and that, like the homely saying of
+Mohammed, as the mountain would not come to him, he must go to the
+mountain. Moses and all the Scriptural writers were well aware of this
+state of affairs, and their manner of using their knowledge was adapted
+and timed to the general intellectual development of the times.
+
+There is one point in connection with the above that should not escape
+our attention, this being that, while the Hebraic creed and the people
+still subscribed to the theological doctrine of the origin of disease,
+in common with the religions then in vogue, here the connection stopped.
+All other creeds--not excepting Christianity--looked forward to a
+theological doctrine of the cure of disease. With the Hebrew, disease
+was looked upon as the result of some infraction on his part of some of
+the laws, and the consequent expression of displeasure on the part of
+the Deity. He was taught, however, that the observance of certain
+ordinances were both conducive to health and to the prevention of
+disease, and acceptable to God, as well as to rely upon his study and
+skill to cure disease. This was equivalent to teaching them that
+diseases arose from physical causes, and that physical means were to be
+used to combat them. From this arose the practice of exposing the sick
+in public places, that they might receive the benefit of the advice of
+such who might have had experience in a like case. It is from their
+religion that Hebraic medicine has received its foundation of
+intelligent philosophy that carried it in its purity through all ages,
+free from magic, superstition, and imposture. With other creeds and
+religions, medicine, disease, as well as the physical phenomena
+affecting nature, were believed to be the arbitrary expression of anger
+of their gods, and that the cure of disease, or alterations in physical
+phenomena, were to be as arbitrarily effected, regardless of the
+existence or action of physical laws. It is to be regretted that one of
+the sects which has sprung from the Hebraic creed, and which worships
+the same God, has been unable to emancipate itself or its people from
+the idea of an arbitrary theological doctrine of the origin and control
+of disease. It is this creation of a narrow-minded theology of a
+vaccilating, unintelligent, unphilosophical, and arbitrary God, who
+would neither respect nor regard the laws of his own creation, that has
+led the great body of physicians out of the modern churches. They do not
+deny the existence of the Deity, but the god of their conception is a
+higher and nobler god,--the Deity of Religio Medici.
+
+When the prize for the best essay on "_the power, wisdom, and goodness
+of God, as manifested in creation_"--a series of publications known as
+the Bridgewater Treatises--has been nearly every other time won by
+physicians, among whom we may mention Sir Charles Bell, Dr. John Kidd,
+Dr. Peter M. Roget, and Dr. William Prout,--not only won on their own
+merit, but in competition with learned theologians and noted
+divines,--we may truly say that physicians are by no means atheists or
+agnostics, but that, on the contrary, they are the real exponents of a
+practical and intelligent religion, which they not only practice, but
+fully and intelligently comprehend.
+
+
+
+
+CHAPTER XII.
+
+HEBRAIC CIRCUMCISION.
+
+
+The first mention that we meet concerning circumcision is in Genesis. It
+is the command of God to Abraham; in establishing the covenant with him,
+He said to him: "This is my covenant, which ye shall keep between me and
+you, and thy seed after thee: every man-child among you shall be
+circumcised. And ye shall circumcise the flesh of your foreskin; and it
+shall be a token of the covenant betwixt me and you" (Gen. xvii, 10,
+11). It was also ordained that this should be extended to servants
+belonging to Abraham and his seed, as well as to their own children; and
+that in case of children it should be done on the eighth day after
+birth.[54] This was appointed as an ordinance of perpetual obligation on
+the Hebraic family, and its neglect or omission entailed being cut off
+from the people (12, 14). In compliance with this ordinance, Abraham,
+although in his ninety-ninth year, circumcised himself and all his
+slaves, as well as his son Ishmael. Slaves by purchase were
+circumcised,[55] as were any strangers, who were also circumcised before
+being allowed to partake of the passover or to become Jewish citizens.
+It was to be observed by all heathens who became converted to the Jewish
+faith. During the wanderings in the wilderness circumcision was not
+practiced, but Joshua caused all to be circumcised before they entered
+the promised land.[56]
+
+The old Hebrews strictly followed the injunction to circumcise on the
+eighth day, and of such importance in a religious sense was this rite
+in their estimation that even when the eighth day fell on the Sabbath
+the eighth day ordinance was observed. The ordinance, however, was not
+blindly arbitrary, as rules were laid down for exception. For instance,
+whenever a family had lost two children through circumcision it did not
+become obligatory on that family to circumcise the third child, who was
+however considered as entitled to all the benefits of the congregation
+or of the Hebraic religion, just the same as if he had been circumcised.
+Again, Maimonides, or Moussa Ben Maimon, a celebrated physician and
+rabbi, born in Cordova in the year 1135 A.D., among his works on
+medicine, has left directions in regard to circumcision which have been
+the guides of the _mohels_. Among the Hebraic physicians it was
+considered that the child partook of the constitutional strength or
+feebleness of the mother; hence the rule above mentioned, in regard to
+exemption to circumcision, only was in operation when the two who had
+formerly died belonged to the same mother as the third one, who would
+thereby be exempt; but if the two children had belonged to another
+woman, and this third child of the father was not from the same mother,
+the rule did not exempt. The third child of the mother who had
+previously lost two infants at the rite was, however, to be circumcised
+when arrived at adult age, provided no further counter-indication
+occurred. The opinion that the mother gave the constitution to the child
+was promulgated by Maimonides and became general.
+
+The eighth day is believed to refer to the eighth day after full term;
+thus, a child born prematurely is not supposed to be circumcised until
+eight days after it would have reached its full term, and only then if
+its general good condition is settled. Maimonides looked upon infantile
+jaundice, general debility, and marasmus as contra-indications to the
+performance of the rite; any erysipelatous inflammation, ophthalmia,
+anæmia, eruption of any kind, fever, tendency to convulsive
+movements--in fact, any observable departure from normal health should
+be allowed to pass before performing the rite. Aside from these general
+conditions that denoted that the operation was contra-indicated, the
+local condition of the organ itself also was to be examined, and if
+certain conditions existed the operation was to be put off. These
+conditions consisted in any irritation or red appearance of the prepuce,
+due to either inflammation or to the irritative action of the sebaceous
+matter underneath the prepuce, the acrid nature of these secretions
+being at times sufficiently virulent to produce an ulceration, even in
+the newborn.[57]
+
+Among the Hebrews themselves there are those who do not look upon
+circumcision in a favorable light, but on something that has served its
+time in its own day, and within the past year a proselyte has been
+accepted into one of the New York synagogues without previous or
+subsequent circumcision, these reformed Jews looking upon adult
+circumcision as too painful an operation to be gone through, as they
+claim, unnecessarily. It must be said, however, that these persons look
+upon circumcision purely in a sacramental light, and simply as an
+arbitrary ordinance of God in the remote ages of antiquity, but which in
+the present century has not enough practical significance to warrant its
+performance on the occasion of an adult joining the congregation. These
+persons look upon it, as has been said, in a purely theological light,
+and ignore any and all considerations of hygiene in connection with it,
+claiming that if it is a simple matter of hygiene, then it is not a
+sacrament, and that, if it is sacramental, then the subject of hygiene
+has nothing whatever to do with it. The force of their reasoning and
+logic is very obscure and clouded, to say the least. The covenant either
+exists or it does not; to do away with one ordinance in any arbitrary
+manner is to gradually begin to crumble down the whole fabric of
+Judaism; for when exceptions are begun, one tenet as well as another is
+liable to topple over. If the rite is a sacrament, then it should be
+performed on all, and a proselyte should not be admitted without being
+circumcised, and, if a hygienic measure only, the same rule holds. These
+Jews evidently ignore the rationalism that governed the promulgation of
+the Mosaic law, and its recognition of the inseparability of the moral
+from the physical nature of man.
+
+Montaigne has left us a description of the performance of the rite, as
+witnessed by him in the city of Rome in the sixteenth century. He
+relates it as follows: "On the thirtieth of January was witnessed one of
+the most ancient ceremonies of religion practiced by mankind, this being
+the circumcision of the Jews. This is performed at the dwelling, the
+most commodious chamber being chosen for the occasion. At this
+particular time, by reason of the incommodity of the house, the rite was
+performed at the door of the domicile. The godfather sat himself on a
+table, with a pillow on his lap. The godmother then brought the child,
+after which she retired. The godfather then undressed the child's lower
+part so as to expose his person, while the operator and his assistant
+began to chant hymns. This operation lasts at least a quarter of an
+hour. The operator may or may not be a rabbi, as it is considered a
+great blessing to perform this operation; so that it follows that many
+are found who are anxious to exercise their faculty in this regard,
+there being a tradition that those who have circumcised a certain number
+do not suffer putrefaction in their mouth, nor does their mouth become
+food for worms after death; so that it often happens that they make
+presents of value to the child for the privilege of operating upon it.
+On the same table on which the godfather is seated all the required
+instruments and apparatus are placed, while an assistant stands by with
+a flask of wine and a glass. A warming-pan full of coals is on the
+floor, at which the operator warms his hands. The child being now ready,
+with its head toward the godfather, the operator, seizing the member,
+draws the foreskin toward him with one hand, while with the fingers of
+the other he pushes back the glans; he then places a silver instrument,
+which fixes the skin, and which at the same time holds back the glans so
+that the knife may not cut it. The foreskin is then cut off and buried
+in the little basin of soil that forms one of the appurtenances to the
+operation. The operator then tears with his nails the skin which lies on
+the glans, which he turns back over the body of the member. This seems
+the hardest and most painful part of the operation, which, however, does
+not seem dangerous, as in four or five days the wound has healed. The
+crying of the child resembles that of an infant undergoing baptism. No
+sooner is the glans uncovered than the operator takes a mouthful of
+wine; he then places the glans in his mouth and sucks the blood out of
+it; this he repeats three times. This done, he applies a powder of
+dragons' blood, with which he covers up all the wound, the parts being
+then done up in expressly-cut bandages. He is then given a glass of
+wine, over which he says some prayers; of this he takes a mouthful, and,
+after moistening his fingers in the same, he applies the wine three
+times to the child's mouth. The wine is then sent to the mother and the
+women, who are in some other apartment, who all take a sip. An assistant
+then takes a silver instrument, pierced with little holes like a small
+strainer, which he first applies to the nose of the officiating
+minister, then to that of the child, and afterward to the nose of the
+godfather."[58] The above description of the performance of the rite in
+the sixteenth century answers to the method of its performance as was
+witnessed some years ago in France.
+
+In the "Biblical, Theological, and Ecclesiastical Cyclopædia" of Drs.
+McClintock and Strong the following description of the rite, as taking
+place in our modern synagogues, is given:--
+
+"The ceremony of circumcision, as practiced by the Jews in our own
+times, is thus: If the eighth day happens to be on the Sabbath, the
+ceremony must be performed on that day, notwithstanding its sanctity.
+When a male child is born the godfather is chosen from amongst his
+relatives or near friends; and if the party is not in circumstances to
+bear the expenses, which are considerable (for after the ceremony is
+performed a breakfast is provided, even amongst the poor, in a luxurious
+manner), it is usual for the poor to get one amongst the richer, who
+accepts the office, and becomes a godfather. There are also societies
+formed amongst them for the purpose of defraying the expenses, and every
+Jew receives the benefit if his child is born in wedlock.
+
+"The ceremony is performed in the following manner, in general: The
+circumciser being provided with a very sharp instrument called the
+circumcising-knife, plasters, cummin-seeds to dress the wound, proper
+bandages, etc., the child is brought to the door of the synagogue by the
+godmother, when the godfather receives it from her and carries it into
+the synagogue, where a large chair with two seats is placed; the one is
+for the godfather to sit upon, the other is called the seat of Elijah
+the Prophet, who is called the angel or messenger of the covenant. As
+soon as the godfather enters with the child, the congregation say,
+'Blessed is he that cometh to be circumcised, and enter into the
+covenant on the eighth day.' The godfather being seated, and the child
+placed on a cushion in his lap, the circumciser performs the operation,
+and, holding the child in his arms, takes a glass of wine into his right
+hand, and says as follows: 'Blessed be Thou, O Lord our God, King of the
+Universe, Creator of the fruit of the vine! Blessed art Thou, O Lord our
+God! who hath sanctified His beloved from the womb, and ordained an
+ordinance for His kindred, and sealed His descendants with the mark of
+His holy covenant; therefore, for the merits of this, O living God! our
+rock and inheritance, command the deliverance of the beloved of our
+kindred from the pit, for the sake of the covenant which He hath put in
+our flesh. Blessed art Thou, O Lord, the Maker of the Covenant! our God,
+and the God of our fathers! Preserve this child to his father and
+mother, and his name shall be called in Israel, A, the son of B. Let the
+father rejoice in those that go forth from his loins, and let his mother
+be glad in the fruit of her womb, as it is written: "Thy father and
+mother shall rejoice, and they that begat thee shall be glad."' The
+father of the child then says the following grace: 'Blessed art Thou, O
+Lord our God, King of the Universe! who hath sanctified us with His
+commandments, and commanded us to enter into the covenant of our holy
+father, Abraham.' The congregation answer: 'As he hath entered into the
+law, the canopy, and the good and virtuous deeds.'"[59]
+
+
+
+
+CHAPTER XIII.
+
+MEZIZAH, THE FOURTH OR OBJECTIONABLE ACT OF SUCTION.
+
+
+Biblical and rabbinical traditions throw no light on the origin of the
+details of the operation as now performed. That it was anciently
+performed with a knife of stone is certain; an event common in its
+general observance, and which seems to have pervaded all nations or
+races, howsoever remote or scattered, that it has induced Tylor[60] to
+ascribe the origin of the rite to the stone age. We are told that when
+Moses was returning to the land of Egypt he had neglected circumcising
+his son, and that because of that neglect he nearly lost his son's life;
+his wife, Zipporah, the daughter of the Midian king and priest, Jethro,
+seeing the danger and knowing its cause, took her little son Gershom and
+circumcised him with a stone knife, and offered the foreskin to God as a
+peace-offering. Just where the wine was first used we are not told.
+Wine, however, was an emblem of thanksgiving, and, being one of the
+fruits of the earth, was considered an acceptable offering to God. It
+has since, in some form or other, either as wine or as the
+representative of either divine or human blood, been used in both the
+Catholic and Protestant Churches in their ceremonials or vicarious
+sacrifices, or imitations of old customs. Circumcision was by many
+connected with a blood sacrifice; it was so suggested by the words of
+Zipporah at the circumcision of Gershom: "And Zipporah, his Midianitish
+wife, took up a sharp stone and cut off the foreskin of her son, and
+cast it at his feet and said, 'Surely a _Khathan_ of blood art thou to
+me.'" Much speculation has followed the use of this word _Khathan_,
+which, in the ordinary Arabian, may mean either husband or son-in-law;
+it also means a newly-admitted member of a family; a similar word means
+"to provide a wedding feast," and one other word from the same root and
+branch means "to give or receive a daughter in marriage." In our own
+day, the _mohel_, or ministerial circumciser, makes it a practice to
+draw a little blood from the skin of such as are presented for the rite,
+but whom nature has not furnished with sufficient foreskin for the
+operation. The application, thrice repeated, of the blood and wine to
+the lips of the child, is probably used as a sign of the sealing of the
+compact. Wine is mentioned in connection with the High-Priest
+Melchisedeck as the wine of thanksgiving at his meeting with Abraham;
+wine was presented to Aaron by the angel, who, giving him a crystal
+glassful of good wine, said to him: "Aaron, drink of this wine which the
+Lord sends you as a pledge of good news." Originally, circumcision must
+have consisted of the simple removal of the foreskin, and the
+elaboration of the ceremonial details must have been a subsequent
+occurrence; persons wounding their fingers will instinctively carry them
+to their mouth, and it may be that the suction practiced by the Hebrews
+had its origin in this natural hæmostatic suggestion. Wine as a
+hæmostatic and as an emblem of thanksgiving and an acceptable offering
+naturally came in as an accessory.
+
+This practice--which, in the old, patriarchal days of the simple
+shepherds, when men only lived on the flesh of their own flocks, their
+diet, however, consisting mostly of cakes of flour, milk, honey, a few
+herbs, or the flesh of the goat or sheep--could not have been as
+objectionable as it is at the present day, with blood and secretions in
+a continued ferment through diet and habits. Man, living in the open air
+of Armenia, Palestine, or Arabia, sleeping in the open tents of our
+Biblical forefathers, living on the simple diet of a shepherd's camp,
+with the abstemiousness that those climates naturally induce in man,
+could not help but be healthy. In those early days, when neither
+passion, anxiety, nor worry disturbed either digestion or sleep, man had
+no vitiated secretions, wine was then a rarity, and water was the drink.
+One of the early patriarchs on such diet would have furnished a dainty
+and savory dish to the most fastidious cannibal, who is now tormented by
+the _komerborg kawan_, this being a term used by the Australian
+cannibals to designate the peculiar nausea that is induced in them when
+they recklessly eat of white man,[61]--something which they do not
+experience from feasting on the savages who live on the simple diet of a
+pastoral tribe. This primitive gastronomic science in regard to
+cannibalism even reached such a pitch of refinement that, as has been
+previously mentioned, some tribes even resorted to emasculation to
+improve the flavor of the animal juices, which by this procedure became
+less acrid. The Arabian and Oriental traditions bring us down tales of
+how, on the same principles, human beings intended to grace the festive
+platter were fed exclusively on rice. The salivary and buccal
+secretions, under such a simple diet as that indulged in by our Biblical
+forefathers, become bland and harmless; not only harmless, but even
+antiseptic and positively beneficial, acting on the same principle as
+local applications of pepsin. So that the practice, at the time of the
+patriarchs and in their own family, of this part of the rite could not
+have offered the same objection that it does at the present day. The
+modern house-dweller, living on a mixed diet and in a climate that
+induces him to eat grossly, both as to quality and quantity, partaking
+more or less of vinous, spirituous, or fermented liquors, as well as
+indulging in tobacco, is quite another being from the Arabian or
+Armenian shepherd of former days. Business anxieties and worry also have
+a very pronounced effect; so that, with the change in the conditions of
+man and the inception and multiplication of diseased conditions, as well
+as the creation of constitutional and transmissible diseases, this
+practice of suction should have been stopped.
+
+Intelligent rabbis, devoted to their religion, are necessarily prone to
+defend any of the details in its ceremonials that age and practice have
+sanctioned, and even some of the later writings of Israelism seem to
+make the mezizah, or suction, a necessary and ceremonial detail. In the
+"Guimara," composed in the fifth century, Rabbi Rav Popè uses these
+words: "All operators who fail to use suction, and thereby cause the
+infant to run any risk, should be destituted of the right to perform the
+ceremony." In the "Mishna" it says, "It is permitted on the Sabbath to
+do all that is necessary to perform circumcision, excision, denudation,
+and suction." The "Mishna" was composed during the second century. The
+celebrated Maimonides lent it his sanction, as in his work on
+circumcision he advises suction, to avoid any subsequent danger. Our
+modern Israelites are supposed, as a rule, to have taken their
+authority, aside from previous usage and custom, from the "Beth Yosef,"
+which was written by Joseph Karo, and subsequently annotated by the
+Rabbi Israel Isserth. In all of these sanctions, however, there is no
+reason expressed why it should be performed.[62] Maimonides undoubtedly
+looked upon this act as having a decided tendency or action in depleting
+the immediate vessels in the vicinity of the cut surface, and that the
+consequent constriction in their calibre would prevent any future
+hæmorrhage. That this is the natural result of suction is a fact readily
+understood by any modern physician. The depletion of the vessel for some
+distance in its length, with the contraction in the coat that follows,
+is certainly a better preventive to consequent hæmorrhage than the
+simple application of any styptic preparation that can only be placed at
+the mouth of the vessel, but which leaves its calibre intact. Hot water,
+or an extreme degree of cold, will answer to produce this contraction
+and depletion, but there is here a local physical reaction that is more
+liable to occur than when the contraction has taken place naturally, as
+when induced by depletion, instead of by the stimulus of either heat or
+cold. So that if, in the light of modern civilization and changed
+conditions of mankind, and the existence of diseases which formerly did
+not exist, we are now convinced that suction is dangerous, we should not
+judge the ancients too hastily or rashly for having adopted the custom,
+as it is certainly not without some scientific merit; although,
+authorities are not wanting who hold that suction or depletion increases
+the danger of hæmorrhage.
+
+It can be understood that the results of suction would be in some
+measure analogous to those left by the application of an Esmarch bandage
+on a limb. The ancients, performing the operation with rude implements
+and having no hæmostatic remedies or appliances, naturally followed the
+best means at their command; they evidently feared hæmorrhage, and their
+rule in regard to exemption shows us that they recognized the existence
+of hæmorrhagic diathesis or other transmissible peculiarities of
+constitution. This same fear of hæmorrhage probably suggested the second
+step of the operation being performed, as it is by laceration instead of
+by cutting instruments, showing in this an evident desire to limit the
+cutting part of the operation to as small a limit as possible. Against
+an infant who has decided hæmorrhagic tendency, we are about as helpless
+as were the ancient Hebrews, and, while the Turkish or some of the
+Arabian methods of performing the operation may be said in ordinary
+cases--by the application of cord and the consequent constriction--to
+limit the danger from subsequent hæmorrhage, still, in the hæmorrhagic
+diathesis this would not be of any avail; so, as already observed, we
+must not too rashly judge those old shepherds of the Armenian plains for
+adopting a practice which to them was calculated to avert subsequent
+dangers, or their descendants following in their footsteps, until having
+learned better, even if that practice is to us disgusting, primitive,
+and useless.
+
+Cases occur,--happily not frequently,--of alarming and uncontrollable
+hæmorrhage. The following case is suggestive of the alarming extent and
+persistence that may attend one of those hæmorrhagic cases, even when
+recovery eventually takes place. It is reported by Dr. Sannanel in the
+_Gazetta Toscana delle science medicale e fisiche_ of 1844. The case was
+that of a Jewish infant circumcised on the eighth day. Some hours after
+the operation the child was observed to be bleeding; the hæmmorrhage
+would only cease for a few moments, and then come on with increased
+force, and which proved rebellious to ordinary remedies. Dr. Sannanel
+was called during the night of the third day after the operation. A
+number of physicians had been in attendance, and neither ice,
+astringents, pressure, nor any usual hæmostatic means had had the least
+effect; cautery with nitrate of silver, sulphuric acid, and the actual
+cautery by means of heated iron were tried in succession, without any
+good results. Ten days passed in this manner, the hæmmorrhage only
+ceasing for a few moments at a time, and the child was nearly
+exsanguinated from the continued serous seepage and the paroxysmal
+hæmorrhages, when a lucky application of caustic potassa almost
+immediately stopped the hæmorrhage. This case was seen by nearly all the
+leading medical men of Leghorn, who lent their aid and counsel to save
+the little life. The case is interesting from the length of time it
+persisted, and that even after all the loss of blood and suffering that
+the little fellow endured he survived.[63]
+
+Dr. Epstein, of Cincinnati, in a letter of March 29, 1872, to the
+_Israelite_ of that city, mentions a nearly fatal case from hæmorrage
+after the rite of "_Milah_," and gives the result of his experience in
+such cases. He argues that _Hitouch_ or _Hitooch_ alone, or the first
+step or cutting off of the prepuce, performed with ordinary care, could
+hardly be followed up with any more serious results than can be
+controlled with the application of a little acidulated water. The second
+act, or _Periah_, the act of laceration, he looks upon as one that calls
+for coolness, judgment, and skill, as the membrane should only be torn
+so far and no farther, the thin, inner fold of the prepuce being
+vascular only in the sulcus back of the corona and at its lower
+attachment, where it forms the frenum, or bridle; any carelessness or
+over-anxiety on the part of the operator in tearing this membrane too
+far back results in danger of hæmorrhage; especially is this part of the
+operation liable to be badly done if the inner preputial fold is thick
+and resisting, as in that case undue force may carry the laceration back
+into the vascular tissue. The means suggested by Dr. Epstein to arrest
+hæmorrhage are those ordinarily used in hæmorrhagic cases, such as will
+be given presently. The doctor regrets that the operators are not as
+they should be, physicians, and that, when _mohels_ are employed,
+persons are not sufficiently exacting as to their qualifications.[64]
+
+In France the government has managed to secure more safety in the
+operation. By a royal decree of date of May 25, 1845, in compliance with
+a desire expressed by the Hebrew Consistory, it was ordered that no one
+should exercise the functions of a _mohel_ or of _schohet_, without
+being duly authorized to perform said functions by the Consistory of the
+Circonscription; and that all _mohels_ and _schohets_ shall be governed
+in the exercise of their functions by the Departmental Consistory and
+the General Consistory. By virtue of this decree a regulation was passed
+by the Consistories on the 12th of July, 1854, ordering that thereafter
+circumcision should only be performed in a rational manner, and by a
+properly qualified person. Suction was likewise abolished, and the wound
+directed to be sponged with wine and water. This decree and the
+resulting regulations have been of the greatest benefit to the French
+Israelites, and some attention to the matter would not be amiss in the
+United States.
+
+This reformation has met with the approval of the leading French Jews,
+whose General Consistory decided that suction was not necessarily a part
+of the religious rite, and that, as it was undoubtedly introduced into
+the rite on the days of primitive surgery, it was perfectly rational to
+suppress this operative accessory, now that that same science, in its
+enlightenment, pronounced it unsafe. The whole body of the Congregation
+did not tamely submit to what they considered an innovation, and from
+some of the mohels all possible resistance was opposed to prevent the
+abolishment of this part of the operation from becoming a law. So
+determined was this opposition in some instances that the Consistory of
+Paris found it necessary to impose on all the mohels an obligation,
+bound by an oath, that they would respect the law. Those who refused to
+take the obligation gave up their vocation.
+
+The Grand Rabbi of Paris, at the time of this reformation, M. Ennery,
+was one of the most zealous supporters of the new departure. The
+influence of the French pervaded northward, and the _mezizah_ was
+abolished in Brunswick, Dr. Solomon, a learned Hebrew of that State,
+being instrumental in having it done legally. The discussion of this
+subject, in 1845, had one very happy effect,--the supporters of the
+reformed idea of the rite issued a circular letter to all the leading
+continental surgeons and medical men asking for their opinion on several
+points in relation thereto, especially, however, on this part of the
+rite. The opinions of many of these will be referred to in the medical
+part of this work.
+
+The after-treatment of the circumcised infant is governed more or less
+by local habits and the individual intelligence of the mohel and his
+experience. After turning back the inner fold of the prepuce, the parts
+are covered with a small, square bandage, with an aperture to admit the
+passage of the glans. This, and the subsequent small bandage of old
+linen, which is calculated to hold it in place, are slightly coated with
+a powder composed of lycopodium, with the slight addition, at times, of
+Monsel's salts, alum-powder, or some vegetable astringent. Over these
+another compress is placed, to prevent the friction of the clothes of
+the infant or of the bedding. The infant then receives a final
+benediction, and the godmother then receives the child in her arms and
+carries it to its cot or crib. The operator generally visits the infant
+in the afternoon of the operation, and carefully inspects the dressings,
+to see that no hæmorrhage has supervened.
+
+It is customary to place the child in a bath, either the same evening or
+on the following morning, the object of this being to remove and to
+facilitate the removal of the dressings, which are more or less
+saturated and clotted with blood. After the removal of these, the wound
+is redressed, as previously, except that some cerate--ointment of roses
+or some other mild ointment--is used. Some prefer the simple water
+dressing from beginning to end. Since the introduction of creasote, acid
+phénique, and carbolic acid, many mohels are in the practice of washing
+the parts with water impregnated with one of these before performing the
+operation, and using subsequently the same form of lotion at every
+dressing. In case of hæmorrhage there is an hæmostatic water or lotion,
+which has been long used by the German and Polish mohels with
+considerable success, and which, in ordinary cases, has been found to be
+all that was required. This water, called by the French "Mixture
+d'arguesbusade," "Eau vulneraire spiriteuse de Theden," and by the
+Germans as "Spritzwasser" and "Schusswasser," is composed as follows:--
+
+  Acetic acid,                  10     grammes.
+  Rectified spirits of wine,     5        "
+  Diluted sulphuric acid,        2½       "
+  Clarified honey,               8        "
+
+This mixture is well mixed and filtered, and is then kept in a
+tightly-stoppered vial.
+
+Dr. Bergson uses a mixture composed of diluted sulphuric acid, 1 part;
+alcohol, 3 parts; honey, 2 parts; and 6 parts of wine vinegar.
+
+Hæmostatic powders are also used by the Hebrews, being more conveniently
+kept or carried than the hæmostatic waters. In Russia and in Poland they
+are composed of decomposed or decayed hawthorn-wood powder and
+lycopodium. That of Berlin is composed of Armenian bole, red clay,
+dragons' blood, powdered rose-leaves, powdered galls, and powdered
+subcarbonate of lead. In France a hæmostatic fluid, composed of dragons'
+blood digested in turpentine, is in vogue. The Eau de Pagliari is also
+used; it is composed of a mixture of tincture of benzoin, 8 ounces;
+powdered alum, 1 pound; and 10 pounds of water, boiled together for six
+hours, and is considered a powerful styptic. In addition to these, burnt
+linen, spiders' webs, starch-powder, powdered alum, and plaster-of-Paris
+powder are used by different mohels. Touching the bleeding points with a
+pointed pencil of nitrate of silver is also a practice understood by the
+Jewish circumcisers.
+
+
+
+
+CHAPTER XIV.
+
+WHAT ARE THE BENEFITS OF CIRCUMCISION?
+
+
+There are those, even among the Hebrews, who are so imbued with the
+purely theological idea of the origin, performance, and causes of
+circumcision, that they cannot see any moral nor hygienic value in the
+operation. Among many Christians the idea still prevails that
+circumcision is the relic of some barbarous rite, practiced in some
+epoch away in the remote ages of the world, grafted on to the Jewish
+religion by some accident or other; but that beyond the clinging of the
+Jews to this custom, as being a remnant of their old religion, they
+neither see in the rite any other significance, moral results, nor
+hygienic precaution; and the fact of a Jew being circumcised is too
+often made a subject of merriment among the unthinking portion of the
+Christian world. Neither are physicians all of one accord on the subject
+as to whether circumcision is a benefit, or, being useless, a dangerous
+and an unnecessary operation. The writer is most emphatically in favor
+of circumcision, and has the fullest faith in the positive moral and
+physical benefits that mankind gains from the operation.
+
+It may well be asked: What does the Jew receive in return for all the
+suffering that he inflicts through circumcision on himself and his
+little children? What is there to repay him or his for all the risks and
+annoyances, besides branding himself and his with an indestructible
+mark, which has been more than once the sign by which they have suffered
+persecution, spoliation, expatriation, and death? Are there any
+benefits enjoyed by the Jew that the uncircumcised does not enjoy in
+equal proportion?
+
+The relative longevity between the Hebrew race and the Christian nations
+that dwell together under like climatic and political conditions
+indicates a stronger tenacity on the part of the Jewish part of the
+nations to life, a greatly less liability to disease, and a stronger
+resistance to epidemic, endemic, and accidental diseases. By some
+authorities it has been held that the occupations followed by the Jew
+are such as do not compel him to risk his life, as he neither follows
+any labor requiring any great and continued exertion, nor any that
+subjects him to any great exposure; that, as a rule, when in business,
+by some intuition he follows some branch that has neither anxiety, care,
+nor great chance of loss connected with it; that he does not follow any
+occupation that is attended with any risk of accident for either life or
+limb. Besides all these, it is also urged that in cities the careful
+inspection of their meat, and the peculiar social fabric of the family,
+the love and veneration for their aged, as well as their proverbial
+charity to their own poor and sick, and their provident habits and
+hygienic regulations imposed upon them by the Mosaic law, are all
+conditions that conspire to induce longevity.
+
+That the Hebrew is generally found in such conditions as above described
+is undisputed; but it is questionable if all these conditions are
+necessarily such as are favorable to health and long life, and that,
+therefore, the longevity of the Jewish race cannot altogether be
+ascribed to the above conditions. Looking at the subject of occupation,
+if we consult Lombard, Thackrah, and the later works on the effects of
+occupation on life, we must admit that the Jew has no visible advantage
+in that regard, as he follows hardly any out-of-door occupation, being
+often in-doors in a confined and foul atmosphere. To those who have
+closely observed the race in this country,--coming as they do from the
+cold-wintered climates of Germany, Austria, or Poland, bringing with
+them the habit of living in small, close rooms, for the sake of economy
+and comfort,--it must be admitted that among the lower classes and the
+poorer of the race, their shops being connected, as they usually are,
+with their living-rooms, the _toute ensemble_ is anything but conducive
+to a long life. Their anæmic and undeveloped physical condition and weak
+muscular organization are sufficient evidence that their surroundings
+are not calculated to improve health. In England, statistics
+sufficiently prove that the fisherman on the coast, exposed to all kinds
+of weather, is not as prone to disease as is his brother Englishman who
+deals out the groceries in his snug shop. Exercise has been held an
+important element in the factory of the long-lived. From the time of
+Hippocrates down to Cheyne, Rush, Hufeland, Tissot, Charcot, Humphry,
+and all authorities on the factors of old age, exercise has been looked
+upon as favoring long life. Exercise cannot be said to enter in any way
+as a factor in the longevity of the Jew; but, on the contrary, his
+in-door life is known to be very productive of phthisis in other races.
+His recreations are, as a rule, of the home social order. They visit and
+spend the time allotted to recreation in social intercourse, which their
+hospitality always insists on accompanying with a generous lunch, which,
+to say the least, is not an element that is conducive to either health
+or long life; for no people excel the Jew in home hospitality, and even
+among the poorer classes a stranger is never allowed to depart without
+some refreshment being offered him. Among the class better able to
+extend hospitality, social reunions and card parties, with lunches of
+fruits, cakes, cold meats and coffee, or wines, are among their regular
+occurrences. Their great affection for the family and for their youth
+and aged suggests these means of recreation, as then they are enjoyed by
+all alike; but, as observed, the hygiene of all this is very doubtful;
+it produces too much irregularity.
+
+It is related that after the Roman conquest of Palestine many of the
+Jews, becoming more or less accustomed to Roman manners and customs,
+often joined in the games which the Romans held in imitation of the old
+Olympic games of the Grecians. Not to be ridiculed, many resorted to the
+practices described in a previous chapter, to efface all the marks of
+their circumcision, that they might enter the games with as much freedom
+as the Romans or other uncircumcised nations; so that the present
+aversion to out-of-door sports evinced by the Jew is not necessarily a
+racial trait; the persecutions and political inequality that until
+lately he has been made to suffer have driven him into retirement and
+seclusion. Although seeking neither converts nor political power and
+influence, he has been hunted down, massacred, and chased about as a
+dangerous beast. As the children of the great Rabbi Moses Mendelssohn
+asked of their father: "Is it a disgrace to be a Jew? Why do people
+throw stones at us and call us names?" It may well be asked, why? These
+actions have forced them into the social and retired habits for which
+they are noted; although it cannot be said that it is from a lack of
+spirit, as one of the Rothschilds is well known to have been present at
+the battle of Waterloo, where from a spot in the vicinity of the
+British right-centre he observed the events of the battle; and when,
+with the failure of Ney's last desperate charge with the formidable
+battalions of the Old Guard, he saw the advance of the Prussians closing
+in on the French right, he galloped to the sea-shore, and, crossing the
+Channel in a frail boat, reached London twenty-four hours in advance of
+the news of the battle,[65] but long enough for him to clear several
+millions from off the panicky state of the money market. Marshal
+Massena, one of Napoleon's bravest generals, the defender of Genoa and
+the hero of Wagram, was of Jewish origin.
+
+Athletic sports are not of necessity conducive to long life, even if
+they are to temporary robust health; but there is no mistaking the fact
+that the sedentary and in-door life of the average Jew is a deteriorator
+to health and life, and especially among that class of families who are
+poor and keep no servant; from heredity and home education having
+adopted unhygienic customs, in which they have grown up,--in these a
+total disregard for all ventilation forms a part. Were an uncircumcised
+race so to live, scrofula and phthisis would be the inevitable result.
+This difference of results I have witnessed more than once as existing
+among the two races coming from the same European nationality, where
+their disregard to ordinary rules of hygiene, induced by climatic
+causes, especially ventilation, were alike in both the Semitic and
+European descendants of the one nation, the purely European being more
+prone to consumption and scrofula. It is interesting to note the
+difference in the moral, mental, and physical conditions induced by
+creeds; it would seem as if it should not make any difference. The
+generally accepted idea of religion is that it should raise the moral
+standard of all those nations who practice religion; but the results
+are very peculiar, as we are forced to admit that reformation in
+religion has not always been a reformation in morals. Take Great Britain
+for example; if illegitimacy is any criterion of the moral state of
+those professing creeds, we find the least among the Jew; next among the
+Catholic; next comes the Episcopalian; then last the Presbyterian,--the
+oldest creed showing the greatest moral tendency, and that of poor Knox,
+which is the youngest, showing the least. This has certainly its
+physical effects, that are not without its influence in producing a
+greater or lesser length of life. The evolution of religion has here
+induced a lower moral tone and a resulting physical degeneracy.
+
+As observed by alienists, religions of different creeds have different
+tendencies in inducing insanity, both as to ratio of population and as
+to manifestations;[66] the Protestant, when unbalanced by religious
+cause, is generally controlled with some idea that shows itself in wild
+and erratic attempts at scriptural interpretation, caused by want of
+fixed dogmas and the unending splittings that are forever taking place
+in the new faith, and the persistent, intrusive, and belligerent spirit
+of proselytism that controls each new branch as it buds into existence.
+The Catholic has a fixed dogma, which the church attends to, and he
+neither feels called upon to make his neighbors miserable or himself
+insane in hunting up new interpretations. When he does go insane on the
+subject of religion, the cause, as a rule, can be traced to some real or
+imagined moral delinquency, which has brought all the terrors of the
+punishment of the damned forcibly and persistently to his disordered
+imagination. In the insane-asylums of Cork, in Ireland, with its
+overwhelming Catholic population, the ratio of inmates in regard to
+creeds is as that of one Catholic to ten of the Reformed religion,
+showing in the most conclusive manner the influence exerted by religion
+in this direction. On the other hand, the Jew has the simplest of
+religious creeds; he neither wastes useful time, robs himself of sleep,
+nor becomes dyspeptic in hunting for hidden meanings in some ambiguous
+scriptural phrase; he is satisfied with his creed, his dogmas are firmly
+anchored, and the nature of his religion being a sort of family
+congregation, he is not called upon to go out in search of proselytes,
+any more than the father of an already large family feels called upon to
+go out and hunt up the homeless, that he may convert his home into a
+promiscuous orphan-asylum. As before remarked, his creed is of the
+simplest, and there exists a complete and explicit understanding between
+his God and himself. There are no mystical, hidden meanings in Scripture
+for the Jew; nor does he dread any eternal, unheard-of, and inexplicable
+torments. His laws are very clear, and the punishments for their
+infraction very explicit. To the Jew it is a straight and well-lighted
+road, as far as religion is concerned. The writer has always felt that
+it took a mind that was incapable of appreciating simple truths, but
+that loved to hover on that mystical border-land on the confines of
+gloomy insanity that would allow its owner to seriously wander through
+and behold any theological beauties in Bunyan. To the Jew there is none
+of the gloomy, weird, mystical, mind-racking, ungodly theology that some
+of our creeds torture the poor brains of their professors with. As the
+wild Indian of the plains runs sticks through his anatomy and capers
+wildly about to torture his body, so some of the creeds delight in
+torturing their devotees. The Jewish religion is the one best suited to
+tranquilize the mind; it is very philosophical and rational. Were he to
+acknowledge Christ, he would not have to change his course of life to
+become a most exemplary Christian. The celebrated letter of Moses
+Mendelssohn to the Swiss clergyman, Lavater, in answer to a dedication
+of the latter to Mendelssohn, is probably the best exposition of the
+essence of the Jewish faith that can be found. Therein he says: "We
+believe that all other nations of the earth have been commanded by God
+to adhere to the laws of nature. Those who regulate their conduct
+according to this religion of nature and of reason are called _virtuous
+men of other nations_, and are the children of eternal salvation." Such
+a religion does not unsettle man's mind.
+
+These apparent digressions are made to show what additional factors
+exist, besides circumcision, to induce longevity in the Jewish race, and
+that the subject may be better understood; for these reasons the above
+comparisons have been made. Students of demographic science are well
+aware that form of government, religion, climate, diet, habit, and
+custom,--all have an important bearing on the mental and physical as
+well as on the moral nature of man. To the true student of his art all
+these conditions are but factors in the physical scale, and should so be
+considered without fear or favor; to him the whole world is but a unit,
+and the people upon its surface are but as one people, alike subject to
+the leveling laws of nature, which recognize neither royalty nor
+vagrant, nationality nor creed, color, condition, nor station in life or
+society.
+
+Professor Bernoulli, of Bale, found the Israelite less prolific than the
+Christian;[67] subject to less mortality, greater longevity, less
+still-born, less illegitimacy, less crime against the person, and less
+insanity and suicide, when compared with his Christian brother--all of
+which he attributes not to a superior physique or organism, but solely
+to the observance of the laws of their religion and to the nature of the
+same, which exercises a beneficial influence on the mind.
+
+B. W. Richardson, in his "Diseases of Modern Life," in speaking of the
+relation of race to disease, says: "Through the valuable labors of MM.
+Legoyt, Hoffmann, Neufville, and Mayer, we have obtained, however, some
+curious facts relative to the most widely disseminated of all races on
+the earth, the Jewish. These facts show that, from some cause or causes,
+this race presents an endurance against disease that does not belong to
+other portions of the civilized communities amongst which its members
+dwell. The distinctness of the Jews in the midst of other and mixed
+races singles them out specially for observation, and the history they
+present of vitality, or, in other words, of the resistance to those
+influences which tend to shorten the natural cycle of life, is
+singularly instructive.
+
+"The resistance dates from the first to the last periods of life.
+Hoffmann finds that in Germany, from 1823 to 1840, the number of
+still-born among the Jews was as 1 in 39, while with other races it was
+1 in 40. Mayer finds that in Furth children from one to five years of
+age die in the proportion of 10 per cent. among the Jewish, and 14 per
+cent. among the Christian population. M. Neufville, dealing with the
+same subject, from the statistics of Frankfurt, gives even a more
+favorable proportion of vitality to the Jewish child population.
+Continuing his estimates from the ages named into riper years, the value
+of life is still in favor of the Jews, the average duration of the life
+of the Jew being forty years and nine months and that of the Christian
+being thirty-six years and eleven months. In the total of all ages, the
+half of the Jews born reach the age of fifty-three years and one month,
+whilst half of the Christians born only reach the age of thirty-six
+years. A quarter of the Jewish population born is found living beyond
+seventy-one years, but a quarter of the Christian population is found
+living beyond fifty-nine years and ten months only. The Civil State
+extracts of Prussia give to the Jews a mortality of 1.61 per cent.; to
+the whole kingdom, 2.62 per cent. To the Jews they give an annual
+increase of 1.73 per cent.; to the Christian, 1.36 per cent. The
+effective of the Jews require a period of forty-one years and a half to
+double themselves; those of other races, fifty-one years. In 1849,
+Prussia returned one death for every forty-one of the Jews and one for
+every thirty-two of the remaining population.
+
+"The Jews escaped the great epidemics more readily than the other races
+with whom they lived. Thus, the mortality from cholera amongst them is
+so small that the very fact of its occurrence has been disputed. Lastly,
+that element of mortality, suicide, which we may look upon
+philosophically as a phenomenon of disease, is computed by Glatter, from
+a proportion of one million of inhabitants of Prussia, Bavaria,
+Würtemburg, Austria, Hungary, and Transylvania, to have been committed
+by rather less than one of the Jewish race to four of the members of the
+mixed races of the Christian population. Different causes have been
+assigned for this higher vitality of the Jewish race, and it were indeed
+wise to seek for the causes, since that race which presents the
+strongest vitality, the greatest increase of life, and the longest
+resistance to death must in course of time become, under the influences
+of civilization, dominant. We see this truth, indeed, actually
+exemplified in the Jews; for no other known race has ever endured so
+much or resisted so much. Persecuted, oppressed by every imaginable form
+of tyranny, they have held together and lived, carrying on intact their
+customs, their beliefs, their faith, for centuries, until, set free at
+last, they flourish as if endowed with new force. They rule more
+potently than ever, far more potently than when Solomon in all his glory
+reigned in Jerusalem. They rule, and neither fight nor waste."[68]
+
+Richardson attributes the great benefits enjoyed in this regard by the
+Jewish race to the soberness of their lives. This position is, however,
+not altogether tenable, if by that we mean abstemiousness; they are
+extremely temperate, but not abstemious. Tissot, Cornaro, Lessius,
+Hufeland, Humphry, Sir Henry Thompson, as well as the older Greek and
+Roman authorities, all are agreed that an abstemious life is the one
+that is most conducive to long life. There is no race that is more
+proverbial for their good cheer and indulgence in the good things of the
+table than the Jewish; no race enjoys feasting any more than they, and
+from childhood they are accustomed to a generous and nutritious diet, as
+well as to their share of the wines with which their tables are
+supplied. Their greater thrift and application to business, their habits
+of economy and carefulness in business affairs enable them to better
+supply their tables. In California there is no class that lives better
+or whose tables are supplied so well either as to quality or quantity as
+those of the Jews, and yet no class is more exempt than they from the
+class of diseases that originate in too good living. As before remarked,
+in relation to the poor of that faith, who are unable to keep a servant,
+and who live in a combination of shop and home in the most unhygienic
+condition, disregarding ventilation and every other sanitary needs, but
+who, nevertheless, escape the evil results that would and do attend such
+social conditions among those of other races, so in this instance of
+good living: the better class of Jews do not suffer in anything near a
+like proportion to the better class Christians from diseases incident to
+too full habits and an inactive life. Richardson observes that he drinks
+less and that he eats better food than his Christian brother. In regard
+to the drinking habit, overindulgence is not a Jewish failing; they do
+not drink to excess, but total abstinence is not in their vocabulary. It
+is inconsistent with their idea of wine as being a gift of God, and
+something that is symbolical of good faith and thanksgiving. Nor is
+total abstinence consistent with their idea of generous hospitality. On
+the eighth day after birth the Jew tastes wine, and from the time he is
+able to sit at table he becomes familiar with its use. To him wine is
+not symbolical of either moral depravity, mental or physical
+deterioration, or of death. Their females are all accustomed to its use
+from childhood, but it does not cause them to become either immoral or
+unchaste; so that in neither sex does wine produce that moral and mental
+wreckage which abbreviates the length of human existence among those of
+other creeds. Radical fanaticism, that drives a tack with a maul and a
+twenty-penny spike with a tack-hammer, cannot be expected to study this
+or any other question in any rational manner; but to the sociologist,
+the question as to what produces this remarkable soberness, in the midst
+of the habitual and continued use of wine in the race from the time of
+its earliest history, is something worthy of calm and careful
+consideration. How much circumcision may have to do with this will be
+discussed in the medical part of the volume.
+
+In London, according to Dr. Stallard, the mortality among Jewish
+children from one to five years is only ten per cent., while among the
+children of the Christians it is fourteen per cent., the rate being
+analogous to that observed by Mayer among those of these ages in Furth.
+Among the London adults the average duration of life among the Jews is
+forty-seven years, while among the Christians it is only thirty-seven.
+
+Dr. Hough[69] has gathered some interesting historical and statistical
+matter bearing on the subject of Jewish resistance to disease and the
+benefit possessed by the race in relation to the immunity enjoyed by
+them in prevailing epidemics. The plague of 1346 did not affect them;
+according to Fracastor they escaped the typhus of 1505; Rau remarks
+their immunity to the typhus of 1824; Ramazzini noticed their exemption
+to the fatal intermittents of Rome, in 1691; and Degner says that they
+escaped the epidemic dysentery at Nimegue, in 1736. Richardson truly
+observes that "from epidemics the Jews have often escaped, as if they
+possessed a charmed life." This racial difference and benefit, when
+compared to other races, has more than once cost them dear. In the dark
+and ignorant ages, when men reasoned nothing from a physical basis, but
+attributed all and every phenomena to some supernatural agency, either
+heavenly or diabolical, it was but natural for such minds to associate
+this exemption with some purchased compact made with the devil, who was
+often also held accountable for the existence of the epidemics. The
+rational and law-of-nature observing Jew supposed to be in league with
+his satanic majesty could neither be seen nor heard in his own defense;
+consequently, massacres, pillaging, and such other barbarities that an
+insane popular fury could suggest, were the humane manifestations with
+which a Christian people visited their Jewish brothers, whose only sin
+consisted in worshiping the God of their fathers, and in strictly
+observing His laws and commandments.
+
+In France, Dr. Neufville found that, of one hundred children in the
+first five years of life, among the Jewish population, 12.9 die; while
+from the same number of the same aged class of Christians 24.1 die.
+One-half of all the Christians die at thirty-six years, and one-half of
+all the Jews at fifty-three years and one month.
+
+Dr. John S. Billings has gathered statistics relating to 10,618 Jewish
+families, consisting of 60,630 persons,[70] living in the United States
+in December, 1889, mostly descendants of Jews from the northern or
+middle nations of Europe. For our purpose only the deductions as to
+death-rate and tendency to longevity will be given. In this valuable
+paper Dr. Billings says: "When we come to examine the reports of deaths
+for five years furnished by these Jewish families, we find that they
+give an average annual death-rate of only 7.1 per 1000, which would be
+about one-half of the annual death-rate among other persons of the same
+average social class and condition living in this country." To this he
+adds that, provided the deaths at different ages among the Jews have
+been correctly reported, this race will, on comparison with those of
+other races, show a greater tendency to longevity, as the Jewish
+expectation of life is at each age markedly greater than that of the
+class of people who insure their lives, the average excess being a
+little over twenty per cent.
+
+In speaking of the death-rate among children, Dr. Billings makes the
+following comparisons: "The low death-rate among the Jews is especially
+marked among the children, and this corresponds to European
+experience. Thus in Prussia, in 1887, the death-rate of the Jews under
+fifteen years of age was 5.63 for 1000, while among the remainder of the
+people it was 10.46 per 1000." This result he accounts for partly to the
+fact that among the Jews illegitimacy is comparatively rare and to the
+high rate of mortality among the illegitimate born, which raises the
+average of the other classes.
+
+In regard to the immunity of the race from consumption or tubercular
+disease, the statistics of the above Jewish families gives to the Jews
+less than one-third of the number of deaths from these diseases than
+what occurs among the others as to the male population, and less than
+one-fourth as to the female population. These statistics coincide with
+the observations of the writer on this part of the subject, and are even
+more than corroborated by the French War-Office Reports from Algeria,
+where the deaths from consumption among the Christians amount to 1 for
+each 9.3 deaths, and among the Jews to 1 in 36.9, while among the
+Mohammedans it is only 1 in 40.7 deaths. In Algeria the relative
+mortality from all causes is only about three-fifths of that of the
+Christian, and the Turk, although seeming to enjoy a greater exemption
+from phthisical or tubercular diseases than the Jew, falls below the Jew
+in exemption from deaths due to general causes, as his mortality is
+one-eighth greater than that of the Jew. Dr. Billings gives us some
+interesting food for thought in the course of his article and some more
+particularly bearing on the subject of immunity from consumption. He
+asks: "Are these differences due to race characteristics, properly
+so-called, to original and inherited differences in bodily organization,
+or are they, rather, to be attributed to the customs, habits, and modes
+of life of the two classes of people?"
+
+Some years ago, Henry I. Bowditch, of Boston, put on foot an extended
+system of inquiry in regard to ascertaining the causes or antecedents of
+consumption in the State of Massachusetts. In answer to some of the
+questions of the circular, Rabbi Dr. Guinzburg, of Boston, answered as
+follows, under date of October 29, 1872:--
+
+1st. The number of Jews living in Boston is about 5000.
+
+2d. There certainly have not died of consumption, during the last five
+years, more than eight or ten Jews in the various congregations.
+
+To this Dr. Bowditch adds, as follows:--
+
+"If Dr. Guinzburg's data be correct, they show a very great immunity
+from consumption on the part of the Jews, compared with the citizens
+generally, as will be seen by the following comparison between these
+numbers and those procured from the Registration Reports, published by
+the State. In the report published in 1869, page 64, we find that for
+the five years preceding 1869 the annual average of deaths by
+consumption was 338 for every 100,000 living. These data from Dr.
+Guinzburg and the State Report give the following table:--
+
+                              Proportion of Deaths to
+                                 100,000 of Living.
+  All religions,                        338
+  Jews,                                  40
+
+"These statements from Dr. Guinzburg are confirmed by the following
+letter from Dr. A. Haskins, of this city. Dr. Haskins is connected with
+one of the Jewish benevolent associations for the benefit of the sick. I
+sent to him similar questions and make the following extracts from his
+reply:--
+
+"'I am generally employed in about sixty families (Jewish). I have had
+these families under my care for two and a half years. During this time
+I have seen but one case of consumption. I have averaged among these
+sixty families about two visits daily. In my other Jewish practice,
+which is not inconsiderable, I have in this time (two and a half years)
+seen two cases of consumption.... I am sorry I have no statistics
+whereby I could compare the two peoples, viz., Jews and Christians. I
+can, therefore, give you only my impressions. I should say that I find
+consumption less frequent among the Jews than among Christians. This
+would be my own impression without any data to fortify it.'
+
+"Dr. Waterman also sustains the same idea. The following extract will
+give some idea of his opportunities for observation and the sources of
+his deductions:--
+
+"'BOSTON, November 2, 1872. Dear Sir,-- ... First, I have attended four
+charitable associations; number about forty, fifty, sixty, and one
+hundred families. At present I only attend one, containing one hundred
+families, and on which I average a fraction over one visit a day. I
+have, besides, many private families among the Jews. I have attended but
+few cases of consumption, and I think the disease is not so prevalent as
+among Christians.'"
+
+The same report of Dr. Bowditch quotes from Stallard's "London Pauperism
+Amongst Jews and Christians," as saying that there is no hereditary
+syphilis, and scarcely any scrofula to augment the mortality in the
+Jewish families.
+
+In relation to the liability of the Hebrew race to phthisis, Richardson
+has the following at page 22 of his "Diseases of Modern Life": "The
+special inroads on vitality made on other races by disease are not
+easily determined, because of the difficulties arising from temporary
+admixture of race. I tried once to elicit some facts from a large
+experience of a particular disease, phthisis pulmonalis, and, as the
+results of this attempt may be useful, I put them briefly on record.
+
+"At a public institution at which large numbers of persons afflicted
+with chest diseases applied for medical assistance, and at which I was
+for many years one of the physicians, I made notes during a short
+portion of the time of the connection that existed between race and the
+particular disease I have instanced--phthisis pulmonalis, or pulmonary
+consumption. The number of persons observed under the disease was three
+hundred, and no person was put on the record who was not suffering from
+a malady pure and simple; I mean without complication with any other
+malady. They who were thus studied were of four classes: (_a_) those who
+were by race distinctly Saxon; (_b_) those who were of mixed race, or
+whose race could not be determined; (_c_) those who were distinctly
+Celtic; (_d_) those who were distinctly Jewish.
+
+"The results were, that of the three hundred patients, one hundred and
+thirty-three, 44.33 per cent., were Saxon; one hundred and eighteen,
+39.33 per cent., were of mixed or undetermined race; thirty-one, 10.33
+per cent., were Celtic; and eighteen, 6 per cent., were Jewish."
+
+Although Dr. Richardson admits it would be unfair to accept the above
+figures as a basis for general application, he argues that they are, on
+the average, sufficiently suggestive, as among the Saxons it was noticed
+that there were more cases in whom the disease was hereditary, while
+among the others it was generally acquired.
+
+In going over the subject of this question in regard to phthisis, we
+must admit that, although the Jew in his own home, synagogue, or in his
+social reunions, is not exposed to tubercular emanations, and that he
+has less chance of contracting the disease from tuberculous meats, he
+is, after all, a theatre-goer; a pretty constant inhabitant of the
+sleeping-car and hotel, as a commercial traveler and general merchant;
+and that, on the whole, he eats the same food, breathes the air and dust
+of the same streets, and drinks the same milk and water as the
+Christian, and, as observed by Dr. Billings, cooking destroys the
+bacillus in meats. So that the comparative exposure in this
+country--where the practice is not as prevalent as in Germany of eating
+raw minced-meat sandwiches--existing between the Jew and the Christian
+to tubercular infection from meat are about equal. The records of the
+Jewish Hospital of New York gives, out of 28,750 persons admitted, only
+44.17 per 1000 of its admissions as being due to consumption; while
+those of the Roosevelt Hospital, out of 25,583 admissions, gives a per
+1000 of 67.93.
+
+From what is known of the relation of syphilis to consumption, not only
+as affecting the primary individual, but the subsequent generations of
+the same, and the known greater exemption of the Jew to syphilitic
+infection, owing to the protecting influence of circumcision, it is safe
+to assert that therein is to be found one of the main reasons of the
+exemption of that race to consumption. If we but look at the
+geographical distribution of phthisis and the history of its progress,
+we shall find that it has had syphilis as its _avant courrier_ on more
+than one occasion. Lancereaux, in his "Distribution of Pulmonary
+Phthisis," points to the fact that where consumption has made its
+greatest ravages, and where it has nearly depopulated one of the great
+divisions of the globe,--namely, the groups of islands in the Pacific
+Ocean,--the disease had no existence at the beginning of the present
+century. Syphilis, scrofula, and a quick, galloping consumption have,
+since the last ninety years, taken off the greater part of the
+population. The same course of transition from the best of physical
+conditions to racial deterioration and extinction from the same relative
+condition of causes--syphilis, scrofula, and phthisis--has been observed
+among the open-air dwellers of the New Mexican Plains, in the mountains
+of Arizona, and on the arid wastes of the Colorado Desert, where the
+appearance of consumption cannot be attributed to housing or incipient
+civilization, as it is attributed to housing among the Chippeways,
+Sioux, or Mandans in the regions that formerly formed the Northwest
+Territory. The question is very plainly answered as to how consumption
+was introduced or whence it sprung that has so ravaged the Oceanic
+Islands. The sailors who first visited those islands were not, as a
+rule, a batch of consumptive tourists on a voyage in search of health or
+recreation; but we can well understand that the proverbially improvident
+mariner has not always had his health looked after by an Anson or a
+Cook, and that many a festive tar who induced the unsophisticated Indian
+maid to join him in worship at the shrine of Venus Porcina carried in
+the innermost recesses of the folds of his pendulous and sea-beaten
+prepuce the remnants of former Bacchanalian festivities performed in the
+questionable temples of Venus and Bacchus in Portsmouth or London.
+Consumption, as such, was neither imported nor propagated by Europeans
+into those islands, its original entry being in the shape of syphilis.
+Had it been the ancient mariners of old Phoenicia in the days of its
+circumcision, or the circumcised marines of the ancient Atlantean fleets
+from the sunken continent of Plato, instead of the uncircumcised
+sailors of modern England, that first and since visited those islands,
+it is safe to say that consumption would not now exist there. From this,
+it may be well to inquire what would be the relation between the Jewish
+race and consumption; were circumcision among them to be done away with,
+would it not be greatly on the increase?
+
+The weight of testimony is evidently convincing that the Jew has a
+greater longevity and stronger resistance to disease, as well as a less
+liability to physical ills, than other races; that all these exemptions
+or benefits are not altogether due to social customs is evident; how
+much circumcision may have to do in inducing these favorable conditions
+can be better appreciated by a consideration of how circumcision affects
+those of other races, and more particularly how its performance works
+changes in the individual in his general health and condition, and in
+doing away with many physical ailments that the individual was
+previously subjected to. So that the Jew cannot be said to be a loser by
+his observance of this rite, and he and his race have been well repaid
+for all the sufferings and persecutions that its observance has
+subjected them to. As observed by John Bell, "The preservation of health
+and the attainment of long life are objects of desire to every man, no
+matter in what age or country his lot is cast, nor by what arbitrary
+tenure he holds his life. They are the wish of the master and the slave,
+of the illiterate and the learned, of the timid Hindoo and the warlike
+Arab, of the natives of New Zealand not less than of the inhabitants of
+New England,--an indispensable condition for the greatest and longest
+enjoyment of the senses and propensities; for the widest range and
+exercise of intellect and gratification of the sentiments, whether these
+be lofty or ignoble, health, in any special degree, has ever been a fit
+subject of contemplation and instruction by the philosopher and
+legislator. Their advice and edicts on the means of preserving it have
+frequently been enforced as a part of religious duty, and, at all times,
+civilization, even in its elementary forms, has been marked by laws on
+this head. With the numerous and minute hygienic enactments of the great
+Jewish lawgiver for the guidance of the people of Israel we are all
+familiar. Prompted, we may suppose, in part by the example of Moses, and
+also by considerations growing out of the nature of the climate in which
+he lived, Mohammed incorporated with the mingled reveries, ethics, and
+blasphemies, which composed his Koran, dietetic rules and observances of
+regimen that are to this day implicitly obeyed by his zealous
+followers."[71]
+
+If circumcision is not a factor in the difference that exists between
+the Jewish race and other races, if it goes for nothing as an exemptor
+of disease and the promoter of longevity, then there must exist some
+other factor or cause that induces these conditions. What this factor
+is, the legislator, the sociologist, and the physician should make it
+their business to find out.
+
+
+
+
+CHAPTER XV.
+
+PREDISPOSITION TO AND EXEMPTION AND IMMUNITY FROM DISEASE.
+
+
+The peculiar differences that exist between different animals in regard
+to their susceptibility to the action of drugs is even more remarkable
+than the differences that exist in their susceptibility to certain forms
+of disease. We can understand and appreciate what Koch tells us in
+regard to the different susceptibilities exhibited by the house-mice and
+the field-mice to the anthrax bacillus, or why a nursing child should
+offer different results, when exposed to the diphtheria bacillus or the
+contagious poison of any of the exanthemata, from those witnessed in the
+meat or promiscuously dieted child. We can also appreciate that
+different individuals have different susceptibilities to disease, as
+well as we understand that the same degree is not always in an unvarying
+point of resistance or susceptibility in the same individual. The
+investigation and study of these conditions teach us, however, that
+there is a cause, or that there are causes that induce and modify this
+susceptibility. But there are conditions that are as yet beyond our
+comprehension. Take, for instance, two animals, both vertebrates,
+mammals, and dwelling together, eating the same food, and even having a
+mutual understanding or sympathy of mind and affections, having a like
+circulation, a like brain and nervous system, it would naturally be
+supposed that these two would exhibit a like susceptibility to the
+actions of narcotic poisons; but when we are told that one dog has
+taken 21 grains of atropia with impunity we are staggered. Atropia may
+not affect rabbits (as it does not), but the rabbit does not approach
+man in the same close relationship as the dog. Richardson administered
+to a healthy young cat 7 drachms of Battley's solution of opium, then 10
+grains of morphia, and a little later 20 grains more of morphia without
+rendering the cat unconscious. The same experimenter gave to a pigeon
+21, 30, and 40, then 50 grains of powdered opium on succeeding days with
+no bad effect. S. Weir Mitchell gave to three pigeons, respectively, 272
+drops of black drop, 21 grains of powdered opium, and 3 grains of
+morphia without any effect.[72] On the other hand, horses show a like
+susceptibility to man to the action of drugs. In the island of Ceylon, a
+sloth can take 10 grains of strychnia with safety,--chickens presenting
+a like immunity to the poisonous effects of this alkaloid. While the dog
+offers such a contrast to the action of drugs as compared to man, he is
+as subject to goitre, and they have been seen in a true state of
+cretinism.[73]
+
+An Apache, or Colorado Indian, will prefer a dessert of decomposed
+gophers to one composed of the best canned peaches or Bartlett pears; he
+will devour the mass without any resulting evil, while a German--after
+many generations of training on all forms of sausages in every degree of
+age and ripeness, and on every form of cheese, from the refreshing
+cottage cheese from curdled milk and the delicious cream cheese, down
+through to all and every grade as far as Limburgher, or maggoty, common
+cheese--has not, in every case overcome the tendency of the civilized
+intestine and constitution to the action of sausage poison, something
+that has no effect on the ordinary Indian, or on the uncivilized
+dweller north of the arctic circle. Even the house-dog, that faithful
+companion of man, in many cases living on exactly the same fare as his
+master, is insensible to the action of this poison. An Indian will gorge
+and gormandize, after a prolonged fast, on such quantities and qualities
+of food that, if the ordinary white man were to indulge in a like feast,
+he would be in imminent danger of literal rupture or explosion, or
+liable to end in sudden apoplectic seizures, or, in case of a too
+healthy and active digestion, liable, owing to a lack of a
+correspondingly active condition of the excretory organs, to go off in
+uræmic coma. This sporadic and fitful feasting has no perceptible effect
+on the Indian, who either simply works it off in exercise, or sleeps it
+off in a long and prolonged period of sleep, during which his lungs work
+with the deep and steady pull and persistence that a tug-boat exhibits
+when towing in a large ship against the tide and a head wind,--working
+in and out more air in one respiration than the ordinary white man will
+in a dozen. All these different conditions are more or less plain to us
+and as easy of explanation,--just as plain as to how and why some birds
+eat gravel to improve their digestion. In the cases of different
+susceptibility to the action of strychnia or of narcotics, the
+explanation must of necessity, for the present, be more or less
+speculative. But how are we to account, even in the way of speculation,
+for the peculiar immunity, lack of predisposition and hereditary
+tendencies to disease exhibited by the Hebrew, who, since the history of
+the world, has been a civilized and rational being,--even for decades of
+centuries before the civilization of Europe? Living under the same forms
+of government, climate, and shelter, practically using the same
+varieties of food and drink, he exhibits an entirely different vitality
+and resistance to disease, decay, and death,--being, in fact, a puzzle
+to the demographic student. The only really marked difference that
+exists between this race and the others lies in the fact that the Hebrew
+is circumcised, other differences not being sufficiently constant to be
+accounted as factors. Circumcision is, in the opinion of the writer, the
+real cause of the differences in longevity and faculty for the enjoyment
+of life that the Hebrew enjoys in contrast to his Christian brother.
+Christian and uncircumcised races may individually, or in classes,
+develop some peculiar immunity or exemption, as, for instance, the
+tolerance to arsenic exhibited by some German mountaineers, or the
+peculiar safety enjoyed by the butcher class from attacks of continued
+fever;[74] but these exemptions are purchased at the expense of the
+future, the effects of arsenic, long continued, finally having its
+morbid effects, and the very plethora which is the bulwark of resistance
+in the butcher, this plethora being in the end a treacherous foe,
+diseases result from it which make a sudden ending to this class when it
+is least expected.
+
+For an all around long-liver the Hebrew holds a pre-eminence, and, as
+the factor in this pre-eminence, circumcision has no counter-claimant.
+Circumcision is like a substantial and well-secured life-annuity; every
+year of life you draw the benefit, and it has not any drawbacks or
+after-claps. Parents cannot make a better paying investment for their
+little boys, as it insures them better health, greater capacity for
+labor, longer life, less nervousness, sickness, loss of time, and less
+doctor-bills, as well as it increases their chances for an euthanasian
+death.
+
+
+
+
+CHAPTER XVI.
+
+THE PREPUCE, SYPHILIS, AND PHTHISIS.
+
+
+It is not alone the tight-constricted, glans-deforming,
+onanism-producing, cancer-generating prepuce that is the particular
+variety of prepuce that is at the bottom of the ills and ailments, local
+or constitutional, that may affect man through its presence. The loose,
+pendulous prepuce, or even the prepuce in the evolutionary stage of
+disappearance, that only loosely covers one-half of the glans, is as
+dangerous as his long and constricted counterpart. If we look over the
+world's history, since in the latter years of the fifteenth century
+syphilis came down like a plague, walking with democratic tread through
+all walks and stations in life, laying out alike royalty or the vagrant,
+the curled-haired and slashed-doubleted knight, or the tonsured monk, we
+must conclude that syphilis has caused more families to become extinct
+than any ordinary plague, black death, or cholera epidemic. Without
+wishing to enter into a history of syphilis, it is not outside of the
+province of this book to allude to its frequency and spread.
+
+Syphilis is not restricted to classes by any means; it is not those of
+the lower class alone who are its victims. Dr. Fr. J. Behrend, in his
+work, "Die Prostitution in Berlin," observes that abolition of the
+brothels in that city in 1845, '46, '47 and '48, trebled the number of
+cases of syphilis treated at the Der Charité; in the year 1848 the cases
+of syphilis treated at that hospital numbered over 1800. It was also
+remarked during this period of legally-enforced virtue, that, as
+inconsistently as it might appear, the disease invaded the best of
+families. From Dr. Neumann, in his brochure entitled "Die Berliner
+Syphilisfrage," published in 1852, we learn that, in the Trades and
+Mechanics' Benevolent Union of Berlin, in 1849, 13.51 per cent. of the
+sick were so from syphilis.
+
+In the thirteenth volume of the _British and Foreign Medico-Chirurgical
+Review_, we find, in a review of the control of prostitution, an
+estimate in regard to the syphilization of a nation. The estimates are
+made on the most conservative figures, as, in the desire of the reviewer
+not to overestimate, he starts by figuring out the actual number of
+prostitutes in England, Wales, and Scotland to be only 50,000, when they
+were estimated, by those who had carefully studied the subject, as being
+more than double that number; the conservative estimate is, however,
+suitable for our purpose; so that we cannot be accused of overestimating
+the results. The portion of the review to which we wish to call
+attention is as follows:--
+
+"Though the result of the evidence contained in the first report of the
+commissioners on the constabulary force of England and Wales was that at
+that time about 2 per cent. of the prostitutes of London were suffering
+under some form of venereal disease, yet we will descend even lower, and
+presume that of one hundred healthy prostitutes, taken promiscuously
+from England and Scotland, if each submits to one indiscriminate sexual
+act in twenty-four hours, not more than one would become infected with
+syphilis, an estimate which is without doubt far too low; yet, if
+admitted to be correct, the necessary consequence will be, _that of the
+fifty thousand prostitutes five hundred are diseased within the
+aforesaid twenty-four hours_.
+
+"If we next admit that a fifth of these five hundred diseased women are
+admitted to hospital on the day on which the disease appears, it follows
+_that there are every day on the streets four hundred diseased women_.
+Let it be supposed that the power of these four hundred to infect be
+limited to twelve days, and that of every six persons who, at the rate
+of one each night, have connection with these women, five become
+infected, it will follow _that there will be four thousand men infected
+every night, and consequently one million four hundred and sixty
+thousand in the year_. Further, as there are every night four hundred
+women diseased by these men, one hundred and eighty-two thousand five
+hundred _public prostitutes will be syphilized during the year; hence,
+one million six hundred and fifty-two thousand five hundred cases of
+syphilis in both sexes occur every twelve months_.
+
+"If, then, the entire population had intercourse with prostitutes in an
+equal ratio, _the gross population of Great Britain, of all ages and
+sexes, would, during eighteen years, have been affected with primary
+syphilis_. Be it remembered, we do not assert that more than a million
+and a half of _persons_ are attacked every year, but that that number of
+_cases_ occurs annually in England, Wales, and Scotland, though the same
+individual may be attacked more than once. Although it is evident that
+all the estimates used for these calculations are (we know no other word
+that expresses it) ridiculously low, yet we find that more than a
+million and a half of cases of syphilis occur every year,--an amount
+which is probably not half the actual number. How enormous, then, must
+be the number of children born with secondary disease! How immense the
+mortality among them! How vast an amount of public and private money
+expended on the cure of this disease!"
+
+The same reviewer (P. S. Holland), in another article on the "Control of
+Prostitution," observes that among the British troops syphilis is one of
+the most frequent of diseases, about one hundred and eighty cases
+occurring annually among every one thousand soldiers.
+
+The effect of syphilis in depopulating the islands of the Pacific has
+been pointed out in a former chapter; the nature and origin of the
+disease that takes them off is unmistakable. Scrofula and rapid phthisis
+are taking off the inhabitants at a rate that, in those islands most
+affected, the native population will soon become extinct. According to
+Lancereaux, in the Marquesas group the women do not live beyond the age
+of thirty to thirty-five years, three or four months being the duration
+of the disease. Ellis, in his "Polynesian Researches," published in
+1836, remarks that at that date the disease, as above described, had but
+recently appeared. In the nineteenth volume of the "Archives de Médecine
+Navale," Rey mentions that at the Easter Island pulmonary phthisis is
+the dominant affection with the adults, and that scrofula is very
+prevalent with the children.[75]
+
+The effect of syphilization in inducing a scrofulous taint and the
+appearance of a rapidly-marching consumption among savage races has been
+well observed among the Indians in the southwestern parts of the United
+States, where the appearance of these fatal diseases can easily be
+traced to that as a cause. There is something peculiar about the
+Anglo-Saxon race that is fatal to the Indian; wherever they come in
+contact, the savage race begins physically and morally to crumble; the
+habits of the Anglo-Saxon in the matter of intemperance and his lust
+soon end the poor Indian; while, on the other hand, the Latin races mix
+with them without any physical detriment to the Indian. In what was
+formerly the Northwest Territory the French and Indian intermarried, and
+syphilis did not begin to tell on the Indian until the Americans settled
+the country. From these observations it is very evident that in the
+Polynesian Archipelago syphilis must have been the precursor of the
+phthisis and scrofula, as we know it to have been that which induced
+those diseases among the Indians of the Mississippi or Missouri Valleys,
+or of the Colorado and Mojave Deserts, or in the mountains and valleys
+of Arizona.
+
+On the other hand, circumcised races, whose women have not carried a
+syphilitic taint into the race, are as a class free from any syphilitic
+taint. Neither their teeth, physiognomy, skin, nor general condition
+denote any syphilitic inheritance. This is true of the Jewish
+descendants of Abraham, who have more strictly adhered to the
+non-intercourse or marriage with other races, and whose women have
+abstained from vice; the Arabian descendants of Ishmael have, in a great
+measure, also retained their marked family individuality, except it be a
+few tribes, who, by contact with the soldiery of European nations, have
+had their women corrupted and syphilis introduced into the tribe through
+this channel.
+
+Richardson, in his "Preventive Medicine," observing on the effects of
+syphilis in inducing deterioration of the organs of circulation and
+their degenerative changes, says that, in his opinion, syphilis is the
+progenitor of various diseases, and that those who give this opinion the
+greatest range are, unfortunately, nearest the truth. The breathing
+organs, he remarks, are distinctly susceptible to injury from this
+hereditary cause.
+
+In 1854, at the Metropolitan Free Hospital, situated in the Jews'
+quarter in London, Hutchinson observed that the proportion of Jews to
+Christians among the out-patients was as one to three; at the same time
+the proportion of cases of syphilis in the former to the latter was one
+to fifteen. Now, this result was not due to any extra morality on the
+part of the Jews, as fully one-half of the gonorrhoea cases occurred
+among those of that faith. J. Royes Bell also observes the less
+syphilization among circumcised races.[76]
+
+The absence of the prepuce and the non-absorbing character of the skin
+of the glans penis, made so by constant exposure, with the necessary and
+unavoidably less tendency that these conditions give to favor syphilitic
+inoculation, are not evidently without their resulting good effects. Now
+and then syphilitic primary sores are found on the glans, or even in the
+urethra or on the outside skin of the penis, or outer parts of the
+prepuce; but the majority are, as a rule, situated either back of the
+corona or on the reflected inner fold of the prepuce immediately
+adjoining the corona, or they may be in the loose folds in the
+neighborhood of the frenum, the retention of the virus seemingly being
+assisted by the topographical condition and relation of the parts, and
+its absorption facilitated by the thinness of the mucous membrane, as
+well as by the active circulation and moisture and heat of the parts. It
+must be evident that but for these favoring conditions the inoculation
+or infection would and could not be either as sure or as frequent. Any
+protecting mechanical aid that interferes with these favoring conditions
+grants an immunity to the individual, even when he is freely exposed;
+this protection has often been obtained by applying to the glans and
+penis a substantial coat of some tenacious oil like castor-oil, which
+was afterward gently washed off, first in a shower of tepid water and
+afterward in a tepid bath of warm water and borax.
+
+Horner, formerly of the navy, in his interesting little work on "Naval
+Practice,"[77] relates that it was customary, in the older navy of the
+United States, to allow public women to come on board at some of the
+ports and to go down to the men between decks, the Department of the
+Navy being probably actuated by the same humane principle that used to
+induce some of the West Indian cannibals to lend their wives to their
+prisoners of war who were intended, in the shape of roast or
+_fricandeau_, to grace the festive board, as it was deemed inhuman by
+these philanthropists to deprive a man of his necessary sexual
+intercourse, even if they were soon to roast him and pick his bones.
+They may, however, have been selfish in the matter, as by some
+authorities it is represented that this was done to improve the flavor
+of the prisoner, who was said to offer a more savory dish through this
+considerate treatment, the strong flavor that the semen gives to flesh
+being well eradicated by free fornication. Whether it was through these
+motives of humanitarianism, or the feeling that an American tar was the
+equal of the British tar, whose praises and equality Sir Joseph Porter,
+K.C.B., writes a song about in "Pinafore," who had as much right to
+contract a left-handed marriage as any Prince of Wales or any other
+prince or crowned head of Europe, the women were, nevertheless, allowed
+to go down between decks in preference to giving the men indiscriminate
+liberty on shore, the government further providing for their welfare by
+causing the assistant surgeon to examine the women at the gangway or
+hatchway, to see that they were not diseased. Horner relates the
+ludicrous appearance presented by a near-sighted assistant at one of
+the hatchways while making this professional examination, surrounded by
+the sailors and marines, who were greatly-interested spectators. Had the
+government provided a pot of castor-oil wherein the tar could dip his
+penile organ, as bridge piles are dipped into a creasoting mixture,
+these humiliations to our professional brother could have been avoided.
+
+In the conclusion to be reached, circumcision is not put forward as the
+only exempting element or preventive measure that deserves all the
+credit for the immunity that the Jews enjoy from syphilis, or to the
+absence of hereditary diseases that are secondary or due to the presence
+of that disease in the parents, as considerable credit is to be given to
+the well-known chastity of their females. This chastity is, in a great
+measure, due to the inseparable conditions of their religion,--moral and
+social fabrics which are welded into one. Their charity assumes the most
+practical form, so that it is not possible for one of their females to
+have to resort to a life of prostitution to save herself or her children
+from starvation, as, unfortunately, is too often the case in Christian
+communities, where religion is put on and off with Sunday clothes. The
+temperance and sobriety, as well as the economy and industry of the
+father, are not without a good moral as well as a hereditary effect on
+the daughters, who are neither rendered brutal nor demoralized through
+the example and instigation of drunken fathers. They have, therefore, a
+better average homelife, to which they cling and which protects them.
+The aid and benevolent associations of the Jews are among the most
+efficacious of charitable institutions, and no class gives more freely
+or generously for this purpose. The Home for Aged Hebrews in New York is
+an example of the character with which they dispense charity. We need
+not, therefore, be surprised to find, in statistics of illegitimacy by
+religious denominations taken in Prussia, that the Jewish women are
+three times as chaste as the Catholics and more than four times as
+chaste as the Evangelists.[78] The Jew has, therefore, two avenues of
+infection from syphilis cut off,--the lesser liability due to his
+circumcision and the chastity of the women.
+
+Richardson mentions the immunity of the Jewish race from tubercular
+disease, and notices the well-known relation existing between a
+syphilitic taint and a phthisical tendency. The comparative statistics
+offered by the Mohammedans, Jews, and Christians in regard to deaths
+from consumption have already been mentioned in a former chapter, they
+being as four Christians to one Jew, while the Mohammedan, from his
+greater abstemiousness and temperance to assist him, shows a still lower
+percentage than the Jew. There can be but little doubt that to this
+particular and well-marked less syphilization the Hebrew race owes much
+of its exemption from many other diseases and its greater resistance to
+ordinary ailments and epidemic diseases.
+
+The relative less frequency of syphilis among all circumcised people is
+noticed by Dr. Bernheim, in his brochure "De la Circoncision," he being
+the surgeon of the Israelitish Consistory of Paris. His utterances on
+this subject are worthy of attention, he having not only paid particular
+attention to this, but having had unusual opportunities for the basis of
+his opinions. Dr. Bernheim looks upon coition as a frequent source of
+tubercular infection, and the sensitive and absorbing covering of the
+uncircumcised glans as a ready medium of transmission of the virus from
+one system to the other. He calls attention to the frequent granular
+condition of the uterine os, in confirmed cases of tuberculosis, as
+something that is too much overlooked. This view of the case, from Dr.
+Bernheim's stand-point, is worthy of greater consideration than it has
+generally received at the hands of the profession.
+
+The great number of examples that have recently come to light in
+connection with the direct inoculability of tubercular consumption, both
+in the later works on phthisis and in the medical press, are not without
+interest or without a lesson. The case recorded within the past year of
+a healthy chambermaid, who was immediately inoculated with tubercular
+matter with rapidly-following constitutional effects through a scratch
+on the hand, received from the sharp edge of a broken china cuspidor
+that a consumptive was using, is one of these cases that are to the
+point; so it is evident that the uncircumcised need not always wait for
+the degeneration of syphilis into syphilitic phthisis or syphilitic
+scrofula to become a consumptive, but it is within the greatest range of
+possibility and probability that he may become at once a consumptive
+through an excoriation or abrasion received during coition with a
+tubercular woman. So many tubercular prostitutes ply their trade, or, to
+be more definite, so many prostitutes become tubercular, and in its
+different stages follow their occupation as the only means of keeping
+out of the poor-house, that man runs as much if not more risk, in
+consorting with the class, of contracting tuberculosis than that of
+contracting syphilis.
+
+There is something about syphilis that is not generally noticed; we are
+all well acquainted with the dire results that usually follow syphilitic
+infection, its course through every stage of suffering and misery, its
+transmission and effects in tubercular meningitis or in syphilitic
+affections of the mesentery through heredity in children, and of the
+many horrible cases of destruction of tissue, in skin, mucous membrane,
+cartilage, or bone, with their attending mutilations and disfigurations;
+but there is no record of the great number of cases, and very few
+physicians of any extended practice but who can recall some such cases,
+where, after undoubted syphilitic infection, with the usual course of
+primary sores and secondary eruption, the patient has suddenly blossomed
+out into a state of robust health that his system was an entire stranger
+to before the infection. The writer has, in the course of a long
+practice, seen a number of such results follow both the infection
+attended with a miliary eruption and that followed by the large
+small-pox-appearing eruption, both kinds being preceded by the primary
+sore; and these results have been observed in cases of both what are
+called the soft and multiple and the hard or Hunterial initial sore.
+Some of these cases rapidly gained in flesh, with an evident increase in
+the redness of their blood, increasing in vigor and strength with a very
+perceptibly less tendency to attacks from accidental or previously
+subject-to diseases.
+
+The same result has been observed to follow an attack of small-pox with
+some individuals, and the writer well remembers a similar result
+following a very extraordinary event. The subject was a man well known
+among his old comrades of the First Minnesota Infantry as "Duke," and to
+many of the older practitioners of Wabashaw County, of that State, as
+"Old Duke." In early life he was sickly and weakly, never having fully
+recovered from a malarial fever contracted in the Mexican war. Coming to
+Minnesota, he adopted the life of a raftsman, with all the
+irregularities that accompanied such a life. On one occasion, after a
+protracted spree, feeling the need of stimulation and not having the
+wherewith to procure it, he secured a jar in which a snake and several
+other reptiles were preserved in spirits, and drank the fluid contents.
+He was, some days afterward, taken violently ill with a high fever and
+racking pains, ending in an eruption of boils that covered him from head
+to foot; he made a slow and tedious recovery; but when recovered he
+seemed to have become imbued with a constitution resembling
+_lignum-vitæ_, for a more stubborn-twisted constitution never existed
+than that of "Old Duke." The power of resistance that this man developed
+was something wonderful. Dr. C. P. Adams, of Hastings, Minnesota, and
+the St. Paul physicians who were connected with the regiment well
+remember, though, wiry, precise, and soldierly "Duke," who, even in the
+old Army of the Potomac, immersed up to his ears like the rest of the
+army in the mud and dirt of the encampment of Falmouth, above
+Fredericksburg, came out on general inspection as prim as if he had just
+stepped out of a bandbox, for which he received a medal for soldierly
+conduct and bearing.
+
+These apparent digressions are not made either to be tedious or to weary
+the reader, nor without an object. They are made to show that, whereas
+syphilis is looked upon as such a deadly disease, and it may be said to
+be the sole cause of fear to the assiduous worshiper at the shrine of
+Venus Porcina, there is another still more fatal danger awaiting him,
+ambushed in the folds of the vaginal mucous membrane, or coming along
+silently out of the cervical canal,--like the legions of Cyrus stealing
+along the dry bed of the Euphrates into ancient Babylon, to fall
+unawares on the feasting Nebuchadnezzar on that fatal night. So, in like
+manner, the virus of tuberculosis, either extruding from a granular os
+or from its neighborhood, gradually moves down on the unsuspecting,
+uncircumcised, and easily inoculable-surfaced glans penis, to infect the
+system with a tubercular poison that has no such exceptions as those
+above noted, as at times are the followers of syphilis. It is not alone
+the individual himself that may be the sufferer from this poison, but
+his progeny for several generations may have to suffer for the infection
+thus received, just as much as they would were that infection to have
+been syphilitic. As before remarked, this has heretofore not
+sufficiently occupied the consideration of the profession, and, as it
+cannot certainly be denied that such a source of tubercular infection is
+both possible and probable, the subject is entitled to more serious and
+deliberate consideration than that which has heretofore been paid to it.
+
+Tuberculosis certainly has these two channels of entrance: either
+through direct infection or through an evolutionary process resulting
+from syphilis. The appearance and vital statistics offered by the French
+War Office in regard to the Algierine provinces, the report of the
+United States Census, the opinion of Dr. Billings deduced from the
+census reports, the opinions of Hutchinson, Richardson, Bernheim, and
+many other observers, as well as the personal but unrecorded
+observations of many practitioners, all tend to bear testimony to the
+remarkable difference that exists between circumcised and uncircumcised
+races in regard to the ravages of consumption. Is circumcision a factor
+in this difference, or is it not? If it is, then circumcision should
+receive more attention than it has; if it is not, then we should not be
+idle in hunting up the cause of difference, for an ounce of prevention
+is certainly worth in this regard a whole pound of Koch's lymph as a
+curative agent.
+
+
+
+
+CHAPTER XVII.
+
+SOME REASONS FOR BEING CIRCUMCISED.
+
+
+The surgical and medical history of circumcision is intimately connected
+with the remotest ages, this being, in fact, the earliest surgical
+procedure of which we have any record. From the same records we obtain
+hints as to two conditions for which circumcision probably was
+suggested, either as a preventive or as a remedy.
+
+Jahn, in speaking of the people by whom the early Hebrews were
+surrounded, mentions their idolatrous practices, and that their peculiar
+forms of Pagan worship were accompanied by indulgence in fornication,
+lascivious songs, and unnatural lust. Others of their neighbors
+worshiped the "_hairy he-goat_," with which they also practiced all
+manner of abominations. Sodomy, or pederasty, seemed a sort of religious
+ceremony with some of these heathen nations; from a religion it
+necessarily became a social practice; this, in connection with the
+phallic practices and worship, necessitated frequent exposure of the
+male member. The evil results, to say nothing of the disgusting and
+demoralizing tendency of these practices of the Pagan, were evidently
+well known to the Jews. The contrast between the physique and health of
+the pastoral habits, out-of-door life and simple diet of the Jews, and
+the necessary opposite condition of health and physique due to luxury
+and to these practices among their neighbors, could not have escaped
+their attention. How much onanism had to do with the establishment of
+circumcision may well be conjectured. Again, the other hint is in
+reference to procreation, as some stress is laid to the connection
+between the conception of Sarah and the circumcision of Abraham. Here we
+have suggestions of a preventive to onanism, and a cure to male
+impotence when due to preputial interference.[79]
+
+Strange as it may seem, these two important results, due to
+circumcision, seem to have been lost sight of for some thousands of
+years, as even the able works of the physicians of the latter part of
+the last century have nothing to say connecting onanism and
+circumcision. Neither the works of Tissot on male onanism nor the
+pioneer work of Bienville on nymphomania speak of the presence of the
+prepuce in the male, or of the nymphar or clitorian prepuce in the
+female, as being causative of, or their removal curative of, either
+masturbation, satyriasis, or nymphomania; moral, hygienic, and internal
+medication being by both these authors considered to be all that our
+science could offer or do to alleviate or cure this unfortunate class.
+It is only of late years that circumcision, in its true relations to
+onanism, has received full consideration. In regard to its being a cure
+of impotence, its recognition has been of longer duration.
+
+It is related by Leonard, in his "Memoires,"--who, in his capacity of
+hair-dresser in ordinary to her Majesty, the unfortunate
+Marie-Antoinette, had ample opportunity for picking up all the domestic
+small talk of the royal family and their affairs,--that Louis XVI, in
+addition to all his troubles and the indignities which he suffered,
+besides finally being beheaded, was afflicted with a congenital phimosis
+which prevented the flow of semen from properly discharging itself. It
+appears that his Majesty was no little annoyed at not being able to
+procure an heir to his throne. His royal sister-in-law, the Countess
+d'Artois, had given birth to a prince, the Duke of Angouleme, who was
+the heir presumptive to the throne in case of the non-issue from Louis;
+another sister-in-law had been brought to bed with a royal princess, and
+here was the king himself without any prospective possibility of any
+heir. Like all kings, he was more or less unreasonable; so he blamed his
+first surgeon in ordinary for all these short-comings,--as if it were
+the duty of these court surgeons, among their many other tribulations,
+to furnish heirs to thrones. The surgeon finally informed his Majesty
+that if he wished to become a father it would be necessary for him to
+submit to the slight operation that was the subject of the church
+festival of the first day of January, namely, the Feast of the
+Circumcision. His most Christian Majesty entered a protest to this
+acknowledgment that there was anything in Judaism worth imitating. The
+surgeon insisted that the operation celebrated on the first of January
+would put him in a way to have the much-desired heir. The king finally
+waived all objections from any religious scruples, but could not be
+brought to look at the prospective operation with any sentiments of
+agreeable expectation.
+
+The king finally became good-natured, and a touch of that plebeian
+jollity which at times made him quite agreeable spread over his features
+as he imagined the ludicrousness of the spectacle that would be
+presented by a king of France in the hands of these handlers of the
+scalpel, treating him like an African savage. He took some days to
+consider the matter. On the next day he informed M. Louis, his first
+surgeon in ordinary, that he had decided on submitting to the operation,
+and the day and hour were fixed. The royal circumcision, however, never
+took place, as it is most likely that in the privacy of his chamber his
+Majesty worked, like many a plebeian or man of low degree had done
+before him and has done since, to bring a refractory prepuce to terms.
+The king was somewhat of a mechanic, as his skill as a locksmith has
+passed into history; so that it is not unlikely that, with what little
+information he had on the subject, he managed to sufficiently dilate, by
+scarification and stretching, the preputial opening, as from the year
+1778 the queen had three children.
+
+Cases of attempted self-circumcision are not rarities, as people have
+some inexplicable idea that a self-inflicted cut is not as painful as
+one that is done by others. The writer well remembers being called to
+assist one of these domestic surgeons who had undertaken to circumcise
+himself with his wife's great scissors. The man had a very long but thin
+and narrow prepuce that had always been an annoyance to him. The writer
+had circumcised two of his children for the same malformation, and the
+father, seeing the benefit to these two, determined to share in the
+general benefit; but at the same time he arranged to do it all by
+himself, and give the family and the surgeon a sample of his courage and
+a simultaneous surprise party. Securing the scissors, he wended his way
+unperceived into the recesses of his wood-shed. The mental and physical
+anguish the poor man underwent, and what soliloquies he must have
+addressed to the rafters of the wood-shed while making up his mind and
+screwing up his physical courage for the last fell act with the
+scissors, can hardly be described, as, in all probability, they were of
+the most rambling and inconsistent order. At any rate, he must have
+reached a climax in time and grasped the fated prepuce with a revengeful
+glee, and, with all his powers concentrated in his good right hand, he
+must have closed the remorseless blades of the scissors on the unlucky
+prepuce. When the surgeon arrived at the scene of carnage, he was
+directed to the wood-shed, on the outskirts of which hovered the family,
+frantic with fear and apprehension; within, in the darkest corner, with
+wildly dilated eyes, and performing a fantastic _pas seul_, was a man
+with a huge pair of scissors dangling between his legs, warning all
+hands as they valued his life not to approach or lay a hand on him. He
+had shut the scissors down so that it clinched the thin prepuce, and
+there his courage and determination had forsaken him; he lost his
+presence of mind, and was not even able to take off the scissors; he had
+simply given one wild, blood-curdling yell--like the last winding notes
+from Roland's horn at Roncevalles--that had brought his family to the
+wood-shed-door, and they had then sent for a surgeon. New terrors here
+awaited the unlucky victim for self-circumcision. He dreaded lest the
+surgeon should accidentally have it enter his mind to finish the
+operation with the scissors, and in that case he would be helpless, as
+the surgeon would, undoubtedly, have a sure and tender hold of it. After
+executing a number of _pas à deux_ on the Magilton step, while the
+surgeon endeavored to reassure him and gain his confidence, promising to
+remove the scissors without inflicting any further harm, he was finally
+allowed to approach, and, while the patient assumed a Taglioni attitude
+on one foot, the other leg being extended at right angles with the body
+and his hands clawing the air, the scissors was removed. The patient,
+through the aid of lead lotions and a week's rest, made a good recovery
+with a whole prepuce, chagrined at his failure, but happy to have
+escaped immediate pain.[80]
+
+There is not much doubt but that the operation could have been
+suggested by its, at times, spontaneous performance, a case of which, by
+Cullerier, and some other additional cases have been mentioned in a
+former chapter. Cases occur at times, also, wherein the person having a
+previously normal and uninterfering prepuce has, through either herpetic
+inflammations or through impure connection, spurious gonorrhoea, or the
+use of some venereal-disease preventing-wash after connection, produced
+some irritation resulting in the abnormal thickening of the inner fold,
+or an interstitial deposit at the junction of the skin and mucous
+membrane, with consequent constriction, this deposit finally forming a
+hard, inelastic ring, which prevented a free exposure of the glans and
+interfered in sexual connection. In such cases,--like in stricture of
+the meatus,--any mechanical interference short of cutting with a knife
+only aggravates the existing difficulty, and it is not uncommon to have
+such cases apply for assistance after they have in vain tried to dilate
+the constricting preputial orifice. In the early writings of the Greeks,
+it is mentioned that among the Egyptians circumcision exempted them from
+a certain form of disease that affected the penis. Philon mentions
+particularly the immunity that the operation conferred against a species
+of affection which Michel Levy asserts to have been a gangrenous
+disease. So that, outside of any religious significance, there is no
+doubt that, in individual cases, circumcision has more than once been
+suggested, although it cannot be said that such individual cases would
+ever, or could, lead to its becoming a national or racial, much less a
+sectarian, rite.
+
+
+
+
+CHAPTER XVIII.
+
+THE PREPUCE AS AN OUTLAW, AND ITS EFFECTS ON THE GLANS.
+
+
+Ricord has well termed this appendage to civilized man "a useless bit of
+flesh." Times were, however, when--man living in a wild state, and when
+in imitation of some of our near relatives with tails and hairy bodies;
+when he still found locomotion on all-fours handier than on his two
+feet; when in pursuit of either the juicy grasshopper or other small
+game, or of the female of his own species to gratify his lust, or in the
+frantic rush to escape the clutches, fangs, or claws of a pursuing
+enemy, he was obliged to fly and leap over thorny briars and
+bramble-bushes or hornets' nests, or plunge through swamps alive with
+blood-sucking insects and leeches--Ricord's definition would certainly
+have been inapplicable. In those days, but for the protecting double
+fold of the preputial envelope that protected it from the thorns and
+cutting grasses, the coarse bark of trees, or the stings and bites of
+insects, the glans penis of primitive man would have often looked like
+the head of the proverbially duel-disfigured German university student,
+or the Bacchus-worshiping nose of a jolly British Boniface. So that in
+those days, unless primitive man was intended to have an organ that
+resembled a battle-scarred Roman legionary, a prepuce was an absolute
+necessity.
+
+With improvement in man's condition and his gradual evolution into a
+higher sphere, the assumption of the erect posture, and the great stride
+in civilization that originated the invention of the manufacture of the
+perineal band, which not only protected the glans in its thorny passage
+through life, but also acted like a protecting ægis to the scrotum and
+its contents, the prepuce became a superfluity; not only a superfluity,
+but, now that its natural office had been replaced by the perineal
+cloth, it actually began to be a nuisance, as its former free contact
+with the air had retained it in a state of vigorous and
+disease-resisting health which was now fast departing. As Montesquieu
+observes, in the causes that led to the decline and fall of the Roman
+Empire, those seasons of trials, tribulations, and struggle for
+existence are those of health and progress and healthy life, and the
+periods of luxury and idleness are those of degeneracy and decay. So
+with the prepuce, the luxury and idleness, voluptuousness and consequent
+feasting incident to its being supplanted in its original functions by
+the perineal cloth, which left it thenceforth unemployed, led it in the
+pathway of disease and death. This first innovation in civilization was
+to the prepuce the beginning of its decay and fall. Like Belshazzar in
+his great banquet-hall in ancient Babylon, the prepuce might have read
+the hand-writing on the wall, "_Mene, Mene, Tekel, Upharsin_," and
+foreseen the gory end that awaited it. Like to other human affairs,
+however, even in his fallen estate a kind word can be said for the
+prepuce. Puzey, of Liverpool, has found it of extreme value, and even
+unequaled by any other part of the body, for furnishing skin-grafts,[81]
+these grafts showing a vitality that is simply phenomenal, considering
+the laxity of its tissues and its seemingly adipose character. There is
+no doubt, however, that for skin-transplanting there is nothing superior
+to the plants offered by the prepuce of a boy, and where any large
+surface is to be covered this should undoubtedly be chosen, as offering
+the greatest and quickest success and the least chances of failure.
+This is really the only disadvantage that can be charged against
+circumcision, as in a strictly circumcised community they would be
+debarred from this great advantage. An uncircumcised individual could be
+procured, however, to supply the deficiency. It is related that in the
+latter part of 1890, a Knight Templar, in Cincinnati, required a great
+supply of grafts or skin-plants to cover a largely-denuded surface, and
+that the whole of his Commandery chivalrously and generously supplied
+the needed skin-plants in a body. A few healthy prepuces would have been
+more efficacious. In advising the use of the prepuce for these purposes
+it must not be overlooked that in case of a white man it would not do to
+use skin of any other color besides his own. We have no data to base any
+assertion as to the relative action of skin-grafts taken from Mongolians
+or Indians, but we have very reliable data in relation to the
+proliferating action of those of the negro,[82] which induces a growth
+of epidermis of its own kind; so that preputial grafts from the negro,
+combining the extra vitality and proliferation of the preputial tissue
+with the strong animal vitality of the negro, if applied to a white man,
+might not produce the most desirable cosmetic effects, especially if on
+one side of the countenance.
+
+But, taken as a whole, when considered in its relation to onanism,
+nocturnal enuresis, preputial calculus, syphilis, cancer, and a lot of
+nervous and other ailments, or induced abnormal physical conditions, we
+can really conclude that the days of the prepuce are past and gone, that
+it has outlived its usefulness, and that those whom a religious or civil
+ordinance or custom happily makes them rid of it are people to be
+greatly envied. As Sancho Panza remarked, "God bless the man who
+invented sleep," so we may well join in blessing the inventor of
+circumcision, as an event that has saved some parts of the human family
+from much ill and suffering.
+
+Phimosis is an ancient attendant on our inheritance of the prepuce, we
+being, in fact, born with it; this is the rule. There are, however,
+exceptions to this rule, which, singularly enough, are found to be
+hereditary. The writer has met with a number of such instances, and they
+have always been found to have been family traits. Within the past year,
+after attending a confinement, his attention was called to the child by
+the nurse, who thought that the child was deformed; the nurse,
+singularly enough, never having seen a natural-looking glans penis in
+all her life, was astonished at the size and appearance of the member.
+On examination, the organ showed a complete absence of prepuce. On
+inquiry, the father and another son, born more than twenty years
+previously,--this comprising every male member of the family,--were
+found to have been thus born, with the glans fully exposed. The family
+is now residing in San Diego, and is naturally one of more than superior
+physical health and intelligence. I saw another family similarly
+affected in the north of France, and of individual cases, without
+knowing the history of the rest of the family, I have seen a large
+number. As the prepuce can be observed in every stage of disappearance
+among mixed races, it would seem that in time it would disappear
+altogether. Its effectual absence in so many cases evidently belongs to
+some evolutionary process, and shows beyond question that nature does
+not insist on its presence either as a necessity or as an ornament.
+
+The word or term "phimosis" is derived from two Greek roots, signifying
+"string" and "to tighten," or "to tie with a string." Galen, from its
+signification, accepted the word, and from him it has been transmitted
+through the different epochs of medicine down to our own times. In
+virtue of its etymological significance, it was formerly applied to any
+stenosis or closure of duct or aperture, but at present the term is used
+simply to denote that constriction that affects the prepuce, and which
+prevents the glans from being passed through the preputial orifice.
+Phimosis is said to be congenital or natural and acquired. The first of
+these is the common lot of all, as a rule, and with some it remains so
+throughout life. As babyhood advances in boyhood and boyhood into youth,
+the prepuce gradually becomes lax and distensible, and in proportion to
+the existence of these conditions it also loses in its length. Where,
+however, the distal end persists in its constricted condition it is
+drawn forward as the penis increases in bulk.
+
+In many cases its tightness prevents the escape of the sebaceous matter
+that collects in the sulcus back of the corona, and the resulting
+irritation on the surface of the glans and the inner mucous fold of the
+prepuce ends in an inflammatory thickening of the latter, its inner
+surface becoming thick, undilatable, hard, and unyielding, all the
+natural elasticity that should be present having departed, with more or
+less inflammatory thickening and adhesions between the two layers of
+skin that form the prepuce. In this unyielding tube the glans is
+imprisoned and compressed, often suffering the tortures that the
+"maiden" of the dungeons of the Inquisition inflicted on the unhappy
+heretics. It becomes elongated, cyanosed, and hyperæsthetic; the meatus
+of the urethra is congested and hypertrophied, the corona is undeveloped
+and often absent, the glans having, on the whole, the long-nosed,
+conical appearance of the head of a field-mouse. There are hardly five
+per cent. of the uncircumcised but who suffer in some degree from this
+constricting result of the prepuce, to a greater or less extent.
+
+On the other hand, the unconstricted glans penis assumes the shape and
+appearance that is seen in the circumcised. The head is shorter, the
+face flat and abrupt, and the meatus, instead of being at the end of a
+conical point, is situated on the smooth, rounded front of the glans,
+and does not differ in color from the covering of the glans itself. From
+the superior commissure of the meatus to the sulcus in the rear of the
+corona its topographical outline may be said to describe two opposite
+segments of a circle, as seen in the cuts representing the glans in its
+natural shape. The corona is prominent and well developed.
+
+The opponents of circumcision base much of their opposition to the fact
+that circumcision interferes with the natural condition of the parts.
+The question may well be asked, which of these two shaped glans is the
+natural product as nature intended it should be? It is a well-known fact
+that the most forlorn and mouse-headed, long-nosed glans penis will,
+within a week or two after its liberation from its fetters of preputial
+bands, assume its true shape. We may naturally inquire if nature made
+the glans of a certain shape, which seems to be the proper shape for
+copulative purposes, only to have the condition most effectually
+abolished by a constricting, unnatural band? How much the shape of this
+glans, from meatus to corona, may have to do with retaining the urethra
+to a healthy and normal calibre and condition has not been inquired
+into, but, as far as the writer has observed, a normal glans seems to
+have less abnormalities of the urethra, and in treating such cases he
+has always found that when the urethra of one of these normal-glans
+subjects was affected it was far easier to manage; on the other hand,
+secondary and even a tertiary recurrence to an operation is often the
+fate of a long, narrow, conical-pointed penis.
+
+Phimosis is known to have been a cause of male impotence by its direct
+interference with the outward flow of the seminal fluid; but, although
+we have cases where impregnation has taken place by the aid of a warm
+spoon and a warm syringe, as in the case related in a former chapter, it
+must be admitted that the corona is not without some functional office
+in the act of procreation. Its shape indicates a valve action like that
+of the valve in a syringe-piston, and if we examine the two extremes of
+these conditions of glans--one devoid of corona, as many are, and the
+other with the corona in its most pronounced form, when in a state of
+erection--the difference, either in the appearance of the two organs or
+in the different philosophical action and results that must necessarily
+follow the use of these two differently shaped glans, will at once be
+apparent. Unfortunately--or, as many may consider it, most
+fortunate--the female organs are not always so shaped as to be in
+themselves wholly favorable to impregnation. The wearing of corsets, the
+habitual constipation of females, the relaxed and unnatural condition of
+the uterine ligaments and vagina in civilized women, all favor uterine
+displacement, with any or all forms of uterine ailments. To this we may
+add the effect of repeated miscarriages, application of astringent
+washes, irregular menstruation, etc., all of which conditions often
+result in an elongation of the neck, constriction of the cervical canal,
+with the external os placed on the depended point of the sharply pointed
+cervix, which is liable to point in any direction. Just imagine one of
+these conditioned females and one of the mouse-headed, corona-deficient,
+long-pointed glans males in the act of copulation! The conical penis
+finds its way in the reflected fold of the vagina, while the point of
+the uterus may be two or three inches in some other direction, making
+impregnation wholly impossible; besides, in the normal-shaped penis, the
+corona acting as a valve, behind which the circular muscular fibres of
+the vagina close themselves, tends to retain the seminal fluid in front,
+while the very shape of the organ assists in straightening out the
+vaginal canal and to bring the uterus in proper position. In the long,
+thin, narrow and pointed glans, devoid of corona, there is no mechanical
+means to retain the seminal discharge. Some years ago some one
+introduced the idea of postural copulation, to be tried in cases of
+sterility, and it has been found that impregnation would take place in
+some cases where it had formerly appeared impossible, this position
+having the effect of righting malpositions during the act, which were
+the cause of the sterility; but it stands to reason that, where the
+shape of the organ is such that it further favors malpositions, as well
+as where it offers no obstacle to the vagina immediately expressing or
+dropping out all the seminal fluid, impregnation is more difficult, and
+that, where the uterine deformity is coincident with this condition of
+penis to assist, it becomes well nigh impossible. Foderè mentions a
+penis about the size of a porcupine-quill on an adult male, and Hammond
+mentions one of the size of a lead-pencil in diameter and two inches in
+length. From total absence of the penis, either through disease or
+accident, to the diminutive organs mentioned by Foderè and Hammond, and
+on up to the full-sized and normal-shaped organ, we have every degree of
+sizes and shapes, and with these go every conceivable degree of ability
+or faculty for impregnation.
+
+Aside from the foregoing considerations, there are others equally
+important. Although Greece was involved for years in war and ancient
+Troy was destroyed and all its inhabitants slaughtered because of the
+seduction of one woman; and Semiramis, through her beauty, got all her
+successive husbands in chancery; and poor, susceptible Samson, from
+firing Philistine vineyards and killing lions bare-handed, and the
+Philistines by the thousands with the jaw-bone of an ass, was reduced
+through Delilah to bitter repentance and turning Philistine mill-stones;
+and we know that the familiar infatuation of Antony for Cleopatra ruined
+Antony; and we are familiar with the well-known maxim of the French
+police-minister, that to catch a criminal it was but necessary to first
+locate _the woman_ and the man would soon be found,--society has
+determined to ignore the influence of the animal passions as factors in
+our every-day life, or factors in the estrangements, coldness, and the
+bickerings that end in divorces. Not to shock the reader with detailed
+accounts as to what an important factor the shape of the penis may be in
+the domestic economy, I will refer the reader to Brantome's works.
+
+Although the councils of the older church were not above giving these
+conditions their calm and deliberate consideration, which resulted in
+the foundation of the present physical considerations in relation to
+divorce laws, such studies or considerations are at present only touched
+upon gingerly and with apologies for doing so, as if the "study of man"
+was of any less importance to-day from what it was in the days of Moses,
+the elder church, or when Pope formulated his oft-quoted but
+little-followed maxim, that "the proper study of mankind is man." The
+present miscalled "delicacy of sentiment" is about as misplaced a
+condition of disastrous and misleading morality as was the out-of-place
+and untimely bravery of poor old Braddock when refusing Washington's
+advice at the Monongahela. The success and beauty of the Mosaic law is
+its squarely facing the conditions of actual life, and its absence from
+nonsense or nauseating sentimentality. Were our present churches to
+observe more of this plain talk, for which the good old Anglo-Saxon is
+as fully expressive and convincing as the old Hebrew, and deal less in
+rhetorical flourishes and figurative mean-nothings to tickle the ears of
+our modern Pharisees, mankind as well as womankind would be infinitely
+so much the better off, mentally, morally, and physically, and there
+would be less of the conflict between science and religion. Luther's
+dream of restoring religion to its primitive purity has come to but as
+poor realization at the hands of his so-called followers, which leads
+one to think that if the martyrs of the Reformation could come back and
+see the fruits of their martyrdom--suffered that pure religion might
+live--they would conclude that, for all the resulting good accomplished,
+they might as well have kept a whole skin and a whole set of bones.
+
+In cases of pronounced phimosis the aperture in the prepuce may not be
+in a line with the meatus, and the resulting discharge of urine or the
+ejaculations of seminal fluid may from this cause be unable to find an
+egress. The fluid escaping from the urethra will, in case the opening is
+at the side or upper part of the prepuce, cause it to balloon out until
+a sufficient quantity is thrown out so as to distend, the opening as
+well as the prepuce, before it can find its way out; in such cases
+impotency is liable to be as complete as in those cases of stricture
+wherein the seminal fluid is forced backward into the bladder. Having
+given this general view of the effects of phimosis as it may affect man
+in the shape of his organ, which may have a serious result in his
+domestic relations or in becoming a father, we will proceed to the
+consideration of diseases and conditions that phimosis encourages and to
+which it renders man more liable. In the consideration of these cases it
+must not be forgotten that the sexual relations are much more to man or
+woman than is generally acknowledged. The days for the establishment of
+the Utopian republic of Plato are not yet with us. That Platonic love
+does exist is true, as it has in the past and will in the future.
+Scipio, refusing to accept the beautiful betrothed bride of an enemy as
+a present, or Joseph leaving his coat-tail in the hands of the amorous
+bride of the eunuch Potiphar, with the suicide of Lucretia, in the past,
+are events which virtue and modern continence probably duplicate every
+day; but these are exceptions to the rule. Physicians daily see
+evidences of the most devoted Platonic affection in either sex, but they
+also see enough of the opposite side of the question to convince them
+that in the majority of cases the sexual relations are the bond of
+union, as well as the mainspring of love. As observed by Montesquieu,
+the bride of a first-class Turkish eunuch has but a sorry time, and a
+woman of the same calibre of mind as that possessed by the ordinary
+Circassian or Armenian bride cannot be in a much happier condition with
+a husband partly eunuchised by a constricted prepuce.
+
+
+
+
+CHAPTER XIX.
+
+IS THE PREPUCE A NATURAL PHYSIOLOGICAL APPENDAGE?
+
+
+By many surgeons the idea of circumcision, unless connected with an
+immediate demand for interference,--such as a phimosis unmanageable by
+any other means, an induced phimosis from gonorrhoea or other
+irritation, syphilis in its initiatory sore, cancer or some such
+cause,--is looked upon as an unwarrantable operation, a procedure not
+only barbarous, painful, and dangerous, but one that directly interferes
+with the intentions of nature. The prepuce is by many looked upon as a
+physiological necessity to health and the enjoyment of life, which, if
+removed, is liable to induce masturbation, excessive venereal desire,
+and a train of other evils. The question then resolves itself, What is
+the real physiological status of this appendage, if it has any, and, if
+it is a physiological appendage, when does it merge into a pathological
+appendage? As by some it is held that the prepuce enjoys the same right
+to live and exist as the nose, ear, or a limb, which are only subject to
+amputation in case of a serious disease, they should be reminded that
+they are not taking into consideration that the nose and ear are
+calculated to warn us of danger, and that our legs are very useful; as
+even the great orator Demosthenes, by the timely and rapid use of his
+legs, was enabled to escape from a battle, where his oratory was of no
+avail against the illiterate javelins of the unscholarly Macedonians. If
+the prepuce only was endowed with an olfactory sense,--as, for instance,
+if a nervous filament from the first pair of nerves had been sent down
+alongside of the pneumogastric and then, by following the track of the
+mammary and epigastric arteries, had at last reached the prepuce, where
+the olfactory sense could have been turned on at will, like an
+incandescent lamp,--it might have been a very useful organ, as in that
+sense it could have scented danger from afar, if not from near, and
+enabled man to avoid any of the many dangers into which he unconsciously
+drops. But, seeing that the prepuce, to say nothing of being neither
+nose, eye, nor ear to warn one away from danger, or a leg to run away on
+after once in it, having not even the precautionary sensitiveness of a
+cat's moustachios, it cannot, in any way that we can see, be compared to
+any other useful part of the body.
+
+All attempts to find reasons for its existence that are of real benefit
+to man have so far proved unsatisfactory, and, unlike the reasons for
+its removal, are, as a rule, founded on speculation. To further reason
+out the why and wherefore of its existence or of its summary surgical
+execution, we must consider its shifting positions as to the effects it
+produces, as well as to its conditions at different ages, sitting on its
+case like an impartial jury in the case of some unconvicted but
+diabolically-inclined criminal.
+
+As before remarked, we are, as a rule, born with this appendage, just as
+much as we are with the appendix vermiformis, which rises up, like
+Banquo's ghost, whenever we eat tomatoes or any small-seeded fruit. This
+prepuce is then long, and the penis is found at the end of an
+undilatable canal, which is formed by the constricted prepuce; at this
+early stage of our existence it is often additionally bound down to the
+glans by a greater or less number of adhesions. We are then in what many
+term a state of physiological phimosis, that being a perfectly natural
+condition, and one consistent with health; at least, we imagine it is
+normal.
+
+Phimosis in childhood is generally considered a physiological state,
+only to be taken as a pathological condition under certain
+circumstances. Preputial adhesions may, according to many observers,
+also be classed as physiological at an early period of life, as it is by
+them considered as congenital, and common enough to warrant its being
+classed as normal. As to the first, or phimosis, it undoubtedly is a
+physiological condition during infancy; but why, we do not know; and it
+is also a fact that from birth to puberty it remains so in fully over
+one-half of the cases. Out of 98 children, from one week to sixteen
+years of age, examined by Dr. Packard, the prepuce was entirely
+unretractable in 54, partly so in 3, and wholly so in 36; while in 1 it
+only half-covered the glans and in 4 the glans was wholly uncovered, 1
+of these 4 being an infant only five weeks old.
+
+Dr. Packard also gives the result of 172 examinations by himself, of
+from twelve to seventy-three years of age, and 106 examinations by Dr.
+Maury, a total of 278, in whom 100 had a long prepuce, 97 a
+partly-covered glans, and 81 (of whom 2 had been circumcised) in whom
+the glans was exposed.[83] As to adhesions, there is an unaccountable
+diversity of opinion as to their constancy as a natural condition, being
+frequent enough to class them as physiological occurrences. Dr. A. B.
+Arnold, of Baltimore, states that his experience in reference to
+preputial adhesions leads him to conclude that the frequency of its
+occurrence has been much overstated. In the number of children that he
+has circumcised, which exceeds 1000, he has met with it in less than
+four per cent. of the cases. He also mentions that in the adult the
+adhesions show greater firmness.[84]
+
+On the other hand, Dr. Bernheim, of the Paris Israelitish Consistory,
+observes that, of over 3000 newborn whom he has examined, with but few
+exceptions he found the presence of preputial adhesions. He remarks,
+however, that in the majority these are detached or broken by the first
+attempt at erection.[85]
+
+Bokai, out of 100 children, found 8 who were over seven years of age,
+who were perfectly free; while of the remaining 92 under that age 6 more
+showed no adhesions and 86 had various degrees of adhesions.[86]
+
+Dr. Holgate, of the out-door department of Bellevue, considered that all
+phimosic cases have adhesions; while Dr. Moses, of New York, out of some
+fifty circumcisions performed at the eighth day, found only adhesions
+three times.[87]
+
+These observations are, however, in perfect accord. If we connect the
+statement of Dr. Arnold, in regard to the increasing character of the
+firmness in the adhesions of the adult, with the statement of Dr.
+Bernheim, that the first erection is often sufficient to break up the
+existing adhesions in the infant, we must conclude that they are nothing
+more at first than a slight agglutination, which the slight manipulation
+required to properly locate the position of the glans, and to space out
+the prepuce preparatory to the operation of circumcision, must, in the
+majority of cases, be sufficient to liberate the prepuce from the glans;
+this is evident also from the statement of Dr. Moses, who only found six
+per cent. of the cases operated upon by him as being so affected.
+
+The writer has been present at a large number of Hebrew circumcisions
+performed on the eighth day, and from that up to the sixth month (as in
+many communities they wait until a number of children are collected, so
+to speak, before sending for the mohel, who may reside at quite a
+distance), and in all of those witnessed he has never seen any
+complications from adhesions; but cases of adhesion have been often
+encountered from the second to the eighth year, and it has always been
+the case, as a rule, that the older the child the greater the firmness
+of the adhesion. In these cases the practice generally advised of using
+a probe is not practicable, as the person is more apt to wound the sound
+prepuce than to tear the adhesions; the practice most effectual is to
+hold the glans firmly but gently with the thumb and forefinger of the
+right hand, and then to draw the prepuce as firmly back with its fold
+held in the forefinger and thumb of the other. It is a more expeditious
+mode, and the least painful; by this method extensive adhesions can
+readily be broken up; vaselin and a piece of fine lint should then be
+interposed for a couple of days to prevent a re-adherence.
+
+Another co-existing condition with phimosis, very often found, is a
+shortening of the frenum. Dr. Jansen, out of 3700 soldiers of the
+Belgian army, found 12.3 per cent. with this pathological condition and
+2.5 per cent. with a narrow prepuce.[88]
+
+Take the three conditions above enumerated,--phimosis, preputial
+adhesions, and short frenum,--all are but a departure from a normal, in
+a greater or less degree; and whether the resulting discomfort consists
+in mere mechanical impediment to urination, erection, or as a factor in
+nocturnal enuresis, dysuria, impotence, either through reflex action or
+interference with emission, malposition of the urethral orifice during
+copulation owing to any of these conditions, or in any of the nervous
+derangements that may accompany this condition, or in the more serious
+results, ending in positive deformity of body or limb, or in the
+warping of moral sentiments, or, even further, in inducing insanity, it
+cannot well be seen how the conditions that will certainly produce these
+results, in a more or less degree, can ever, in any logical sense, be
+considered a physiological condition.
+
+There are certain conditions to life, up to the time of birth, which,
+unless they then cease at once to exist, immediately become from a
+physiological into very serious pathological conditions. These are well
+understood, and have their reasons for existing during our pre-natal
+existence; but the prepuce has no known function during uterine life or
+subsequently; and there being no valid reason for its existence, there
+are certainly no logical grounds for its being considered a
+physiological condition, especially when the serious results attending
+the most accentuated form of the above three conditions are considered,
+and as its necessity, in cases of its entire absence, has not yet been
+demonstrated.
+
+It can well be said that about two-thirds of mankind are affected in a
+greater or less degree with these pathological conditions, causing them
+more or less annoyance. Of these, a certain percentage suffer a life of
+continued misery, as a direct or indirect result of these conditions.
+
+As to the actual necessity of a prepuce existing, or as to what
+annoyances or diseases persons are subjected to who are born without it,
+there is a most singular and expressive silence in medical literature.
+It stands to reason that, if it is a necessity, some one person should
+have found it out long ago, and there should then be some evidence to
+present in relation thereto. There are cases reported in some of the
+older surgeries wherein an attempt has been made, in the absence of a
+prepuce, to restore or manufacture one by means of a plastic operation.
+Vidal describes such an operation,[89] but there is no reason given as
+to why the operation was undertaken; there is no record of any diseased
+condition which it was intended either to cure or to alleviate; so that
+we are left to infer that the person simply submitted to the operation
+from purely cosmetic reasons. The Hebrews of Palestine, after the Roman
+conquest, or those in Italy or Spain, attempted a like operation, but
+not from any reason of lessened health or to restore any lacking
+physiological action, their aim having simply been to hide their
+identity, for the purpose of escaping persecutions, exactions, or
+annoyances, either from their rulers or their fellow-citizens.
+
+Dr. A. B. Arnold, in a paper on circumcision, read before the Academy of
+Medicine of Baltimore, argues that it is not difficult to divine the
+purposes of the prepuce, holding that it is necessary to protect the
+tactile sensibility of the glans, due to the presence of the Pacinian
+bodies which Schweigger Seidel discovered in the nerves, and that a
+better provision than the anatomy of the prepuce cannot be conceived for
+shielding the very vascular and sensitive structure of the glans from
+external sources of irritation and friction, that might rouse the
+sensibility of this organ, which, on physiological grounds, may cause
+early masturbation; further arguing that, the corona being undoubtedly
+the most excitable part of the glans, its denudation by circumcision
+leaves it more apt to be affected by chance titillations.[90] In this
+latter view of the case the preponderance of views is, however, in the
+opposite direction. J. Royes Bell states that, owing to the induration
+of the glans through the means of circumcision, masturbation and
+syphilis are less rife amongst the circumcised than amongst the
+uncircumcised.[91] M. Lallemand, whose experience in the treatment of
+seminal emissions is of the greatest value, looked upon circumcision as
+one of the means of curing those diseases, looking on the diminished
+irritability of the glans resulting from the operation as the curative
+element.[92] Dr. Cahen, in a "Dissertation sur la Circoncision," in
+1816, before the Faculty of Medicine of Paris, called the attention to
+the diminished sensibility of the glans induced by circumcision. Dr.
+Vanier, of Havre, looks upon the prepuce as the most frequent cause of
+onanism. "If the prepuce is lax, its mobility produces an irritation to
+the highly irritable and sensitive nervous system of the child by the
+titillation in its movements on the glans; if too tight and constricted,
+then it compresses the glans, and by its irritation it leads the child
+to seize the organ."[93] So that in either case he looks upon the
+prepuce, through the sensitiveness it retains and induces in the glans,
+as the principle cause of masturbation. M. Debreyne, the Trappist monk
+and physician of La Trappe, who has paid considerable attention to
+medicine as applied to morality, practically makes the same
+observations. In children who have not yet the suggestions of sexual
+desire imparted by the presence of the spermatic fluid, the presence of
+the prepuce seems to anticipate those promptings. Circumcised boys may,
+in individual cases, either through precept or example, physical or
+mental imperfection, be found to practice onanism, but in general the
+practice can be asserted as being very rare among the children of
+circumcised races, showing the less irritability of the organs in the
+class; neither in infancy are they as liable to priapism during sleep as
+those that are uncircumcised.
+
+Dr. Bernheim says that "the prepuce may be said in general to be an
+appendage to man, if not positively harmful in some cases, at least
+useless, requiring constant care, the neglect of which is liable to
+entail disease and suffering; the irritation it produces through the
+sebaceous secretion is a frequent cause of masturbation which nothing
+short of circumcision will remedy."
+
+Through middle life, unless the prepuce be the subject of some vicious
+conformation, little inconvenience may result from its presence, except
+it be from the dangers to infections already pointed out during this
+period of life; an ordinarily movable and retractable prepuce will not
+acquire the condition of phimosis, unless it be through disease or
+accident; but with our entrance into old age, or after having passed our
+vigorous prime, the torment of the days of our infancy and childhood
+come to harass us again. Persons given to corpulency, with a long
+prepuce, are apt to become affected with phimosis in their latter years,
+as such persons are more subject to loss of their sexual vigor and power
+of erection than lean and spare people; in these, the gradual diminution
+of the size of the erectile tissues of the organ and its retraction
+allows of the reconstriction of the preputial opening, which, in the
+end, will not allow the prepuce to be drawn back over the gland. These
+conditions are followed by the irritating affections incident to
+phimosis of our earlier life, with the modification that age has induced
+in making us subject to more serious and fatal ailments, both locally
+and generally.
+
+
+
+
+CHAPTER XX.
+
+THE PREPUCE, PHIMOSIS, AND CANCER.
+
+
+In the _British Medical Journal_ of January 7, 1882, there is an
+interesting article by Jonathan Hutchinson on the "Pre-cancerous Stage
+of Cancer." In this article he states that, whereas, twenty years
+previously, his suggestion had been to treat all suspicious sores as
+being due to syphilis until a clearer diagnosis could be made out, he
+"had more recently often explained and enforced the doctrine of a
+pre-cancerous stage of cancer. According to this doctrine, in most cases
+of cancer, either of penis, lips, tongue, or skin, there is a
+stage--often a long one--during which a condition of chronic
+inflammation only is present, and upon this the cancerous process
+becomes ingrafted. Phimosis and the consequent balanitis lead to cancer
+of the penis.... A general acceptance of the belief that cancer usually
+has a pre-cancerous stage, and that this stage is the one in which
+operations ought to be performed, would save many hundreds of lives
+every year.... Instead of looking on whilst the fire smouldered, and
+waiting till it blazed up, we should stamp it out on the first
+suspicion.... What is a man the worse if you have cut away a warty sore
+from his lip; and, when all is done, a zealous pathologist demonstrates
+to you that the ulcer is not cancerous, need your conscience be
+troubled? You have operated in a pre-cancerous stage, and you have
+probably effected a permanent cure of what would soon have become an
+incurable disease. I do not wish to offer any apology for carelessness,
+but I have not in this matter any fear for it."
+
+In view of the great frequency of the occurrence of cancer of the penis,
+and the facts pointed out by Roux, that, after the removal of the
+cancerous prepuce or a portion of the penis for cancer, in case of a
+recurrence the disease does not do so in the penis, but that it attacks
+the inguinal glands, showing conclusively that the prepuce is the
+inciting cause as well as the initial point of attack, the sentiments in
+the foregoing paragraph, taken from the words of Hutchinson, are worthy
+of our most careful consideration.
+
+M. Roux, Surgeon to the Charité, during the second decade of the present
+century, first called the attention of the French profession to the
+intimate relation or dependence that cancer of the penis bears to
+phimosis. In England he was preceded in this field of surgical
+investigation by William Hey, whom Roux met in London in 1814. Hey had
+then operated by amputation of the penis on twelve cases of cancer, nine
+of whom had had phimosis at the time of the development of the cancer.
+Wadd at this time also published a work on the subject, but, although he
+noticed that phimosis was a cause of cancer, he did not fully grasp the
+subject as Hey and Roux had done, as he believed a cancerous diathesis a
+primary necessity, and did not then recognize that the primary cause was
+fully to be found in the prepuce itself.
+
+Roux was probably the first to point out the peculiarly local character
+of penile cancer, as there is no locality wherein a timely operation is
+less apt to be followed by a recurrence. He records a number of cases
+where the prepuce alone was affected when first seen, but none wherein
+the glans was attacked and where the prepuce was exempt, giving ample
+evidence of the original starting-point of the disease.[94]
+
+Erichsen also remarks on the little liability to recurrence of cancer of
+the penis after a timely operation; he divides the cancer to which the
+penis is subject to as being of two distinct kinds,--scirrhus and
+epithelioma. The latter variety commences as a tubercle in the prepuce,
+and, according to Erichsen, does not occur in the body of the penis
+except as a secondary infiltration or deposit.[95] Travers states that
+Jews who are circumcised are not subject to either form of cancer.[96]
+
+Repeated attacks of herpes preputialis and some consequent point of
+induration are looked upon by Petit-Radel, Chauvin, and Bernard as
+frequent starting-points for the cancerous affection of the prepuce. The
+aged or persons of lax fibre being more subject to these inflammatory
+attacks, are also the most frequent victims of cancer in this situation.
+The celebrated Lallemand, in regard to the tendency to cancer induced by
+the presence of the prepuce, observes as follows:--
+
+"Besides simple balanitis ... there also result various indurations,
+which are proportionate in their degree to the length or time and
+intensity with which the inciting inflammatory conditions have existed.
+I have repeatedly found the mucous lining of the prepuce thickened,
+hardened, ulcerated, and nodulated; at other times converted into a
+fibrous or even into cartilaginous tissue of excessive thickness; in
+others, still, in which it had assumed a scirrhous and cancerous nature.
+I have repeatedly operated on such cases, wherein the prolongation of
+the prepuce was the only recognized primary cause, the subjects being
+often countrymen of from fifty to sixty years of age, who had never
+known any women except their own, but who had, nevertheless, been long
+sufferers from balanitic attacks, accompanied by abundant acrid
+discharges, swellings of the prepuce, with more or less consequent
+excoriations and narrowing of the preputial orifice."[97]
+
+Claparède sums up the inconveniences and dangers to which the possessor
+of a prepuce is liable to suffer from, as follows: "The retention of the
+sebaceous secretion is liable to alter its character, converting it into
+an acrid, irritating discharge, which induces more or less burning,
+smarting, itching, excoriations, and swelling, which, affecting the
+little glands situated about the corona and sulcus, induces them to
+secrete an altered and vicious secretion. In this manner a simple
+elongation of the prepuce will produce an inflammation of the surface of
+the glans (balanitis), or that of the prepuce itself (posthitis), or the
+two conjoined (balano-posthitis), complicated possibly with phimosis. By
+an extension to the mucous membrane of the urethra of the same condition
+of the inflammatory process, we have blennorrhagia; blennorrhagia is
+liable to be followed by inguinal swellings or tenderness, orchitis,
+stricture, and prostatic disease; the formation of preputial calculus,
+from retention of the urine in the prepuce; and cancer is apt to be the
+end of any of these conditions."[98]
+
+J. Royes Bell, in Ashhurst's "International Encyclopædia of Surgery,"
+observes as follows: "Carcinoma attacking the genital organs usually
+assumes the form of epithelioma; the other kinds are rarely met with.
+Epithelioma may invade the prepuce, or the whole penis, or any part of
+it. The most common age for it is fifty years or over. In the great
+majority of cases there has existed a congenital or acquired phimosis. A
+contusion or a urinary fistula may be the exciting cause. With a
+phimosis the parts are not kept clean, but the gland is macerated and
+rendered tender and excoriated by retained secretions, and the
+irritation causes an epithelioma to grow in those predisposed to the
+disease, as is found to be the case when the tongue is irritated by a
+broken tooth, or the scrotum by the presence of soot in its folds.
+Syphilis has no direct influence in inducing the disease, but a
+syphilitic chap or ulcer may be the starting-point of an epithelioma.
+Two kinds of epithelioma affect the penis,--the indurated and the
+vegetating, or cauliflower growth.... The nature of the disease, in
+either the prepuce or the glans, is masked by a phimosis.... The
+prognosis in these cases is much more hopeful than in epithelioma, in
+other situations.... Sir William Lawrence operated on a patient who was
+quite well years afterward, and Sir William Ferguson amputated the penis
+of a man of note in the political world, who lived many years after the
+operation, and died at an advanced age."
+
+Agnew, of Philadelphia, describes an epithelioma of the prepuce
+occurring in persons past middle life, beginning as a tubercle, crack,
+or wart, for which he advises an early circumcision; he admits, however,
+to not having sufficient data to determine whether Jews and circumcised
+persons are exempt from carcinoma of the penis; but as its usual
+starting-point he evidently admits to be in the prepuce, circumcision
+must certainly be a preventive to its appearance. Gross gives
+substantially the same opinion as Agnew in this regard. Dr. John S.
+Billings, in his article on the "Vital Statistics of the Jews," in the
+January _North American Review_, of 1891, on the subject of cancer,
+observes as follows:--
+
+"As regards cancer and malignant tumors, we find that the deaths from
+these causes among the Hebrews occur in about the same proportion to
+deaths from other diseases as they do in the average population. But as
+the ratio of deaths to population is less among the Jews, so the ratio
+of deaths from malignant diseases to population is also less. Among the
+living population the proportion found affected with cancer among the
+Jews was 6.48 per 1000, while of those reported sick by the United
+States census of 1880, for the general population, the proportion was
+10.01 per 1000."
+
+There are no convenient data as to the prevalence or percentage of cases
+of cancer among the Arabian or Mohammedan population of Asia and Africa,
+but the above comparison of 6.48 per 1000 among the Jews of the United
+States, against 10.01 per 1000 of the general population, shows that the
+circumcised race does, in the instance of cancer, certainly enjoy a
+certain amount of immunity, having in this regard not quite such an
+exemption as they enjoy from consumption, but still sufficient to assist
+in making them longer-lived and more able to enjoy life and die a less
+lingering and painful death.
+
+It is surprising that, in view of the fact that carcinoma of the penis,
+starting with such frequency in the prepuce, should have left any doubt
+but that with the absence of this appendage there would follow less
+liability to cancer. Cullerier informs us that he had several times
+amputated the penis for cancerous diseases, but that he is unable to
+tell us whether the persons were affected with phimosis, remarking that
+on the last case he had observed the indurated remains of the prepuce;
+he had, however, recognized the necessity of freely exposing the gland
+in cases where, from continued irritation and inflammation, there was
+danger of cancer formation.
+
+Nelaton describes two varieties of cancer that affect the penis,--that
+which attacks the integument and that which attacks the glans. The
+first of these varieties he observes as generally beginning as a
+hardened nodule in the prepuce, which becomes at once more or less
+thickened and indurated. He gives Lisfranc the credit of pointing out
+the fact, that, even in the most hopeless-looking case, the glans and
+body of the penis may be simply pushed back and compressed, but
+otherwise sound, and that before resorting to an amputation of the whole
+organ it is better to make a careful exploratory dissection in search of
+the penis, as it oftentimes happens that the prepuce and integument can
+be dissected off, leaving the organ intact. He also mentions that
+elephantiasis of the penile integument generally begins in the prepuce.
+
+Baron Boyer believed that the vitiated preputial secretion allowed to
+remain beneath the prepuce was one of the causes of cancer of the penis,
+observing that it would be interesting to know whether cancer of the
+penis was a rarity among circumcised people, such as the Jews and
+Mohammedans.[99]
+
+It is easy to perceive why or how Agnew, Gross, Cullerier, and many of
+those who have written on the subject, have failed to appreciate the
+existence of the prepuce as an exciting cause, or as being, in the
+majority of instances, the part primarily attacked. The nodule,
+excoriation, or abrasion that develops into a cancer generally produces
+more or less local disturbance; in many it produces a phimosis that is
+only relieved by the ulcerative process that exposes the gland, which
+may by that time itself be attacked or even destroyed. They are then
+seen by either the rural practitioner or the family physician, but
+before submitting to an operation they run the gauntlet of many
+physicians, and, when it comes to operating, they generally apply to
+some one of great skill and reputation. By this time there is little
+left of the organ, and, as a rule, the party is unable to tell where the
+disease originated, whether in the prepuce or glans, to them the swollen
+prepuce seeming to be the whole organ. Of late years, however, it has
+been pretty well established that it generally begins in the prepuce,
+and the great number of amputations of the penis on record for this
+disease does not lead one to believe that it is as rare a disease as was
+formerly believed. In Langenbeck's _Archiv_, Bd. xii, 1870, Dr.
+Zielewicz reports fifty cases of amputation of the penis by the
+galvano-cautery loop, mostly for carcinoma, one of the fifty being for
+gangrene and one other for a large papillary tumor. That one surgeon was
+able to report forty-eight cases of carcinoma or cancer that were
+treated by one special system of operating tells us plainly enough that
+the unfortunate possessor of a prepuce, no matter how normal or
+unobjectionable it may seem to be in the prime of man's existence, or
+however physiologically necessary it may be deemed, runs too many risks
+in holding on to his possessions.
+
+The views set forth by Hutchinson in the beginning of this chapter are
+precisely those that are held by the writer, who would even go further,
+by advising all such as have, in their youth or since, suffered with
+balano-posthitis in any degree or form, or whose prepuce shows a
+tendency to elongation with age, to have the same removed at once; where
+the prepuce is not redundant, but only tight, a slight operation, such
+as slitting, will at once remove the possibility of any future danger,
+without keeping a man from his business a single day.
+
+It may here be remarked that, although always favorably impressed with
+the great benefits arising out of circumcision, nothing ever resulted in
+such a serious consideration of the subject as seeing a professional
+brother dying with a cancerous affection of the penis. The disease had
+originated in the mucous lining of the prepuce, and when seen in
+consultation with his attending physicians the gland had already
+disappeared and the inguinal glands were affected. The man was in the
+prime of life, and, aside from the local trouble, a specimen of perfect
+health and physique. He informed us that while a youth he had suffered
+from repeated attacks of herpes preputialis; that he had suggested
+circumcision more than once to his father, who also was a physician, but
+who, unfortunately for the son, could not see any merit in circumcision.
+To his eyes there was nothing that circumcision could do but what could
+be accomplished by washing and personal attention to cleanliness. When
+older, the prepuce gave him less trouble, and for a long time after his
+marriage it ceased to trouble him altogether. The idea of the necessity
+of circumcision did not occur to him again until the appearance of the
+cancerous disease; even then, not appreciating the danger, and looking
+upon the trouble as a simple transient result of some inflammatory
+action, he waited until the parts would be in a better state or
+condition of health before resorting to an operation,--that time never
+came.
+
+Although to Roux, Wadd, and Hey the credit must be given for bringing
+the subject of cancer of this organ so prominently before the
+profession, the knowledge of the existence of the disease has long been
+a matter of record. Patissier, in the fortieth volume of the "Dict. des
+Sciences Médicales," quotes from the third volume of the "Mémoires de
+l'Académie Royale de Chirurgie," that in 1724 an officer, aged fifty,
+was attacked by a cancerous affection originating underneath the
+prepuce; at the time he consulted MM. Chicoineau and Sonlier the
+disease had existed for two years, the inguinal glands were implicated,
+and even the suspensory ligament was affected. These surgeons,
+nevertheless, determined upon an operation, and, after a long chapter of
+hæmorrhagic accidents, the patient finally made a recovery. Another
+case, quoted by Patissier, was operated upon by M. Ceyrac de la Coste,
+the patient a man of sixty, the disease originating, like the preceding
+case, underneath the prepuce.
+
+Warren, in his "Surgical Observations on Tumors," observes that cancer
+of the penis begins by a warty excrescence on the glans or prepuce.
+Walshe, in his work on the "Nature and Treatment of Cancer," says: "The
+disease may commence in almost all parts of the organ, but the glans and
+prepuce are by far its most common primary seats. It may originate
+either from a warty excrescence or a pimple, or it may infiltrate the
+glans, or appear as a complication of venereal ulceration. Phimosis,
+either congenital or acquired, is an exceedingly common accompaniment,
+and it appears probable that the irritation occasioned by this condition
+of the parts may act as an exciting cause of the disease in persons
+predisposed to cancer. Circumcision is, therefore, an advisable
+prophylactic measure, where the constitutional taint is known to
+exist."
+
+
+
+
+CHAPTER XXI.
+
+THE PREPUCE AND GANGRENE OF THE PENIS.
+
+
+Another accompaniment of that preputial appendage is gangrene of the
+penis, which, like carcinoma, starting in at the prepuce, may invade the
+pubes and scrotum. This disease is not so rare as to merit the little
+attention it has received from our text-books. M. Demarquay has
+collected the history of twenty-five cases; from him we learn that the
+prepuce is the most frequent seat of the start of the affection, from
+whence, according to Astruc, it rapidly spreads to the skin of the whole
+organ, and then attacks the corpora cavernosa; it may even extend as
+high as the umbilicus. This disease spares no age; it attacks young and
+old alike.
+
+There is not a case recorded of this disease that particularized any
+other starting-point than the swelling, tension, active or passive
+congestion that takes place in the integument of the penis. By this it
+must not be understood that the initial disease or inflammatory action
+that produces the gangrene must necessarily have its seat in the
+integument, but that it is the integument of the penis (and especially
+that of the prepuce) in which, through the laxity of its tissues,
+passive congestion is favored that the gangrenous action begins. That
+this is the actual case there can be but little doubt about, as, even
+where the gangrene invades the body of the penis itself, even where the
+inflammatory action may have started from a violent urethritis, that
+condition of blood which favors gangrenous results will be found to
+have begun during its state of stasis, where it has parted with much of
+its watery element, as well as considerable of its vitality, while in
+its slow, tedious, and obstructed passage through the prepuce. Some of
+this dark, thickish blood, finding its way from the integumentary return
+circulation to that of the deeper structure, becomes there a mechanical
+as well as a pathological cause for that impediment to the free
+circulation of the parts, through its altered physiological condition.
+The deeper structures of the penis, besides their own blood-supply,
+carry back into the deeper or systemic circulation a large supply from
+the integumentary tissues, when in the latter, owing to the greater
+supply due to any inflammatory action, the blood-current is delayed and
+impeded in its lax and easily-dilatable tissues, and blood-changes occur
+favoring the gangrene in the deeper tissues, so that, whether the
+gangrene first takes place in the body of the penis or in the scrotum,
+it will be in the prepuce or adjoining integument that its real
+originating causes will be found.
+
+Baron Boyer, in speaking of the inflammation of the penis, observes that
+the intensity of the swelling, great pain, and difficulty of urination
+that follow have led many to believe that the inflammation of the deeper
+structures really always formed a part of the disease. In otherwise
+healthy and vigorous subjects it does not, however, extend beyond the
+skin, as has been demonstrated where the resulting gangrene from excess
+of inflammatory action has ended in resolution, the deeper tissues not
+having been found to be injured. It is only where the tone of the
+general system is lowered, through disease, age, or other deteriorating
+conditions, that the whole organ is liable to become affected or to
+break down.
+
+Boyer, in the tenth volume of his "Treatise on Surgical Affections,"
+gives several examples of this affection not due to age: one case was a
+person, simultaneously attacked by an adynamic fever and a
+blennorrhagia, who suffered from gangrene of the penis; the local and
+constitutional disturbance was not high, however, and the patient
+escaped with the simple loss of the prepuce.
+
+Another case admitted to the Charité, aged thirty-six, was afflicted
+with a blennorrhagia, upon which an attack of low fever supervened. The
+penis inflamed, became engorged and livid, and soon gangrenous symptoms
+presented themselves, making rapid progress; at first the integument
+alone was affected, but later all the structures became implicated and
+the penis was completely destroyed, the sloughs detaching themselves in
+shreds, leaving a conical stump that healed but slowly.
+
+One case, a young man of twenty, also at the Charité, was admitted with
+adynamic fever; a few days after admission the prepuce was observed to
+be somewhat inflamed; in spite of all treatment this progressed so
+rapidly that the purple discoloration presaged a gangrene, which was not
+slow in following; the focus seemed to be at the superior and back
+portion of the prepuce; an incision evacuated a quantity of purulent,
+serous fluid; the disease, however, extended up the organ as far as its
+middle before its actions ceased; the sloughs were then cast off, when
+it was found that part of the gland and a portion of the cavernous body
+had followed the integument in the general wreck, subjecting the patient
+to intolerable pain during micturition. After the recovery from the
+fever, the remaining portion of the gland and the mutilated parts of the
+cavernous body were amputated to remedy this condition; the patient
+subsequently admitted to have had a blennorrhagia at the time of his
+admission to the hospital.
+
+The gangrenous action may, in proportion to the low condition of the
+patient, be as proportionately rapid. Another case from Boyer, quoted
+from the works of Forestus, relates how the whole organ underwent such
+speedy disorganization that its liquefied remains were found in a
+poultice, which had been applied with a view of relieving the
+congestion,--a very dear price to pay for retaining the prepuce, that
+the exquisite sensitiveness of the tactile faculty for enjoyment,
+resident in the corona of the gland, might not be interfered with.
+
+Gross does not mention this affection in his work on surgery, but Agnew
+devotes considerable space to its description, dividing the disease into
+two forms: the inflammatory, such as may follow venereal primary sores
+or operations on the penis, not excepting circumcision; and the
+obstructive variety, such as may follow embolism or any mechanical
+obstruction, either purposely or accidentally applied. Of the latter he
+gives a number of quoted instances; he only admits seeing one case, that
+of an aged man in the Pennsylvania Hospital, in whom the disease was
+caused by embolism of the dorsal artery.
+
+J. Royes Bell, in the "International Encyclopædia of Surgery," pays more
+attention to it than any of our American authors; mentioning, among the
+causes which may give rise to it, the exanthemata, especially small-pox,
+and the poisoning by ergot of rye and erysipelas. Among the local causes
+lie mentions phimosis, paraphimosis, and balano-posthitis.
+
+Bell quotes the case reported by Mr. Partridge, in the sixteenth volume
+of the "Transactions of the Pathological Society of London," wherein a
+sober man, aged forty, lost the whole of his penis up to the root,
+during the course of a typhus fever. Also the case reported by Mr. Gay,
+in the thirtieth volume of the same "Transactions," wherein a
+cabinet-maker, aged thirty-one, lost his penis through the probable
+results of rheumatic phlebitis, and due to the presence of a plug in the
+internal iliac vein. In the twelfth volume of the "Transactions" of the
+same society he finds the record of the case of a soldier who lost his
+penis through gangrene induced by syphilitic phagedena.
+
+In the consideration of the subject of the prepuce as connected with
+penile gangrene, it must not be overlooked that the presence of a
+prepuce may be the inciting cause of some rheumatic affection (the
+writer has repeatedly seen such), just as such cases are often the
+result of stricture; as cases of rheumatism that have resisted all
+remedial means, but that have readily given way to the dilatation of a
+stricture, are by no means uncommon; not a mere muscular reflex
+rheumatic pain, but even when accompanied by a rheumatic blood
+condition. So that even in such a case as above reported as being due to
+rheumatic phlebitis, or the case reported in the fortieth volume of the
+"Dictionaire des Sciences Médicales" by Patissier, wherein a man lost
+penis and scrotum through gangrene, induced by urinous infiltration, may
+all in the origin be due, if not to the immediate, to the remote effects
+of the presence of the prepuce.
+
+In the first volume of the _Journal of Venereal and Cutaneous Diseases_
+the writer reported a case of the complete loss of penis in a young man
+as a result of phagedena due to syphilis. The man had had a long and
+pendulous prepuce; in his case, had circumcision been performed in early
+childhood, it would have lessened the chances of primary infection, and
+had it been performed after his infection, it would have removed one
+cause--if not the principal cause--of the ease with which the phagedenic
+action was inaugurated. The case already mentioned as an example of
+spontaneous and natural circumcision belongs to the gangrenous results
+following phimosis, ending with the loss of the prepuce. In Maclise's
+"Surgical Anatomy" several specimens of deformity are figured, showing
+the results of this mildest of the effects of a phagedenic action. The
+beginning of the interference in the return preputial circulation
+undoubtedly always takes place over the superior aspect of the corona,
+where the pressure of the glans is most sharply defined against the
+inner fold of the prepuce.
+
+There are milder conditions, wherein the circulation of the prepuce is
+materially interfered with, both through the lax tissues of the parts
+and the peculiar anatomical construction and shape of the neighboring
+parts, wherein, without going as far as gangrenous breakdown, the person
+suffers considerably nevertheless, and is placed in danger of losing his
+penis; for, as observed by Patissier, whenever a person affected with a
+gonorrhoea is attacked by a putrid or any low-grade fever, he runs the
+greatest danger of losing his virile member through gangrene.
+
+Even where phimosis does not exist, but only the long, lax, and
+retractable prepuce, that is considered a perfectly physiological
+condition, the prepuce is liable to cause very distressing and
+complicating annoyances during the progress of other diseases. The
+writer has noticed that cases with a thick, leathery, and redundant
+prepuce, even when perfectly retractable, are more liable to require the
+use of the catheter during the course of a continued fever. Such a
+condition is also a very frequent accompaniment of prostatic
+obstruction. So often has this been noticed that its association with
+prostatic trouble or disease tends to the belief that the irritation
+produced by this condition of prepuce often lays the foundation for
+prostatic disease in not a few cases.[100] In elderly people, with the
+atrophied penis and elongating prepuce, the constant moisture from the
+urine on the inner fold and glans adds greatly to the irritation as well
+as to the discomfort of the patient.
+
+A number of affections are accompanied by oedema, especially toward the
+latter stages of the disease; such, for instance, as the ending of cases
+of mitral insufficiency. In these, the distension of the prepuce and the
+resulting balano-posthitis is at times a source of great distress, and
+at times the resulting engorgement produces a retention of urine. It was
+after an attendance on one such case that required daily and frequent
+puncturings for its relief, but which, in spite of all care, finally
+became gangrenous, that a fellow practitioner cheerfully submitted to
+circumcision, to avoid the possibility of any such complication
+occurring to embitter his closing illness.[101]
+
+The prepuce is the starting-point of many of the cases of penitis and
+retention of urine that often accompany attacks of gonorroea; especially
+can this result be anticipated where the prepuce is long, pendulous, and
+with its veins in a varicose condition. Why it should be so is
+self-evident. Anything that will add to the interference of the return
+circulation only exaggerates the tendency to penis engorgement; this
+increases the difficulty of urination, which, by the retention that
+results, in turn increases the constriction at the root of the penis,
+and adds to the already difficult return circulation. The bladder by its
+urine, and the penis by its blood, actually form, by their mutual
+pressures, an impassable dam at the root of the organ. That this is the
+true condition has been more than once verified from the instant relief
+given to the whole condition by the prompt employment of the supra-pubic
+puncture or aspiration, as catheterization in such cases is altogether
+out of the question, and should never be attempted or employed unless a
+soft catheter can be inserted.
+
+A person laboring under a continued fever has his blood in a condition
+to favor sphacelus; with the slow-moving current of vitiated blood and
+its retention in such lax tissues as those of the prepuce, through the
+medium of the enlarged preputial veins, coupled with the lessened
+sensibilities of the bladder and his perhaps semi-conscious or
+unconscious condition, and an equally unconscious bladder, he is, to say
+the least of it,--if in possession of a prepuce,--also the unconscious
+possessor of a certain degree of percentage, no matter how small or
+fractional that may be, of recovering from his fever without his penis.
+Dr. W. W. McKay, of the U. S. Marine Hospital Service of San Diego,
+attended a case of typho-malarial fever in consultation with me, where,
+but for the persistent, intelligent, but delicate use of the catheter
+for nearly three weeks the penis would have become gangrenous. The
+subject was an uræmic, irritable, nervous, leathery-prepuced individual;
+the organ was unusually large, the skin of the penis thick, and it was
+only by keeping the bladder empty that prevented a state of engorgement
+that would have effectually interfered with further catheterization. As
+it was, the penis was often dank, livid, and discolored from the passive
+engorgement.
+
+The writer saw a similar case with the late Dr. F. H. Milligan, of
+Minnesota. The congestion in this case was due to a gonorrhoeal
+inflammation involving the skin of the whole penis, retention having
+followed painful micturition, and the swelling of the penis following
+the retention; the prepuce was enormously distended, and the penis
+seemed in a state of erection as far as dimension and rigidity were
+concerned. The man, a steam-boat cook, informed us that it was fully
+twice as large as when rigidly erect in health. All efforts to reduce
+the swelling were unavailing; neither punctures, leeches, nor
+scarifications were of any avail; catheterization was impossible, but,
+after relieving the bladder by the supra-pubic aspiration, the patient
+experienced some relief. He, nevertheless, lost the whole skin of the
+penis, with that of the pubis and on the front of the scrotum. The man
+ran into a low form of fever, with uræmic symptoms; the stench was so
+great that it was almost impossible to remain in the same room with him;
+but he finally made a slow and very tedious recovery. In healing there
+was considerable downward curvature of the penis, which, however, did
+not prevent him from following his old, dissolute course of life.[102]
+
+A calm, unprejudiced consideration of the subject of the liability of
+the uncircumcised races dwelling in the temperate and semi-tropical
+countries to cancer, gangrene, and elephantiasis might well lead one to
+ask: Why are we afflicted with a prepuce? We can understand how a man
+may become gouty, and become a subject in the end for a gangrene of the
+extremities; or how senile gangrene may, through a series of
+pathological processes and blood changes, with the aid of age, finally
+be reached; or how, by a like course of diseased processes, we reach the
+apoplectic stage. These conditions, however, can be put off, or partly,
+if not wholly avoided, by a proper course of life, and, at the worst,
+it is only after the fires of our youth and prime have completely burned
+out, that these conditions are liable to claim us as their lawful
+victim. Not so, however, with some of these conditions that may end in
+penile gangrene; that are liable to pounce upon us unawares, like an
+Apache in an Arizona cañon; or as the hired mercenaries of old Canon
+Fulbert did upon poor Abelard in his study, and, without further ado or
+ceremony emasculate man as effectually as the most exacting Turk could
+demand, with a veritable _taillè à fleur de ventre_ operation.
+
+Nature has her own ways of protecting what there is of any utility;
+there is a law of the survival of the fittest that we all appreciate.
+If, then, this penile appendage is of any utility, why is it that,
+unlike the rest of the body, it falls such an easy victim to gangrene?
+The procreative function seems to be, in a sense, one of the main cares
+of nature in its relation to the animal as well as the vegetable
+kingdom; but here is a useless bit of skin, adipose tissue, mucous
+membrane, and some connective tissue, that on the least provocation is
+liable to go off into a gangrene and drag one of the main generative, or
+even all the procreative, apparatus into the general wreck. Nature
+certainly never intended anything of the kind. To be generous, and not
+libel nature, we must conclude that the prepuce is a near relative to
+the fast-disappearing climbing-muscle; very useful in our primitive,
+arboreal days, when we needed such a muscle to reach our perch for the
+night, and a prepuce or something of the kind, in default of a
+breech-cloth, to protect the glans penis from being scratched by the
+briars or thorny and rough bark of the trees in our ascent. The prepuce
+was well enough in our primitive and arboreal days,--ages and ages ahead
+of our cave and lake dwellings,--when the notch in a tree and its rough
+bark formed our couch; but in these days of plush-cushioned pews and
+opera-seats, cosy office-chairs, car-seats, and upholstered furniture or
+polished-oak seats, it serves no intelligent purpose.
+
+Emasculation has never been looked upon with favor by its victim, and it
+would be but natural to suppose that man would take every precaution
+against the accidental occurrence of such an undesired condition. The
+writer well remembers that, in his "Tom Sawyer" days on the banks of the
+upper Mississippi, in the happy days of the crack rafting crews, before
+the introduction of the towage steamer, when the river towns were more
+or less terrorized by wild gangs of these men, some of whom were always
+fighting and quarreling and drinking when not at work. In the lot there
+was one man with a great reputation at a rough-and-tumble fight. His
+main hold was that he generally tried to emasculate his adversary by
+destroying the physiological condition of the testicle. The man was not
+a large or powerful man, nor was he a great boxer or wrestler, but this
+reputation made him feared by all the bullies on the river. The report
+that not a few who had tackled him had subsequently been of no value,
+either as fornicators or fecundators, or had to be castrated on account
+of the resulting testicular degeneration, seemed in no way to encourage
+any one to wish to meet him in a personal encounter. It would seem as if
+the desire to avoid such an accident--provided persons knew the dangers
+that lurk in a prepuce--would induce many to submit to circumcision.
+That many more do not do so can only be attributed to the general human
+wish to escape a less present evil for a greater unknown one, being
+evidently deterred by the prospective pain that must be suffered
+immediately.
+
+There is a question that should interest man above that of the simple
+loss of penis. It appears that there is a powerful moral effect that
+follows this loss, as might, in the majority, be anticipated. According
+to the experience of Civiale, many who have lost the penis, through
+amputation for disease or through disease itself, end in suicide. He
+mentions particularly a patient at the Charité who had lost his penis,
+who, finding no other means to take himself off, saved up sufficient
+opium, from that given him to calm his pains, to take all at one dose
+and commit suicide. In the London _Lancet_ for March 27, 1886, there is
+reported a discussion on this subject, to which the reader is referred,
+as it fully covers the moral and physical effects of castration and
+penis amputation for disease. M. Roux, who amputated the penis of a
+brother of Buffon, in 1810, reported that, in that case, M. Buffon lost
+none of his customary gayety.
+
+
+
+
+CHAPTER XXII.
+
+THE PREPUCE, CALCULI, AND OTHER ANNOYANCES.
+
+
+From an article published in the New York _Medical Times_ of March,
+1872, from the pen of Dr. J. G. Kerr, of Canton, China, we learn that
+phimosis is not an uncommon occurrence among the Chinese. As has been
+demonstrated by C. H. Mastin, of Mobile, climate is a great factor of
+calculus. ("Transactions International Medical Congress" of 1876, page
+609.) That of China seems a most favorable climate in this regard; so
+that, between the prevalence of phimosis among the Chinese and the
+calculus-producing tendency of the climate, China may be said to be the
+classic land of preputial calculi, as England is that of the gout, or
+the United States that of delirium tremens. From Dr. Kerr we learn that
+the occurrence of these concretions were, as a rule, multiple, and that
+in two cases that fell under his observation the number of stones from
+each individual exceeded one hundred. In one case there were forty, and
+in three cases there were between twenty and thirty. These were of
+different sizes and weight, some being an inch and five-eighths in
+diameter, and from that size down to where one hundred and sixteen taken
+from one individual case only weighed one ounce. The tendency to
+calculous disease in that climate may well be imagined, when the same
+observer relates a case of urinary infiltration into the skin on the
+under side of the penis that gave rise to the formation of a collection
+of calculi in that locality, four of which were the size of pigeons'
+eggs; and another case in which a urinary fistula induced the formation
+of a calculus in the groin, near the scrotum, the calculus weighing two
+and a half drachms and measuring one and a half inches by three-quarters
+of an inch in diameter.
+
+Claparède mentions a case in the practice of M. Dumèril, in which the
+stone extracted from the prepuce weighed two hundred and twenty-five
+grammes, or about eight ounces. Civiale speaks of a young man of twenty
+with phimosis, who, after practicing sexual connection for the first
+time, experienced pain and a purulent discharge, from whom, on
+examination, he removed five stones as large as prunes. The patient had
+felt them in their position, but had imagined the condition to be a
+natural one.
+
+E. L. Keyes gives their composition as being of calcified smegma, urate
+of ammonium, triple and earthy phosphates and mucus, and as symptoms and
+results: pain, purulent discharges, interference with urination and the
+sexual act, involuntary emission, ulceration of the preputial cavity,
+and impotence.
+
+Enoch mentions a child of two years in the Charité, who, being operated
+upon for phimosis, was found to have a preputial calculus occluding the
+urethral meatus. At the autopsy a calculus as large as an egg was found
+in the bladder.
+
+The presence of these formations, although not necessarily dangerous in
+themselves, may, by their effects and in the irritation they induce, be
+the means of producing serious mischief. The only preventive or remedy
+for this condition is circumcision.
+
+Acquired phimosis has been mentioned as a result of inflammatory lotion,
+such as is connected with balano-posthitis; it sometimes happens that,
+the act of coitus being done forcibly, especially with public women, who
+are apt to use very astringent and constricting washes, the prepuce
+becomes injured, with the result of producing a phimosis. One man will
+produce the same results through the means of some vaunted wash or dip
+which is supposed to act as a prophylactic to any venereal infection.
+One patient had developed a chronic herpetic affection by the constant
+use of an iodized ointment which he regarded as an infallible
+prophylactic. Many cases of phimosis result from the attending
+inflammation that follows on the liberal domestic application of nitrate
+of silver to an abrasion after connection, in the mistaken idea that the
+party labors under, that he is destroying some venereal virus.
+
+By the irritation that all these applications and accidents induce,
+warts and vegetations are the but too frequent results. These I have
+never seen in a circumcised individual, and their occurrence and
+frequency, as well as persistency, are directly proportionate with the
+degree of tightness, thickness, or redundancy of the prepuce and the
+irritability of the gland. As remarked by Lallemand, in reference to the
+victim of nocturnal enuresis becoming a future victim of nocturnal
+emissions, so it may be said of the person subject in early life to
+either warts, excoriations or vegetations on the penis, that it is this
+class that furnishes in after life the subjects for cancerous disease as
+well as furnishing the easiest victims for venereal infection. These
+warts, although easily removed, have a tendency to recurrence,
+especially as long as the moist bed that has once grown them there is
+still vegetating.
+
+The prepuce is liable to indurations and hypertrophy. Of the first
+anomaly, the London _Lancet_ of 1846 has a record of two cases in which
+paraphimosis was induced in elderly subjects, and of one in which it
+induced phimosis. Since then a number of cases of thickening and
+induration have been reported. Hypertrophy may take place in any degree,
+varying from the mere leathery and overpendulous but unobstructive
+prepuce to the case recorded by Vidal, in the fifth volume of his
+"Pathologie Externe et Médecine Operatoire," which happened in the
+practice of M. Rigal, de Gaillae. The hypertrophied prepuce was
+something enormous, and hung down to below the patient's knees; it was
+pear-shaped, with the base hanging downward; this base was as large as a
+man's head. This prepuce was successfully removed by M. Rigal, who
+presented the specimen before the Paris Surgical Society, who were then
+discussing a somewhat similar but not so extensive a case, presented by
+M. Lenoire. Vidal mentions having operated on a number of cases of this
+deformity of the prepuce in various degrees of growth.
+
+As a rule, simple hypertrophic disease of the penile integument does not
+interfere with the sexual functions of the male organ after its removal;
+it being susceptible of complete removal in exaggerated cases, even
+without touching the body of the organ. There are exceptions to this
+rule, however, when even this otherwise non-malignant disease may entail
+the loss of all the genitals. In the London _Lancet_ of July 11, 1846,
+at page 46, there is a record of a remarkable case of this nature
+reported by F. H. Brett, Esq., F.R.C.S. The case was that of a locksmith
+of forty years of age, who was naturally much phimosed. The penis was
+enormously enlarged, as well as the scrotum, which was more or less
+ulcerated and full of sinuses filled with a serous pus; some six months
+prior to the final operation, a part of the prepuce was removed to
+facilitate urination, but the whole mass had to be subsequently removed,
+including the whole of the skin of the penis and the scrotum, the
+testicles having been carefully dissected out and recovered with some
+skin flap.
+
+In this case the disease was believed to have originated from a perineal
+fistula. The pathological investigation in the case, however, by Mr.
+Quekett, who submitted the mass to a microscopical examination,
+confirmed Mr. Brett in his original opinion that the disease had the
+same pathological conditions as the similar disease found in India,
+where it originates from local inflammatory causes. In this case the
+preputial irritation was, in all probability, the precursor of the
+conditions that led to the perineal fistula, the patient having had a
+stricture for some twelve years. Mr. Brett states that the man had been
+abandoned by his wife on account of his previous sexual disability, and
+on account, as well, of his having been incapacitated from following any
+vocation. After the operation all his functions were restored and his
+organs were sound.
+
+Nelaton records a case reported by Wadd, in 1817, of an African negro so
+affected, whose penis measured fourteen inches in length and twelve and
+a half inches in circumference; also the case reported by Gibert, of
+Hospital St. Louis, of a subject "with a penis the size of a mule's."
+
+Mr. Brett attributes the recovery of his case as being due in a great
+measure to the moral support given to the patient from the knowledge
+that his procreative organs were not interfered with, and on the same
+grounds he attributes the great fatality previously attending the
+operation to the fact that it previously had been the custom in many
+cases to make a clean general _taillè à fleur de ventre_, sacrificing
+all the genital organs. In simple hypertrophy, he considers that the
+body of the penis and the testicles will always be found to be in a
+normal condition; a careful dissection of the parts will invariably save
+not only the man's sexual functions, but his moral stamina, which he
+sadly needs in such an emergency. In the discussion on this subject
+heretofore mentioned as taking place in the London Medical Society, Mr.
+Pye, Mr. John A. Morgan, and others insisted on the necessity of
+retaining the testicles, whenever possible, in all these sweeping
+operations upon the genitals, they being actually necessary for the
+moral and physical support of man, Mr. Morgan observing that their
+removal would depress parts controlled by the sympathetic system.
+
+
+
+
+CHAPTER XXIII.
+
+REFLEX NEUROSES AND THE PREPUCE.
+
+
+We have seen in the previous chapters what the immediate effects of the
+prepuce may lead to; we have followed its local effects in childhood to
+youth, thence into what it does in our prime, and we have seen how, when
+we are on the down grade, owing to the increase of years, then, like the
+minute-men of Concord, wakened up by Paul Revere's classic ride, hanging
+on to the rear of the retreating and disheartened British, it harasses,
+worries, and downs a man here and there, striking down the man as if it
+had some undying, irremediable spite, which nothing but his misery and
+death could alleviate. Some authorities will argue that all that is
+required is cleanliness; that all men need do is to be like a true
+American, with the old Continental watchword of "eternal vigilance is
+the price of liberty" in continued active practice. A bowlful of some
+antiseptic wash and a small sponge should always be at hand, and he
+should be as industrious as if haltered in a tread-mill; he should make
+this a part of his toilet, and his daily and hourly care. This will, we
+are told, lessen his chances of becoming a victim to the many ills that
+lie in wait for him, all on account of the glory, honor, and comfort of
+wearing a prepuce, which is a perfectly physiological appendage.
+
+From these visible and apparently easily understood conditions and
+results we are now to enter a broad field, wherein the prepuce seems to
+exercise a malign influence in the most distant and apparently
+unconnected manner; where, like some of the evil genii or sprites in
+the Arabian tales, it can reach from afar the object of its malignity,
+striking him down unawares in the most unaccountable manner; making him
+a victim to all manner of ills, sufferings, and tribulations; unfitting
+him for marriage or the cares of business; making him miserable and an
+object of continual scolding and punishment in childhood, through its
+worriments and nocturnal enuresis; later on, beginning to affect him
+with all kinds of physical distortions and ailments, nocturnal
+pollutions, and other conditions calculated to weaken him physically,
+mentally, and morally; to land him, perchance, in the jail, or even in a
+lunatic asylum. Man's whole life is subject to the capricious
+dispensations and whims of this Job's-comforts-dispensing enemy of man.
+
+As strange as it may seem, this field of knowledge, this field of misery
+and suffering, disease and distortion, of physical and mental obliquity,
+presided over by this preputial Afrit of malignant disposition, was an
+unknown, undiscovered, and therefore unexplored region for some
+thousands of years, and it remained for an American to discover and
+describe this vast territorial acquisition, and to annex it to the
+domain of medicine, which, through its skill, could modify the influence
+of the evil genius that there presided and spare humanity much of the
+ills to which it had been subjected.
+
+In this regard, Louis A. Sayre was to medicine what Columbus was to
+geography. Neither Strabo nor Herodotus had anything to say regarding
+what existed beyond the pillars of Hercules, and neither Hippocrates nor
+Galen had anything in regard to this preputial Merlin, which in their
+day, even, had its existence. Neither did Tissot nor Bienville, the two
+pioneers in the field of our knowledge regarding onanism and
+nymphomania, dream of the existence of this one cause of the diseases
+to which they gave so much time and study. It is only some twenty years
+since Louis A. Sayre read his paper, entitled "Partial Paralysis from
+Reflex Irritation Caused by Congenital Phimosis and Adherent Prepuce,"
+before the American Medical Association. This was the starting-point
+from whence the profession entered into what had previously been a
+veritable "Darkest Africa."
+
+When we read that only some fifty years before the times of Columbus
+Christian Europe had no lunatic asylum,--not that there was a lack of
+lunatics or that the existence of lunacy was entirely ignored, but that
+the then state of medicine and the general intelligence was not
+emancipated from the idea of demoniacs,--and we are told that the
+lunatics were in many instances hung, quartered and burned, hooted and
+chased about the streets, or chained in gloomy dungeons; until, as
+related by Lecky, a Spanish monk named Juan Gilaberto Joffe, filled with
+compassion at the sight of the maniacs who were hooted by crowds through
+the streets of Valencia, founded an asylum in that city. His movement in
+this direction called the attention of the Church and people to this
+class in a practical light, and from Spain a more enlightened idea in
+regard to this class swept onward throughout Europe. As observed, it
+seems strange to us of the present day that such ignorance in these
+matters should, or could, have so long existed. It seems impossible for
+us to conceive how these conditions of incoherent action and of mental
+derangements could have existed and their causes have not been fully
+appreciated; and yet we were not above, some twenty years ago only,
+subjecting children to punishment and scoldings for being addicted to
+nocturnal enuresis, or of accusing cases of nocturnal and involuntary
+emissions as being due to masturbation. The child was allowed then to
+grow up paralytic, or with a deformed limb, or continually punished to
+correct what was imagined to be a condition of willful carelessness,
+irritability, or willful moral perversion. Perversion, stupidity, and
+irritability of the mind or temper were not known to depend, in many
+instances, on preputial irritation; children were, accordingly, worried
+and punished for something over which they had no earthly control or the
+least volition. Humanity cannot, at present, sufficiently appreciate
+what Louis A. Sayre has done in its behalf. It is here that we realize
+the hidden wisdom of the Mosaic law and the truth of the assertion of
+the late Dr. Edward Clarke, that, "The instructors, the houses and
+schools of our country's daughters, would profit by reading the old
+Levitical law. The race has not yet outgrown the physiology of Moses."
+
+These irritations from the preputial irritability are not always so slow
+moving as to span over either months or years in their fell work.
+Instances of their sudden action have been sufficiently recorded as to
+warrant them as being classed as causative agents in acute affections
+that instantly threaten life. In the London _Lancet_ of May 16, 1846,
+there is a record of a very peculiar case reported to the London Medical
+Society by Dr. Golding Bird: "The case was that of a child seven or
+eight weeks old only, an out-patient of Guy's Hospital. The child had
+become almost lifeless immediately after nursing, and to all appearances
+looked as if under the influence of some narcotic. It had not, however,
+had anything of the kind given to it, nor had it sustained a fall, nor
+was the head so large as to lead to suspicion of congenital
+hydrocephalus. On inquiring if the child passed water, the answer led to
+an examination of the prepuce, which was found to be elongated, and had
+an aperture only of the size of a pin-hole, like a puncture in the
+intestines. The urine was dribbling out; it was evident that the child
+had never completely emptied its bladder. Mr. Hilton slit up the
+prepuce, and all the symptoms were immediately relieved and soon
+entirely removed." Dr. Bird referred to a case which he had related to
+the Society some years before, which was reported in the _Lancet_ at the
+time, of a child who fell a victim to a malformation of this kind, and
+after death the bladder and ureter were found like those of a man who
+had long suffered from stricture. Mr. Hilton has seen many cases similar
+to the one mentioned by Dr. Bird. The greatest benefit resulted from
+slitting up the prepuce. In this case the benefit was very remarkable, a
+partial paralysis of the left side, under which the little patient
+labored, being quite removed in twenty-four hours.
+
+In this case the difficulty was evidently both the result of mechanical
+pressure and reflex irritation. A somewhat similar case as to its
+results is given by Dr. Sayre, to whom the case was reported by Dr. A.
+R. Mott, Jr., of Randall's Island, in January of 1880: "John English,
+aged 46, native of England, widower, clerk; admitted to workhouse
+hospital. Patient had been at work for a week as a prisoner; on the 23d
+of December was noticed to be restless and uneasy, and finally, in the
+evening, he fell from his bunk in a fit. During the next forty-eight
+hours he had several convulsions, and during the intervals lay in a
+semi-comatose condition, showing no consciousness except to stir a limb
+when pinched. Pulse, 120; temperature, 101½°; respiration, 18.
+Swallowed nothing, and passed fæces in bed. Continued in this condition
+until December 25th (temperature having fallen to 100°), when a string
+was discovered passed twice around the penis behind corona and tied, the
+long prepuce serving to conceal it from observation. While not
+sufficiently tight to occlude the urethral canal, still a firm,
+indurated band remained after the string was cut, and did not disappear
+for four or five days.
+
+"Within one hour after the removal of the string the man sat up and
+asked for milk, and from this time remained perfectly well (was under
+observation for three months). He declared that he remembered nothing
+that had taken place during the past three days; had never had fits,
+denied venereal diseases, was moderately addicted to drink, but had led
+a 'virtuous life since the death of his wife, two years before.'"
+
+The following case in the practice of Dr. F. J. Wirthington, of
+Livermore, Pa., was also reported to Dr. Sayre: "When the child was
+born, he was considered the biggest and finest boy that had been born in
+the community for a long time, until, when he was about two and a-half
+years old, and being sick, a doctor was called in, who told them that
+their child was paralyzed, the paralysis being in his lower extremities,
+and who treated him with the usual nerve-tonic and with electricity.
+Notwithstanding all this, the boy went steadily down, and the paralysis
+continued until he was seen by Dr. Wirthington. The child was then
+unable to walk; on examination, the prepuce was found to be adherent
+almost all the way around the glans penis. Behind the corona was a solid
+cake of sebaceous matter. The case was promptly operated upon, and,
+although the previous attendant had not found any cause to account for
+the paralysis, a rapid recovery took place, the boy being able to walk
+even before the complete cicatrization of the wound, and was soon the
+picture of health."
+
+Dr. T. F. Leech, of Attica, Fountain County, Ind., reports a case of a
+fourteen-month-old child, who had been the terror of all that part of
+the town for over six months, as he cried constantly. Except when asleep
+or nursed by his mother, he would lie perfectly still and squall, not
+showing any disposition to sit up; nor did he like to be raised up. He
+was very nervous, and would have times when his limbs would be rigid.
+This state of things grew worse, until the child was accidentally seen
+by Dr. Leech, who, on examination, found a contracted and adherent
+prepuce, the child being at the time in a high fever and suffering great
+nervous excitement. An operation by slitting and breaking up the
+adhesion afforded immediate relief; the spinal irritation, partial
+paralysis of the lower extremities, spasms during urination, and all
+trouble disappeared as if by magic.
+
+Prof. J. H. Pooley, of Columbus, Ohio, reported the case of a fine,
+healthy boy who, up to three months before being seen professionally,
+had always been well and in perfect health. His condition was found by
+Professor Pooley to be one of localized chorea, manifesting itself in
+constant convulsive movements of the head. They were nodding or
+antero-posterior movements, alternating with lateral or shaking and
+twisting motions; these movements had become almost constant during the
+waking hours of the child. There was no distortion of the features nor
+any choreic movements of the extremities; indeed, the whole affection
+consisted in the nodding and shaking movements of the head referred to.
+These were almost incessant, sometimes slow and almost rhythmical, then
+for a minute or two rapid and irregular, seeming to fatigue the little
+fellow, and accompanied by a fretful, whimpering cry. The child had been
+subjected to a variety of treatment, but without any benefit or effect
+of any kind. Upon the most careful examination of the patient and his
+history, Professor Pooley could not discover anything that seemed to
+throw any light upon the case, except a condition of well-marked
+phimosis. Acting upon this, the Professor immediately circumcised the
+child, and from the very day of the operation the spasmodic action began
+to diminish, and in two weeks he was entirely well, without any other
+treatment of any kind.
+
+Dr. W. R. McMahon, of Huntington, Indiana, has reported three cases of
+epilepsy in children caused by congenital phimosis that were entirely
+relieved by an operation without any subsequent return of the
+difficulty. One of the cases was in a boy ten years old, with very firm
+preputial adhesions and a high grade of inflammation of the parts.
+
+Dr. J. D. Griffith, of Kansas City, Mo., operated on a case of phimosis
+on a child nearly three years of age, who was afflicted with repeated
+attacks of convulsions and paralysis of the hips and lower extremities;
+the little fellow had as many as fifteen convulsions in a day; the
+patient was greatly troubled with painful urination and priapism. On
+examination at the operation, a firmly adherent prepuce and a large roll
+of caseous matter was found just back of the corona. A complete recovery
+followed the removal of these conditions.
+
+The above cases are taken from the paper read before the Section of
+Diseases of Children at the International Medical Congress of 1887, by
+Dr. Sayre. It contains a number of additional cases of an analogous
+character to the above, reported to him by physicians in different parts
+of the country. They show the variety, extent, and far-reaching
+character of the diseases induced by any preputial irritation. Dr. G. L.
+Magruder, of Washington, D. C., in the same paper, has a record of
+twenty-five cases of various nervous disturbances which he had entirely
+relieved by circumcision or dilatation, without any medication whatever.
+Dr. Magruder, in concluding his report, in which he quotes the authority
+of Brown-Séquard, Charcot, and Leyden, as having noticed serious nervous
+disturbances resulting from reflex irritation due to affections of the
+genito-urinary organs, observes as follows:--
+
+"From the foregoing, I think that we are justified in the conclusion
+that phimosis and adherent prepuce give rise to varied troubles of more
+or less gravity, manifesting themselves either in the muscular, osseous,
+or nervous systems; and that the removal of these abnormal conditions of
+the penis frequently affords marked relief, and, at times, perfect and
+permanent cure."
+
+In the discussion that followed the reading of Dr. Sayre's paper, Dr. De
+Forest Willard, of Philadelphia, remarked that he had operated by simply
+stripping back the prepuce and that he did not circumcise, but that he
+looked upon the subsequent cleanliness of the parts as the greatest
+safeguard, not only as against reflex irritation, but also against
+masturbation. Retained filth and smegma are far more likely to call a
+boy's attention to his penis by their unrecognized irritative effects
+than washing can possibly do. His practice is in accordance with the
+belief that young children can be relieved by the simpler methods, such
+as dilatation; but he also observes that when a child has reached eight
+or ten years of age, and has never been able to expose the glans,
+contraction is almost certain to be present, and circumcision must be
+performed. In adults there is rarely any escape when the prepuce is
+tight.
+
+Dr. I. N. Love, of St. Louis, said: "It has been my judgment and my
+practice for many years, in these reflex irritations, to pursue the
+radical course of circumcision. I believe thoroughly in the Mosaic law,
+not only from a moral but also from a sanitary stand-point. All genital
+irritation should be thoroughly removed. It is all very well to instruct
+the mother or the nurse to keep the parts within the prepuce clean, but
+they can not or will not do it. Complete and proper removal of the
+covering to the glans takes away all the cause of disturbance. Dr. Sayre
+takes a more pronounced position on this subject than the majority of
+those who have discussed his paper. An improper performance of a
+surgical procedure is no argument against the operation, but rather
+against the operator. For the reasons I have given, I am in favor of the
+radical application of the Mosaic rite of circumcision."
+
+Dr. J. Lewis Smith, the president of the Section, believed in the evil
+results of the reflex irritation due to abnormality of the prepuce. In
+many instances the causative relation of the preputial disease to the
+symptoms which it produces is not so apparent as it may be in others,
+but after correct treatment of the prepuce they disappear. There was one
+result of phimosis which, he observed, neither Professor Sayre nor those
+who contributed to his paper noticed. The expulsive efforts accompanying
+urination sometimes cause prolapsus of the rectum, and frequently
+produce inguinal hernia. In a lecture before the Harveian Society
+(_British Medical Journal_, February 28, 1880), Edmund Owen, Surgeon to
+St. Mary's Hospital and to the Hospital for Sick Children, says:
+"Perhaps the commonest cause of hernia in childhood is a small preputial
+or urethral orifice, and next to that I would put the smegma-hiding or
+adherent prepuce." Arthur Kemp (London _Lancet_, July 27, 1878), Senior
+House-Surgeon to the Children's Hospital, says: "Phimosis is a common
+occurrence, and numerous ill effects can undoubtedly be attributed to
+it;" and he alludes to the observation of Mr. Bryant, as published in
+his book on the "Surgical Diseases of Children": "In fifty consecutive
+cases of congenital phimosis, thirty-one had hernia, five had double
+inguinal hernia, and many had umbilical hernia besides. In no one was
+the hernia congenital, its earliest occurrence being at three weeks.
+Circumcision was performed in these cases, and all were much
+benefited."[103]
+
+During the session of the Ninth International Congress, where the above
+paper was read and remarks made, which appear in the third volume of its
+"Transactions," another paper was also presented by Dr. Saint-Germain,
+of Paris. The Doctor fully recognized the dangers from a narrow or
+adherent prepuce, but did not think that more than one case in three
+hundred really required circumcision; he believed in dilatation, as
+employed by Nelaton, with the exception that, whereas Nelaton employs
+three branches to his dilator, Saint-Germain preferred only a two-branch
+dilator.
+
+Dr. Lewis, the president of the Section, related a number of cases where
+the use of uncleanly instruments had resulted disastrously. But, for
+that matter, the same objection can be offered against dilatation, as a
+filthy instrument is as liable to infect the patient as a knife. There
+is no earthly excuse why a knife that has been used on a case of
+diphtheritic croup should be used some hours afterward to circumcise a
+child. As to the operation of dilatation practiced by Dr. Holgate, it
+can really be said to answer the _immediate_ demands, but how far its
+utility is efficient as to _permanent_ results Dr. Holgate has not
+given the profession any information.[104]
+
+One of the most interesting and instructive papers that it was ever the
+fortune of the writer to listen to, touching on the subject of reflex
+nervous diseases or neuroses due to preputial adhesions, was one
+prepared by Dr. M. F. Price, of Colton, California, and read at the
+semi-annual meeting of the Southern California Medical Society, at its
+Pasadena meeting in December, 1889. In the course of the paper he gives
+a considerable number of examples, of which some extracts are herewith
+given: One case was a boy aged seven, who for two years had had frequent
+attacks of palpitation of the heart; when seen by Dr. Price the little
+heart was laboring hard, beating at a furious rate (far beyond
+counting), with a loud blowing or splashing sound, and the pulse at the
+wrist a mere flutter. The breath was inspired in a series of jerks, the
+face flushed and somewhat swollen. The chest-wall was visibly moved at
+every thump of the heart. The doctor attended the child for a month
+without the little patient making any appreciable improvement. Some time
+during this period of observation the father happened to mention that
+the boy sometimes complained of his penis hurting him at the time of an
+erection. This led the doctor to examine the parts, when he found a long
+prepuce, with a mucous membrane adherent to the glans, about a line
+beyond the corona, the whole circumference of the organ. With the use of
+cocaine and a blunt instrument the adhesions were removed, with an
+immediate amelioration of all the reflex symptoms. The very next
+paroxysm was lighter and less exhausting; the improvement was
+continuous. The child soon went to school and had no further trouble;
+but, in the doctor's opinion, the two years' hard struggle have not
+been without its evil results on the constitution and organism of the
+child.
+
+The next case was born November 2, 1888; a large, healthy boy at birth.
+By June of the following year the child was afflicted with what the
+mother called "jerky spells;" up to this time the boy seemed listless,
+did not care to sit up, and seemed from some cause to be in more or less
+pain, with his eyes turned to the left. The parents dreaded that the
+child, their only one, would turn out idiotic. The spasmodic spells
+alluded to were of a tetanic nature, the body being thrown backward; his
+head and eyes continued to be turned to the left, and nothing could
+attract the child's attention. The boy cried night and day, but he was
+in good flesh, had all the teeth he should have, bowels were regular,
+and the appetite good. Whatever the doctor did in the medical way seemed
+to be of no avail. One day, however, he thought of examining the
+prepuce, thinking, perhaps, that it might be contracted and that the
+convulsive movements might be reflexes from the parts. On examination
+the prepuce was found elongated and distended, with a very minute
+opening; this was dilated with difficulty, when the inner fold was found
+adhering almost the whole extent of the glans; the dilatation and
+breaking down of these adhesions was slowly persevered in, until
+sufficient dilatation was obtained and the glans was freed. From the
+very first operation the convulsions commenced to diminish, both in
+force and frequency, and a constant and rapid improvement of the child
+took place. Six months afterward the boy was perfectly normal, stood by
+himself, played with play-things, and was an interested member of the
+family circle.
+
+Case No. 3 was a repetition of Case No. 2, except that, with the
+experience of the latter case, the doctor wasted no time with
+medication, but proceeded at once to examine the prepuce, which was
+found to be very long, and with a pin-hole opening. The dilatation of
+this and the breaking up of the adhesions gave immediate relief. During
+the course of the paper he quoted the case related by Brown-Séquard, and
+recorded in the New York _Medical Record_, vol. xxxiv, p. 314, where he
+"related a very interesting case that presented all the rational signs
+of advanced cerebral disease, a case that he considered quite hopeless,
+that was relieved by an operation for phimosis and the treatment of an
+inflammatory condition of the glans penis." To use Brown-Séquard's own
+words, "So rapid was the recovery that within six weeks from the day of
+the operation he presented himself at my office perfectly well in every
+respect."
+
+In the early part of this book, in speaking of female circumcision, it
+was mentioned that when the medical part of the volume should be reached
+some medical reasons for its necessity would be given. Dr. Price, in his
+paper, gives some information on this subject, which is of the greatest
+interest. In the course of the paper he says as follows: "Nor do I think
+these reflex neuroses from adherent prepuce wholly confined to the male
+sex. The preputium-clitoridis may be adherent and produce in the female
+similar reflexes. During the session of the American Medical
+Association, held in Chicago in 1874, I think, I attended one afternoon
+a clinical lecture by Dr. Sayre. A little girl, fourteen years of age,
+but about the size of a seven-year-old child, was brought in, who had
+never walked nor spoken, but with quite an intelligent countenance, who
+was in constant motion, and who presented very many nervous symptoms.
+Dr. Sayre examined her, and found the prepuce adherent the whole extent
+of the clitoris. He gave it as his opinion that here was the primary and
+sole cause of the symptoms, and that appropriate treatment shortly after
+birth would have prevented all the serious consequences so painfully
+apparent, and which was then too late to remedy.
+
+"I once had occasion to pass a catheter into the bladder of a lady who
+presented an innumerable train of nervous symptoms, often bordering on
+insanity, but was unable to do so without exposing the parts. Although
+the meatus could be distinctly felt, the catheter would not enter. On
+exposure to view, an opening was seen in the clitoris, which was firmly
+bound down by preputial adhesions near the extremity of the organ.
+Entering the catheter at this point, it readily passed through the
+clitoris, then down through a passage under the mucous membrane to the
+natural site of the meatus, on into the urethra, and through into the
+bladder. In the light of recent experience, my opinion now is, that here
+was the cause of all the nervous symptoms in this case."
+
+The relative disposition in regard to the irritability of the external
+sexual organs as existing in the female, when contrasted with the male,
+is, for some reason, not sufficiently considered or understood. The idea
+of masturbation or of irritation from the genitals ending in reflex
+neuroses is always, as a rule, associated with the male, and that it has
+not been more associated with the female has deprived her of the same
+benefit that the prosecution of the study in this regard has been to the
+male sex. Masturbation among the feeble-minded, which is so common,
+must, of necessity, have for its determining cause a foundation of
+morbid irritability of the sexual organs. This is well known to be so
+among the males, whose hands seem instinctively to be drawn to those
+parts. Dr. C. F. Taylor, of New York, in an article on the "Effect of
+Imperfect Hygiene of the Sexual Function," published in the _American
+Journal of Obstetrics_ for January, 1882, gives us an account of his
+investigations in this regard, with the following results: "In an asylum
+for the feeble-minded of both sexes, it was found that the habit was
+about equal in the two sexes, there being only this difference: that the
+females began to masturbate one or two years earlier than the males, and
+that the habit, once established, was found to be more persistent than
+in the males. It was, further, ascertained that the habit came
+naturally, without the aid of precept or example to either sex."
+
+It may well be a question as to whether the feeble-mindedness be not a
+reflex condition from this excessive morbid irritability of the sexual
+organs. There is not much doubt but that, if one of the cases reported
+by Dr. Price had not been circumcised, the expressionless, listless
+infant would have grown, in time, into a masturbating, feeble-minded,
+idiotic creature, as many others, so situated, have done before it. Now,
+would it have been logical to have laid the morbid irritability of its
+generative organs to its feeble-mindedness, when its feeble-mindedness
+was fully demonstrated to have been wholly dependent on the sexual
+irritation? From these premises we might take another step forward, and
+ask whether, under a proper hygienic prophylaxis,--which would involve a
+thorough inspection of the genitals of _all_ children reported to be
+either physically or mentally deficient,--such a course would not
+greatly diminish the number of paralytics, feeble-minded, and generally
+deficient of both sexes? If the results in private practice are any
+criterion, it is safe to assert that a strict adherence to the Mosaic
+law for the males and to some of the African customs for the females
+would most assuredly relieve all these cases that might come under the
+caption of results of reflex neuroses. Twenty years ago this subject
+was, to the body of the profession, a _terra incognita_ in regard to the
+male, and, as the female is similarly subject to the same morbid
+influence, it is to be hoped that in the present decade she will receive
+the same attention which the profession is now beginning to pay to the
+male sex.[105]
+
+In the foregoing parts of this chapter, examples of reflex neuroses have
+been given to show the different effects that genital irritation will
+produce. The cases given were chosen for the diversity of variety of
+symptoms, and as cases representing the affection, without any other
+complication. Many more could have been added, but they are unnecessary.
+In the writer's practice there has been a number of cases in the adult
+that have exemplified that this form of ailment is by no means
+restricted to children, as has been shown in the case reported by Dr.
+Mott to Dr. Sayre, in regard to the middle-aged man with a string about
+his penis. One of these cases was that of a young man, six feet in
+stature, broad-shouldered, and well built. He applied for relief for a
+dyspepsia that affected his stomach and also his heart. The man had an
+apparently feeble and irritable heart; cold, clammy skin; disturbed
+digestion, and uneasy sleep; was constipated and flatulent. No treatment
+seemed to make any impression upon his case. At last he began to
+emaciate and look haggard. His mind was also becoming visibly weaker,
+was attacked by dizziness, and on several occasions he fell in a fit.
+With this condition he at last began to have frequent nocturnal
+emissions. On account of the latter his genital organs were examined,
+and the penis was found smaller than the average, with a long and narrow
+prepuce. The glans could easily be uncovered, but the tightness of the
+prepuce and its unyielding qualities made paraphimosis a possibility; so
+that the young man, having once or twice had considerable difficulty in
+returning the prepuce to its place, never attempted its retraction
+again. There were no adhesions, but the inner fold of the prepuce had
+been thickened by balanitis. Seeing the need of circumcision _for the
+local benefit_, the operation was suggested with a view of relieving the
+pressure on the glans, which was looked upon as the probable cause, in
+his broken-down condition, of the advent of the nocturnal emissions. He
+gladly submitted, and, to the surprise of both physician and patient,
+_all_ his troubles disappeared, and he at once became a changed man. So
+impressed was he with the result, that, on his return to his home, he
+examined his younger brother, and, finding him with a like long, narrow
+prepuce, he immediately brought him in and had him circumcised, as a
+prophylactic against his being subjected to the risk of lost health as
+he himself had suffered.
+
+Another case, a man of forty-five, also a farmer, was afflicted with
+dyspepsia, palpitation of the heart, general debility, constipation,
+constant headache, etc. He could not cut up an armful of wood without
+bringing on palpitations and gaseous eructations, or being upset for the
+day; and after having connection with his wife he generally had a
+terrific headache, lasting for two or three days;[106] he could stand no
+protracted mental effort, even such as is required to make an addition
+of a long line of figures, or the least business worry, without the
+supervening headache. All treatment against these conditions was
+useless; the colon was kept empty, the diet was changed; pepsin and
+bismuth, tonics, frictions, Turkish baths, and all hygienic observances
+and moral treatment were all of no avail. One day, on consulting the
+writer, he complained of a pruritus at the head of the penis. On
+examination it was found that he had a narrow, long prepuce, a
+congenitally-contracted meatus, and was then suffering with a slight
+balanitis. He was very careful to keep the parts clean, but, he informed
+me, that in spite of all precautions, these attacks would come on. The
+mucous covering of the inner fold of the prepuce and glans was so
+irritable that connection often brought it about. The glans was small
+and elongated, with the meatus red, and with lips oedematous and
+congested. To free him from this tormenter, circumcision was advised.
+The party could not, however, remain away from home for the time
+required for the operation; so that a compromise operation was
+performed,--one that would not keep him from business, and, at the same
+time, relieve the contracting pressure on the glans. This was by
+Clouquet's operation and bandaging back the prepuce over the penis, back
+of the corona,--an operation that, in my hands, has often filled all the
+desired purpose. The meatus was also incised. After the operation _all_
+of his troubles disappeared, as they had done in the preceding case, and
+he was soon a hearty and well man, able to chop wood, attend to
+business, and, in case of need, do family duty for a Turkish harem
+without recurrence of his old tormenting, dyspeptic palpitation or
+sick-headache.
+
+The writer has resorted to circumcision in many cases to improve the
+temper and disposition of children, with the best of results, and in one
+case, in association with another physician, performed the operation on
+a lunatic, whose lunacy ran to women and girls, with whom he would fall
+desperately in love, without any encouragement or provocation, or even
+acquaintance; finally reaching spells of such incoherence of action and
+speech that confinement would be required. The peculiarity of his
+hallucinations called attention to the genital organs. This man had
+never masturbated, and was, when well, a compactly-built, active, and
+intelligent man. By occupation he was a contractor, and a man of more
+than usual executive ability besides. On examination it was found that
+he was a subject of congenital phimosis, never having been able to
+uncover the glans. He had been in the habit of washing out the preputial
+cavity by the aid of a flat-nozzled syringe. The prepuce was long, but
+not thick; nevertheless, it was inelastic and very firm. The examination
+seemed to have a good mental effect upon the man, as it made him quite
+rational for the moment. He entered into the idea that this condition
+had some connection with his derangement very intelligently, even
+suggesting many symptoms and attacks that he had suffered from childhood
+up as probably gradual-stepping processes through which his present
+condition had been reached. He cheerfully submitted to a thorough
+circumcision, which had the effect of ameliorating his condition. He was
+subsequently sent to an asylum, where, after a short time, he was
+discharged well. Some years afterward, conscious of feeling a return of
+the mental derangement, he voluntarily applied for admission to the same
+institution and remained until better.
+
+This case is very instructive. The patient readily connected his
+mental trouble, by a retrospective view through a series of
+gradually-increasing troubles, that originated in the preputial
+condition, to the phimosed condition of that appendage, and he was
+certain that this prepuce had been at the bottom of all the physical and
+mental trouble he had experienced. The reflex nervous train of
+affections had undoubtedly produced some localized lesion in the
+brain-structure. The natural sound, healthy organism of that organ, and
+the bright, active nature of his mind, however, prevented a total
+wreckage of the mental faculties. It is safe to assume that, had he had
+the ordinary listless, unresisting mind, disposed to brood, and easily
+cast down, he would, from the first derangement, have become a hopeless
+and demented lunatic. The circumcision could not undo all the mischief
+that had been accomplished, some of which had certainly left a permanent
+taint, but the mildness of his future attacks and the better exercise of
+his volition were the undoubted results of the operation.
+
+
+
+
+CHAPTER XXIV.
+
+DYSURIA, ENURESIS, AND RETENTION OF URINE.
+
+
+Any dissertation on circumcision and its many uses, either prophylactic
+or curative, would be incomplete without a reference to enuresis;
+another reason for making a somewhat full reference to the subject would
+be the undecided position that this morbid condition seems to occupy in
+medical literature, as well as the meagre and unsatisfactory treatment
+it has received by the majority of those who have mentioned it. It is
+anomalous, to say the least, to find, in general or special literature,
+enuresis mentioned as a diseased condition peculiar from babyhood to
+puberty; to find it fully described and to have it stated that it is a
+widely-prevalent distemper, affecting both sexes alike; to know that it
+is an annoying, intractable, persistent condition, wearing to the child
+in every sense, subjecting it to a demoralizing mortification as well as
+to unmerited scoldings, humiliations, and punishments, and that its
+habit, in badly-ventilated quarters, will breed other diseases,[107] as
+well as that its continued action tends to the development of onanism,
+with its long and widely-ramifying trains of physical and social ills;
+and to find works especially devoted to children's diseases silent on
+the subject. Knowing all these things, and also that Ultzmann,
+Lallemand, and others who have treated this affection, mention it as a
+children's disease, it is unaccountable to reason out why most of our
+text-books and treatises on children's diseases should be so remarkably
+and unreasonably silent. It certainly cannot be laid to its lacking in
+study material, as the author of "Quain's Dictionary of Medicine" says:
+"It is one relative to which much might be written without exhausting
+the subject, the pathology of which has wide and manifold relations....
+There appears to be something analogous between this condition and that
+which determines in after life the seminal emissions under similar
+circumstances." Our American works are notably deficient in this regard;
+although Stewart, of New York, in his "Diseases of Children," published
+over fifty years ago, devotes a chapter to dysuria and one to retention
+of urine, treating the subject quite fully, even down to the description
+of preputial calculi; he, however, failed to notice that the irritation
+of preputial constriction or adhesions will produce both conditions,
+and, following many of the authors of the time, as has been done since,
+he adopted the urino-digestion theory of acid and irritating urine, due
+to faulty digestion, of Prout and Magendie, who looked to regulating the
+digestion of the child, or the mother who nursed it, as the only method
+of cure; the lithic-acid diathesis being, in their opinion, the main
+thing to be guarded from.
+
+Other works that mention these conditions are equally on the wide sea of
+speculation, as they all, more or less, look upon the treatment that
+they advise as indefinite and unsatisfactory, showing an equal want of
+sound anchorage-grounds for their etiological reasonings. Dillnberger,
+of Vienna, in his hand-book of children's diseases, mentions enuresis,
+but has nothing better to offer for its relief than that advised by
+Bednar, who followed a systematically-timed period of awakening,
+gradually lengthened out, from the time of putting the child to bed. In
+addition, he advises internal medication, and, like Ultzmann, he
+recognizes the possibility of a local cause in little girls, in whom he
+advises the local application of nitrate of silver. Edward Ellis
+mentions dysuria, and a long prepuce is noticed among its numerous
+causes. The works that give the subject the most intelligent treatment
+(the word "intelligent" is here used advisedly, and is in reference to
+the results obtained) are those of West, of London, and Henoch, of
+Berlin. West, in his "Diseases of Children," says: "In the child,
+however, we sometimes find the symptoms produced by difficulty in making
+water owing to the length of the prepuce and the extreme narrowness of
+its orifice, which may even be scarcely large enough to admit the head
+of a pin. This congenital phimosis is, I may add, not an infrequent
+occasion of incontinence of urine in children, and is also an exciting
+cause of the habit of masturbation, owing to the discomfort and
+irritation which it constantly keeps up. In every case, therefore, where
+any difficulty attends the passing or the retention of the urine, or
+where the practice of masturbation is suspected, the penis ought to be
+examined, and circumcision performed if the preputial opening is too
+small. This little operation, too, ought never to be delayed, since, if
+put off, adhesions are very likely to form between the glans and the
+foreskin, which render the necessary surgical proceeding less easy and
+more severe."
+
+In the "Lectures on Diseases of Children," Henoch, of Berlin, says: "I
+need scarcely add that an examination of the external genitals should
+never be omitted in any case of dysuria during childhood. You will not
+infrequently discover a phimosis which interferes more or less with the
+discharge of urine and retains portions of the latter behind the
+foreskin, where it may decompose and give rise to an inflammatory
+condition of the prepuce, with painful dysuria.... This is also true of
+the occasional adhesion of the labia minora in little girls, like the
+similar adhesion of the foreskin in boys. It is almost constant in the
+first period of life, but sometimes persists to the end of the first
+year; can usually be torn by the handle of the scalpel, and rarely
+requires an incision. In a few cases this adhesion appeared to me to be
+the cause of the dysuria, which disappeared after the separation of the
+labia from one another."
+
+Henoch, however, does not seem to have grasped the full relation that
+the natural phimosis of young children bears to dysuria, as he here
+follows the prevailing opinion, that where by dint, push, hauling, and
+hard work the prepuce can be pushed back phimosis does not exist, as
+well as the general apathy to the fact that a prepuce can exert a very
+injurious influence by its pressure, even when not adherent and very
+retractable; such a prepuce is often attended by balanitis and
+posthitis, with an accompanying difficult, frequent, and painful
+urination. In a case which will be related farther on, in the discussion
+of the systemic effects of a long, contracted prepuce, as it induces
+diseased action by continuity of tissues, there is an account of a death
+of a two-year-old child which we can assume to have had its original
+starting-point in a condition of phimosis. Henoch, however, rather
+attributes the death in that case to what may well be considered the
+result of a cause, leaving the original cause more to appear as a final
+accessory condition.
+
+My reasons for this view of the subject are simply owing to the fact
+that I do not believe that a child can long be afflicted with the
+_ischuria phimosica_ of Sauvages without having the urinary organs
+beyond more or less seriously affected from the mere retention alone,
+irrespective of any reflex irritation from the pressure on the glans or
+of any from the irritation of the peripheral nerves; the dilatation of
+the adjacent cavities or channels and the deposit of calcareous matter
+being facilitated by the retention of urine and its naturally altered
+condition owing to that retention. So that dysuria in young children,
+beginning in a slightly phimosed condition, or in the irritability of
+the glans and meatus, due to its preputial covering, it is safe to
+assume, may produce a train of symptoms ending in permanently-injured
+health, or even death. The irritating urine of a slight access of fever
+may, by its passage over the irritable mucous lining of the prepuce, be
+the initial starting-point of a serious or fatally-ending disease. In
+all of these, it must be admitted, the presence of the prepuce is either
+actively or passively the cause of the most serious disease processes
+that may follow.
+
+Ultzmann, of Vienna, in his work on the "Neuroses of the Genito-Urinary
+Organs," gives the subject of enuresis considerable attention. It is not
+a work on diseases of children, but it, nevertheless, goes into the
+subject as if it were, and furnishes the profession with considerable
+information. He defines enuresis to be the passage of urine of a normal
+quality in a child who, with the exception of this involuntary
+urination, is healthy. In the first periods of life, a slight vesical or
+intestinal expulsive effort is sufficient to overcome the guarding
+sphincter muscles at their outlet; the child first obtains a voluntary
+control of the rectal sphincter; and, generally, with the second year it
+gains control of the vesical. Those who pass their second year without
+obtaining this control, but in whom the organs and urine are normal, may
+be said to be afflicted with enuresis. He divides enuresis into three
+varieties; that involuntary urination which takes place at night during
+sleep he terms the _nocturnal_; that which takes place while climbing,
+laughing, coughing, or in the course of any violent muscular exercise is
+the _diurnal_; and that wherein the involuntary evacuation takes place
+day and night alike he terms as the _continued_. This last is again
+subdivided into the continuous and periodical. As a cause, he cites
+anæmia, scrofula, rachitis; but adds that physical debility is not
+necessary for its presence, as well-developed, vigorous, puffy children
+are as liable to be affected as thin and scrawny ones; while not all
+scrofulous or rachitic children are so affected, only a small portion
+being enuretic. Sex has no influence on the liability that tends to
+being attacked, the proportion between the sexes being about equal. As
+to age, he finds the greatest proportion to be between three and ten
+years, but he has often treated those of either sex even at the age of
+fourteen and up to seventeen years. It is absolutely necessary to
+examine the external genitals and the urine of those affected by this
+disease, as phlegmasiæ of the vagina, of the vestibule or urethra in
+girls, or the practice of onanism, or lithiasis, cystitis, or pyelitis
+may be the cause of the disease. Girls are apt to be found affected with
+polypoid excrescences at the meatus, which when removed will cause the
+enuresis to disappear.
+
+From the above it will be observed that Ultzmann has paid much attention
+to these neuroses; but it will also be remarked that neither the
+balanitis, collection of infantile smegma, preputial adhesions nor
+irritations are taken into any account as possible factors of either
+dysuria or enuresis; he has followed more or less an electrical form of
+treatment for genito-urinary neuroses, the rectal rheophore being one of
+his favorite modes of treating enuresis; in his etiological views of
+these disturbances he has adhered more or less to the views of
+Trousseau, Bretonneau, and Dessault, who looked upon a debilitated or
+anomalous condition of the vesical neck as the cause of the majority of
+neuroses in that region.
+
+It may be asked why these celebrated and observing physicians have
+neglected the preputial condition, if, as it is claimed, it is, in
+itself, so important and sure a factor of the derangements at the
+vesical neck? To answer this, or to explain any marked discrepancy that
+may occur in medicine between minds equally as acute and observing, it
+is but necessary to observe that there is, in medicine, to a certain
+extent, a like rule of inheritance, education, with fashion or custom of
+habit of thought and practice, as we find in religion. Canon Kingsley
+and Froude are equally as acute and discerning as the late Cardinal
+Newman, but that did not necessitate their following that prelate into
+the foremost ranks of the Catholic Church; and Pere Hyacynthe was
+equally as intelligent as Cardinal Newman, but that did not prevent him
+from leaving the fold into which the Cardinal had entered from out of
+the Reformed Church. Some are born Catholics or Protestants, and are so
+with vehemence; others are born in these religions, but are only
+lukewarm in their doctrinal observance; while others reason and jump the
+traces in either direction. The followers of the destructive theories of
+Bronssais could not see the errors of their ways, and neither could they
+be made to see the merits of a less interfering form of medical
+practice. Trousseau was himself at one time tainted with Bronssaisism,
+but, like Paul of Tarsus, he was made to see the error of his way, as he
+relates, through a case of gout that he nearly laid out in trying to lay
+out the disease antiphlogistically.
+
+I do not assume that preputial irritation is at the bottom of _all_
+cases of dysuria or enuresis, any more than it would be rational to deny
+that cases of circumcision performed in some cases of diabetic enuresis
+have proved fatal as a result of the operative interference; but it is
+safe to assume that, in the great number of cases in whom some
+irritating conditions were found and removed, the enuresis or dysuria
+was due to such preputial irritation. It is also logical to assume, with
+West and Henoch, that the organ should in all cases be examined, and its
+condition rendered as harmless as possible. That the condition of
+preputial irritation has not been fully recognized by all parties as a
+cause of enuresis does not do away with the fact that it does exist, any
+more than the refusal of the prelates and doctors of Salamanca to listen
+to Columbus did away with the fact of the existence of the American
+continents.
+
+A. L. Ranney, in his "Lectures on Nervous Diseases," pages 174, 175,
+speaks of enuresis in children as being a reflex cachexia, "excessive
+stimulation of the centripetal nerves connected with the so-called
+'vesical centres' of the spinal cord,"--a condition which may be
+produced by either worms in the intestines or by preputial irritation.
+Ranney advises a careful exploration of the urethra and rectum in these
+cases, and the elimination of all local causes of the conditions.
+
+Probably the most remarkable case of the immediate continuous effects
+resulting from phimosis is the one recorded by Vidal, in the fifth
+volume of the third edition of his "Surgery." This was a young man with
+a congenital phimosis, having but a very small aperture; on an operation
+to relieve the phimosis there was a gush of water, but this only fell at
+the feet of the patient, without being ejected at any distance; the
+urethra was found to have undergone precisely the same dilatation back
+of this preputial orifice that it usually undergoes back of a stricture;
+the whole urethra from the meatus backward was found to have exceeded
+the calibre of that of the vesical neck; the bladder was greatly
+dilated.
+
+
+
+
+CHAPTER XXV.
+
+GENERAL SYSTEMIC DISEASES INDUCED BY THE PREPUCE.
+
+
+Aside from all the local affections or reflex neuroses, either mental or
+physical, that a prepuce may induce, there are an innumerable train of
+diseases that may originate in this one cause that at first sight would
+seem to have no connecting-link with any preputial condition.
+
+It has already been suggested that the prepuce does not at all ages bear
+the same analogous relation to man. In childhood, especially during our
+earliest years, it is out of all proportion in size when compared to the
+rest of the organ, or to any use it may have placed to its credit. Man
+does not, then, certainly need that refinement of nervous sensitiveness
+in the corona that is useful in after life in inducing the flow or
+ejaculation of the seminal fluid; neither is there at that age much of a
+corona to protect. In middle life, or what might be called the
+procreative period of man, when the corona would seem to require all its
+excitability or sensitiveness, seems to be the very season in life when
+the glans is most apt to remain uncovered; so that nature and this
+hypothetical idea of the use of the prepuce are evidently at variance.
+So we go through childhood with this long funnel-shaped appendage into
+manhood, when the increasing size of the body of the penis restores a
+sort of equilibrium between the size and bulk of the organ and its
+integumentary covering. At this period, as we have seen, although it
+does not, from the equilibrium restored, and the more or less use to
+which it is subjected, induce any great immediate or uncomplicated
+troubles, it nevertheless endangers the existence of the penis through
+the accidental course of some putrid or continued fever, or it subjects
+man to the manifold dangers of venereal or tubercular infections.
+
+In advanced age, owing to the diminution in size of the organ, the
+prepuce resumes the proportionate bulky dimensions of childhood, and as
+the organ recedes and becomes more and more diminutive, the prepuce
+again, like in childhood, begins to tend to phimosis; the urine of the
+aged is also more irritating and prone to decomposition or putrefaction,
+and the constant state of moisture that the preputial canal of the aged
+is necessarily kept in, either by frequent urination or the incomplete
+emptying of the urethra that is peculiar to old age, and which results
+in more or less dribbling, is a powerful factor in inducing the many
+attacks of posthitis and balanitis, as well as those attacks of
+excoriation and eczema which are so annoying to the aged. I have often
+seen such cases happening to men past fifty, who, being widowers, and
+never having had anything of the kind, as well as being in the most
+complete ignorance of the nature of the disease, have, from delicacy and
+fear that the disease might induce some suspicions as to their conduct
+in the minds of those whose good opinions they value above all else,
+gone on suffering untold miseries, especially if the urine were in the
+least diabetic.
+
+One such case that fell under my observation not only produced such
+misery as to entail a loss of rest and of appetite, but even induced
+such a disturbance of assimilation and nutrition that the resulting
+hypochondriacal condition that developed from these enervating causes
+ran the patient into a low condition, ending in complete prostration of
+all vital powers and death, without the intervention of any other
+disease. The subject was a timid, retiring man of about fifty-five
+years, and this was the first and only time that the prepuce had ever
+caused him any annoyance,--a circumstance which greatly preyed upon his
+mind, as he could not disconnect it with the idea that it must be
+suspected as venereal, although he had always led a most continent life
+since the death of his wife. This is, of course, an extreme case; but as
+it is a result beginning in a certain condition, be it an extreme,
+erratic, or infrequent occurrence, it is, nevertheless, an example of
+what may happen in advanced life, even where the prepuce has never
+before been a source of the least disturbance or annoyance. Persons who,
+with the increase of years, are also liable to an increase of adipose
+tissue, are more subject to this dwindling down of the penis and
+consequent elongation of the prepuce, with all the attendant annoyances,
+than thin or spare people.
+
+In this irritation that the prepuce is liable to cause, we have not only
+to encounter the dangers that its thickenings or indurations may bring
+on in their train, in the shape of cancer, gangrene, or hypertrophies,
+but other and no less serious results are liable to follow a herpetic
+attack, or in consequence of an attack of balanitis or posthitis. The
+dysuria attending any of these conditions may be the initial move for
+such a serious complication that life may be brought to a sudden end,
+even in infancy, to say nothing of the ease with which life is taken off
+in after years and in old age; with debilitated and imperfect kidney
+action, it takes very little to hustle us off from life's foot-bridge.
+
+A case as occurring in Henoch's clinic, already mentioned or referred to
+in a previous chapter, shows what a simple phimosis is capable of
+inducing. In the history of the case the phimosis and the resulting
+retention in the preputial cavity no doubt were the causes of the
+calculus found there; and the succeeding calculi and abnormal condition
+of the urinary organs, we can safely assume, were a subsequent creation
+to that in the prepuce. The case is taken from Henoch's "Lectures on
+Diseases of Children," Wood Library edition, page 256, and is as
+follows:--
+
+"A. L., aged two, admitted November 28, 1877. Quite well nourished, but
+pale. Complete retention of urine for two days; slight redness and
+marked oedema of penis, scrotum, and perineum. The foreskin cannot be
+retracted, on account of phimosis. Abdomen distended, hard, and
+sensitive, the dilated bladder extending a few fingers' breadth above
+the symphysis. In order to introduce the catheter, it was first
+necessary to operate upon the phimosis, during which a calculus, which
+completely occluded the meatus, was removed. The catheter, when
+introduced into the bladder, removed a quantity of cloudy urine. The
+oedema, rapidly disappeared under applications of lead-wash, but on
+November 29th vomiting and diarrhoea occurred during the night, with
+rapid collapse; December 1st, death. Autopsy: In the bladder, a
+sulphur-yellow stone, as large as a hen's egg, completely filling the
+organ; similar calculi, from the size of a pea to that of a bean, in the
+pelvis of the left kidney; right kidney normal."
+
+In the above case, the oedema of the penis, scrotum, and perineum was as
+much a result of the distension of the bladder by the retained urine
+interfering with the return circulation from the oedematous parts as the
+different appearances of diseased conditions were a result of the
+primary phimosis; yet this case, if seen during its early infancy, when
+probably the contraction of the preputial orifice was as yet not so
+well marked, would have been pronounced one in which it would be
+needless and barbarous to perform circumcision upon. We would most
+assuredly have to wander aimlessly and unprofitably in the region of
+speculation to build up the etiology of the above-related case and reach
+the culmination there found, unless we accept the one that it was all,
+from first to last, the result of the phimosis.
+
+Jonah, pitched overboard at sea to appease the tempest and swallowed by
+the whale, became convinced finally that he had better return to Nineveh
+to preach reform; while Pharaoh would not let the children of Israel
+depart even after Moses had so frightened him--as it is related in the
+rabbinical traditions compiled by the Rev. T. Baring-Gould, M.A.--that
+the royal bowels were completely relaxed at the sight of the snakes
+turned loose about the royal throne,--a circumstance which nearly lost
+him his claim to divinity, which was based on the fact that his bowels
+moved only once a week, as in this case they not only moved out of time
+and in the most unkingly manner, so that the noble king hid underneath
+the throne, but before even Pharaoh could disengage himself from the
+royal robes, which event could hardly have raised him in the estimation
+of the gentlemen eunuchs of the bed-chamber. Those who unwound the mummy
+of Pharaoh tell us that he had the appearance of a self-willed,
+despotic, but intelligent, old gentleman; but the above rabbinical
+relation, from Baring-Gould's "Legends of the Patriarchs and Prophets,"
+seems to have had no convincing effect on Pharaoh; so we must not be
+surprised if even a case like the one from Henoch's clinic would, with
+many, carry no conviction.
+
+In the second volume of Otis on "Genito-Urinary Diseases," of the
+Birmingham edition, at page 380, there is an interesting account of a
+physician who, in youth, was troubled with an annoying prepuce, which,
+from frequent attacks of balanitis, had finally become more or less
+adherent to the glans penis; up to the age of nineteen he had been
+unable to completely uncover the glans. By six months of hard and
+persistent labor he had finally broken up these adhesions. At the age of
+twenty-two he married, and he then ruptured the frenum, which bled
+profusely and left him sore for some days. Then for twenty-seven years
+he had no further trouble, but at the end of that time he began to
+experience what he believed were attacks of dumb ague, and the scrotum
+began to swell and felt sore on firm pressure. Heavy, aching pains then
+followed. This condition of things lasted for over five years, varied by
+the appearance of carbuncles on the nose and elsewhere, to relieve the
+monotony of the thing. From this time on, abscesses began to form in the
+scrotum and into the integument of the penis, burrowing forward into the
+prepuce, which was much swollen and painful. A gangrenous opening
+effected itself in the dorsal surface, which relieved him somewhat. The
+patient was finally examined by Dr. Otis, who found a badly strictured
+urethra, the strictures beginning at the meatus, and at intervals
+extended down as far as two and three-fourths inches. The case had no
+venereal history, the patient never having had any disease or anything
+of the kind. The strictures were plainly the result of the
+balano-posthitic attacks as much as they were the cause of the
+degeneration of the mucous membrane in the lower urethra, that allowed
+of the infiltration of urine into the tissues, which caused all the
+systemic disturbances, abscesses, misery, and agony of the patient,
+depriving him of comfort, sleep, or ability for labor, and which sent
+him here and there in search of health and relief.
+
+It would seem really as if a prepuce was a dangerous appendage at any
+time, and life-insurance companies should class the wearer of a prepuce
+under the head of hazardous risks, for a circumcised laborer in a
+powder-mill or a circumcised brakeman or locomotive engineer runs
+actually less risk than an uncircumcised tailor or watchmaker. They
+recognize the danger that lurks in a stricture, but what a prepuce can
+and does do, they entirely ignore. I have not had any opportunities for
+comparison, but it would be interesting to know, from the statistics of
+some of these companies, how much more the Hebrew is, as a
+premium-payer, of value to the company than his uncircumcised brother.
+Were they to offer some inducement, in the shape of lower rates, to the
+circumcised, as they should do, they would not only benefit the
+companies by insuring a longer number of years, on which the insured
+would pay premiums, but they would be instrumental in decreasing the
+death-rate and extending longevity.
+
+I have seen so many cases of stricture whose origin could be traced to
+balanitis that it can almost with confidence be assumed that, wherever
+there is a long prepuce with a red and inflamed meatus in a child, that
+unfortunate child will be a victim of fossal strictures when arrived to
+manhood, and that, moreover, he will be a surer victim to the reflex
+neuroses which so often accompany strictures, and which have been so
+ably described by Otis, than the victim of uncomplicated strictures
+acquired in the worship of Venus. There is no end to the misery that
+these poor fellows have to suffer, besides the habitual hypochondriacal
+condition into which the accompanying physical depression, throws them;
+it unfits them for business, any undertaking, or even for social
+enjoyment or entertainment; they keep themselves and their families in
+continued hot water. These subjects are, also, more prone to gouty and
+rheumatic affections, asthma, and other neuroses.
+
+Among the many cases of nervous disorders simulating other diseases that
+I have seen relieved were two Jewish lads with an imperfection of the
+meatus. They were two brothers, and from the history of the cases, and
+that given me by the mother of the lads in regard to the father, the
+malformation must have been hereditary and congenital. It consisted of a
+partial occlusion of the meatus by a false membrane, which divided the
+meatus in two, horizontally, but which was closed at the posterior end
+of the lower passage, which readily admitted a probe from the front as
+far as the occlusion, about a third of an inch to the rear. The
+restoration, or rather the making the anterior urethra and meatus to
+their normal condition, relieved both boys of asthma, under which they
+had labored for years.
+
+The many cases simulating the general disturbances that accompany many
+kidney disorders, that are simply the result, in their primary causes,
+of preputial irritation and the disturbances to the kidney function due
+to the same cause, have long induced me to look upon the prepuce as a
+great and avoidable factor to some of the many forms of kidney diseases,
+prostatic enlargements, vesical diseases, and many other diseases of the
+urinary organs, which we know full well can result from strictures, as
+the latter need not always act in a purely mechanical mode to do its
+full extent of mischief.
+
+One result of these preputial irritations not generally or particularly
+mentioned in any of our text-books--a condition far-reaching as regards
+its own results, and more annoying and serious than it appears at first
+sight--usually begins with a reflex irritability of the anal sphincter
+muscle, or a rectal irritation of the same order, which in time produces
+such organic change that an hypertrophied and irritable, indurated,
+unyielding muscle is the result. Agnew, of Philadelphia, describes the
+condition, but does not mention this frequent cause under the name of
+sphincterismus; once this is established, the train of resulting
+pathological or diseased conditions that may follow are without
+end.[108] This is no fancy sketch, nor will the student of the pedigree
+and origin of diseases feel that the case is exaggerated or imaginative.
+These are some of those cases that are always ailing, never well and
+really never sick, but who are, nevertheless, gradually breaking down
+and finally die of what is termed "a complication of diseases," before
+living out half their term of life.
+
+How this happens is simple enough--the straining required to produce an
+evacuation is out of all proportion with the character of the discharge;
+such patients often complain of being constipated when the evacuations
+are semi-fluid; this straining is followed by a dilatation and
+consequent loss of power of the rectum, which becomes pouched and its
+mucous membrane thickened; the whole intestinal tract sympathizes and
+digestion is interfered with, and the forcible expulsive efforts affect
+all the abdominal and thoracic organs in a more or less degree, laying
+the foundation for serious organic diseases. Now, this condition, which
+may be said to be no more than one of obstinate constipation, is a far
+more reaching condition and a far more injurious state than can be
+imagined at a first glance. Constipation is not, as a rule, always
+accompanied by the indigestion, either stomachic or intestinal, that
+goes with this condition; the contents of the intestines in simple
+constipation may simply lack fluidity without undergoing putrefactive
+fermentation, but in this condition the undigested and retained
+intestinal contents do undergo that change, resulting in the generation
+of material whose re-absorption produces a toxic condition of the blood,
+from whence begins a series of serious organic changes in the blood, and
+from this in the organs.
+
+To the practical physician these changes are evident and their cause
+just as plain, and it is just here where the laity lack the proper
+education, and where they should understand that the intelligent
+physician generalizes the disease and only individualizes the patient;
+and it is this ignorance on the part of the laity that gives to
+empiricism and quackery that advantage over them, as they look upon all
+disease as a distinct individual ailment, that should have an equally
+distinct and individual therapeutic agent to cope singly with. The laity
+know very little of these things, and in their happy ignorance care
+still less for the finer definitions of or of the clinical importance of
+toxæmia, or the processes of abnormal conditions that lead up to such a
+state, or the results that may follow when that condition is once
+reached. To them, dyspepsia is an indigestion ascribable to the stomach,
+and a sick-headache is ascribed to something wrong about the stomach or
+liver.
+
+The laity have never been called upon to answer the questioning of the
+late Prof. Robley Dunglison: "What do you mean, sir, by biliousness? Do
+you mean, sir, that the liver does not secrete or manufacture a
+sufficiency of bile, or not enough? Do you mean that the bile-material
+is left in the blood, or too much poured in? Do you mean that there is
+an excess in the alimentary canal, and a deficiency elsewhere? Please,
+sir, explain what you really mean by the term 'bilious!'" The Professor
+had a way about him that at least made one stop and seriously inquire,
+before adopting any random notion in regard to medicine. It is to be
+regretted that, in the humdrum tread-mill work of many physicians, they
+even have to drop into the commonplace way of treating dyspepsias and
+such ailments without any further inquiry. A farmer knows better than to
+drive a dishing wheel, or with merely having a nail clinched in the
+loose shoe of a valuable horse; but he is fully satisfied to do so in a
+metaphorical sense, as regards his own constitution, and the mere hint
+from his physician that he had better lay up for repairs, or that there
+is something wrong about him that will require investigation, and that
+there is an ulterior cause to his feeling tired, headachy, or dyspeptic,
+or an allusion that there is something systemic, as a cause, to his
+momentary attacks of disordered vision or amaurosis, will generally make
+him look on the doctor with mistrust.
+
+The merchant, banker, and mechanic are not up to Professor von Jaksch's
+ideas of toxæmia,--that toxæmia may be exogenous or endogenous, or that
+the latter is further subdivided into three more varieties,--and, what
+is worse, he cares still less. The above three classes of humanity, when
+sick, simply would want to know if Professor von Jaksch was good on
+dyspepsia, the measles, or typhoid fever. They care very little that he
+divides endogenous or auto-toxæmia into that produced by the normal
+products of tissue-interchange, abnormally retained in the body, giving
+rise to uræmia, toxæmia from acute intestinal obstruction, etc., the
+above being the first division. The second depends on the outcome of
+pathological processes, which change the normal course of assimilation
+of food and tissue-interchange; so that, instead of non-toxic, toxic
+matter is formed. The second group he names noso-toxicoses, which he
+subdivides into two principal divisions:--
+
+(_a_) The carbohydrates, fats, or albuminous matter, which may be
+decomposed abnormally and give rise to toxic products, _e.g._, diabetic
+intoxication, coma carcinomatosum.
+
+(_b_) A _contagium vivum_ enters the body through the skin, or the
+respiratory or digestive tract, and develops toxic agents in the tissues
+on which it feeds, as in infectious diseases.
+
+In the third group the toxic substance results from pathological
+non-toxic products, which again produce a toxic agent, only under
+certain conditions. This group he calls auto-toxicoses, and includes in
+it poisonous substances, resulting from decomposition of the urine in
+the bladder, under certain pathological conditions, and giving rise to
+the condition called ammoniæmia. (_Medical News_ of January 7, 1891;
+from _Wiener klinische Wochenschrift_ of December 25, 1890.)
+
+As observed above, unfortunately the patients know nothing, nor can they
+be made to understand these conditions, that are only reached through
+labyrinthic pathological processes, and, what is still worse, this way
+of looking at disease is incompatible with the idea of specific-disease
+treatment, which to them looks more practicable and quick, and which is
+also more to their liking. They cannot see any sense in such reasoning,
+which to them is something eminently impracticable; neither can they see
+a reasonable being in the doctor who practices on such, as they call
+them, _theories_.
+
+The practical physician, however, sees in Professor von Jaksch's
+summary the turning-point of many a poor fellow's career,--from one of
+comparative health into one of organic disintegration, decay, and
+dissolution,--all the required processes starting visibly from the very
+smallest of beginnings; any obstruction in the urinary tract or
+intestinal canal being sufficient to start any of the conditions which
+end in toxæmia; and, from a careful observation running over several
+years, I do not think that I am assuming too much in saying that a
+balanitis is often the tiny match that lights the train that later
+explodes in an apoplectic attack or sudden heart-failure due to toxæmia;
+the organic and vascular systems being gradually undermined until,
+unannounced and unawares, the ground gives way and the final catastrophe
+occurs,--unfortunately, an occurrence or ending looked upon as
+unavoidable by the friends of the victim. They cannot see any danger;
+the idea that diseases have the road paved, not only for an easy
+entrance but an easy conquest, by the action of these toxic agents on
+the tissues, is something that they cannot grasp. These blood changes or
+blood conditions are things too intricate, and the physician who
+understands them is, to them, a visionary and unpractical man. These
+conditions are, however, neither new nor unknown, and there is really no
+excuse for the ignorance exhibited in these matters by the general
+public, as it is through the blood that this mischief takes place. They
+can reason in their impotent way, that they should drench themselves
+with "blood tonics" and all manner of nauseous compounds to "purify"
+their blood, but the simple, scientific truth is something beyond their
+understanding, as well as something that they steel themselves against.
+
+Sir Lionel Beale, in observing the immense importance he attaches to
+blood composition and blood change in diseases of various organs, truly
+remarks that "blood change is the starting-point, and may be looked upon
+as the cause, of what follows," the other factor being the "'tendency'
+or inherent weakness or developmental defect of the organ which is the
+subject of attack;" to which he adds that he feels convinced that, if
+only the blood could be kept right, thousands of serious cases of
+illness would not occur; while the persistence of a healthy state of the
+blood is the explanation of the fact that many get through a long life
+without a single attack of illness, although they may have several weak
+organs; and that an altered state of the blood, a departure from the
+normal physiological condition, often explains the first step in many
+forms of acute or chronic disease. Sir Lionel has been a pioneer in the
+field of thought that looks for the cause of the disease, which, however
+remote it may be, should not be overlooked as a really primary
+affection. His extensive labor in the microscopic field has fully
+convinced him that many of the pathological changes in the different
+organs are due to what might be called some intercellular substance that
+is deposited from the blood. (Beale: "Urinary and Renal Disorders.")
+
+Toxic elements in the blood affect the kidneys in a greater or less
+degree, and there produce changes at first unnoticed,--at least, as long
+as the kidney can perform its function,--but the day arrives when, as
+described by Fothergill, blood depuration is imperfect, and we get many
+diseases which are distinctly uræmic in character, and ending in any of
+the so-called kidney diseases, Bright's disease being one of the most
+common. As observed by Fothergill, however, the kidney is not the
+starting-point, the new departure only taking place when the structural
+change on the kidney has reached that point that it is no longer equal
+to its function--the "renal inadequacy" of Sir Andrew Clarke. (J. Milner
+Fothergill, in the _Satellite_, February, 1889.)
+
+During the Bradshawe lecture, Dr. William Carter made the following
+remarks: "According to Bonchard, one-fifth of the total toxicity of
+normal urines is due to the poisonous products re-absorbed into the
+blood from the intestines, and resulting from putrefactive changes which
+the residue of the food undergoes there." In the course of the lecture,
+Dr. Carter fully explains that one of the benefits derived from milk
+diet in Bright's disease is the small residuum deficient in toxic
+properties, and lays great stress on the employment of intestinal
+disinfectants or antiseptics that exercise their influence throughout
+the whole tract, suggesting naphthalin as peculiarly efficacious,
+thereby cutting off one source of blood contamination at its source.
+Although these are recent developments in medicine, Bonchard mentions
+that in the practice of M. Tapret cases treated on this principle did
+well. (Braithwaite's _Retrospect_, January, 1889.)
+
+Persons laboring under this toxic condition of the blood, with a
+consequent deterioration in the texture and the physiological function
+of the vital organs, are of that class that easily succumb to injuries
+or serious sickness, and of that class to whom a surgical operation of
+even medium magnitude is equal to a death-warrant.
+
+The above conditions are an almost constant attendant on that condition
+of the sphincter described by Agnew as sphincterismus, which also is
+productive of hæmorrhoids and fissure, and often of fistula. That
+sphincterismus is caused in many cases by preputial irritation is as
+evident as that the same affection, or hæmorrhoids or any other rectal
+or anal affection, will, in its turn, produce vesical and urethral
+reflex actions, and primarily functional and secondarily organic changes
+in those parts. Besides, the great number of cases wherein the gradual
+and progressive march of each pathological event could be traced with
+accuracy has convinced me of the true cause of the difficulty being the
+result of reflex irritation.
+
+Delafield, in his "Studies in Pathological Anatomy," gives, as the first
+form of pneumonia, that from heart disease; in the days of Broussais
+this would have sounded absurd, but, to-day, some forms of heart disease
+are known to be the regular sequences of some particular form of kidney
+disease, just as some form of pneumonia attends an affected heart and
+that some forms of pneumonia degenerate into phthisis. When the blood
+change is an established fact, it is only a question as to which is the
+weak organ, and the organism of the individual will decide whether it
+will be a simple sick-headache or the beginning of a pneumonia ending in
+phthisis.
+
+I have purposely dwelt on this part of this subject, owing to the recent
+origin and publication of many of the views connected with it; also on
+account of the greater ease of making the subject plain by fully
+discussing each step of the process; and if the views of Sir Lionel will
+be recalled, that a toxic element in the blood is the starting-point,
+and that an irritable or weakened organ invites destruction,--the
+induction of serious and fatal kidney disorder by the transmitted
+irritability and consequent injury to the kidney produced by preputial
+irritation in the first instance, and the supplemental blood-poisoning
+by intestinal absorption of septic matter, which soon brings about Sir
+Andrew Clarke's "inadequacy of kidney,"--all will be readily understood.
+When this point is reached, a too hearty meal, exposure to variable
+weather, or a little extra care or anxiety, are sufficient, as
+determining causes, to bring life into danger.
+
+As pointed out, many cases of Bright's disease or other renal difficulty
+have their origin in this distant but visible source, and, although
+malarial poisoning and a great number of other causes will produce the
+same particular organic changes and diseases, this condition must be
+admitted as one of the frequent causes. The influence of the
+genito-urinary tract on the rest of the economy, and the importance of
+the sympathy it excites, or how quickly, by its being irritated, some
+apparently dormant pathological condition will be awakened to life and
+activity, is not sufficiently appreciated. As observed by Hutchinson, a
+patient who has once been the subject of intermittent fever is more
+prone, on catheterization, to have a urethral chill and fever than one
+who had never had the fever. (Hutchinson: "Pedigree of Diseases.")
+
+Ralfe observes, in his "Kidney Diseases," that long-standing disease of
+the genito-urinary passages must be reckoned as among the chief
+etiological factors of chronic interstitial nephritis (page 227). The
+condition of the kidneys in cases of strictures of long standing is
+known not to be a reliable one, and any incentive to dysuria or to
+retention, no matter how slight, is apt to lead, eventually--and that
+even in very young subjects--to that toxic condition mentioned in a
+former part of this chapter as one of von Jaksch's subdivisions of
+toxæmia, the ammoniæmia of Frerichs; this condition being the fatal
+ending of the case of the two-year-old child mentioned by Henoch, who
+died after the relief of a retention due to phimosis and calculi
+resulting from the phimotic occlusion. Having seen so many cases wherein
+the conditions described in this chapter were so apparently--whether
+from ammoniæmia due to infection, or toxæmia from the urinary tract, or
+uræmic toxæmia from the intestinal tract--all due to some preputial
+interference or irritation, I cannot help but feel that in these
+conditions--which, singularly, are not so prevalent with the Hebrews as
+with Christians--we have one factor in the cause of the shorter and more
+precarious vitality of the latter.
+
+Morel, in his "Traité des Dégénérescences Phisiques," ably discusses the
+degenerative and morbific influences and results of toxæmia, as well as
+he clearly defines their sources. The connection between toxæmia and
+mental affections has already been shown, and Prof. Hobart A. Hare, in
+his instructive and interesting prize essay on "La Pathogénie et la
+Thérapeutique de l'Épilepsie (Bruxelles, 1890)", mentions that
+convulsive disorders resulting from the presence of some toxic substance
+are of frequent occurrence. How much this may enter as a partial factor
+into many of the cases of epilepsy which are classed in the order of
+"reflex" may well challenge our consideration. Hare lays great stress on
+the necessity of circumcision wherever there is an indication of
+preputial local irritation. "If practicable, circumcision should be
+performed; it is an operation with but small risk or danger, and easy of
+performance. In such circumstances it is always permissible to
+circumcise, were it for no other end than an acknowledged attempt to
+reach a cure."
+
+
+
+
+CHAPTER XXVI.
+
+SURGICAL OPERATIONS PERFORMED ON THE PREPUCE.
+
+
+In operative interference there is one point which should not be lost
+sight of, this being that the length and bulk of the prepuce in a great
+measure depends on the constriction at its orifice; if the orifice is
+small, the prepuce tight and inelastic, every erection, by putting the
+penis-integument on the stretch, adds to its bulk,--nature naturally
+trying to make up the deficiency,--the two points of resistance being
+where the glans pushes it ahead, having the constricting orifice for a
+hold or purchase, and the skin at the pubes, which is called upon to
+furnish the extra tissue for the time being needed during erection,
+which should be supplied by the prepuce--this being the only office
+which I have been able to assign to this otherwise useless but very
+mischievous appendage. In cases where preputial irritation produces more
+or less priapism, the continued stretching of this integument causes a
+marked increase in its growth, which is mostly added forward. It was on
+this principle or its recognition, that Celsus devised his operations,
+and on which the persecuted Jews undertook to recover their glans by
+manufacturing a prepuce; and, although the trial was not reported as
+being very successful, I do not doubt but that, if the skin could have
+been drawn sufficiently over so as to constrict it anteriorly so as to
+give the glans a purchase, as in the case of phimosis with an inelastic
+prepuce, the operation could be more of a success; all that is required
+is the continued extension and the prepuce might be made to rival in
+length the labia majoræ of the females of some African tribes, or the
+pendulous buttocks of the Hottentot Venus.
+
+I have employed the knowledge of this elasticity and source of supply of
+the penis-integument, on more than one occasion, in recovering the
+denuded organ with skin. A number of cases are on record where, owing to
+the want of that artistic and mechanical knowledge without which no
+surgeon is perfect, the operator has drawn forward the skin too tight in
+circumcising, after which, owing to the natural elasticity of the skin,
+the integument has retracted, leaving the penis like a skinned eel or
+sausage. This accident is even liable to occur where the skin has not
+been tightly drawn, but where subsequent erections have torn through the
+sutures, and where the natural retraction of the skin has laid the organ
+bare for some distance. I have seen a number so recorded, but do not
+remember seeing any remedy suggested, it seemingly being accepted that
+the recovery must take place by gradual granulation,--a necessarily very
+slow process, owing to the constant interference by--the always present
+in such cases--unavoidable erections.
+
+Several years ago I advised circumcision to a gentleman owing to a
+contracted condition of the muscles of one hip and thigh, which was
+threatening to render him a deformed cripple; he had a congenital
+phimosis and a very irritable glans penis. The operation was performed
+in a proper manner by a surgical friend, but this friend, unfortunately,
+was a great believer in antiseptic and wet dressings. A few days after
+the operation he called upon me to ask me to go and see the patient, as
+they were both in a pickle, the patient being exceedingly angry, being
+in constant misery, and the penis so denuded by the giving way of the
+sutures--owing to the erections--that it looked to the patient as if he
+never could have a whole penis again, and the doctor saw no way out of
+the difficulty; the penis was, in reality, a dilapidated and
+sorrowful-looking appendage, and anything else but a thing of beauty or
+pride; it was raw, angry-looking, and bleeding at every move; the first
+wink of sleep was followed by an attempt at erection that raised the
+patient as effectually as an Indian would in scalping him; so that,
+taken altogether, the penis, anxious countenance, and the flexed
+position of the whole body to relieve the tension on the organ, the man
+looked about as battered, cast down, and sorrowful as Don Quixote did in
+the garret of the old Spanish inn, with his plastered ribs and
+demolished lantern-jaw.
+
+Luckily, the patient was seen before the retracted portion of the penile
+integument had had a chance to condense and indurate. The bed was
+slopping wet with the drenchings of carbolized water that the penis had
+undergone, the man's clothing was necessarily damp, and the whole
+bedding and clothes were steamy,--all of which greatly added to his
+discomfort and tendency to erections. The man was washed, placed in a
+new, clean, and dry bed, and his clothing changed. The organ was then
+forced backward until the preputial frill or edge was approximated to
+the cut end of the penis-skin, where it was made fast by an
+uninterrupted suture around the whole of the circumference. A short
+catheter, about three inches in length,--the catheter being as full size
+as the urethra would comfortably hold, and of the best and thickest of
+the red, stiff variety,--was introduced into the urethra. This protruded
+about half an inch beyond the meatus. A stiff, square piece of
+card-board was pierced and slipped over this, and then adhesive rubber
+straps were brought from the integument to this little platform, the
+first being from the median line of the scrotum, lifting the sac forward
+and upward. The pubes were shaved and the next four straps started from
+the root of the penis, each strap being split at the glans-end so as to
+encircle the protruding end of the catheter. By these means the skin was
+brought back and firmly supported over the penis, toward the glans; and,
+in case of any erection, the act would only assist in drawing the
+covering farther over the penis as the pasteboard platform and adhesive
+straps formed the distal end of an artificial phimosis. The catheter
+allowed of free urination, and the scrotum was further held up in
+position by a flat suspensory bandage passed underneath the scrotum and
+fastened over the abdomen near each hip. The penis wound was then
+dressed with a very little benzoated oxide-of-zinc ointment passed
+between the adhesive straps; a bridge-support placed over the hips to
+support the bed-clothes, and all was finished, and full doses of bromide
+of sodium and chloral were ordered at bed-time. When the dressings were
+removed, five days afterward, all was healed, the sutures removed, and
+the suspensory alone replaced. The patient had not been troubled with
+any more erections or annoyances of any kind. These are the points which
+often do more or less mischief: wet dressings are uncomfortable and
+favor erections, while the effect of the weight and action of the
+scrotum in drawing backward on the integument should not be overlooked;
+in addition, it should not be overlooked that we have it in our power to
+produce, so to speak, an artificial phimotic action, which has the same
+traction on the penis-integument that the natural phimosis induces.
+
+The foregoing method, to be used in these cases, has proved very
+serviceable in my hands, and it is here given that it may assist others;
+as there is no need of waiting for granulations or of allowing the
+patient to undergo so much misery, which, besides the local injury,
+cannot help but affect the general health very injuriously. The penis
+can stand any amount of forcing backward; it stands this in cancer or
+hypertrophy of the prepuce, or in the inflammatory thickenings that
+precede gangrene of the prepuce, in any extended degree; becoming, for
+the time being, more or less atrophied. As has been shown by Lisfranc,
+the penis can be made nearly to disappear into the pubes; so that we are
+not as helpless in these cases as our text-books would have us believe.
+
+In infants, and in young children below the age of ten or twelve, the
+Jewish operation, as modified and done in accordance with the dictates
+of modern surgery, will be found the most expedient. By this method we
+avoid the need of any anæsthetic agents, which are more or less
+dangerous with children, as well as the need of sutures, which are
+painful of adjustment and very annoying to remove in those little
+fellows who dread new harm; there is also much less risk of
+hæmmorrhages, as the frenal artery is not wounded. In children of a year
+or over, a very good result will be found often to follow Cloquet's
+operation, care being taken to carry the slitting well back, as well as
+care in taking it on one side of the frenum, so as to avoid any wound of
+that artery, the subsequent dressing being a small Maltese-cross
+bandage, pierced so as to admit the glans to pass through; the prepuce
+is retracted and the tails folded over each other and held there by a
+small strip of rubber adhesive plaster; a little vaselin prevents the
+soiling by urine underneath. This last operation is short and very
+easy, is not painful, nor does it require much manipulation; it is only
+one quick cut on the grooved director and it is over; by the retraction
+of the prepuce, the longitudinal cut becomes a transverse one, making
+the prepuce wider and shorter at once; the glans soon develops and
+remains uncovered. As there is a very small wound to heal over, the
+repair is very prompt.
+
+In adults with a very narrow, thin, not overlong prepuce, a very good
+result often follows a combination of the dorsal slit with the inferior
+slit alongside of the frenum of Cloquet. The narrower and tighter the
+prepuce, the better the result, as the cuts are at once converted from
+longitudinal into transverse wounds, and the organ at once assumes the
+shape and condition of a circumcised organ, without having suffered any
+loss of substance; three stitches or sutures in each cut (silver or
+catgut) adjust the cut edges; a small roller of lint and adhesive
+plaster, placed so as to shoulder up against the corona, completes the
+dressing. Where this operation is practicable, by the thinness and
+narrowness of the prepuce, it has many advantages. I have repeatedly
+performed it on lawyers, book-keepers, clerks, and even laboring men,
+who have gone from the office to the courts, counting-rooms, or stores
+without the least resulting inconvenience or loss of time. In laborers
+it is better to perform the operation on a Saturday evening, which gives
+them a rest of thirty-six hours before going to their labor again. The
+operation is comparatively painless and almost bloodless, as there need
+not be more than half a teaspoonful of blood lost during the operation;
+there is no danger of any subsequent hæmorrhage, and, with proper
+precautions against the occurrence of erections, from seventy-two to
+ninety-six hours is sufficient for a complete union; the sutures are
+then removed and a simple lint and adhesive-plaster dressing worn for a
+few days more. In many, no more dressings are required. In many cases,
+with a properly adjusted dressing, that comes forward underneath so as
+to include the frenum, the simple dorsal slit is sufficient; but if any
+of the prepuce depasses the dressing underneath, it will puff and become
+oedematous and require frequent puncturing. To avoid it, it is better to
+make the Cloquet slit at once. This operation is of no value, and
+perfectly impracticable in a thick, pendulous prepuce. Absorption will
+often remove considerable preputial tissue, but where there is too much
+its very bulk interferes with its removal by any natural means.
+
+Dilatation is recommended by a number of surgeons, but, I must admit, in
+my hands it has always proved a failure; it may be, that if the
+subsequent history of the cases reported as so operated upon had been
+carefully traced, the reports would not have been so good. Nelaton,
+whose dilating instrument is generally recommended, seems, himself, to
+prefer some of the circumcising methods, as in the volume on "Diseases
+of the Genito-Urinary Organs," in his "Surgery," being the sixth volume
+of the revised edition of 1884, by Desprès, Gillettte, and Horteloup,
+the subject of dilatation is dismissed in two short lines. St. Germain,
+of Paris, uses, as has been before observed, a two-bladed forceps, used
+after the manner of Nelaton, and reports good results. Dr. J. Lewis
+Smith agrees in his statements with Dr. St. Germain. Dr. Holgate, of New
+York, reports a like experience. In my own practice the prepuce has
+often been made _temporarily_ lax and retractable, but with the usual
+results of the return of the contraction, with a possible thickening of
+the inner fold, as a result of the interference; so that only in case of
+any immediate demand, where the tight prepuce is producing irritation,
+either through pressure or adhesions, or retained sebaceous matter, do I
+ever resort to dilatation; always, however, even then, not as a final
+operation, but merely as preparatory procedure toward a future operation
+of a more efficient order.
+
+In cases of timid adults, who refuse all kinds of operative
+interference, good results may be obtained by the use of a mild
+lead-wash or cold tea-baths and the introduction of flat layers of dry
+lint interposed between the prepuce and the glans; this has a very good
+effect in keeping the parts apart and dry, and may in time produce a
+certain amount of dilatation; but even when this is done, unless it will
+render the foreskin sufficiently loose to allow of its being kept
+finally back of the corona, it is, after all, but a temporary makeshift.
+The corona should be exposed and kept clear of the preputial covering;
+anything short of this will not give all the good results to be desired.
+I have more than once performed a secondary operation on Jews, who had
+been imperfectly circumcised by not having the prepuce removed
+sufficiently, and in whom the subsequent contraction of the preputial
+orifice had re-covered part of the glans, and only lately visited a
+four-year-old boy, circumcised when eight days old, in whom the prepuce
+covered half of the glans, the corona acting as a tractive point from
+which the penile integument was being drawn forward. In this case the
+simple pierced-lint Maltese cross was used, with an adhesive band to
+hold the tails down behind and around the penis just back of the corona.
+
+These means, although not circumcision either in a surgical or in the
+Hebraic religious sense, are, nevertheless, sufficient in a medical
+sense for all desired purposes; provided, however, that there is no
+resulting constriction, or a mild condition of paraphimosis, back of
+the corona, and that the whole of the glans is sufficiently uncovered,
+and that no abnormal dog-ears are left to garnish each side of the penis
+like an Elizabethan frill or collar; although Agnew holds that, in
+slitting, the practice adopted by many of rounding off the corners is
+mostly superfluous, as nature will do so itself in time.
+
+The ordinary way of performing the operation by modern surgeons is by
+what is known as the Bumstead circumcision. It was not an invention of
+Bumstead, but was adopted by him in preference to all others. The
+requisites are a sharp-pointed bistoury, blunt-pointed scissors, and a
+pair of Henry's phimosis forceps, with fine needles and fine oculists'
+suture silk. The penis is allowed to hang naturally and the position of
+the corona glandis marked on the outer skin with a pen and ink, which is
+to serve as a guide for the incision. The prepuce is now drawn forward
+until this line is brought in front of the glans and grasped between the
+blades of the forceps. The prepuce is now transfixed, and, with a
+downward cut, that portion is severed; the knife's edge is now turned
+upward and the excision finished. The forceps are now removed and the
+integument allowed to retract; with the scissors the inner mucous fold
+is now split along the dorsum and trimmed off so as to leave about half
+an inch in front of the corona. The parts are then brought together with
+the continuous suture and dressed according to the fancy of the surgeon.
+Care must be taken _not to bruise_ the parts with the forceps, as, in
+such cases, sloughing of the sutured edges will be the result instead of
+union. I have seen this accident happen more than once, in one case
+being followed by a penitis that seriously complicated matters.
+
+It has been my practice to use fine silver-wire and catgut sutures in
+all operations on the prepuce; they excite less suppuration as well as
+less irritation. In case of need, the silver can be left in longer, and
+they are much easier of removal than the silk; besides, they have the
+advantage of not cutting. In the after-treatment the same general plan
+can be followed as with any amputated stump, except that it must not be
+forgotten that at the end of this organ dwells what has been termed the
+_sixth_ sense, and that heat and moisture are very apt to awaken the
+dormant energies of the organ, even after it has undergone cruel
+mutilation, and even has suffered considerable loss of blood; for that
+reason it is best always to avoid wet or sloppy dressing, or too much
+ointment, as they are more apt to cause erection than to do any good.
+Besides, I find water does here, as elsewhere, interfere with the
+deposited plastic matter, properly organizing into cicatricial tissue;
+so that I prefer a snug, dry dressing, which is left on for four or five
+days without being interfered with, and light covering, plain diet,
+quiet, with fifteen grains each of bromide of sodium and chloral hydrate
+at bed-time to insure rest and freedom from annoying erections. Where
+the organ is large in its flaccid state, it is better to support it on a
+small oakum-stuffed pillow, made for the purpose, than to let it hang
+downward. Should the stitches give way and the skin tend to retract, the
+plan proposed on a previous page can be followed to advantage. In
+urinating, care must be taken not to soil the dressings; some patients
+are very careless about this if not warned. The penis should hang nearly
+perpendicular while in the act, and all dribbling should have ceased and
+the meatus and underneath be mopped dry with some soft cotton before
+raising the organ; nothing so irritates the parts, retards union, or is
+more offensive than a urine-saturated dressing.
+
+Dr. Hue, of Rouen, uses an elastic ligature, which he introduces into
+the dorsal aspect of the prepuce by means of a curved needle. This he
+ties in front, and in three or four days it cuts its way through.
+Although Hue reports a large number so operated upon, the tediousness of
+the procedure and the swelling and oedema, as well as the active pain
+that must necessarily accompany the operation, will hardly recommend the
+ligature in preference to the incision by the knife.
+
+Dr. Bernheim, the surgeon of the Israelitish Consistory of Paris, has
+operated on over eleven hundred circumcisions, besides the cases of
+phimosis occurring in his general practice. His opinion of the procedure
+of M. de Saint-Germain by dilatation is not favorable. He has employed
+it in a number of cases of phimosis, at the time unfit for a more
+radical operation. He has, however, observed that cicatricial
+thickenings and recontractions are very apt to occur, and, as to the
+septic accidents mentioned in connection with circumcision, he has noted
+that they are as liable to occur in hands that are as careless and
+slovenly with what they do with their dilating forceps as they are with
+what they do with their bistouries. Dr. Bernheim prefers the
+circumcision forceps of Ricord, as modified by M. Mathieu. This
+instrument he prefers by reason of its gentler pressure, which, at the
+same time, is all-sufficient to properly fix the prepuce. In applying
+the forceps, he includes as little as possible of the lower part,
+keeping away as much as possible from the frenic artery. The dorsum of
+the inner fold he cuts with the scissors. In children under two years of
+age, he simply turns this back over the free edge of the integument; in
+children over two years of age, he uses serres-fines. In children, he
+uses a piece of lint dressing steeped in a watery solution of boracic
+acid; in adults, he uses iodoform-gauze dressings. He finds cases unite
+in from three to ten days. Dr. Bernheim warns us against using
+antiseptics on infants or young children, in connection with the
+after-dressing of circumcision. Neither phenic acid, corrosive
+sublimate, nor iodoform are well borne by these young subjects, and he
+has seen serious results follow upon as light an application as a 1/100
+solution of phenic acid. In a number of cases he reports operating with
+the galvano-cautery of Chardin, instead of the knife. These operations
+were bloodless, and cicatrization was as rapid as when the knife was
+used. He has in several cases operated by the dorsal incision, owing to
+disease of the prepuce not allowing any other operation.
+
+In France, the Bumstead operation is known under the title of Ricord's
+procedure. Lisfranc, Malapert, M. Coster, and Vidal all have operations
+which are not as useful as Ricord's, and have not, therefore, come into
+general use. M. Sedillot condemns the dorsal incision as leaving two
+unsightly-looking flaps. The reverse, or inferior incision of M. Jules
+Cloquet is likewise not in favor with either Malgaigne or Ricord. This
+inferior incision or section, alongside of the frenum was first advised
+by Celsus. M. Cullerier contented himself with slitting the inner
+preputial fold, longitudinally, from its junction with the skin backward
+to the corona. M. Chauvin, by the aid of a complicated instrument with
+barbed points, drew out the mucous fold as far as possible before
+excising.
+
+There is something unaccountable in the difference in results that
+various operations give in the hands of different surgeons. It must be
+that all methods are correct _with properly-chosen cases_ and when
+properly _performed_, as well as properly looked after subsequently to
+the operation. It must not be expected, however, that, in operations
+where the kindly assistance of nature is a thing contemplated in
+absorbing superfluous tissue, the case will at once give satisfaction to
+all. These cases must have the required time before judgment can be
+passed upon the merits of the operation, just as required time in cases
+of dilatation or in the method of M. Cullerier will often demonstrate
+that the benefits are but transient, and that often even cases that have
+been so operated upon will require a complete circumcision, _à la_
+Ricord or _à la_ Bumstead, owing to the resulting thickening induration
+and overconstriction, when, if left alone, the dorsal slitting or the
+inferior incision of Cloquet would have previously given satisfactory
+results.
+
+The final cosmetic results in the combined Cloquet and dorsal-slit
+operation, for instance, depend on, first, properly choosing the case.
+One on whom the operation is unadaptable it is useless to attempt it on,
+as a future circumcision or tedious and annoying re-operation of
+trimming would be required. The next care is to properly cut through all
+constricting bands, which, like fine, tough strings, will be found to
+encircle the penis. These must be carefully clipped with a fine pair of
+strabismus scissors, as these bands do not give way, either then or
+afterward, of their own accord, but form the nucleus for stronger
+constricting bands for the future. Then you must be sure to cut far
+enough back, either above or below, until you have reached where you
+obtain the normal and largest calibre of circumference of the penis. The
+adaptation of the edges of the parts and the proper application of a
+smooth, equal pressure, by means of the lint strap, is of the next
+importance; and then comes the strapping of the whole surface for about
+an inch and a half back of the corona, which should and must include all
+the tissues of the preputial part of the frenum. A neglect or careless
+performance of any of the details, or the carelessness of the patient in
+not keeping the dressing clean, necessitating its change before the
+fourth day, all tend not only to interrupt the union, but to mar the
+future cosmetic results as well. It may be asked why all this care and
+trouble, and not circumcise at once? As already observed, this operation
+admits of the patient following his business; whereas circumcision, on
+the male, will assuredly lay him up for four or five days, and perhaps
+ten days,--something that many, be they rich or poor, cannot afford, and
+will not submit to.
+
+The cosmetic condition of the penis as a copulating organ is a thing of
+some importance, and this should not be overlooked; for, although the
+particular dimension, shape, or peculiarity of the penile end never
+figures prominently in the complaints of women who apply for
+divorce,--the charges being everything else under the sun,--it can
+safely be assumed that this organ and its condition is the original,
+silent and unseen, as well as unconscious power behind the throne that
+is at the bottom of the whole business in more than one case. Like the
+fable of the poor lamb that the wolf wished to devour: the real reason
+of his wishing to kill him was that he might eat him, the pretext set
+forth by the wolf that the lamb had encroached on his pasture, muddied
+his brook, or kept him awake by his bleating having been disproven by
+the lamb. Besides, it is well not to leave any distinctive or
+distinguishing mark, like an individual baronial crest, on the head of
+the organ.
+
+To return, however, to the operative procedures, we find that Dr. Vanier
+finds that the operation of Cloquet by incision alongside of the frenum
+has the advantage of not leaving any deformity--contrary to the opinion
+of Ricord and Malgaigne. He, in fact, holds this procedure in such high
+esteem that he considers that Cloquet deserves great credit for reviving
+this old Celsian operation. H. H. Smith, in his "Operative Surgery,"
+coincides with Vanier in his favorable opinion of this method, as he
+there says: "Frequent opportunities of testing the advantages of the
+plan of Cloquet having satisfied me of its value, I do not hesitate to
+recommend it as that best adapted to the adult, because it fully exposes
+the glans and leaves little or no lateral deformity, as is frequently
+the case with the dorsal incision,"--an opinion that I can fully agree
+with, from the results of the same operation in my hands, although I
+have used the method even on infants. Vanier does not approve of the
+dorsal incision unless it is made V-shaped, as it otherwise leaves the
+unsightly lateral flaps, but thinks well of the modification of
+Cloquet's practiced by M. Vidal de Cassis, which is performed in the
+following manner: The patient stands before the operator, who remains
+sitting; the operator seizes the prepuce on its dorsum and draws it
+toward him; he then introduces a narrow, sharp-pointed bistoury, with
+its point armed with a small waxen bullet, down alongside of the frenum
+until he reaches the pouched extremity of the preputial cavity at this
+point; the point of the bistoury is now made to transfix the waxen
+bullet and out through the skin, which from this point is divided from
+behind forward. Vanier very sensibly suggests that the operation that is
+effectual, and which can be accomplished in the least number of
+movements or _temps_, as being the least likely to cause extensive pain
+and agony, should be the one preferred, and that the aim of the surgeon
+should be to simplify the operation by reducing the number of necessary
+movements. For this reason, where an excision of considerable amount of
+tissue is required by the nature of the case, he prefers another
+operation, performed by Lallemand,--that of making a dorsal transfixion
+and cutting off the two lateral flaps, which can all be done in three
+movements.
+
+It makes but little difference as to which operation is performed on the
+adult, but that the subsequent dressing will exercise a good or evil
+influence, and greatly assist not only in the present comfort or
+discomfort of the patient, but in the ultimate result as well. Bearing
+these points in view, Charles A. Ballance, of St. Thomas's Hospital, has
+adopted the following procedure:--
+
+"When the patient is etherized, the outline of the posterior border of
+the glans is marked on the skin with an aniline pencil. The skin of the
+prepuce is slit and removed up to the aniline line. The mucous membrane
+is next cut away, leaving only a free edge of about one-eighth of an
+inch in width. Any bleeding which occurs should be entirely arrested,
+and asepsis must be insured by frequent sponging with carbolic or
+sublimate solution. Numerous coarse-hair stitches are then inserted, so
+as to bring accurately together the fresh-cut edges of the skin and
+mucous membrane, and subsequently, after a further sponging and drying,
+a piece of gauze two layers of thickness, and wide enough to reach from
+the root of the penis nearly to the meatus, is wrapped loosely around
+the penis and secured by several applications of the collodion-brush.
+The setting of the collodion is hastened by the use of a fan, so that
+the air is kept in motion, and the patient should not be allowed to
+recover from the anæsthetic until the dressing is quite firm and hard.
+This dressing forms a carapace for the penis, protecting it from the
+bedclothes and effectually preventing the annoying and distressing
+erections. Mr. Ballance reports excellent results from this dressing."
+(Braithwaite's _Retrospect_, July, 1888.)
+
+In applying the above dressing, the shrinking incident to the drying of
+the collodion must not be overlooked, and the gauze layers must be
+loosely applied, as they would otherwise become too tight. The dressing
+is a very ingenious and serviceable one.
+
+Mr. A. G. Miller, at a meeting of the Edinburgh Medico-Chirurgical
+Society, reported a new method of dressing after circumcision. "It
+consisted in first closely suturing the skin and mucous membrane by
+numerous catgut sutures, then painting the surface with Friar's balsam
+and covering it over with two or three layers of cotton wadding, on
+which the balsam is poured. The glans penis was left sufficiently free
+to allow of water passing. The band or ring of dressing should be at
+least one inch broad. The dressing was not suitable for young infants
+who were frequently wetting. In the case of older children, they might
+be allowed to go about on the second or third day, when the dressing
+would be quite dry, and would not be required to be changed or renewed."
+(Braithwaite's _Retrospect_, January, 1888.)
+
+Any constricting or immovable and inelastic dressing is subject to the
+same objections as plaster-of-Paris dressings in thigh-fractures,--that
+of being dangerous and not expedient, unless the patient is constantly
+under your eye.
+
+Dr. Neil Macleod, in the _Edinburgh Medical Journal_ for March, 1883,
+advises a procedure that has always looked favorably to me, and which I
+once put in practice through the means of the ordinary ptosis
+fenestrated forceps, in place of the ordinary circumcision forceps, the
+sutures being introduced through the fenestra and the prepuce cut off on
+the outer side of the forceps, the thickness of the steel arm on the
+outer side of the fenestra allowing of the properly-sized border for the
+hold of the sutures. Dr. Macleod places his sutures all in position
+before making any incisions,--a procedure which will be found to save
+the patient considerable pain; as with many the seizing and holding of
+the edges of the skin and mucous membrane and the forcible pressure
+exerted by the fingers or forceps while the needle is being forced
+through is the most painful part of the operation. In doing this, care
+must be taken to allow sufficient length to each thread to make two
+sutures, as well as care must be taken to properly pull out the thread
+in the centre between the four folds of tissue and to cut it
+equidistant, after the ablation of the prepuce, a blunt hook being used
+to fish up the threads from the preputial opening.
+
+Erichsen favors the Jewish operation in young children, as being the
+easiest and safest of performance. Slitting, or the inferior or superior
+incision, he thought, left too much of the prepuce, which, wherever
+there is a tendency to phimosis, should be entirely removed, "with a
+view of preserving the health and cleanliness of the parts in after
+life." In the phimosis that is acquired by old men, he found dilatation
+with a two-bladed instrument to be sufficient, provided the indurated
+circle was made to yield. For the circumcision of adults he has invented
+an adjustable shield, something like the Jewish spatula, with which he
+protects the glans.
+
+Gross (the elder) used both slitting on the dorsum and circumcision. He
+found neither objection nor deformity in the flaps left by the dorsal
+incision, as they were only temporary; in some cases, he simply followed
+the practice of Cullerier, of making multiple slits in the constricting
+and inelastic mucous membrane.
+
+Agnew believes in circumcision in the treatment of reflex troubles. He
+relates a case, in the second volume of his "Surgery," of eczema
+extending over the abdomen, of over a year's standing, cured in a child
+by circumcision; he operates by incision on the dorsum, in which he
+leaves nature to make away with the flaps, or he circumcises by the
+Bumstead method.
+
+Van Buren and Keyes recommend both the incision on the dorsum and the
+operation of Ricord; where the mucous membrane alone is tight and
+constricted, they follow Cullerier's method of either single or multiple
+incisions of the inner coat. They lay great stress on the necessity of
+keeping the patient quietly in bed to insure rapid and complete union.
+
+My friend, Dr. Robert J. Gregg, of San Diego, has lately operated on a
+number of cases, the operation being perfectly painless, the little
+patients submitting to it and feeling no more pain than if it were
+having its toe-nails trimmed, the local anæsthesia being produced by the
+hypodermatic injection of cocaine. This procedure is now used to a
+considerable extent throughout the country, and it is a far safer and
+more comfortable performance than either etherizing or chloroforming, as
+the sudden and spasmodic filling of the lungs of young children--who
+will resist and hold their breath for a long time, then suddenly
+inhale--with anæsthetic vapor is almost unavoidable, having in two
+instances nearly lost two children from such an accident.
+
+Dr. G. W. Overall, in a late _Medical Record_, which is quoted in the
+_Journal of the American Medical Association_ of February 21, 1891,
+gives the description of a very good and painless method of producing
+this local anæsthesia; for it need hardly be said that with a nervous,
+irritable child the introduction of the hypodermatic needle is as
+formidable an operation as either slitting or the Jewish operation. Dr.
+Overall is in the habit of holding a solution within the preputial
+cavity and then to introduce the needle in the mucous fold, having
+previously applied a light rubber band back of the corona, on the outer
+integument, so as to act like a tourniquet and limit the action of the
+anæsthetic effect to the prepuce. By this procedure he avoids all pain
+and the operation can be performed while the child is even amusing
+itself, care being taken that it does not see it. Sutures that require
+removal should not be used, according to the Doctor, and the operation
+thereby becomes a perfectly painless and unalarming performance to the
+patient in all its details.
+
+
+
+
+NOTES TO TEXT.
+
+
+    [1] "Letters of Certain Jews to Monsieur Voltaire, Containing an
+          Apology for their own People." Pages 451-476. Translated by
+          Dr. Lefann. Philadelphia, 1848.
+
+    [2] "Circoncision chez les Egyptiens." Brochure by F. Chabas. Paris,
+          1861.
+
+    [3] "Atlantis." By Ignatius Donnelly. Page 472.
+
+    [4] _Ibid._, page 115.
+
+    [5] _Ibid._, page 234.
+
+    [6] _Ibid._, page 178.
+
+    [7] "Circumcision." A. B. Arnold. _New York Med. Record_, Feb. 13,
+          1886.
+
+    [8] "Atlantis," page 178.
+
+    [9] This word is, in the Mandan, _Maho-peneta_; in the Welsh,
+          _Mawr-penæthir_. "Atlantis," page 115.
+
+    [10] "Cyclopedia of Biblical, Theological, and Ecclesiastical
+          Literature," vol. viii, page 58. Article, Phallus.
+
+    [11] "Origine, Signification et Histoire, de la Castration, de
+          l'eunuchism, et la circoncision." Par. F. Bergmann. Published
+          in the "Archivio per le Traditione Populaire," 1883.
+
+    [12] "Dictionaire des Sciences Médicales." Par une Société de
+          médecins et de Chirurgiens. Paris, 1826, 60-volume edition.
+
+    [13] Dr. Delange mentions a peculiar social habit or custom among a
+          tribe of Arabians that in a sociological sense is worth
+          mentioning. He observes that for these dances females are
+          preferred, but owing to the peculiar habit about to be related
+          it is impossible to have any of the village women in Algeria
+          assist at this part of the festivities; hence the men have to
+          do the dancing. It appears that the females of one tribe--this
+          being the tribe of Ouleds-Nails, who live on the southern
+          borders of Algiers--are in the habit, when young, of
+          emigrating to the oases of the Sahara, which are occupied by
+          the French and traveling Arabs, where they give themselves up
+          to a life of prostitution. After having exercised this life
+          for some years they return to the tribe with a dowry in money,
+          besides an ample supply of clothes and jewelry,--the result of
+          their economy,--which enables them to contract favorable
+          marriages. This practice is so common in this one particular
+          tribe, and so much have they monopolized the profession of
+          courtesan, that the name of the tribe of Ouleds-Nails is in
+          Arabia synonymous with that of courtesan. These young women
+          dance every evening in the Arab cafés, and are at times
+          employed to do the dancing at Arab feasts. For this reason no
+          self-respecting Arab woman ever allows herself to dance in
+          public, or why the practice of both sexes dancing together is
+          not practiced in Algerian villages, as a man would thereby
+          consider himself disgraced.--Dr. Delange, in _Receuil de
+          Mémoires de Médecine de Chirurgie et de Pharmacie Militaire_,
+          No. 105, August, 1868.
+
+    [14] "Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim
+          Interpretis primarii, De Turcarum Liturgia, peregrinatione
+          Meccana, Circumcisione, Ægrotorum Visitatione," etc. Oxonii,
+          1690.
+
+    [15] Michel Le Feber. "Le Theatre de la Turquie." Paris, 1681.
+
+    [16] "La Circoncision, Sa Signification Social et Religieuse." Par
+          M. Paul Lafargue, in the _Bulletins de la Société
+          d'Anthropologie de Paris_. Tome x, 3d fascicule, Juin à
+          Octobre, 1887.
+
+    [17] "Circumcision." By A. B. Arnold. _New York Med. Record_, Feb.
+          13, 1886.
+
+    [18] Bancroft's "Native Races," vol. ii, page 278.
+
+    [19] "Recherches Philosophiques sur les Americains, ou Memoires
+          Interessants pour servir à l'Histoire de l'Espece Humaine."
+          Par M. de P. Edition par Dom Pernety. Tome ii. Article,
+          Circoncision, Berlin, 1774.
+
+    [20] "The Family, a Historical and Social Study." By Charles
+          Franklin Thwing. Boston, 1887.
+
+    [21] The "Recherches Philosophiques sur les Americains" and Virey,
+          in the 24th volume of the "Dictionaire des Sciences
+          Médicales," are very full on this subject, and for fuller
+          information the reader is referred to those works.
+
+    [22] "Cause Morale de la Circoncision des Israelites, Institution
+          Preventive de l'Onanisme des Enfants." Par le Docteur Vanier,
+          du Havre. Paris, 1847.
+
+    [23] "Annual Report of the Bureau of Ethnology." By J. W. Powell.
+          Washington, 1881, 1882.
+
+    [24] "Among Cannibals, or Four Years' Travels in Australia." By Carl
+          Lumholtz. Page 46. Charles Scribner & Son, 1889.
+
+    [25] These interesting historical facts in relation to the holy
+          prepuce were published in the _Journal l'Excommunier_ in
+          January of 1870, when the writer was in France. They were
+          contributed by A. S. Morin, of Miron, a learned
+          historiographer and antiquary. Europe has not recovered from
+          its love of the supernatural that it had so strongly in the
+          middle ages. The blood of St. Gennaro still liquefies once a
+          year, and many churches still claim to possess the identical
+          winding sheet that served our Lord prior to his resurrection,
+          as well as more than one church has the holy cloth that St.
+          Veronica used on the way to Calvary, which has an impression
+          of the face of the Saviour.
+
+    [26] This church has a remarkable history connected with its
+          foundation. The tradition relates that in the dark ages some
+          sacrilegious soldier had robbed a church in the neighborhood
+          of its holy vessels of gold and silver. In the vessel in the
+          Tabernacle there happened to be a consecrated wafer. The
+          soldier journeyed on to Turin to dispose of his plunder, when,
+          on arriving at the spot on which the church now stands, the
+          wafer is said to have ascended miraculously to some distance
+          above the soldier's head, while at the same time the mule he
+          rode, being imbued with more religious piety than his master,
+          reverently knelt down on his front legs. The holy wafer was
+          now encircled by a halo of shining light; this, with the
+          kneeling donkey and the soldier raining blows on the pious
+          animal, while he himself was unconscious of the presence of
+          the host above him, attracted the attention of the populace,
+          who apprehended the soldier, on whom the stolen vessels were
+          found. The bishop in his pontificial robes, in solemn
+          procession, received the consecrated wafer, which promptly
+          descended into pious hands. The donkey was adopted by the
+          bishop and the soldier was promptly hanged, in accordance with
+          the general treatment of thieves in those days. The writer has
+          more than once seen a flagstone inclosed within a railing that
+          occupies the central spot of the floor or pavement of the
+          church, it being the identical spot on which the donkey knelt.
+
+    [27] Rush's "Medical Inquiries," vol. i, page 217.
+
+    [28] Fothergill. "Gout in its Protean Aspects," page 158.
+
+    [29] "Philosophy of Magic," from the French of Eusebe Salverte, vol.
+          ii, page 143.
+
+    [30] "Dictionaire des Sciences Médicales." Cullerier. Article,
+          Phimosis. Vol. xli.
+
+    [31] Bergmann has gone into this subject at length, and the writer
+          has drawn freely from his brochure on "Castration and
+          Eunuchism," reprinted from the "Archivio per le Traditione
+          Populaire" of 1883.
+
+    [32] "The Hermit." By the Rev. Charles Kingsley. See Introduction.
+
+    [33] "Dictionaire des Sciences Médicales," vol. liv, page 570.
+
+    [34] _Ibid._, page 567.
+
+    [35] _Ibid._, page 570.
+
+    [36] "Cyclopedia of Biblical, Theological, and Ecclesiastical
+          Literature," vol. iii, page 351.
+
+    [37] Smollett gives a good account of the Carthagena expedition in
+          his "Roderick Random," and for a good satisfactory detail of
+          the blundering Walcheren expedition the reader is referred to
+          Harriet Martineau's "History of England," vol. i, pages 269,
+          272, 273, and 354.
+
+    [38] Schoopanism, or pæderastia, is at times practiced by the
+          Omahas, and the man or boy who suffers as the passive agent is
+          called _min-quga_, or hermaphrodite.--"Third Annual Report of
+          the Bureau of Ethnology." By J. W. Powell. Washington, 1881,
+          1882.
+
+    [39] When the missionaries first arrived in this region they found
+          men dressed as women and performing women's duties who were
+          kept for unnatural purposes. From their youth up they were
+          treated, instructed, and used as females, and were even
+          frequently publicly married to the chiefs or great
+          men.--Bancroft's works, vol. i, "Native Races," page 415.
+
+    [40] "Recherches Philosophiques sur les Americains," tome ii.
+
+    [41] "The History of the Hebrew Commonwealth." From the German of
+          John Jahn, D.D. Page 25. Oxford, 1840.
+
+    [42] "L'Hermaphrodite devant le Code Civil." Par le Docteur Charles
+          Debierre. Bailliére et Fils. Paris, 1886.
+
+    [43] "Recherches Philosophiques sur les Americains," tome ii, page
+          78.
+
+    [44] "L'Hermaphrodite devant le Code Civil." Debierre.
+
+    [45] _Occidental Medical Times_, Sacramento, Cal., October, 1890,
+          page 543.
+
+    [46] "Dictionaire des Sciences Médicales," vol. xxxi., page 41.
+
+    [47] _British and Foreign Medico-Chirurgical Review_, vol. xviii,
+          1856.
+
+    [48] "L'Hermaphrodite devant le Code Civil." Debierre.
+
+    [49] Sir Thomas Brown's works, vol. ii, "Religio Medici."
+
+    [50] "The Bible and other Ancient Literature in the Nineteenth
+          Century." L. T. Townsend, D.D. Chautauqua press, 1889. See
+          pages 32-45.
+
+    [51] "The Religions of the Ancient World." George Rawlinson, M.A.
+          Alden edition of 1885. Page 174.
+
+    [52] "The Intellectual Development of Europe." John W. Draper. Vol.
+          ii, page 113.
+
+    [53] _Ibid._ vol. ii, page 122.
+
+    [54] In "Clarke's Commentary," vol. i, page 113, the reason of
+          choosing the eighth day is given. Circumcision was not only a
+          covenant, but an offering to God; and all born, whether human
+          or animal, were considered unclean previous to the eighth day.
+          Neither calf, lamb, or kid was offered to God until it was
+          eight days old.--Lev., xxii, 27.
+
+    [55] A father circumcised his children and the master his slaves. In
+          case of neglect the operation was performed by the magistrate.
+          If its neglect was unknown to the magistrate, then it became
+          the duty of the Hebrew, upon arriving of age, to either do it
+          himself or have it done.--"Clarke's Commentary," vol. i, page
+          113.
+
+    [56] Bishop Newton points out the remarkable analogy that marks the
+          Hebrew race as descendants of Isaac and the Arab race as the
+          descendants of Ishmael, from whom sprung the Saracenic people.
+          These are the only two races that have gone on in their purity
+          from their beginning. They intermarry only among themselves
+          and have, alike, the same customs and habits as their fathers.
+          The sculptured faces of the Hebrew on the Babylonian monuments
+          are the same faces that are met in the synagogues of Paris or
+          New York. So with the descendants of Ishmael, in whom there
+          flows partly the blood of the dominant element of ancient
+          Egypt; neither custom, habit, nor physiognomy have changed. In
+          these two races, as observed by Bishop Newton, we have an
+          ocular demonstration of the Divine origin of our faith, if
+          verification of Scripture history is any criterion.--"Clarke's
+          Commentary," vol. i, page 111; also, Hosmer's "Story of the
+          Jews," page 5.
+
+    [57] "Cause Morale de la Circoncision." Vanier, du Havre. Pages
+          40-45.
+
+    [58] "De la Circoncision." Par le Dr. S. Bernheim. Page 7. Paris,
+          1889.
+
+    [59] "Cyclopedia of Biblical, Theological, and Ecclesiastical
+          Literature," vol. ii, page 350.
+
+    [60] Among the Semitic race, however, it seems possible to bring
+          forward better evidence than this of an early Stone Age. If we
+          follow one way of translating we find, in two passages of the
+          Old Testament, an account of the use of sharp stones or stone
+          knives for circumcision,--Exodus, iv, 25: "And Zipporah took a
+          stone"; and Joshua, v, 2: "At that time Jehovah said to
+          Joshua, Make thee knives of stone." ... The Septuagint
+          altogether favors the opinion that the knives in question were
+          of stone, by reading, in the first place, a stone or pebble,
+          and, in the second, stone knives of sharp-cut stone. These are
+          mentioned again in the remarkable passage which follows the
+          account of the death and burial of Joshua (Joshua, xxiv, 29,
+          30),--"And it came to pass, after these things, that Joshua,
+          the son of Nun, the servant of Jehovah, died, being a hundred
+          and ten years old, and they buried him in the border of his
+          inheritance in Timnath Serah, which is in Mount Ephraim, on
+          the north side of the hill of Gaash." Here follows, in the
+          LXX, a passage not in the Hebrew text, which has come down to
+          us: "And there they laid with him in the tomb, wherein they
+          buried him there, the stone knives wherewith he circumcised
+          the children of Israel at the Gilgals, when he led them out of
+          Egypt, as the Lord commanded. And they are there unto this
+          day." The rabbinical law, in connection with this subject,
+          reads as follows: "We may circumcise with anything, even with
+          a flint, with crystal (glass), or with anything that cuts,
+          except with the sharp edge of a reed, because enchanters made
+          use of that, or it may bring on a disease; and it is a
+          precept of the wise men to circumcise with iron, whether in
+          the form of a knife or scissors, but it is customary to use a
+          knife." This mention of the objectionable nature of the reed
+          as a circumcising medium is attributed to the danger that may
+          arise from splinters. The Fiji Islanders use both a rattan
+          knife and a sharp splinter of bamboo in performing
+          circumcision and in cutting the umbilical cord at child-birth.
+          Herodotus mentions the use of stone knives by the Egyptian
+          embalmers. Stone knives were supposed to produce less
+          inflammation than those of bronze or iron, and it was for this
+          reason that the Cybelian priests operated upon themselves with
+          a sherd of Samian ware (Samia testa), as thus avoiding danger.
+          There seems, on the whole, to be a fair case for believing
+          that among the Israelites, as in Arabia, Ethiopia, and Egypt,
+          a ceremonial use of stone instruments long survived the
+          general adoption of metal, and that such observances are to be
+          interpreted as relics of an earlier Stone Age.--"Researches
+          into the Early History of Mankind." By Edward B. Tylor. Pages
+          217-220. London, 1870.
+
+    [61] The cannibals of Australia do not eat white people, as the
+          flesh of these produces a nausea, which the flesh of the
+          vegetable-fed blacks does not do. The rice-fed Chinese are
+          considered a treat, and these are slaughtered in great number,
+          ten Chinamen having been served up at one dinner.--"Among
+          Cannibals." By Carl Lumholtz. Page 273.
+
+    [62] "Cause Moral de la Circoncision." Par le Dr. Vanier. Page 266.
+
+    [63] _Ibid._, page 288.
+
+    [64] _Cincinnati Clinic_, vol. ii, page 165.
+
+    [65] "The Story of the Jews." Hosmer. Page 263.
+
+    [66] "Traité d'Hygiène, publique et privée." Michel Levy. 2d.
+          edition, vol. ii, page 754.
+
+    [67] _Ibid._
+
+    [68] "Diseases of Modern Life." B. W. Richardson. Page 19.
+
+    [69] "Longevity and other Biostatic Peculiarities of the Jewish
+          Race." By John Stockton Hough, M.D. _New York Med. Record_,
+          1873.
+
+    [70] "Vital Statistics of the Jews." By Dr. John S. Billings. _North
+          American Review_, No. 1, vol. 152, page 70, January, 1891.
+
+    [71] "On Regimen and Longevity." By John Bell, M.D. Page 13.
+
+    [72] _British and Foreign Medico-Chirurgical Review_, vol. xliii,
+          page 539.
+
+    [73] _Ibid._, vol. xlii, page 17.
+
+    [74] In "Influence of the Trades on Health," Thakrah mentions the
+          peculiar exemption enjoyed in this regard by the butcher
+          class. He quotes Tweedie in saying that he never saw a butcher
+          admitted to the fever hospital.
+
+    [75] Lancereaux. "Distribution de la Phthisie Pulmonaire."
+
+    [76] Ashhurst. "Int. Enc. Surgery."
+
+    [77] Horner. "Naval Practice."
+
+    [78] _Cincinnati Lancet and Observer._, vol. xvi, 1873.
+
+    [79] It may well be a question of some interest whether the atrophy
+          of the testicle in the aged may not at times be partly due to
+          the compression exercised by the prepuce on the glans through
+          reflex action, and whether at times the virility that is
+          departing cannot be restored by circumcision in such cases. I
+          have seen such results, being guided to the idea by the
+          Biblical relation in the case of Abraham.
+
+    [80] This patient subsequently died of a uræmic complication
+          following on an attack of fever. The man was in his prime, and
+          had been of most exemplary habits. The fever that he had was,
+          I had every reason to believe, directly due to the results of
+          imperfect blood depuration incident on the irritability of his
+          kidneys, which, retroactively, again allowed the uræmic
+          condition to assume that dangerous degree that suddenly and
+          very unexpectedly to his friends and family ushered the
+          patient into eternity. This man had only been merely
+          inconvenienced by his prepuce up to the time that it caused
+          his death. It is interesting to observe what little trifles
+          bring about the end of some men. The unlucky habit of putting
+          the royal countenance on paper brought Louis XVI to a sudden
+          halt at Varennes, and his head to the scaffold. The lucky
+          meeting of the _aides_ of Bonaparte and Desaix between Novi
+          and Marengo gave to France its empire and to Europe the
+          enlightenment that was diffused by that event. If such trifles
+          affect individuals and nations, we must not be astonished that
+          the little useless prepuce should be endowed with the
+          mischief-working power of the historical old cow and kerosene
+          lamp that reduced Chicago to ashes.
+
+    [81] In the London _Lancet_ for 1885 there is a very interesting
+          communication at page 46 on this subject. There is no doubt
+          but that the prepuce offers the best skin-grafting material.
+
+    [82] In the seventeenth volume (third series) of "Guy's Hospital
+          Reports" there is a most interesting report at page 243 of a
+          case of skin-grafting that was performed by Thomas Bryant. The
+          case was an extensive ulcer resulting from an injury. Bryant
+          took some skin-grafts from the man's arm and some from a
+          colored man in an adjoining bed. The account gives the daily
+          report as taken from the note-book of Mr. Clarke, and is
+          accompanied by a colored plate to illustrate the subject; the
+          proliferation of the black skin is astonishing. In closing the
+          report Mr. Clarke says: "But in the figures depicted the
+          amount of increase in the black patches will be well seen. In
+          ten weeks the four or five pieces of black skin, which
+          together were not larger than a grain of barley, had grown
+          twentyfold, and in an another month the black patch was more
+          than one inch long by half an inch broad, the black centres of
+          cutification having clearly grown very rapidly by the
+          proliferation of their own black cells."
+
+    [83] _American Journal Med. Sciences_, vol. lx.
+
+    [84] "Circumcision." By Dr. A. B. Arnold, of Baltimore.
+
+    [85] "De la Circoncision." By Dr. S. Bernheim. Paris.
+
+    [86] The reader is referred to a very interesting paper detailing
+          conditions of adhesions in the _American Journal Med.
+          Sciences_ for July, 1872. It is taken from the Hungarian of M.
+          Bokai.
+
+    [87] _New York Med. Journal_, vol. xxvi.
+
+    [88] _American Journal Med. Sciences_, vol. lx.
+
+    [89] Dr. Vanier describes this operation of Celsus mentioned by
+          Vidal in his work on "Circumcision," at page 294, which
+          consisted in making, by a circular incision immediately back
+          of the glans, like in a circular amputation, a complete
+          detachment of the integument from back of the corona. The
+          penis was then made to retreat into the sheath thus made and a
+          short catheter introduced into the urethra, to the end of
+          which the free end of the new preputial fold was made fast, a
+          piece of oiled lint being interposed between the raw inner
+          surface and the glans. Another operation consisted in
+          forcibly drawing the integument forward and in making a number
+          of transverse incisions in the integument so as to assist its
+          extensibility. By these means it was drawn sufficiently
+          forward so as to fasten it to a canula or catheter made fast
+          in the urethra. But it can well be imagined that a person must
+          possess the most exalted idea of the physiological needs of a
+          prepuce and feel the most sensitive need of such an appendage
+          to submit to the first of these operations, although it is
+          more than probable that many Jews submitted to the operation
+          in the days of Celsus to avoid being exiled or plundered of
+          all their possessions. The resulting prepuce could not have
+          been a much more unsightly appendage than that which ornaments
+          the overburdened virile organ of many Christians, and there is
+          no doubt but that in many cases they passed muster.
+
+    [90] "Circumcision." Dr. A. B. Arnold.
+
+    [91] Ashhurst. "Int. Enc. Surgery," vol. vi.
+
+    [92] "Pertes Seminales."
+
+    [93] "Circoncision." Dr. Vanier, du Havre.
+
+    [94] "Dictionaire des Sciences Médicales."
+
+    [95] Erichsen's "Surgery," page 1144. Edition of 1869.
+
+    [96] _Medical News_ of Philadelphia, page 115. Vol. for 1860.
+
+    [97] "Pertes Seminales." In the fourth American edition of the
+          English translation of McDougall of Lallemand we find that he
+          fully appreciated the dangers that lurk in a prepuce. At page
+          216 he says: "Such is the condition which the parts present in
+          cases of recent balanitis, and these are the inflammations and
+          ulcerations that cause more or less extensive adhesions of the
+          prepuce to the glans. Such adhesions are generally cellular,
+          but sometimes fibrous or even cartilaginous, according to the
+          severity and frequent repetition of the inflammation. Various
+          degrees of induration also results according to the intensity,
+          the duration, and the frequency of the phlogosis. Thus, I have
+          often found a mucous membrane hardened, thickened, and covered
+          with numerous papillæ, sometimes fibrous or cartilaginous,
+          with three times its natural thickness. I have also met with
+          cases in which the prepuce has become cancerous. I have
+          operated in several cases of cancer of the penis, too, which
+          certainly arose from no other cause. The patients were
+          generally peasants between fifty and sixty years of age, who
+          had never known other than their own wives, but who had
+          frequently suffered from balanitis attended by abundant
+          discharge, swelling of the prepuce, and excoriation of its
+          opening, which was so contracted as to prevent the passage of
+          the glans. I have seen one case, also, in which balanitis,
+          irritated by a forced march and the abuse of alcoholic
+          stimulants, passed into gangrene, by which the greater part of
+          the glans was destroyed. Such have been the accidents which I
+          have observed on those whose prepuce was too narrow to permit
+          the glans being uncovered; accidents which I can only
+          attribute to the long retention of the sebaceous matter in a
+          kind of _cul-de-sac_, into which a certain quantity of urine
+          passes every time the patient makes water."
+
+    [98] Claparède. "La Circoncision."
+
+    [99] Baron Boyer. "Traité des Maladies Chirurgicales," vol. x, page
+          370.
+
+    [100] I have practiced considerably among the Jewish people, but I
+          have never seen their elderly men suffer with prostatic
+          troubles like our own people who are uncircumcised. From
+          having observed the tendency to prostatic complications in
+          young people with troublesome prepuces, and that the great
+          number of the elderly people who are affected with prostatic
+          disease or enlargement are the unlucky possessors of long or
+          large prepuces, I have arrived at the conclusion that the
+          prepuce can be entered as a factor in the etiology of enlarged
+          prostate.
+
+    [101] I have now under my care a poor consumptive who has all the
+          appearance of having always been as virtuous as Joseph, but
+          who, unlike Joseph, has from infancy had as a constant
+          companion a long, miserable, smegmanous, and annoying prepuce.
+          The young man has an oedema which first affected his feet, but
+          one day, owing to the irritation of a slight balanitis, the
+          prepuce swelled at once; it proceeded through the penis
+          integument to the scrotum; the penis itself retracted, leaving
+          the integument and scrotum to assume a translucent, puffy,
+          cork-screw appearance and attitude; from its labyrinthic
+          passage the urine slowly dribbles during urination in a
+          scalding stream. In addition to the physical sufferings, he is
+          tormented by the knowledge that his friends attribute all his
+          disease and troubles--since the occurence of the penile
+          oedema--to the fact that his earlier manhood must have been
+          indiscreet, as well as sinful. The laity cannot connect any
+          penile, scrotal, or testicular disease with anything except
+          venereal disease; and if the physician attempts to explain
+          matters, they simply look upon it as the good-natured and
+          well-intentioned efforts of the doctor to deceive them and to
+          cover up the shortcomings of some frail mortal. Many a poor
+          fellow has to leave this world under a cloud of mistrust and a
+          bad odor of past deviltry to which he is not entitled, and
+          suffer all this in addition to all his physical ills, owing to
+          his having been ornamented through life with an annoying
+          prepuce,--the luckless heritage of having been born a
+          Christian. Columbus in chains moralizing on the ingratitude of
+          this world is nothing to the poor invalid with a swollen
+          prepuce, innocently acquired, silently "cussing" the ignorance
+          of his relatives and friends.
+
+    [102] This patient, on convalescing, suffered considerable from the
+          action of numerous small carbuncles, resulting from the
+          toxæmic condition induced by the partial suppression of urine
+          that he at times suffered from, and, when nearly well, brought
+          on a serious relapse by the mail-bag appendage at the penis
+          working up the organ into a state of erection. While so
+          situated he had intercourse, and from 99° his temperature
+          immediately rose to 104½°, where it remained for several days,
+          lengthening out his illness by several weeks, into a
+          long-protracted convalescence. The man is not yet circumcised,
+          and, from the knowledge that I have of his tendency to uræmia,
+          I feel that, although in his prime, a fever or an accident may
+          take him off at any moment.
+
+    [103] In looking over the literature of reflex neuroses and more
+          direct injurious results, I find that George Macilwain, in a
+          work on "Surgical Observations on the More Important Diseases
+          of the Mucous Canals of the Body," published in London in
+          1830, calls special attention to the case of a man aged
+          thirty-eight, admitted to the Finsbury Dispensary, and who was
+          in the care of Mr. Hancock. The patient was suffering from
+          excruciating pain in different joints, the pain being so
+          great that he was confined to his bed and unable to stand on
+          his feet. He was unable to rest at nights, and neither
+          rheumatic nor any other apparently suitable treatment was of
+          any service. Rigors were soon added to his other troubles, and
+          during their continuance the pain in his joints was greatly
+          aggravated. He was referred to Mr. Macilwain for treatment,
+          who promptly relieved him by the removal of a urethral
+          stricture, which had quietly been the cause of all the
+          disturbance. It is particularly interesting that even at that
+          early day the reflex neuroses and complications that may arise
+          from the irritability of the genito-urinary organs were so
+          well understood. How well Dr. Macilwain appreciated the nicety
+          of these relations can be seen from his remarks in connection
+          with the above case, in which he says: "It may be observed
+          that the severity of the symptoms is not always commensurate
+          either with the duration of the disease or the degree of
+          stricture, and that, although the progressive development of
+          them varies considerably in rapidity, in different
+          individuals, it is, nevertheless, in the latter stages, always
+          more rapid." Macilwain also graphically describes the
+          insidious approach of these genito-urinary troubles. In
+          speaking of stricture he says: "Although minute inquiry
+          generally informs us that the stricture has been of some
+          standing, and in some instances has existed for years, yet it
+          may happen that it is only a few months or a year since the
+          patient's attention has been directed to the disease. This is
+          very intelligible; for, in conformity with what we observe in
+          other parts of the body, the bladder has a power of
+          accommodating itself to a change of circumstances. Its
+          strength, for a long time, may increase so correctly in
+          proportion to the increase of the obstacle which opposes the
+          ejection of its contents that a very considerable period
+          elapses before the difficulty in making water becomes
+          cognizable to the patient, or it occasions an annoyance so
+          trifling as scarcely to excite his attention. This increase of
+          strength in the bladder frequently renders the formation of
+          stricture so insidious that the urethra at the affected part
+          is very narrow before the individual is aware of the existence
+          of any contraction whatever; the bladder, however, at length
+          becomes unable to empty itself, and the abdominal muscles and
+          diaphragm powerfully act as coadjutors, so that each effort to
+          make water is accompanied by a straining which is very
+          distressing, and the complete evacuation of the bladder is
+          often not accomplished even by these combined forces. The
+          straining which accompanies stricture, and which seems
+          necessary to evacuate the bladder, although it be occasionally
+          exceedingly annoying to the patient at the time, is more
+          important with reference to the results which are its
+          consequence. I am firmly of opinion that there are a great
+          number of patients laboring under hernia which has been
+          produced by no other cause. I must confess that I had seen a
+          great number of instances of stricture in ruptured patients
+          before I drew any inference from the observation of their
+          co-existence." The foregoing observations of Macilwain, made
+          in 1830, are here reproduced for their clearness of expression
+          and explanation, as well as to show what injuries can be
+          produced on the young child afflicted with phimosis. We are,
+          as surgeons, familiar with the anatomical and pathological
+          changes there are undergone by the bladder and its lining
+          membrane, as well as in the ureters and kidneys, in many
+          cases of stricture, as well as of the great amount of
+          prostatic irritability and enlargement that is due to the same
+          cause. How similarly these results can be and are actually
+          produced by phimosis is undeniably expressed by the
+          post-mortem appearances in the poor infant described by
+          Golding Bird to the London Medical Society, and mentioned in
+          the London _Lancet_ of May 16, 1846. The bladder and ureter
+          were like those of a man who had long suffered from stricture.
+          From the remarks of Dr. J. Lewis Smith, that phimosis may be
+          productive of inguinal hernia and prolapsus of the rectum, and
+          the observations of Edmund Owens and Arthur Kemp, both high
+          authorities on children's diseases, being both connected with
+          children's hospitals, as well as the remarks of Mr. Bryant in
+          his "Surgical Diseases of Children," who all concur in looking
+          upon phimosis as a great factor in hernia, Bryant having
+          observed thirty-one in fifty consecutive cases of phimosis, we
+          are certainly warranted in assuming that phimosis is not only
+          a mere local timely inconvenience that will disappear with the
+          approach of puberty, but a condition which, in the more easily
+          affected organism of the child,--lacking, as it does, that
+          resistance that comes with our prime,--is productive of
+          serious harm; as even the first few years of life, even a few
+          months of infant life, with a phimosis, are sufficient to so
+          change the structures of parts that the poor child will grow
+          into a man with an impaired kidney or sacculated ureter. The
+          strain required to induce a prolapsus of the bowel or a
+          rupture into the inguinal canal is exerted as much on the
+          bladder, ureter, and kidney as on the other localities.
+          Physicians who have taken the pains to observe must have
+          noticed, more than once, how the child afflicted with a
+          phimosis has not only at times to wait for the stream of urine
+          to appear, there seemingly being some obstruction to its
+          starting, but how often such a case is afflicted with a
+          stammering, halting urination. A child thus started out into
+          life, with a defective kidney or kidneys, is sadly handicapped
+          in his usefulness, comfort, or in properly competing in the
+          race of life. No parent would for a moment think of starting
+          his son in life by giving him a business that is heavily
+          mortgaged at the start, but many a parent unconsciously
+          launches the unsuspecting child into a life of such ill
+          health--resulting from a simple narrow prepuce--beside which a
+          heavy mortgage or a heavy yearly tribute would be but a mere
+          trifle. I have seen such men, who in after life, broken-down
+          and perfectly physical wrecks, would gladly have given all
+          their wealth and been willing to have some genii set them down
+          in the middle of the Sahara, shirtless and pennyless, provided
+          they had their health. To say nothing of the trifling loss of
+          the prepuce, these parties would gladly have had a foot or a
+          leg go with the prepuce if necessary, and have their health.
+
+    [104] I have often performed dilatation where, for some reason,
+          either the timidity of the parents or the health of the child
+          seemed to contraindicate any more radical procedure. It is
+          customary to advise mothers or the nurses to retract the skin
+          daily, but even after a good dilatation I have found as sudden
+          a recontraction, and even in the majority of cases, where
+          daily drawing back the skin might have been practicable, the
+          cries and struggles of the child are a positive prohibition to
+          these instructions being carried out; it is not once in ten
+          times that it can be carried out. I have seen two very
+          annoying cases of paraphimosis resulting from this procedure,
+          the struggles of the child having prevented the return of the
+          prepuce to its proper place, and the violent crying and
+          sobbing of the child having assisted to congest the organ.
+
+    [105] It may well be a question, considering the well-established
+          fact that nervous injuries and affections are easily
+          transmissible and become hereditary, how much
+          feeble-mindedness is due to an heredity originally induced in
+          either parent through reflex neuroses from the genital organs.
+          The Jews have a very small percentage of feeble-minded; it is
+          true that they have not any inebriates to assist in their
+          manufacture, but still the absence of these well-pronounced
+          cases of reflex neuroses among the race must be largely
+          ascribed to their practice of circumcision, as that operation
+          cures the gentiles so afflicted.
+
+    [106] I have seen precisely similar conditions resulting from a
+          sphincterismus being relieved by anal dilatation. I had one
+          such case who had fallen into the hands of a quack, who made
+          him believe that he was being affected with incipient
+          softening of the brain; systematic dilatation or a rupture of
+          the sphincter _à la_ Van Buren is the appropriate remedy.
+
+    [107] In the first volume of the "American and English Encyclopedia
+          of Law" there is an interesting account of a young child (who
+          had been bound out by the parish officials) who murdered his
+          little bed-fellow and, on trial and conviction, was sentenced
+          to be hanged, but who was reprieved by royal favor on account
+          of his tender years, the sentence being changed to
+          imprisonment for life. The little fellow was only eight years
+          of age. On the trial the boy said he was driven to commit the
+          crime because the other child soiled the bed. The two children
+          being both paupers, it may well be imagined that their bedding
+          was none of the cleanest at the best, or that their bed-room
+          had the best of ventilation. As at the time the murder was
+          committed English paupers were not treated in the most humane
+          manner, it is not surprising that a nervous, sensitive child
+          would, under such a combination of circumstances, be converted
+          into an insane murderer.
+
+    [108] The study of prematurely acquired impotence in the male is a
+          most interesting one. I have frequently seen it result from
+          the presence of anal or rectal irritation, from hæmorrhoids. I
+          have seen cases who could not have erections, and in whom all
+          sexual desire was extinct at a very early age, who have
+          informed me that, although unable to have sexual intercourse
+          because of the total absence of sexual desire, the flaccidity
+          of the organ, and the want of sound physiological organic
+          functional activity to suggest the thought, they had,
+          nevertheless, frequently been the victims of nocturnal
+          emissions before the total extinction of the function. As a
+          rule, much of this premature impotence--induced by either
+          irritation of the genital organs or rectal or anal
+          troubles--runs its unfortunate possessor through such a course
+          of physical incidents as described by Hammond, as the wild
+          Indians of the Southwest induce in the _mujerado_. At first
+          the sound organ responds in a natural manner to any stimulus
+          that may affect it, but soon a local satyriacal condition is
+          set up, which, running a more or less rapid period of intense
+          activity, soon leaves its victim completely, permanently, and
+          hopelessly impotent, even as much so as if eunuchized in the
+          most approved manner. Hammond's description of the manner in
+          which these unfortunates are manufactured is an interesting
+          addition to the facts contained in the natural history of man,
+          and is as follows: "A _mujerado_ is an essential person in the
+          saturnalia, or orgies, in which these Indians, like the
+          ancient Greeks, Egyptians, and other nations, indulge. He is
+          the chief passive agent in the pederastic ceremonies which
+          form so important a part in the performances. These take place
+          in the spring of every year, and are conducted with the utmost
+          secrecy, as regards the non-Indian part of the population. For
+          the making of a _mujerado_ one of the most virile men is
+          selected, and the act of masturbation is performed upon him
+          many times every day; at the same time he is made to ride
+          almost continuously on horseback. The genital organs are thus
+          brought, at first, into a state of extreme erethism, so that
+          the motion of the horse is sufficient to produce a discharge
+          of seminal fluid, while at the same time the pressure of the
+          body on the animal's back--for the riding is done without a
+          saddle--interferes with their proper nutrition. It eventually
+          happens that, though an orgasm may be caused, emissions can no
+          longer be effected, even upon the most intense degree of
+          excitation. Finally, the accomplishment of an orgasm becomes
+          impossible; in the meantime the penis and testicles begin to
+          shrink, and in time reach their lowest plane of degradation.
+          But the most decided changes are at the same time going on,
+          little by little, in the instincts and proclivities of the
+          subject. He loses his taste for those sports and occupations
+          in which he formerly indulged, his courage disappears, and he
+          becomes timid to such an extent that, if he is a man occupying
+          a prominent place in the council of the pueblo, he is at once
+          relieved of all power and responsibility, and his influence is
+          at an end. If he is married his wife and children pass from
+          under his control,--whether, however, through his wish or
+          theirs, or by the orders of the council, I could not
+          ascertain. They certainly become no more to him than other
+          women and children of the pueblo." Hammond examined one of
+          these men, who had, as he himself informed him, formerly
+          possessed a large penis and testicles "grande como
+          huevos,"--as large as eggs. The penis was in its flaccid state
+          and about an inch and a half in length, with the glans about
+          the size of a thimble, which it very much resembled in shape.
+          The glandular structure of the testicles had disappeared; they
+          were atrophied, little besides connective tissue remaining. He
+          examined another _mujerado_ in the pueblo of Acoma, who had
+          been so made when at about the age of twenty-six. The penis
+          was not more than an inch in length and about the diameter of
+          the little finger, and of the testicles there was apparently
+          nothing left but a little connective tissue. Both of these men
+          had high-pitched voices. The last one examined was then
+          thirty-six years of age. (Hammond: "Male Impotence.") The
+          foregoing detailed description shows an extreme degree of
+          results produced by an equally extreme degree of intense and
+          persistent irritation applied to the genital organs, purposely
+          employed to obtain certain results. In the cases cited the
+          irritation or excitation is directly applied, but it is safe
+          to assume that reflex irritability from the anus or rectum,
+          or from that of a stricture or of a prepuce, will in some
+          cases produce a certain degree of excitation in the testicles
+          that may result in their functional or organic derangement, in
+          a degree proportionate to that of the amount of excitation
+          from which they have suffered. That the testicles are very apt
+          to suffer from the existence of a stricture is a well-known
+          fact. I have myself worried over a case of stricture, in whom
+          the attempted passage of a filiform bougie was always
+          immediately followed by a severe attack of epididymitis, and
+          who had always been afflicted with a tenderness and a tendency
+          to inflammation of the testes. I have also noticed a much
+          greater tendency to orchitis in the wearer of an irritating
+          prepuce than where it was absent; so that the presence of a
+          satyriacal tendency, no matter in what proportion of a degree
+          it may be present, can safely be assumed to result in a
+          corresponding degree of apathy, due to an actual physical
+          degeneration of the parts. That these conditions, when present
+          in any degree of permanency or persistence, will in the end
+          induce early impotence, I have no reason to doubt. In this
+          regard we must not overlook the fact that persons with
+          phimosis, stricture, or other genital irritants and
+          impediments, are more liable to be afflicted with hæmorrhoids,
+          prolapsus ani, or other anal and rectal irritation, which
+          retroactively assist in bringing about the condition under
+          question. How much this may have to do with certain prolific
+          peculiarities among the Jews may well be questioned; it is a
+          well-known fact that in London the Jewish excess of male
+          births has been as high as eighteen per cent., while among the
+          Christian or Gentile population it is only six and one-half
+          per cent.,--a somewhat analogous condition of proportion being
+          also observable in the United States. Here, it is accounted
+          for, in a measure, by Dr. Billings, in the following words:
+          "This comparatively large proportion of males among the Jews
+          is probably due to the fact that the death-rate of their
+          infants is less for males, as compared with females, than it
+          is among the average population." Children gotten during the
+          prime of life of the parents are naturally more virile and
+          have better stamina than those gotten before full maturity is
+          reached. If the father is on the verge of impotency just about
+          the time he is expected to beget his best offspring, that
+          offspring cannot be expected to present an extra amount of
+          vitality, virility, or physical stamina; hence, the prepuce
+          can be brought in as directly tending--in no matter how small
+          the degree it may be, but nevertheless a factor--to the
+          physical degeneracy of the race, as well as it demonstrates
+          the existence of some law for the production of the sexes
+          which we do not as yet fully comprehend. Aside from the above
+          considerations, there are those of the actual bar to the
+          increase of population which the prepuce induces, either by
+          primarily being the cause of impotence or by direct
+          interference, as already mentioned, and the impotence that
+          naturally results from the causes set forth in this note. The
+          results of a prepuce are certainly such as must act like a
+          moist, warm, and oily poultice to the irritability induced in
+          the most confirmed Malthusian when contemplating the--to
+          him--rapid and unwarranted increase of population.
+
+
+
+
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+
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+
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+Consideration sur le Phimosis et Operation de la Circoncision par un
+procédé nouveau. Strasbourg, 1851.
+
+De la Circoncision chez les Egyptiens. F. Chabas. Paris, 1861.
+
+Cause Morale de la Circoncision des Israelites. Vanier, du Havre. Paris,
+1847.
+
+La Circoncision, son importance dans la Famille et dans l'Etat. Par le
+Docteur Claparéde. Paris, 1861.
+
+Dissertation sur la Circoncision, sons les rapports religieux,
+hygieniques, et Pathologiques. Par le Docteur Moyse Cahen. Paris, 1816.
+
+Origine, Signification, et Histoire, de la Castration, de l'Eunuchisme,
+et de la Circoncision. Par le Docteur F. Bergmann de Strasbourg.
+Archivio per le Tradizioni Populari, vol. ii.
+
+Darstellung der Biblichen Krankheiten. Von Dr. J. P. Trusen. Posen,
+1843.
+
+Archives Israelites de France, No. 9, 4em année, Septembre, 1843.
+
+Bulletins de la Société d'Anthropologie de Paris. Tome x (serie iii), 3d
+fascicule, Juin à Octobre, 1887.
+
+Recueil de Mémoires de Médecine, de Chirurgie, et de Pharmacie
+Militaires. Tome xxi (serie iii), No. 105, August, 1868.
+
+Traité d'Hygiène, publique et privée. Michel Levy. 2d ed. Paris, 1850.
+
+Neuroses des Organes Génito-Urinaires de l'homme. Ultzmann. Paris, 1883.
+
+L'Hermaphrodisme, sa Nature, son Origine, ses Consequences Sociales. Par
+le Docteur Charles Debierre. Paris, 1886.
+
+L'Onanisme. Tissot. Lausanne, 1787.
+
+Traité de la nymphomanie. Dr. Bienville. Amsterdam, 1784.
+
+La Folie Erotique. Par Prof. B. Balt. Paris, 1888.
+
+Des Pertes Seminales Involontaires. Lallemand. Paris, 1836.
+
+Spermatorrhoea. Lallemand and Wilson. Philadelphia, 1861.
+
+The Philosophical Dictionary. Voltaire. London, 1765.
+
+Oeuvres Complétes, avec notes, etc. Montesquieu. Paris, 1838.
+
+Dictionaire d'Hygiène, publique et de salubrite. Tardieu. Paris, 1862.
+
+Guide du Posthétomiste. Par le Docteur L. Terquem. Paris.
+
+La Circoncision et ses suites. Par A.S. Morin. Ext. du Journal
+l'Excommunié, January, 1870.
+
+La Circoncision. Par le Docteur S. Bernheim.
+
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+York Medical Journal of February 13, 1886.
+
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+
+Recueil de Questions proposés par une Société de savants voyageant an
+Arabie, Michealis. Amsterdam, 1774.
+
+Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim Interpretis
+primarii, De Turcarum Liturgia, peregrinatione Meccana, Circumcisione,
+Ægrotorum Visitatione, etc. Oxonii, 1690.
+
+Le Theatre de la Turquie. Michel Le Feber. Paris, 1681.
+
+Recherches Philosophiques sur les Americains, ou Mémoires Interessants
+pour servir à l'Histoire de l'Espece Humaine. Par M. de P. Augumentée
+par Dom Pernety. Berlin, 1774. (Also the first edition of the same work
+printed at Cleves in 1772.)
+
+History of the Hebrews' Second Commonwealth. Wise. Cincinnati, 1880.
+
+History of the Hebrew Commonwealth. Jahn. Oxford, 1840.
+
+Jews' Letters to Voltaire. Philadelphia, 1848.
+
+The Jewish Nation. Revised by Kidder. New York, 1850.
+
+The Jews Under Roman Rule. By W. D. Morrison. New York, 1890.
+
+The Story of the Jews. By James K. Hosmer. New York, 1887.
+
+The History of the Jews. By the Rev. H. H. Milman. New York, 1843.
+
+Early Oriental History. By John Eadie, D.D., LL.D. London, 1852.
+
+The Bible and the Nineteenth Century. By L. T. Townsend, D.D. New York,
+1889.
+
+Legends of the Patriarchs and Prophets. By the Rev. S. Baring-Gould. New
+York, 1884.
+
+The Religions of the Ancient World. By George Rawlinson, M.A. New York,
+1885.
+
+The Hermits. By the Rev. Charles Kingsley. New York, 1885.
+
+Letters on Demonology and Witchcraft. Letters addressed to J. G.
+Lockhart, Esq., by Sir Walter Scott. London, 1831.
+
+The Philosophy of Magic, Prodigies, and Apparent Miracles. From the
+French of Eusebe Salvert. New York, 1855.
+
+Atlantis, the Antediluvian World. Donnelly. New York, 1882.
+
+Sir Thomas Browne's Works. London, 1852.
+
+Physical Education, or the Health Laws of Nature. By Felix Oswald, M.D.
+New York, 1882.
+
+The Family: an Historical and Social Study. By Thwing. Boston, 1887.
+
+The Intellectual Development of Europe. By John W. Draper, M.D. New
+York, 1876.
+
+History of European Morals. By W. E. H. Lecky, M.A. New York, 1884.
+
+Longevity and other Biostatic Peculiarities of the Jewish Race. By John
+Stockton Hough. Reprinted from New York Medical Record, 1873.
+
+Vital Statistics of the Jews. By Dr. John S. Billings, in North American
+Review for January, 1891.
+
+On Regimen and Longevity. By John Bell, M.D. New York, 1842.
+
+Diseases of Modern Life. By B. W. Richardson, M.D. New York, 1876.
+
+Cyclopedia of Biblical, Theological, and Ecclesiastical Literature. By
+McClintock and Strong. New York, 1886.
+
+Early History of Mankind. Tylor. London, 1870.
+
+Dictionaire des Sciences Médicales. 60-vol. edition. Paris, 1816.
+
+British and Foreign Medico-Chirurgical Review, vols. for 1846, 1854,
+1856, 1858, 1863, 1868, and 1869. London.
+
+Braithwaite's Retrospect of Medicine and Surgery.
+
+The Chinese. By John Francis Davis, Esq., F.R.S. London, 1851.
+
+Massachusetts State Board of Health Report for 1873.
+
+On Diseases of Children. Stewart. New York, 1844.
+
+Diseases of Children. West. Philadelphia.
+
+Lectures on Diseases of Children. Henoch. New York, 1882.
+
+Women's and Children's Diseases. Dillnberger. Philadelphia, 1871.
+
+Male Impotence. Hammond. New York, 1883.
+
+Genito-Urinary Diseases. Otis. New York, 1883.
+
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+
+Urinary and Renal Disorders. Beale.
+
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+
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+
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+
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+1850.
+
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+
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+
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+
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+Washington, 1887.
+
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+
+On the Reproductive Organs. Acton. Philadelphia, 1883.
+
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+
+Operative Surgery. Stephen Smith. Philadelphia, 1887.
+
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+
+Principles and Practice of Surgery. Agnew. Philadelphia, 1881.
+
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+
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+
+Diseases of the Kidneys. Ralfe. Philadelphia, 1885.
+
+The Clinic. Cincinnati, 1872.
+
+American Journal of the Medical Sciences for July, 1872; also vol. lx.
+
+New York Medical Journal, vols. xvi, xix, xxvi.
+
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+
+London Lancet, 1875.
+
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+1877.
+
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+1884.
+
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+
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+
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+
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+
+Commentary on the Bible. Clark.
+
+Satellite for February, 1889, and January, 1891. Philadelphia.
+
+Pedigree of Diseases. Hutchinson.
+
+Medical Inquiries. Rush. Philadelphia.
+
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+Philadelphia.
+
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+
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+
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+
+
+
+
+INDEX
+
+
+Abolishment
+  of circumcision by Christians, 18;
+    by the Romans, 66
+  of eunuchism in Italy, 91, 96
+
+Abraham, 32
+
+Absence of penis, 13
+  of testicles, 105
+
+Abyssinians, carry off the male members of slain enemies, 30;
+  circumcised bishop among the, 64
+
+Acosta, Rev. Father, on Mexican circumcision, 47
+
+Adams, Dr. C. Powell, of Hastings, Minn., 198
+
+After-treatment of circumcised Hebrews, 158
+
+Agnew, D. Hayes, on penile cancer, 230;
+  on eczema as a reflex neurosis from phimosis, 320
+
+Albutt, T. Clifford, on primary cause of disease, 13
+
+American circumcision, 47;
+  infibulation and muzzling, 48
+
+Amputation of penis, 230, 233, 247
+
+Androgynes, 118
+
+Augleria, Pierre d', on American circumcision, 47
+
+Apis, the white bull, sacred to the Egyptians, 29
+
+Apollo Belvidere, as evidence of exactness of ancient sculpture, 62
+
+Apure Indians and their circumcision, 48
+
+Arabian circumcision, 38;
+  prostitutes, 323
+
+Arias Montan, on Mexico, 46
+
+Arnold, Dr. A. B., of Baltimore, 25, 219, 220, 223
+
+Asthma as a reflex neurosis from genital irritation, 291
+
+Australian circumcision, 44;
+  operation on the urethra, 56
+
+Author's modification of circumcision, 307
+
+Aztec circumcision, 46
+
+
+Ballance, C. W., dressing after circumcision, 317
+
+Bamboo stick worn in vagina as a chastity protector, 52
+
+Baptismal ceremonies of Omaha Indians, 56
+
+Barbarous Arabian marriage custom, 54
+  mutilations of Guamo and Othomaco Indians, 48
+
+Bas-relief representing Egyptian emasculation, 31
+
+Bassouto circumcision, 42
+
+Battos circumcision, 45
+
+Baumgartner's devout and chaste dervish, 49
+
+Beale, Sir Lionel, on blood changes, 296
+
+Bell, Dr. John, on Jewish hygiene, 181
+  Dr. J. Royes, 191, 223, 229, 239
+
+Bells, jingling of, under the skirts, denotive of Judean virginity, 52
+
+Belt of brass mail to insure female chastity, 51
+
+Berbers, mutilations of their prisoners, 30
+
+Bergmann, of Strasburg, 20, 27
+
+Bergson, Dr., 160
+
+Bernbeim, Dr., on freedom of Jews from syphilis, 195;
+  on preputial statistics, 220;
+  on circumcisial operation, 312
+
+Bernoulli, Prof., of Bale, 168
+
+"Beth Yosef" of Joseph Karo, 153
+
+Biblical vouching for homoeopathy, 113
+
+Billings, Dr. John S., U. S. Army, on Jewish vital statistics, 174;
+  on cancer amongst Jews, 230
+
+Bird, Dr. Golding, on phimosis, 257
+
+Bishop of Abyssinia accused of heresy on account of circumcision, 64
+
+Blood of prepuce sprinkled on bride's veil, 55;
+  sprinkled on ears of corn, 56
+  changes as starting-points of disease, 293, 298
+
+Bobovii, Alberti, on Mohammedan circumcision, 39
+
+Bogera, or African circumcision, 44
+
+Bokai, on preputial statistics, 220
+
+Bornean circumcision, 45
+
+Bowditch, Henry I., on Jewish vital statistics, 176
+
+Boyer, Baron, on cancer of the penis, 232;
+  on gangrene of the penis, 237
+
+Brett, Dr. F. H., case of hypertrophy of prepuce, 251
+
+Bryant, Thomas, on skin-grafting, 328
+
+Bumstead, on circumcision, 310
+
+Burial of Algerine prepuces in the sands of the deserts, 39
+
+
+Cahen, Dr., on diminished sensibility of glans after circumcision, 224
+
+Calculus, liability of the Chinese to preputial, 248;
+  Dr. J. G. Kerr, on preputial, 248;
+  C. H. Martin, of Mobile, on climatic influence on, 248;
+  Prof. Enoch, of Berlin, on preputial and vesical calculi, 249;
+  Claparède's case, 249;
+  composition of preputial, 249;
+  Civiale's case, 249;
+  induced by phimosis, 287
+
+Canary Islands, remains of an antediluvian world, 25
+
+Cancer of the penis, 232;
+  views of Jonathan Hutchinson as to its origin, 226;
+  pre-cancerous stage of, 226;
+  views of Lallemand, 228, 329;
+  statistics of, 231;
+  Cullerier on, 231;
+  fifty cases reported by Dr. Zielewicz, 233;
+  early mention of, 234;
+  views of Prof. John C. Warren, 235;
+  views of Walshe, 235
+
+Canon of St. John Lateran and his profane doubts, 74
+
+Carter, Dr. Wm., on toxic urines, 298
+
+Casalis, M., on Bassouto circumcision, 42
+
+Cases of spontaneous circumcision, 58
+
+Castration, etymology of the term, 80;
+  as a self-sacrifice to deities, 89
+
+Celsus, on Roman infibulation, 50;
+  on operations on the prepuce, 302, 313, 328;
+  originator of Cloquet's operation, 313
+
+Chabas, M., description of Egyptian _bas-relief_, 23
+
+Charlemagne endows an abbey with a holy prepuce, 72
+
+Charles V sacks Rome, and robbery of the holy prepuce, 73
+
+Chastity among Egyptian dervishes, 49;
+  belt of brass mail of the Ethiopians, 51;
+  plug of bamboo of Soudan, 51;
+  rings to insure chastity in the male mentioned by Nelaton, 54;
+  enforced among the Hindoo bonzes by infibulation, 54;
+  among the Cybelian priesthood, 89;
+  Greek monks, ideas of, 89;
+  comparative, among the different religious creeds of Prussia, 195
+
+Chinese, peculiar liability of, to calculous disease, 248;
+  considered a delicate diet by Australian cannibals, 327
+
+Chippeway Indians and circumcision, 23
+
+Chivalry of the male Hottentot, 60
+
+Christian abolishment of circumcision, 18;
+  circumcision in Abyssinia, 63
+
+Circumcised phallus as a religious and civic symbol, 35;
+  races peculiarly exempt from syphilis, 192
+
+Circumcising knife (see Knife).
+
+Circumcision, abolished by Christians, 18;
+  among Chippeway Indians, 23;
+  among the Atlanteans of Plato, 23;
+  among the Phoenicians, 34;
+  among the Egyptians, 34;
+  Arabian, 35, 54;
+  during the reign of Psammétich, 34;
+  civil and religious symbol of ancient Egypt, 35;
+  Aztec, 46;
+  among the Mijes, 46;
+  Mexican, 46;
+  Totonac, 46;
+  among the Orinoco Indians, 47
+  the climatic limits of, as a general rite, 47;
+  in the Island of Cosumel, 47;
+  in Yucatan, 47;
+  in old Florida, 47;
+  Apure Indians, 48;
+  among the Amazons, 56;
+  accidental case of, mentioned by Cullerier, 57;
+  spontaneous, 58;
+  abolished by the Romans, 66;
+  destroying marks of, 68;
+  of Abraham, 143;
+  Hebraic, 143;
+  not practiced in the wilderness, 143;
+  physical conditions that exempt Jewish children from, 144, 145;
+  description of Hebraic, by Montaigne, 146;
+  as a cure for epilepsy, 261;
+  as a preventive of hernia or rupture, 263;
+  as a preventive to prolapsus of the bowel, 263;
+  as a preventive of idiocy, 266;
+  as a cure for dyspepsia, 270, 271
+
+Civiale, on moral effects of penis amputation, 247;
+  case of phimosis and preputial calculi, 249
+
+Claparède, on evils resulting from the prepuce, 229;
+  on preputial calculi, 249
+
+Clarke, Sir Andrew, on renal inadequacy, 300
+
+Clavigero, on Mexican circumcision, 46
+
+Climatic limits of circumcision, 65
+
+Cloquet operation, 306, 316
+
+Colchis, colony of, 33
+
+Constantine punished circumcisers with death, 66
+
+Constipation as a divine attribute, 288;
+  as a result of phimosis and its results, 292
+
+Consumption, relation of, to Jewish race, 178, 179
+
+Controversy about the holy prepuce, 73
+
+Convent of St. Corneille and the holy knife, 78
+
+Convulsions induced by phimosis, 260, 261
+
+Cullerier, accidental circumcision, 57;
+  on penile cancer, 231
+
+Cybelian priesthood and castration, 89
+
+
+Dakotas, the white bull sacred among the, 26
+
+David and the Philistine prepuces, 31
+
+Debreyne, trappist, monk, and physician, 224
+
+Delange, on Arabian circumcision, 37
+
+Delpech, on female circumcision, 36
+
+Demarquay, on penile gangrene, 236
+
+Dervishes, holy and chaste, 49
+
+Difference between Turkish and Buddhist heaven, 116
+
+Dilatation of prepuce, 308, 312, 332
+
+Donnelly, Hon. Ignatius, on Atlantean circumcision, 23
+
+Dressing in cases of retraction of penile skin, 304;
+  C. W. Ballance's, after circumcision, 317;
+  A. G. Miller's, 318
+
+Du Bisson, on Soudanese harems, 52
+
+Dyspepsia induced by preputial irritation, 270, 271
+
+
+Ebers, Dr., on Karnac _bas-relief_, 23
+
+Eczema induced by phimosis, 320
+
+Effect of the holy prepuce on the hands of a lady, 74
+
+Effects of age on the prepuce, 285
+
+Egypt, uncircumcised persons not allowed to study in ancient, 34
+
+Egyptians emasculated their prisoners, 30
+
+Emasculation, its early practices and evolutions, 29;
+  of Uranos, 83
+
+Emperor Adrian forbids circumcision, 66
+
+Endurance and fortitude of Arabs, 55
+
+Enforced continence and its effects on the penis, 61
+
+Ennery, M., Grand Rabbi of Paris, 158
+
+Enoch, Prof., of Berlin, on preputial calculi, 249;
+  on results of phimosis, 266;
+  on enuresis, 277
+
+Enuresis, 275
+
+Epilepsy, induced by the prepuce, 258, 261, 301
+
+Epstein, Dr., of Cincinnati, 156
+
+Erichsen, Prof., on cancer of the penis, 228
+
+Ethics at the battle of Fontenoy, 76
+
+Ethiopian infibulation of infant females, 51
+
+Eunuchism, beneficial to guardians of public funds, 84;
+  as excluding from the priesthood, 90;
+  in Italy, 91;
+  in China, 91, 93;
+  in India, 92;
+  in the Soudan, 99;
+  and music, 94;
+  as a punishment, 97;
+  mortality attending its manufacture, 91, 92, 93, 99, 100, 107;
+  does not prevent copulation at all times, 92, 100, 101, 102, 103;
+  manner of procedure among the Pagan priesthood, 106;
+  prices of eunuchs, 99;
+  numbers annually made, 91, 98;
+  fecundating eunuch of Mecca, 100;
+  Velutti, the opera-singer, 102;
+  eunuchs as possessors of harems, 90;
+  eunuch warriors and statesmen, 90
+
+Evidence of circumcision on Egyptian monuments, 23
+
+Extraordinary results of phimosis, 282
+
+
+Female circumcisers in Arabia, 36
+
+Females subject to preputial reflex neuroses, 267, 268
+
+Flaccourt, M. Martin, account of the Madécasses, 54
+
+Fothergill and the unlicensed practitioner on renal pathology, 77
+
+French war-office records, on Jewish vital statistics, 175
+
+Frenum, statistics relating to abnormalities of, 221
+
+Frerichs' ammoniæmia, 300
+
+Fresnel, M., on marriage circumcision, 54
+
+Full-moon rites among the Bassouto maidens, 44
+
+
+Galen, on the flaccid virile member, 60, 61
+
+Gangrene of the penis, 236
+
+Golden padlocks worn on prepuce for five years, 54
+
+Greek and Roman statuary and the penis, 60
+
+Greek monks' object in infibulations, 54;
+  extreme ideas of chastity, 89
+
+Gregg, Dr. Robert J., operative procedure, 320
+
+Griffith, Dr. J. D., cases of reflex irritation, 261
+
+Gross, Prof. S. D., on penile cancer, 230;
+  operations, 320
+
+Grotius and the origin of the Peruvians, 46
+
+Guimara, the, 153
+
+Guinzburg, Dr., on Jewish vital statistics, 176
+
+Gumilla and his South American voyages, 47
+
+
+Hæmostatic powders, 160
+
+Hare, Prof. Hobart A., on circumcision, 301
+
+Haskins, Dr. A., on Jewish vital statistics, 176
+
+Heaven, Turkish, 115;
+  Buddhist, 116
+
+Hebraic idea of parental origin of constitution of the child, 144
+
+Hebrew Consistory of Paris, 157
+
+Hebrew words in Central American languages, 24
+
+Hebrews, attempts to efface signs of circumcision, 69;
+  secretly circumcise their dead, 68;
+  Hebrew vital statistics, 169 to 179;
+  as proverbial good livers, 171;
+  escape epidemics, 173;
+  peculiarly free from syphilitic taint, 191;
+  their circumcision suitable to young children, 306
+
+Heliogabalus, Emperor, was circumcised, 66
+
+Henry III of France as a Moslem godfather, 64
+
+Henry V of England and the holy prepuce, 71
+
+Heraclius, Emperor, persecuted the Jews, 67
+
+Hermaphrodites, earliest mention of, 117;
+  pederasty causes belief in their existence, 118, 119, 120;
+  Debierre on, 123;
+  notable cases of, 124, 125, 127, 128
+
+Hernia induced by phimosis, 263
+
+Herodotus, his views adopted by Voltaire, 22;
+  visits Egypt, 34
+
+Herrera, on Mexican circumcision, 47
+
+Hey, Dr. William, on preputial cancer, 227
+
+Hindoo devotee wears a six-inch ring in prepuce, 54
+
+Hitouch, 156
+
+Holgate, Dr., of New York, on preputial adhesions, 220;
+  on preputial dilatation, 308
+
+Holy circumcision, 70, 78
+  prepuces, 70, 72
+  vinegar and its miraculous effects, 79
+
+Homer, Surgeon U. S. Navy, on the worship of Venus Porclna, 193
+
+Horrible marriage performance, 54
+
+Hottentot restriction on making twins, 60
+
+Hough, Dr., on Jewish longevity, 173
+
+Humphry, Geo. Murray, on "Old Age," 14
+
+Hutchinson, Dr. Jonathan, on the pre-cancerous stage of cancer, 226;
+  on urethral child, 300
+
+Hypospadias, as a heredity, 129;
+  artificially made, 56;
+  formerly led to belief in hermaphrodism, 129;
+  fecundation in, 129;
+  difficulty in determining sex owing to, 131
+
+
+Idiocy induced by phimosis and preputial adhesions, 265, 269
+
+Impious wretch steals the holy prepuce, 74
+
+Impotence, holy vinegar and shrinal observances in, 71 to 81
+
+Indians and circumcision, 46 to 48
+
+Induration of prepuce, 250
+
+Inflbulation practices, 48 to 52
+
+Isis inaugurates Osirian rites, 29
+
+Isserth, Rabbi Israel, 153
+
+
+Jansen, Surgeon of the Belgian Armies, on frenum deformities, 221
+
+Jews' letters to Voltaire, 22;
+  Jews (see Hebrews).
+
+Judaism unfavorable to religious insanity, 166
+
+Justinia, Emperor, persecuted the Jews, 67
+
+
+Karo, Joseph, and the "Beth Yosef," 153
+
+Kemp, Dr. Arthur, on phimosis as a cause of hernia, 264
+
+Kerr, Dr. J. G., on Chinese preputial calculi, 248
+
+Keyes, Dr. E. L., on composition of preputial calculi, 249, 264
+
+King David, the first homoeopathic patient, 113;
+  secures two hundred Philistine prepuces, 31
+
+Knife, circumcising, used in ancient Egyptian rite, 23;
+  of shell used by Tonga Islanders, 45;
+  of stone used by Australians, 45;
+  of the holy circumcision, 78;
+  made of rattan among the Fiji Islanders, 327
+
+
+Lafargue, on Australian circumcision, 44
+
+Lallemand, on masturbation, 223;
+  on tendency to preputial cancer, 228, 329;
+  on circumcision, 317
+
+Las Casas, on Aztec circumcision, 46
+
+Leech, Dr. T. F., on preputial irritation, 260
+
+Letenneur, Prof., on the knife of the holy circumcision, 78
+
+Life-insurance and the circumcised, 290
+
+Lisfrane, rules for operations on the penis, 232;
+  on recession of the body of the penis, 306
+
+Livingstone, on Bassouto circumcision, 44
+
+Longevity of Hebrews, 162, 169, 179
+
+Lonyer-Villermay, M., on female circumcision, 36
+
+Louis XVI as a candidate for the rite, 201
+
+Love, Dr. I. N, on the Mosaic law, 262
+
+Lumholtz, on Australian hypospadias, 56
+
+
+Macilwain, on reflex neuroses, 330
+
+Magruder, Dr. G. L., on reflex irritation, 261
+
+Maids as heat radiators, 114
+
+Maimonides, Jewish rabbi and physician, 32, 144, 153
+
+Malay circumcision, 45
+
+Malgaigne, operative views, 313, 316
+
+Mapato, or mystery hut, 42
+
+Marriage preceded by circumcision, 54
+
+Martius and Spix, on circumcision on the Amazon, 56
+
+Mastin, Dr. C. H., on calculous disease, 248
+
+Masturbation, 224
+
+Maury, Dr. Frank, on preputial statistics, 219
+
+McLeod, Dr. Neil, circumcision operation, 318
+
+McMahon, Dr. W. R., on reflex epilepsy, 261
+
+Mendelssohn, Rabbi Moses, 164, 168
+
+Mexican circumcision, 46
+
+Mezizah, or act of suction, 150
+
+Milah, 156
+
+Miracles performed by the holy prepuce, 70 to 74
+
+Mishna, the, 153
+
+Mohammed, 65
+
+Mohel, 157, 158
+
+Moses, Dr., of New York, preputial statistics, 220
+
+Moses circumcises his son, 150
+
+Mott, Jr., Dr. A. R., cases of reflex irritation, 258
+
+Music, first schools of, 94
+
+Music at Algerine circumcision, 39;
+  at Mohammedan, in Asia, 39;
+  at Turkish feast, 41
+
+
+Nelaton, case of infibulation, 54;
+  on penile cancer, 231;
+  on penile hypertrophy, 252
+
+Nelson, Lord, disregard for red tape, 77
+
+New Caledonian circumcision, 45
+
+Newton, Sir Isaac, and the storm-predicting cow, 77
+
+Nicaraguan baptism of blood, 56
+
+
+Oath of mohel, 158
+
+Oath, Egyptian manner of making oath, 35
+
+Obod, Battle of, 36
+
+Operations on the prepuce, 302;
+  Cloquet's, 306;
+  Bumstead's, 310;
+  Hue's, 312;
+  Bernheim's, Sedillat's, 313;
+  Chauvin's, 313;
+  Cullerier's, 313;
+  Vanier's, 316;
+  Vidal de Cassis', 316;
+  Lallemand's, 317;
+  A. G. Miller's, Neil McLeod's, 318;
+  Erichsen's, 319;
+  Gross's, 320;
+  Van Buren and Keyes', 320;
+  D. Hayes Agnew's, 320;
+  Overall's procedure, 321
+
+Origin of phallic worship, 29
+  of human slavery, 29
+
+Orinoco, circumcision on the, 47
+
+Orloth, penis or prepuce? 31
+
+Osiris vanquished by Typhon, 28
+
+Othomacos Indians and their bloody rite, 48
+
+Owen, Dr. Edmund, on phimosis, 263
+
+
+Packard, Dr., on preputial statistics, 219
+
+Papal indulgences to worshipers of holy prepuce, 72
+
+Paralysis induced by phimosis, 259
+
+Penis, absence of, 132;
+  diminutive specimens, 213;
+  amputation of, 230, 233, 234, 247;
+  cancer of, 232;
+  gangrene of, 236;
+  hypertrophy of, 248, 251, 252
+
+Periah, 156
+
+Persecutions on account of circumcision, 66
+
+Phoenician origin of circumcision, 22
+
+Phimosed penis on ancient statues, 60
+
+Phimosis, 218, 221;
+  as a cause of hernia, 263
+
+Physicians as practical Christians, 141
+
+Pooley, Prof. J. H., case of preputial irritation, 260
+
+Popè, Rabbi Rav, and the _Guimara_, 153
+
+Portuguese sailors as Mohammedan proselytes, 40
+
+Potentia generandi, 103
+  coeundi, 104
+
+Prepuce, infibulated, 54;
+  swallowed by mother, 54;
+  fired off in gun, 54;
+  holy, 71;
+  useful for skin grafts, 207;
+  absence of, 209;
+  influence on man at different ages, 225;
+  induration of, 250;
+  warts of, 250;
+  reflex neuroses from, 256
+
+Preputial miracles, 72;
+  statistics, 219;
+  adhesions, 219, 220;
+  calculi, 248
+
+Price, Dr. M. F., on reflex neuroses, 265;
+  on female preputial irritation, 267, 268
+
+Primitive phallic rites, 28
+  homoeopaths, 113
+
+Procedure in retraction of skin of penis after circumcision, 304
+
+Proselytes, Mohammedan, how circumcised, 40, 41
+
+Public women between decks in U. S. Navy, 193
+
+Puzey, Dr., of Liverpool, on preputial skin grafts, 207
+
+Pythagoras 32;
+  visits Egypt, 34
+
+
+Ralfe, on causes of interstitial nephritis, 300
+
+Rameses II, circumcision of his sons, 23
+
+Ranney, Prof. A. L., on enuresis, 282
+
+Reconstruction of a prepuce, 68, 69, 328
+
+Rectum, prolapsus of, induced by phimosis, 263
+
+Reflex neuroses from preputial irritation, 254, 330, 331
+
+Regulations of French Hebrew consistories of 1854, 157
+
+Religion, its connection to insanity, 166
+
+Resectricis nympharum, profession of, 36
+
+Restriction on impregnation, 57;
+  on twins, 60
+
+Retraction of skin of penis after circumcision, 303
+
+Richardson, Dr. B. W., on relation of race to disease, 169, 170, 171, 177
+
+Ricord's definition of the prepuce, 206;
+  operations on the prepuce, 313
+
+Roman infibulation, 58
+
+Royal decree of 1845 in France, 157
+
+Roux, on cancer of the prepuce, 227
+
+Rush, Benjamin, and the cancer quack, 77
+
+
+Saint-Germain, Dr., on preputial abnormalities, 264
+
+Saint Foutin and his shrine, 78
+
+Saint Guerluchon at Bourg-Dieu, 79
+
+Saint Guignole and the miraculous phallus, 80
+
+Saint Coulombs and the miraculous prepuce, 70
+
+Saturnus the first eunuchiser, 83
+
+Sayer, Prof. Lewis A., contributions to medical science, 255
+
+Scythians carry off heads of the slain, 30
+
+Self-circumcision, attempt at, 203
+
+Semiramis first employs eunuchs, 85
+
+Severus Sulpicius, on effects of climate, 50
+
+Sham battles at circumcision feasts, 37, 41, 42, 44
+
+She-circumcisers, 36
+
+Shrine for the recovery of impotent males, 79
+
+Smith, Dr. J. Lewis, on preputial irritation, 263
+
+Solomon, Dr., of Brunswick, on suction, 158
+
+Soudanese chastity protector, 52
+
+Sphincterismus due to phimosis, 292
+
+Spiked chastity belt in Naples museum, 52
+
+Stallard, Dr., on Jewish vital statistics, 173
+
+Sterility cured at sacred shrines, 71 to 81
+
+Stricture of urethra and phimosis, 289, 290
+
+Styptics used by mohels, 158, 159
+
+Syphilis, statistics relating to, 187 to 199
+
+Syphilis and scrofula, 190
+
+
+Taylor, Dr. C. F., on masturbation, 269
+
+Totonac circumcision, 46
+
+Tonga Islanders' rite, 45
+
+Toxæmia, resulting from phimosis, 293;
+  of von Jaksch, 294
+
+Tube, penis carried in, 56
+
+Tunca Indian circumcision, 56
+
+Turkish circumcision, 39 to 41
+
+Tylor, on the Stone Age and circumcision, 336
+
+
+Van Buren and Keyes, on circumcision, 320
+
+Vanier du Havre, Dr., 54, 224;
+  on operations, 316
+
+Venus, birth of, 84
+
+Vidal de Cassis, on preputial operations, 316
+
+Virey, account of Hindoo bonze, 54
+
+Virgins' chain of bells in ancient Judea, 52
+
+Vital statistics of Jews, 169 to 179
+
+Voltaire, on origins of circumcision, 22
+
+Von Jaksch's definition of Toxæmia, 294
+
+
+Wadd, Dr., on preputial cancer, 227;
+  on hypertrophy of penis, 252
+
+Walshe, on preputial cancer, 235
+
+Warren, on preputial cancer, 235
+
+Warts of penis and prepuce, 250
+
+Waterman, Dr., on Jewish vital statistics, 177
+
+Wax images of penis deposited on shrines, 79
+
+Welsh words in Mandan language, 24
+
+Wet dressing objectionable after circumcision, 304, 311
+
+White Bull, sacred among Sioux and Egyptians, 26;
+  origin of sacredness, 29
+
+Willard, Dr. De Forest, observations on the prepuce, 262
+
+Wine at circumcision feasts, 151
+
+Wirthington, Dr. F. J., on preputial irritation, 259
+
+Wise, Dr. I. M., on St. Paul the apostle, 19
+
+Warman, Prof., of Brooklyn, on circumcision, 26
+
+
+
+
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+enhance their happiness.
+
+The facial indications of those who are not thorough-bred,
+speaking physiologically, are as follow: A coarse, thick skin; a
+"muddy" complexion, or one permanently blotched, pimpled, or
+discolored; dull eyes, very small or very large and bulging;
+coarse hair, or that which is very light or colorless,--that is to say,
+of no _decided_ hue. I regard very light colored, pallid people as
+morbid varieties; also those with irregular teeth, a very small or
+ill-shapen nose, small nostrils, perpendicular jaws, exposed gums,
+open mouth, receding chin, or one that projects greatly forward,
+ending in a point; thin, pallid, dry lips; hollow cheeks, flat upper
+cheeks. ugly or ill-shapen ears, a voice weak, thin, hoarse, shrill
+or nasal; a long, cylindrical neck; a high, narrow forehead.
+
+The undue development of certain organs and systems of the
+body induces abnormal conditions, as, for example, an excessive
+disposition of fatty tissue. When the appetite is voracious, or the
+nutritive system uncommonly active, too much of the carbonaceous
+elements of the food are eliminated, or, as it often occurs, too much
+carbonaceous food, such as white bread, potatoes, etc., is consumed
+for the needs of the body; the consequence is an excess of fat,
+which, in many subjects, impedes respiration, prevents activity,
+and gives a generally uncomfortable feeling. For this condition a
+spare diet is often prescribed, but as this is felt to be a hardship,
+and as few who attempt it succeed in continuing it long enough to
+produce satisfactory results, it is pronounced a failure.
+
+For this class of people there is a very agreeable and sure
+method of reducing the bulk without reducing strength and without
+compelling too great a sacrifice of the appetite.
+
+
+HOW TO REDUCE THE SIZE WITHOUT LOSING STRENGTH.
+
+A diet which will attain this result is easily obtained, and of
+it the subject can use a quantity sufficient to allay the craving
+for food.
+
+This diet consists of absolutely _raw_ foods, nothing cooked
+being allowed. This diet, of course, must consist mainly of fruits,
+nuts, grains, milk, and, when flesh-meat is desired, a Hamburg
+beefsteak may be partaken of; this steak is raw beef chopped fine
+and seasoned with onion, salt, pepper, or other condiments; to
+this may be added raw oysters and clams. Every kind of fruit
+
+
+
+
+_FAC-SIMILE PAGE FROM "STANTON'S PHYSIOGNOMY"--Reduced._
+
+SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON. 1143
+
+is a dangerous being); he should develop his friendliness, love of
+children, and of the opposite sex; in short, he should be a _lover_
+of _humanity_.
+
+
+THE SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON.
+
+[Illustration: FIG. 300--EDWARD JENNER, M.D. (CELEBRATED ENGLISH
+PHYSICIAN, AUTHOR, AND DISCOVERER OF VACCINATION.)
+
+No scientific physiognomist could mistake this face for other than that
+of a physician, and an earnest and attentive one as well, as evidenced
+by the signs of "natural physician" in the cheek-bones, in the attitude
+of the head and neck, and by the thoughtful, observant expression of the
+eye. The combination of systems in this subject is such as is most
+frequently observed among physicians, viz., the supremacy of the osseous
+and brain systems. The muscular, thoracic, and vegetative powers all
+assist in this combination by their development. The signs for
+Conscience and Firmness are apparent. Love of Home and Patriotism rank
+high. Benevolence, Amativeness, Love of Young, Mirth, Approbation,
+Self-esteem, Modesty, Friendship, Alimentiveness, Sanativeness,
+Pneumativeness, and Color combine to form a lovely domestic and social
+nature. The form, size, and peculiarities of the nose claim attention.
+It is a nose denoting Constructiveness, Originality, and logical power.
+The signs for Hope, Analysis, Mental Imitation, Human Nature, Ideality,
+Sublimity, Construction, and Acquisition are strongly delineated.
+Self-will is normally developed, while Size, Form, Observation, Weight,
+Locality, Calculation, and Memory of various sorts are manifest. The
+signs of Language in the eye and mouth denote fluency, while the
+practical faculties, being dominant, would give clearness, perspicacity,
+and directness to his style of expression, either oral or written. Time,
+Order, Reason, and Intuition are well developed. The long-continued
+observation and experiments of this noble physician in his endeavor to
+protect humanity from the ravages of small-pox by his discovery of
+vaccination, met at last with a suitable recognition, for he received by
+a vote of Parliament the sum of £30,000, and special honors were awarded
+him. It is a singular fact that all of the benefactors of the human
+race--those who have benefited it by discoveries of any kind
+whatever--have met with the most violent opposition, treachery, and
+often disgrace, before they could make the world see the value of their
+discoveries. Such was the case with Dr. Jenner, but his firmness and
+truth at last gained the victory.]
+
+The best _form_ for a surgeon who attempts the most severe
+operations is the round build of body and head, and many of them
+are of this shape. The muscular system should be supreme, with
+the brain system a close second, the bony and thoracic systems
+about equal and next in development.
+
+The muscular tissue is _comparatively unfeeling_--insensitive;
+
+
+
+
+_FAC-SIMILE PAGE FROM "STANTON'S PHYSIOGNOMY"--Reduced._
+
+OTHER CLASSES OF SURGEONS" 1145
+
+in the body. Form and Size are also requisite to aid the memory of
+the shape and relative position of each part, and to assist Locality.
+Human Nature is essential in order that he may be _en rapport_
+with his patients, and also to enable him to _divine_ instinctively all
+bodily and mental states. He should be a good physiognomist, and
+be well versed in the _pathology_ of physiognomy. He must have
+large Observation, in order to take cognizance of the most minute
+changes and appearances. Calculation is a useful trait also, as it
+is required in many ways in the medication and treatment of the
+wounded, as in chemistry and in making surgical implements, etc.
+He should have large Friendship; in order to attach his patients to
+him and to command their esteem; enough Benevolence to sympathize,
+but not enough to weaken the feelings when severity is required.
+The faculty of Amativeness is necessary to _comprehend_ the nature of
+the opposite sex; Love of Young also, that he may inspire children with
+love and confidence.
+
+The sense of Weight should be a strong one, for the muscular
+sense is dependent upon its power in order to _gauge_ the amount
+of force to be used in handling instruments and in bandaging
+wounds, limbs, etc. Executiveness is required to assist authority
+and give resistance. Self-will is another ally most necessary, as
+well as Analysis, Time, Order, and Reason. A fair share of
+musical ability is required to assist the ear in making examinations
+of the heart and lungs, and in auscultation for various other purposes.
+If to these faculties one adds large Intuition, he has a fine
+bodily and mental equipment for the practice of surgery.
+
+
+OTHER CLASSES OF SURGEONS.
+
+Many army surgeons are characterized by a round and broad
+form, with broad, rather low, and round heads; short, round arms,
+and round and tapering fingers. This build is the most suitable
+for those severe operations which require the greatest exhibition of
+force, endurance, and coolness; another class of surgeons--those
+who undertake the more delicate and less forceful operations--are
+characterized by about an equal development of the brain and
+muscular systems. This class of surgeons tend naturally to the
+treatment of those finer, less difficult, and more delicate cases of
+operative surgery, such, for example, as treatment of the ear, the
+eye, etc. This class of surgeons require a fine endowment of the
+brain and nervous system. In short, the muscles as well as nerves
+of this class must be sensitive to a great degree, and this combination
+calls for a fine and high organization.
+
+The surgeon should be something of an actor in order to
+know when to be sympathetic and when to be severe. Yet he
+
+
+
+
+  +--------------------------------------------------------------+
+  | Transcriber's Notes and Errata                               |
+  |                                                              |
+  | Footnotes 25-30 have been renumbered in sequence.            |
+  |                                                              |
+  | The anchor for footnote 102 was missing. Has been inserted   |
+  | at the appropriate place.                                    |
+  |                                                              |
+  | 'oe' ligatures have been expanded to separate 'o' and 'e'    |
+  | characters.                                                  |
+  |                                                              |
+  | The following words were found in both hyphenated and        |
+  | unhyphenated forms once each.                                |
+  |                                                              |
+  |                |bed-clothes   |bedclothes   |                |
+  |                |co-existence  |coexistence  |                |
+  |                |short-comings |shortcomings |                |
+  |                                                              |
+  | The word 'pre-cancerous' occurred four times in the text,    |
+  | while 'precancerous' occurred twice, both in the index.      |
+  | These index entries have been hyphenated.                    |
+  |                                                              |
+  | The following typographical errors have been corrected.      |
+  |                                                              |
+  |                |Error        |Correction   |                 |
+  |                |route        |rout         |                 |
+  |                |prepuse      |prepuce      |                 |
+  |                |a a          |a            |                 |
+  |                |siezes       |seizes       |                 |
+  |                |Stèrilitè    |Stérilité    |                 |
+  |                |others       |others'      |                 |
+  |                |Tranyslvania |Transylvania |                 |
+  |                |occasian     |occasion     |                 |
+  |                |suprised     |surprised    |                 |
+  |                |function     |junction     |                 |
+  |                |orginated    |originated   |                 |
+  |                |smoulderd    |smouldered   |                 |
+  |                |wes          |was          |                 |
+  |                |tisses       |tissues      |                 |
+  |                |dut          |but          |                 |
+  |                |innner       |inner        |                 |
+  |                |may          |many         |                 |
+  |                |brakemen     |brakeman     |                 |
+  |                |thinnes      |thinness     |                 |
+  |                |totel        |total        |                 |
+  |                |America      |American     |                 |
+  |                                                              |
+  +--------------------------------------------------------------+
+
+
+
+
+
+End of the Project Gutenberg EBook of History of Circumcision from the
+Earliest Times to the Present, by Peter Charles Remondino
+
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+      The Project Gutenberg eBook of History of Circumcision from the Earliest Times to the Present, by P. C. Remondino, M.D.
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+<pre>
+
+The Project Gutenberg EBook of History of Circumcision from the Earliest
+Times to the Present, by Peter Charles Remondino
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: History of Circumcision from the Earliest Times to the Present
+       Moral and Physical Reasons for its Performance
+
+Author: Peter Charles Remondino
+
+Release Date: October 21, 2007 [EBook #23135]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK HISTORY OF CIRCUMCISION ***
+
+
+
+
+Produced by Bryan Ness, LN Yaddanapudi and the Online
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+
+
+
+</pre>
+
+
+<p class='pagenum'><a name="Page_i" id="Page_i">[i]</a></p>
+
+<p class='b c noin'>No. 11 IN THE PHYSICIANS&rsquo; AND STUDENTS&rsquo; READY
+REFERENCE SERIES</p>
+
+<h1><span class='sf75'>HISTORY</span><br />
+<span class='sf30'>OF</span><br />
+CIRCUMCISION<br />
+<span class='sf30'>FROM THE</span><br />
+<span class='sf50'>EARLIEST TIMES TO THE PRESENT.</span></h1>
+
+<p class='c noin sc'>Moral and Physical Reasons for its Performance,<br />
+with a<br />
+<span class='lc'>HISTORY OF EUNUCHISM, HERMAPHRODISM, ETC., AND
+OF THE DIFFERENT OPERATIONS PRACTICED
+UPON THE PREPUCE.</span></p>
+
+<p class='c noin sf75 sc lc'>BY</p>
+
+<p class='c noin'>P. C. REMONDINO, M.D.<br />
+<span class='sf75'>(JEFFERSON),</span><br />
+
+<span class='sf75'>Member of the American Medical Association, of the American Public Health Association,
+of the San Diego County Medical Society, of the State Board of Health of
+California, and of the Board of Health of the City of San Diego;
+Vice-President of California State Medical Society and of
+Southern California Medical Society, etc.</span></p>
+
+<div class="figcenter" style="width: 150px;">
+<img src="images/illus-title.png" width="150" height="97" alt="" title="" />
+</div>
+
+<p class='c noin'><span class='sc sf75'>Philadelphia and London:</span><br />
+F. A. DAVIS, PUBLISHER.<br />
+1891.</p>
+
+<p class='pagenum'><a name="Page_ii" id="Page_ii">[ii]</a></p>
+<p class='c mt2 noin sf75'>Entered according to Act of Congress, in the year 1891, by<br />
+F. A. DAVIS,<br />
+In the Office of the Librarian of Congress, at Washington, D. C., U. S. A.</p>
+
+<p class='c mt2 noin sf75'>Philadelphia Pa., U. S. A.:<br />
+The Medical Bulletin Printing House,<br />
+1231 Filbert Street.</p>
+
+<div class="figcenter" style="width: 352px;">
+<img src="images/illus-frontispiece.png" width="352" height="500" alt="Hebraic Circumcision" title=""
+style="border: 1px solid black;" />
+<span class="caption sc">Hebraic Circumcision</span><br />
+<span class="caption">(From an old sixeenth century Italian print in the author&rsquo;s collection,
+representing the scene of the Holy Circumcision.)</span></div>
+
+<hr /><p class='pagenum'><a name="Page_iii" id="Page_iii">[iii]</a></p>
+<h2><a name="PREFACE" id="PREFACE"></a>PREFACE.</h2>
+
+<p>In ancient Egypt the performance of circumcision was at one time limited
+to the priesthood, who, in addition to the cleanliness that this
+operation imparted to that class, added the shaving of the whole body as
+a means of further purification. The nobility, royalty, and the higher
+warrior class seem to have adopted circumcision as well, either as a
+hygienic precaution or as an aristocratic prerogative and insignia.
+Among the Greeks we find a like practice, and we are told that in the
+times of Pythagoras the Greek philosophers were also circumcised,
+although we find no mention that the operation went beyond the
+intellectual class. In the United States, France, and in England, there
+is a class which also observe circumcision as a hygienic precaution,
+where, from my personal observation, I have found that circumcision is
+thoroughly practiced in every male member of many of the families of the
+class,&mdash;this being the physician class. In general conversation with
+physicians on this subject, it has really been surprising to see the
+large number who have had themselves circumcised, either through the
+advice of some college professor while attending lectures or as a result
+of their <span class='pagenum'><a name="Page_iv" id="Page_iv">[iv]</a></span>own subsequent convictions when engaged in actual practice and
+daily coming in contact both with the benefits that are to be derived in
+the way of a better physical, mental, and moral health, as well as with
+the many dangers and disadvantages that follow the uncircumcised,&mdash;the
+latter being probably the most frequent incentive and determinator,&mdash;as
+in many of these latter examples the operation of circumcision, with its
+pains, annoyances, and possible and probable dangers, sink into the most
+trifling insignificance in comparison to some of the results that are
+daily observed as the tribute that is paid by the unlucky and unhappy
+wearer of a prepuce for the privilege of possessing such an appendage.</p>
+
+<p>There is one thing that must be admitted concerning circumcision: this
+being that, among medical men or men of ordinary intelligence who have
+had the operation performed, instead of being dissatisfied, they have
+extended the advantages they have themselves received, by having those
+in their charge likewise operated upon. The practice is now much more
+prevalent than is supposed, as there are many Christian families where
+males are regularly circumcised soon after birth, who simply do so as a
+hygienic measure.</p>
+
+<p>For the benefit of these, who may congratulate themselves upon the
+dangers and annoyances that they <span class='pagenum'><a name="Page_v" id="Page_v">[v]</a></span>and their families have escaped, and
+for the benefit of those who would run into these dangers but for timely
+warning, this book has been especially written. To my professional
+brothers the book will prove a source of instruction and recreation,
+for, while it contains a lot of pathology regarding the moral and
+physical reasons why circumcision should be performed, which might be as
+undigestible as a mess of Boston brown bread and beans on a French
+stomach, I have endeavored to make that part of the book readable and
+interesting. The operative chapter will be particularly useful and
+interesting to physicians, as I have there given a careful and impartial
+review of all the operative procedures,&mdash;from the most simple to the
+most elaborate,&mdash;besides paying more than particular attention to the
+subject of after-dressings. The part that relates to the natural history
+of man will interest all manner of people. I regret that the tabular
+statistics are not to be had, but in this regard we must use our best
+judgment from the material we have on hand; at any rate, I have tried to
+furnish a sufficiency of facts, so that, unless the reader is too
+overexacting, he will not find much difficulty in arriving at a
+conclusion on the subject.</p>
+
+<p class='sc ralign'>P. C. Remondino, M.D.</p>
+
+<p class='sc sf75'>San Diego, California, 1891.</p>
+
+<hr /><p class='pagenum'><a name="Page_vii" id="Page_vii">[vii]</a></p>
+<h2><a name="CONTENTS" id="CONTENTS"></a>CONTENTS.</h2>
+
+<p><span class='ralign sc lc'>PAGE</span><br /></p>
+
+<p class='noin'><a href="#PREFACE"><span class='sc'>Preface</span></a>, <span class='ralign'><a href="#Page_iii">iii</a></span><br /></p>
+
+<p class='noin sc'><a href="#INTRODUCTION">Introduction</a>, <span class='ralign'><a href="#Page_1">1</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_I">CHAPTER I.</a></p>
+
+<p class='noin sc'>Antiquity of Circumcision, <span class='ralign'><a href="#Page_21">21</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_II">CHAPTER II.</a></p>
+
+<p class='noin sc'>Theories as to the Origin of Circumcision, <span class='ralign'><a href="#Page_28">28</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_III">CHAPTER III.</a></p>
+
+<p class='noin sc'>Spread of Circumcision, <span class='ralign'><a href="#Page_34">34</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_IV">CHAPTER IV.</a></p>
+
+<p class='noin sc'>Circumcision Among Savage Tribes, <span class='ralign'><a href="#Page_42">42</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_V">CHAPTER V.</a></p>
+
+<p class='noin sc'>Infibulation, Muzzling, and Other Curious Practices, <span class='ralign'><a href="#Page_46">46</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_VI">CHAPTER VI.</a></p>
+
+<p class='noin sc'>Attempts To Abolish Circumcision, <span class='ralign'><a href="#Page_63">63</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_VII">CHAPTER VII.</a> <span class='pagenum'><a name="Page_viii" id="Page_viii">[viii]</a></span></p>
+
+<p class='noin sc'>Miracles and the Holy Prepuce, <span class='ralign'><a href="#Page_70">70</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_VIII">CHAPTER VIII.</a></p>
+
+<p class='noin sc'>History of Emasculation, Castration, and Eunuchism, <span class='ralign'><a href="#Page_82">82</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_IX">CHAPTER IX.</a></p>
+
+<p class='noin sc'>Philosophical Considerations Relating to Eunuchism and Medicine, <span class='ralign'><a href="#Page_105">105</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_X">CHAPTER X.</a></p>
+
+<p class='noin sc'>Hermaphrodism and Hypospadias, <span class='ralign'><a href="#Page_117">117</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XI">CHAPTER XI.</a></p>
+
+<p class='noin sc'>Religio Medici, <span class='ralign'><a href="#Page_134">134</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XII">CHAPTER XII.</a></p>
+
+<p class='noin sc'>Hebraic Circumcision, <span class='ralign'><a href="#Page_143">143</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XIII">CHAPTER XIII.</a></p>
+
+<p class='noin sc'>Mezizah, the Fourth or Objectionable Act of Suction, <span class='ralign'><a href="#Page_150">150</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XIV">CHAPTER XIV.</a></p>
+
+<p class='noin sc'>What are the Benefits of Circumcision? <span class='ralign'><a href="#Page_161">161</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XV">CHAPTER XV.</a></p>
+
+<p class='noin sc'>Predisposition to and Exemption and Immunity from Disease, <span class='ralign'><a href="#Page_183">183</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XVI">CHAPTER XVI.</a> <span class='pagenum'><a name="Page_ix" id="Page_ix">[ix]</a></span></p>
+
+<p class='noin sc'>The Prepuce, Syphilis, and Phthisis, <span class='ralign'><a href="#Page_187">187</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XVII">CHAPTER XVII.</a></p>
+
+<p class='noin sc'>Some Reasons for Being Circumcised, <span class='ralign'><a href="#Page_200">200</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XVIII">CHAPTER XVIII.</a></p>
+
+<p class='noin sc'>The Prepuce as an Outlaw, and its Effects on the Glans, <span class='ralign'><a href="#Page_206">206</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XIX">CHAPTER XIX.</a></p>
+
+<p class='noin sc'>Is the Prepuce a Natural Physiological Appendage? <span class='ralign'><a href="#Page_217">217</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XX">CHAPTER XX.</a></p>
+
+<p class='noin sc'>The Prepuce, Phimosis, and Cancer, <span class='ralign'><a href="#Page_226">226</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XXI">CHAPTER XXI.</a></p>
+
+<p class='noin sc'>The Prepuce and Gangrene of the Penis, <span class='ralign'><a href="#Page_236">236</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XXII">CHAPTER XXII.</a></p>
+
+<p class='noin sc'>The Prepuce, Calculi, and other Annoyances, <span class='ralign'><a href="#Page_248">248</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XXIII">CHAPTER XXIII.</a></p>
+
+<p class='noin sc'>Reflex Neuroses and the Prepuce, <span class='ralign'><a href="#Page_254">254</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XXIV">CHAPTER XXIV.</a></p>
+
+<p class='noin sc'>Dysuria, Enuresis, and Retention of Urine, 2<span class='ralign'><a href="#Page_75">75</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XXV">CHAPTER XXV.</a> <span class='pagenum'><a name="Page_x" id="Page_x">[x]</a></span></p>
+
+<p class='noin sc'>General Systemic Diseases Induced by the Prepuce, <span class='ralign'><a href="#Page_284">284</a></span><br /></p>
+
+<p class='noin c mt1'><a href="#CHAPTER_XXVI">CHAPTER XXVI.</a></p>
+
+<p class='noin sc'>Surgical Operations Performed on the Prepuce, <span class='ralign'><a href="#Page_302">302</a></span><br /></p>
+
+<p class='noin sc'><a href="#NOTES_TO_TEXT">Notes to Text</a>, <span class='ralign'><a href="#Page_323">323</a></span><br /></p>
+
+<p class='noin sc'><a href="#WORKS_AND_AUTHORITIES_QUOTED">Works and Authorities Quoted</a>, <span class='ralign'><a href="#Page_336">336</a></span><br /></p>
+
+<p class='noin sc'><a href="#INDEX">Index</a>, <span class='ralign'><a href="#Page_339">339</a></span><br /></p>
+
+<hr /><p class='pagenum'><a name="Page_1" id="Page_1">[1]</a></p>
+<h2><a name="INTRODUCTION" id="INTRODUCTION"></a>INTRODUCTION.</h2>
+
+<p>This book is the amplification of a paper, the subject of which was,
+&ldquo;A Plea for Circumcision; or, the Dangers that Arise from the
+Prepuce,&rdquo; which was read at the meeting of the Southern California
+Medical Society, at Pasadena, in December, 1889. The material gathered
+for that paper was more than could be used in the ordinary limits of a
+society paper; it was gathered and ready for use, and this suggested its
+arrangement into book form. The subject of the paper was itself
+suggested by a long and personal observation of the changes made in man
+by circumcision. From the individual observation of cases, it was but
+natural to wish to enlarge the scope of our observation and comparison;
+this naturally led to a study of the physical characteristics of the
+only race that could practically be used for the purpose. This race is
+the Jewish race. On carefully studying into the subject, I plainly saw
+that much of their longevity could consistently be ascribed to their
+more practical humanitarianism, in caring for their poor, their sick, as
+well as in their generous provision for their unfortunate aged people.
+The social fabric of the Jewish family is also more calculated to
+promote long life, as, strangely as it may seem, family veneration and
+family love and attachment are far more strong and practical among this
+people than among Christians, this sentiment not being even as strong in
+the Christian races as it is in the Chinese or Japanese. It certainly
+forms as much of a part of the teachings of Christianity as it does of
+Judaism, Buddhism, or Confucianism, only<span class='pagenum'><a name="Page_2" id="Page_2">[2]</a></span>
+Christians, as a mass, have practically forgotten it. The occupation
+followed by the Jews also in a certain degree favors longevity, and the
+influence on heredity induced by all these combined conditions goes for
+something. But it is not alone in the matter of simple
+longevity&mdash;although that implies considerable&mdash;that the Jewish
+race is found to be better situated. Actual observations show them to be
+exempt from many diseases which affect other races; so that it is not
+only that they recover more promptly, but that they are not, as a class,
+subjected to the loss of time by illness, or to the consequent
+sufferings due to illness or disease, in anything like or like ratio
+with other people.</p>
+
+<p>There is also a less tendency to criminality, debauchery, and
+intemperance in the race; this, again, can in a measure be ascribed to
+their family influence, which even in our day has not lost that
+patriarchal influence which tinges the home or family life in the Old
+Testament. Crimes against the person or property committed by Jews are
+rare. They likewise do not figure in either police courts or
+penitentiary records; they are not inmates of our poor-houses, but, what
+is also singular, they are never accused of many silly crimes, such as
+indecent exposures, assaults on young girls; nor do they figure in any
+such exposures as the one recently made by the <i>Pall Mall Gazette</i>.</p>
+
+<p>After allowing all that, which we can, in its fullest limit, to
+religion, family, or social habit, there is still a wide margin to be
+accounted for. This has naturally let the inquiry, followed in the
+course of this book, into a careful review of the Jewish people; into
+their religion and its character, its relation to other creeds, and to
+the world&rsquo;s history; into their many wanderings, and into the
+dispersion, and we have even been obliged to follow <span class='pagenum'><a name="Page_3" id="Page_3">[3]</a></span>
+them into the midst of the people among whom they have become nationed,
+to try, if possible, to find the cause of this racial difference in
+health, resistance to disease, decay, and death. It has been necessary,
+in following out the research, to give a condensed
+<i>r&eacute;sum&eacute;</i> of the religious, political, and social condition
+of the Jewish commonwealth, which, although in a state of dispersion,
+still exists. I need offer no apology for the extended notice this has
+received in the course of the book. We read with increasing interest
+either Hallam or May, Buckle or Guizot, through the spasmodic, halting,
+retrograding, advancing, erratic, aimless, and accidental phases that
+England has plowed through, from the days of goutless, simple, and
+chaste, but barbarian England of the Saxons, to the present civilized,
+enlightened, gouty, &ldquo;Darkest England&rdquo; of General Booth; and,
+after all is said and done, we are no wiser in any practical resulting
+good. We simply know that the English people, so to speak, have, as it
+were, gone through the figures of some social aspects, as if dancing the
+&ldquo;Lancers,&rdquo; with its forward and back movements, gallop,
+etc., and have finally sat down, better dressed and better housed, but
+in an acquired state of moral and physical degeneration. The Briton of
+Queen Victoria is not the Briton of Queen Boadicea, either morally or
+physically. On the other hand, the system of sociological tables adopted
+by Herbert Spencer would have but little to record for some six thousand
+years&mdash;either in religion, morals, or physique&mdash;as making any
+changes in the history of that simple people which, in the mountainous
+regions of Ur, in distant Armenia, started on its pilgrimage of life and
+racial existence; in one branch of the family&mdash;that of
+Ishmael&mdash;the changes to be recorded are so invisible that its
+descendants may really be said <span class='pagenum'><a name="Page_4" id="Page_4">[4]</a></span>
+to live to-day as they lived then. So that I do not feel that I need to
+apologize for the space I have given to this subject in the course of
+the book. The causes that make these racial distinctions should be of
+interest alike to the moralist, theologist, sociologist, and to the
+physician.</p>
+
+<p>Ecclesiastical writers and moralists, as well as writers of fiction or
+dramatizers, can write on anything they please, and it is eagerly taken
+up and read by the people generally, either of high or low degree,
+alike; and somehow these people seem never to require an apology on the
+part of the author, for having attempted rapes, seductions, or even
+unavoidable fornication committed through the leaves of the story, or
+having it imaginably take place between acts on the stage. But if the
+physician writes a book touching anything connected with the generative
+functions, and with the best intent and for the good of humanity, he is
+expected to make some prefatory apology. He is supposed to address a
+public who all of a sudden have become intensely moral and extremely
+sensitive in their modesty. Why things are thus I cannot explain. They
+are so, nevertheless. From the time that the celebrated Astruc wrote his
+treatise on female diseases, near the end of the seventeenth
+century,&mdash;who felt compelled by the extreme modesty of the people in
+this particular&mdash;but who, outside of medicine, were about as virtuous as
+the average Tabby or Tom cats in the midnight hour&mdash;to write the chapter
+touching on nymphomania in Latin, so as not to shock the morbidly
+sensitive modesty of the French nobility, who then enjoyed <i>Le Droit de
+cuissage</i>,&mdash;down through to Bienville, who wrote the first extended work
+on nymphomania, and Tissot, who first broached the subject and the
+danger of Onanism, all have felt that <span class='pagenum'><a name="Page_5" id="Page_5">[5]</a></span>
+they must stop on the threshold and &ldquo;apologize.&rdquo; Tissot,
+however, seemed to possess a robust and a plain Hippocratic mind, and as
+he apologized he could not help but see the ridiculousness of so doing,
+as in the preface to his work we find the following: &ldquo;Shall we
+remain silent on so important a subject? By no means. The sacred
+authors, the Fathers of the Church, who present their thoughts in living
+words, and ecclesiastical authors have not felt that silence was best. I
+have followed their example, and shall exclaim, with St. Augustine,
+&lsquo;If what I have written scandalizes any prudish persons, let them
+rather accuse the turpitude of their own thoughts than the words I have
+been obliged to use.&rsquo;&rdquo;</p>
+
+<p>For my part, I think that people who can go to the theatre and enjoy
+&ldquo;As in a Looking-Glass,&rdquo; and witness some of the satyrical
+or billy-goat traits of humanity so graphically exhibited in &ldquo;La
+Tosca,&rdquo; with evident satisfaction; or attend the more robust plays
+of &ldquo;Virginius&rdquo; or of &ldquo;Galba, the Gladiator,&rdquo;
+with all its suggestions of the C&aelig;sarian section, and the lust and the
+fornications of an intensely animal Roman empress, without the
+destruction of their moral equilibrium or tending to induce in them a
+disposition to commit a rape on the first met,&mdash;I think such people can
+be safely intrusted to read this book.</p>
+
+<p>And as to the reading public, there are but few general readers who
+could honestly plead an ignorance of the &ldquo;Decameron,&rdquo;
+Balzac, La Fontaine, &ldquo;Heptameron,&rdquo; Cr&eacute;billon <i>fils</i>, or of
+matter-of-fact Monsieur le Docteur Maitre Rabelais,&mdash;works which, more
+or less, carry a moral instruction in every tale, which, like the tales
+of the &ldquo;Malice of Women,&rdquo; in the unexpurged edition of the
+literal translation of the &ldquo;Arabian Nights,&rdquo; contains much
+more of practical moral lessons, even if in the <span class='pagenum'><a name="Page_6" id="Page_6">[6]</a></span>
+flowery and warm, spiced language of the Orient, than any supposed
+nastiness, on account of which they are classed among the prohibited. To
+these, and the readers of Amelie Rives&rsquo;s books, or other intensely
+realistic literature, I need not imitate the warning of Ansonius, who
+warned his readers on the threshold of a part of his book to &ldquo;stop
+and consider well their strength before proceeding with its
+lecture.&rdquo; Metaphorically speaking, the general theatre-going, or
+modern literature-reading public, can be considered pretty callous and
+morally bullet proof. I shall therefore make no apology.</p>
+
+<p>Some fault may, perhaps, be found with some of the occasional style of
+the book, or with some of the subjects used to illustrate a principle.
+To the extremely wise, good, and scientific, these illustrations were
+unnecessary; this need hardly be mentioned; and the passages which to
+some may prove objectionable were not intended for them, either with the
+expectation of delighting them or with the purpose of shocking them.
+These passages, they can easily avoid. This book, however, was written
+that it might be read: not only read by the Solon, Socrates, Plato, or
+Seneca of the laity or the profession, but even by the billy-goated
+dispositioned, vulgar plebeian, who could no more be made to read cold,
+scientific, ungarnished facts than you can make an unwilling horse drink
+at the watering-trough. Human weakness and perversity is silly, but it
+is sillier to ignore that it exists. So, for the sake of boring and
+driving a few solid facts into the otherwise undigesting and unthinking,
+as well as primarily obdurate understanding of the untutored plebeian, I
+ask the indulgence of the intelligent and broad-minded as well as the
+easily inducted reader. Cleopatra was smuggled into C&aelig;sar&rsquo;s
+presence in a roll of tapestry; the Greeks introduced <span class='pagenum'><a name="Page_7" id="Page_7">[7]</a></span>
+their men into Troy by means of a wooden horse; and the discoverer of
+the broad Pacific Ocean made his escape from his importunate creditors
+disguised as a cask of merchandise. So, when we wish to accomplish an
+object, we must adopt appropriate means, even if they may apparently
+seem to have an entirely diametrically opposite object. The Athenian,
+Themistocles, when wishing to make the battle of Salamis decisive, was
+inspired with the idea of sending word to the Persian monarch that the
+Greeks were trying to escape, advising him to block the passage; this
+saved Greece.</p>
+
+<p>There is a weird and ghostly but interesting tale connected with the
+Moslem conquest of Spain, of how Roderick, the last of the Gothic kings,
+when in trouble and worry, repaired to an old castle, in the secret
+recesses of which was a magic table whereon would pass in grim
+procession the different events of the future of Spain; as he gazed on
+the enchanted table he there saw his own ruin and his country&rsquo;s
+and nation&rsquo;s subjugation. Anatomy is generally called a dry study,
+but, like the enchanted brazen table in the ancient Gothic castle, it
+tells a no less weird or interesting tale of the past. Its revelations
+lighten up a long vista, through the thousands of years through which
+the human species has evolved from its earliest appearance on earth,
+gradually working up through the different evolutionary processes to
+what is to-day supposed to be the acme of perfection as seen in the
+Indo-European and Semitic races of man. Anatomy points to the
+rudiment&mdash;still lingering, now and then still appearing in some one man
+and without a trace in the next&mdash;of that climbing muscle which shows man
+in the past either nervously escaping up the trunk of a tree in his
+flight from many of the carnivorous animals with whom he was
+contemporary, or, as the shades <span class='pagenum'><a name="Page_8" id="Page_8">[8]</a></span>
+of night were beginning to gather around him, we again see him by the
+aid of these muscles leisurely climbing up to some hospitable fork in
+the tree, where the robust habits of the age allowed him to find a
+comfortable resting-place; protected from the dew of the night by the
+overhanging branches and from the prowling hyena by the height of the
+tree, he passed the night in security. The now useless ear-muscles, as
+well as the equally useless series of muscles about the nose, also tell
+us of a movable, flapping ear capable of being turned in any direction
+to catch the sound of approaching danger, as well as of a movable and
+dilated nostril that scented danger from afar,&mdash;the olfactory sense
+at one time having a different function and more essential to life than
+that of merely noting the differential aroma emitted by segars or cups
+of Mocha or Java, and the ear being then used for some more useful
+purpose than having its tympanum tortured by Wagnerian discordant
+sounds. Our ancestors might not have been a very handsome set, nor,
+judging from the Neanderthal skull, could they have had a very winning
+physiognomy, but they were a very hardy and self-reliant set of men.
+Nature&mdash;always careful that nothing should interfere with the
+procreative functions&mdash;had provided him with a sheath or prepuce,
+wherein he carried his procreative organ safely out of harm&rsquo;s way,
+in wild steeple-chases through thorny briars and bramble-brakes, or,
+when hardly pushed, and not able to climb quickly a tree of his own
+choice, he was by circumstances forced up the sides of some rough-barked
+or thorny tree. This leathery pouch also protected him from the many
+leeches, small aquatic lizards, or other animals that infested the
+marshes or rivers through which he had at times to wade or swim; or
+served as a protection from the bites of ants or other <span class='pagenum'><a name="Page_9" id="Page_9">[9]</a></span>
+vermin when, tired, he rested on his haunches on some mossy bank or
+sand-hill.</p>
+
+<p>Man has now no use for any of these necessaries of a long-past age,&mdash;an
+age so remote that the speculations of Ernest Renan regarding the
+differences between the Semitic race of Shem and the idolatrous
+descendants of Ham, away off in the far mountains and valleys of Asia
+lying between the Mediterranean Sea and the Euphrates, seem more as if
+he were discussing an event of yesterday than something which is
+considered contemporary with our earlier history,&mdash;and we find them
+disappearing, disuse gradually producing an obliteration of this tissue
+in some cases, and the modifying influence of evolution producing it in
+others; the climbing muscle, probably the oldest remnant and legacy that
+has descended from our long-haired and muscular ancestry, is the best
+example of disappearance caused by disuse, while the effectual
+disappearance of the prepuce in many cases shows that in that regard
+there exists a marked difference in the evolutionary march among
+different individuals.</p>
+
+<p>There is a strange and unaccountable condition of things, however,
+connected with the prepuce that does not exist with the other vestiges
+of our arboreal or sylvan existence. Firstly, the other conditions have
+nothing that interferes with their disappearance; whereas the prepuce,
+by its mechanical construction and the expanding portions which it
+incloses, tends at times rather to its exaggerated development than to
+its disappearance. Again, whereas the other vestiges have no injury that
+they inflict by their presence, or danger that they cause their
+possessors to run, the prepuce is from time of birth a source of
+annoyance, danger, suffering, <span class='pagenum'><a name="Page_10" id="Page_10">[10]</a></span>
+and death. Then, again, the other conditions are not more developed at
+birth; whereas the prepuce seems, in our pre-natal life, to have an
+unusual and unseen-for-use existence, being in bulk out of all
+proportion to the organ it is intended to cover. Speculation as to its
+existence is as unprolific of results as any we may indulge in regarding
+the nature, object, or uses of that other evolutionary appendage, the
+appendix vermiformis, the recollection of whose existence always adds an
+extra flavor to tomatoes, figs, or any other small-seeded fruits.</p>
+
+<p>We may well exclaim, as we behold this appendage to man,&mdash;now of no use
+in health and of the most doubtful assistance to the very organ it was
+intended to protect, when that organ, through its iniquitous tastes, has
+got itself into trouble, and, Job-like, is lying repentant and sick in
+its many wrappings of lint, with perhaps its companions in crime
+imprisoned in a suspensory bandage,&mdash;what is this prepuce? Whence, why,
+where, and whither? At times, Nature, as if impatient of the slow march
+of gradual evolution, and exasperated at this persistent and useless as
+well as dangerous relic of a far-distant prehistoric age, takes things
+in her own hands and induces a sloughing to take place, which rids it of
+its annoyance. In the far-off land of Ur, among the mountainous regions
+of Kurdistan, something over six thousand years ago, the fathers of the
+Hebrew race, inspired by a wisdom that could be nothing less than of
+divine origin, forestalled the process of evolution by establishing the
+rite of circumcision. Whether this has been beneficial or injurious to
+the race will be, in a measure, the object of the discussion in this
+book.</p>
+
+<p>One object of this book is to furnish my professional brothers with some
+embodied facts that they may use in <span class='pagenum'><a name="Page_11" id="Page_11">[11]</a></span>
+convincing the laity in many cases where they themselves are convinced
+that circumcision is absolutely necessary; but, having nothing in their
+text-books to back up their opinion with, their explanations are too apt
+to pass for their mere unfounded personal view of the matter. If the
+patient, or the parents of the patient, ask the physician for his
+authority, he is at a loss, as there is nothing that deals with the
+subject in any extended manner; so that this book has been written in as
+plain English as the subject-matter could possibly allow, so that
+non-professionals could easily read and understand it. I have often felt
+the need of such a work; people can understand emergency or accident
+surgery, military surgery, or reparative surgery, but such a thing as
+surgery to remedy a seemingly medical disease, or what might be called
+the preventive practice of surgery, is something they cannot understand.
+First, and not the least, among the incentives to skepticism on this
+subject is the unwelcome fact of a surgical operation, which, no matter
+how trivial it may seem to the surgeon, is a matter of considerable
+magnitude to the patient, his parents, or friends; there are risks,
+pain, worry, annoyances, and expenses to be
+undergone,&mdash;considerations which, either singly or unitedly, often
+lead one to reason against the operation, even when otherwise convinced
+of its need or utility.</p>
+
+<p>The hardest to convince are those, however, who insist on having a
+four-and-a-half-foot-gauge fact driven through their two-foot-gated
+understanding, without it ever occurring to them that the gate, and not
+the fact, is the faulty article, Some of these gentry are very
+unconvincible. They at times remind one of that description given by
+Carlyle in regard to one of the Georges, who found himself, when Prince
+of Wales, <span class='pagenum'><a name="Page_12" id="Page_12">[12]</a></span>
+leading an army in Flanders, and actually engaged in a battle. His
+Royal Highness was on foot, and was seen standing facing the enemy, with
+outstretched legs, like a Colossus of Rhodes, impassive and
+stolid,&mdash;the very impersonification of Dutch courage and
+aggressiveness. There he stood, unconscious whether he was at the head
+of an army or single attendant; he might be overridden and annihilated,
+overturned and expunged, but there he would most assuredly stand and
+fall, if need be; overwhelming squadrons, by their impetus and weight,
+might ride him down and crush him; but one thing was most certain, this
+certain fact being that he never could be made to retreat or advance, as
+no impression from front or rear could convince him of the necessity of
+either.</p>
+
+<p>Then, there is our statistical friend, who cannot discriminate between
+the exception and the rule by any common-sense deductions. He must have
+all the authentic, carefully-compiled statistics before he can allow
+himself to form any opinion. As long as there is the smallest fraction
+of a decimal unaccounted for in a mathematical way, this individual is
+inconvincible. These men pride themselves upon being methodically exact;
+they express their willingness to be convinced if you can present
+acceptable proofs; but, trying to present simple rational proofs to
+these individuals is considerably like presenting a meal of boiled pork
+and cabbage to a confirmed and hypochondriacal dyspeptic,&mdash;it only
+increases their mental dyspepsia.</p>
+
+<p>Had Columbus waited to discover America, or had Galileo waited to
+proclaim the motion of the earth, until authorized to a serious
+consideration of the matter by properly-tabled statistics, they would
+have waited a long, long time; and, it may be added, the inconveniences
+that attend the proving of a negative will so <span class='pagenum'><a name="Page_13" id="Page_13">[13]</a></span>
+interfere with the proper arrangement of statistical matter which
+relates to the prepuce and circumcision that, before such tables could
+be satisfactorily and convincingly constructed, time and the
+evolutionary processes that follow it will bid fair to completely remove
+this debatable appendage from man. It may be at a very far-distant
+period that this evolutionary preputial extinction will take
+place,&mdash;probably contemporary with the existence of Bulwer&rsquo;s
+&ldquo;Coming Race,&rdquo;&mdash;but not at a too remote period for the
+proper and satisfactory tabulation of the statistics.</p>
+
+<p>The ideas of the etiology and pathological processes through which we
+journey,&mdash;from a condition of health and good feeling to one of disease,
+miserable feeling, and death,&mdash;as described in, or rather as they
+control the sentiment and policy of, this work, are such as have been
+followed by Hutchinson, Fothergill, Beale, Black, Albutt, and
+Richardson, so that if I have totally ignored the old conventional
+systems, with their hide-bound classification of diseases to control the
+etiology, I have not done so without some reliable authority. In
+studying the etiology of diseases we have, as a rule, been content to
+accept the disease when fully formed and properly labeled, being
+apparently satisfied with beginning our investigation not at the initial
+point of departure from health, but at some distant point from this, at
+the point where this departure has elaborated itself, on favorable
+ground, into a tangible general or local disease. As truthfully observed
+by T. Clifford Albutt: &ldquo;The philosophic inquirer is not satisfied
+to know that a person is suffering, for example, from a cancer. He
+desires to know why he is so suffering,&mdash;that is, what are the processes
+which necessarily precede or follow it. He wishes to include this
+phenomena, now isolated, in <span class='pagenum'><a name="Page_14" id="Page_14">[14]</a></span>
+a series of which it must necessarily be but a member, to trace the
+period of which it must be but a phase. He believes that diseased
+processes have their evolution and the laws of it, as have other natural
+processes, and he believes that these are fixed and knowable.&rdquo; To
+do this, the physician must travel beyond the beaten path of etiology as
+found in our text-books. He must follow Hutchinson in the train of
+reasoning that elucidates the pre-cancerous stage of cancer, or tread in
+the path followed by Sir Lionel Beale, in finding that the cause of
+disease depends on a blood change and the developmental defect, or the
+tendency or inherent weakness of the affected part or organ; to fully
+appreciate the inherent etiological factors that reside in man, and
+which constitute the tendency to disease or premature decay and death,
+we must also be able to follow Canstatt, Day, Rostan, Charcot, Rush,
+Cheyne, Humphry, or Reveille-Parise into the study of the different
+conditions which, though normal, are nevertheless factors of a slow or a
+long life. We must also be able to appreciate fully the value of that
+interdependence of each part of our organism, which often, owing to a
+want of equilibrium of strength and resistance in some part when
+compared to the rest, causes the whole to give way, just as a flaw in a
+levee will cause the whole of the solidly-constructed mass to give way,
+or a demoralized regiment may entail the utter <ins class='corr'
+title="Transcriber&rsquo;s Note: The original showed
+&lsquo;route&rsquo;.">rout</ins> of an army. As described by George Murray
+Humphry, in his instructive work on &ldquo;Old Age,&rdquo; at page
+11:&mdash;</p>
+
+<p>&ldquo;The first requisite for longevity must clearly be an inherent or
+inborn quality of endurance, of steady, persistent nutritive force,
+which includes reparative force and resistance to disturbing agencies,
+and a good proportion or balance between the several organs. Each organ
+<span class='pagenum'><a name="Page_15" id="Page_15">[15]</a></span>
+must be sound in itself, and its strength must have a due relation to
+the strength of the other organs. If the heart and the digestive system
+be disproportionately strong, they will overload and oppress the other
+organs, one of which will soon give way; and, as the strength of the
+human body, like that of a chain, is to be measured by its weaker link,
+one disproportionately feeble organ endangers or destroys the whole. The
+second requisite is freedom from exposure to the various casualties,
+indiscretions, and other causes of disease to which illness and early
+death are so much due.&rdquo;</p>
+
+<p>In following out our study of diseases, we have been too closely
+narrowed down by the old symptomatic story of disease; we have too much
+treated surface symptoms, and neglected to study the man and his
+surroundings as a whole; we have overlooked the fact that there exists a
+geographical fatalism in a physical sense as well as the existence of
+the influence of that climatic fatalism so well described by Alfred
+Haviland, and the presence of a fatalism of individual constitution as
+well, which is either inherited or acquired. The idea that Charcot
+elaborates, that, as the year passes successively through the hot and
+the cold, through the dry and the wet season, with advancing age the
+human body undergoes like changes, and diseases assume certain
+characteristics, are also points that are overlooked; and nowhere is
+this latter view seen to be more neglected than in the relations the
+prepuce bears to infancy, prime and old age, as will be more fully
+explained in the chapters in this book which treat of cancer and
+gangrene. Admitting that Haviland has exaggerated the influence of
+climate as an etiological factor in its specific influence in producing
+certain diseases; or that M. Taine claims more than he should for his
+&ldquo;Th&egrave;orie <span class='pagenum'><a name="Page_16" id="Page_16">[16]</a></span>
+des Milieux,&rdquo; or influence of surroundings; or that Hutchinson
+has drawn the hereditary and pedigreeal fatherhood of disease too
+finely; it must also be admitted that the solid, tangible truths upon
+which these authors have founded their premises are plainly visible to
+the most skeptical; the architectural details of the superstructure may
+be defective, but the foundation is permanent.</p>
+
+<p>From the above outline it will be easier for the reader to follow out
+the reasons, or the whys or wherefores, of the views expressed on
+medicine in the course of the book; and, although I do not wish to enter
+the medical field like a Peter the Hermit on a new crusade, to lure
+thousands into the hands of the circumcisers, nor, as a new Mohammed,
+promise the eternal bliss and glory of the seventh heaven to all the
+circumcised, I ask of my professional brothers a calm and unprejudiced
+perusal of the tangible and authentic facts that I have honestly
+gathered and conscientiously commented upon from my field of vision,
+which will be plainly presented in the following pages. I simply have
+given the facts and my impressions: the reader is at liberty to draw his
+own conclusions.</p>
+
+<p>If I have been too tedious in the multiplication of incidents in support
+of certain views, I must remind the reader that the verdict goes to him
+who has the preponderance of testimony, and that many a lawsuit is lost
+from the neglect, on the part of the loser, to secure all the available
+testimony. Having brought the subject of circumcision before the bar of
+public opinion, as well as that of my professional brother, I would but
+illy do justice to the subject at the bar, or to myself, not to properly
+present the case; as it was remarked by Napoleon, &ldquo;God is on the
+side of the heaviest artillery,&rdquo; and <span class='pagenum'><a name="Page_17" id="Page_17">[17]</a></span>
+he who loses a battle for want of guns should not rail at Providence
+if, having them on hand, he has neglected to bring them into action.</p>
+
+<p>The reasons for the existence of the book will become self-evident as
+the reader labors through the medical part of the work. Our text-books
+are, as a class, even those on diseases of children as a specialty,
+singularly and unpardonably silent and deficient on the subject of
+either the prepuce and the diseases to which it leads, or circumcision;
+and even our surgical works are not sufficiently explicit, as they deal
+more with the developed disease and the operative measures for its
+removal than on any preventive surgery or medicine. Our works on
+medicine are equally silent, and, although from a perusal of the latter
+part of the book the prepuce and circumcision will be seen to have
+considerable bearing on the production and nature of phthisis, this
+subject would, owing to our strabismic way of studying medicine, look
+most singularly out of place in a work devoted to diseases of the lungs
+or throat. Owing to this poverty of literature on the subject, and that
+the library of the average practitioner could therefore not furnish all
+the data relating to it that the profession have in their possession, a
+book of this nature will furnish them the required material whereupon to
+form the basis of an opinion on the subject.</p>
+
+<p>To argue that the prepuce is not such a deadly appendage because so many
+escape alive and well who are uncircumcised, would be as logical as to
+assume that Lee&rsquo;s chief of artillery neglected to properly place
+his guns on the heights back of Fredericksburg. He had asserted, the
+night before the battle, that not a chicken could live on the
+intervening plateau between the heights and the town. On the next day,
+when these guns opened their <span class='pagenum'><a name="Page_18" id="Page_18">[18]</a></span>
+fire, the Federals were unable to reach the heights, while many men
+were for hours in the iron hail-sweeping discharges of that artillery
+that mowed them down by whole ranks, and yet the majority escaped alive.
+We take the middle ground, and, while admitting that many escape alive
+with a prepuce, claim that more are crippled than are visibly seen, as,
+like Bret Harte&rsquo;s &ldquo;Heathen Chinee,&rdquo; the ways of the
+prepuce are dark and mysterious as well as peculiar.</p>
+
+<p>A discussion of the relative merits of religious creeds, when considered
+in relation to health, has been, from the nature of the subject of the
+book, unavoidable. Modern Christianity but very imperfectly explains why
+this rite was either neglected or abolished. Frequent reference is made
+to what Saint Paul said and did, but, as Saint Paul was not one of the
+Disciples, it is inexplicable wherefrom he received his authority in
+this matter, seeing that the Disciples themselves had no new views on
+the subject. To the student who prefers to study his subject from all
+its aspects, the question naturally arises, &ldquo;Where, when, and why
+came the authority that abolished this rite?&rdquo; There is one
+probable explanation, this being that Paul, who was the real promulgator
+of Gentile Christianity, had to establish his creed among an
+uncircumcised race; although, as we shall see, devotees have not
+scrupled to sacrifice their virility in the hope of being more
+acceptable to God and to be better able to observe His commandments, and
+others, in their blind bigotry, have not objected to sitting naked on
+sand-hills, with a six-inch iron ring passed through the prepuce, it is
+very evident that the Apostle Paul&rsquo;s good sense showed him the
+uselessness of attempting to found the new creed, and at the same time
+hold on to the truly distinctive marking of Judaism among Gentiles, <span class='pagenum'><a name="Page_19" id="Page_19">[19]</a></span>
+the Hebrew race being those among whom he found the least converts, as
+even the Disciples and Apostles in Palestine disagreed with him. In the
+words of Dr. I. M. Wise, it was impossible for the Palestine Apostles,
+or their flock, either to acknowledge Paul as one of their own set or
+submit to his teaching; for they obeyed the Law and he abolished it;
+they were sent to the house of Israel only, and Paul sought the Gentiles
+with the message that the Covenant and the Law were at an end; they had
+one gospel story and he another; they prophesied the speedy return of
+the Master and a restoration of the throne of David in the kingdom of
+heaven, and he prophesied the end of the world and the last day of
+judgment to be at hand; they forbade their converts to eat of unclean
+food, and especially of the sacrificial meats of the Pagans, and he made
+light of both, as well as of the Sabbath and circumcision. In the
+attempted reconciliation that subsequently took place in Jerusalem at
+the house of James, the Jacob of Kaphersamia of the Talmud, Paul was
+charged by the synod of Jewish Christians &ldquo;with disregarding the
+Law, forsaking the teachings of Moses, and attempting to abolish
+circumcision.&rdquo; He was bid to recant and undergo humiliation with
+four other Nazarenes, that it might be known that he walked orderly and
+observed the Law; Paul submitted to all that was demanded.</p>
+
+<p>This, in short, with the exception of the sayings of Paul on the
+subject, which are all secondary considerations, is really all that
+there is relating to the abolishment of circumcision by the Christians.
+The real Disciples and Apostles believed in Jesus with as much fervor as
+Paul, but it is singular that they who were with the Master should
+always have insisted on the <span class='pagenum'><a name="Page_20" id="Page_20">[20]</a></span>
+observance of the Law, while Paul as energetically insisted on its
+abolishment.</p>
+
+<p>From these premises, I have seen fit to inquire into the relative merits
+of the three religions practiced by what we call the civilized nations,
+as they affect man morally, physically, and mentally. I have given the
+facts, my impressions, and reasons for being so impressed; from these,
+the reader can easily see that religion has more to do with man&rsquo;s
+temporal existence than is generally believed; its discussion is not,
+therefore, out of place in this book.</p>
+
+<p>Repetitions in the course of the work have been unavoidable. This is not
+a novel nor a work of fiction, and wherever the want of repetition would
+have been an injury, either to the proper representation of a fact or a
+principle, the repetition has not been avoided. In describing the
+operations, I had desired to avoid any too numerous descriptions, as
+that is confusing, but have thought it best to give a number, as the
+reader will thereby obtain the views of the different operators, the
+mode of the operation often being an index to the view of the operator
+in regard to the needs or utility of a prepuce. In the general plan of
+the work, I have adopted the idea and the historical relation carried
+out by Bergmann, of Strasburg, who included all the mutilations
+practiced on the genitals while discussing the subject of circumcision,
+they being, in the originality of performance, somewhat intimately
+connected; this also tends to make the subject more interesting as a
+contribution to the natural history of man,&mdash;something in which all
+intelligent persons are more or less interested.</p>
+
+<p class='sc ralign'>P. C. Remondino, M.D.</p>
+
+<p class='sc sf75'>San Diego, California.</p>
+
+<div class="figcenter mt2" style="width: 500px;">
+<img src="images/illus-egypt.png" width="500" height="215" alt="Egyptian Circumcision." title="" />
+<span class="caption sc">Egyptian Circumcision.</span><br />
+<span class="caption">(From Chabas and Ebers&rsquo; description of the <i>bas-relief</i> found in the
+temple of Khons, near the great temple of Maut, at Karnac.)</span></div>
+
+<hr /><p class='pagenum'><a name="Page_21" id="Page_21">[21]</a></p>
+<h2><a name="CHAPTER_I" id="CHAPTER_I"></a>CHAPTER I.<br />
+<span class='sc sf75'>Antiquity of Circumcision.</span></h2>
+
+<p>If the ceremonials of the Catholic Church or the High Church
+Episcopalians carry us back into the depths of antiquity, or, as
+remarked by Frothingham, that the ceremonies of St. Peter, at Rome,
+carried him back to the mysteries of Eulesis, to the sacrificial rites
+of ancient Ph&oelig;nicia, to what misty antiquity does not the
+contemplation of the rite of circumcision take us? The Alexandrian
+library, with its vast collection of precious records, could probably
+have furnished us some information as to its origin and antiquity; but
+Moslem fanaticism, with its belief in the all-sufficiency and
+infallibility of the Koran, was the destruction of that wonderful
+repository. We must now depend wholly on the relation of the Old
+Testament or on what has since been written by the Greek and Italian
+historians as to its origin and practices. The Egyptian monuments and
+their hyeroglyphics give us no information on the subject further back
+than the reign of Rameses II; while the oft-quoted Herodotus wrote some
+fourteen centuries after the Old Testament relation, and Strabo and
+Diodorus some nineteen centuries after the same chronicler. We have,
+therefore, in their chronological order, first, the relation of the
+Bible; then the Egyptian monuments and their revelations; and, thirdly,
+the information gathered by Pythagoras, Herodotus, and other
+philosophers and <span class='pagenum'><a name="Page_22" id="Page_22">[22]</a></span>
+historians. To these three sources we may add the misty mixture of
+tradition and mythological events, whose beginnings as to period of time
+are indefinite. These are the sources from which we are to determine the
+origin and antiquity as well as the character of the rite.</p>
+
+<p>Voltaire found in the subject of circumcision one that he could not
+satisfactorily make enter into his peculiar system of general
+philosophy. For some reason, he did not wish that the Israelites should
+have the credit of its introduction; were he to have admitted that, he
+would have had to explain away the divine origin of the
+rite,&mdash;something that the Hebrew has tenaciously held for over
+thirty-seven centuries. Voltaire thought it would simplify the subject
+by making it originate with the Egyptians, from whom the Hebrews were to
+borrow it. To do this he adopted the relation of Herodotus on the
+subject. His treatment of the Jewish race, however, brought out a strong
+antagonism from those people to his attacks, and in a volume entitled,
+&ldquo;Letters of Certain Jews to Monsieur Voltaire,&rdquo;&mdash;being
+a series of criticisms on his aspersions on the race and on the writings
+of the Old Testament (written by a number of Portuguese, German, and
+Polish Jews then residing in Holland<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a>),&mdash;they
+proved conclusively that the Ph&oelig;nicians had borrowed the rite from
+the Israelites, as they (the Ph&oelig;nicians) had practiced the rite on
+the newborn, whereas, had they followed the Egyptian rite, they would
+have only circumcised the child after its having passed its thirteenth
+year,&mdash;these being the distinctive differences between the Jewish
+and Egyptian rites.</p>
+
+<p>Luckily, in the small temple of Khons, which formed an annex to the
+greater temple of Maut, at Karnac, <span class='pagenum'><a name="Page_23" id="Page_23">[23]</a></span>
+there was found a <i>bas-relief</i>, partly perfect, which goes far toward
+giving light on the subject of Egyptian circumcision. The upper part of
+the sculpture was so defaced that the upper portions of four of the five
+figures were destroyed, but the lower portions were so perfect in every
+detail as to furnish a full history of the age of the candidates for the
+rite and the manner of its performance. It is further interesting from
+the fact that it establishes also the time during which the rite was so
+performed. M. Chabas and Dr. Ebers argue, from the founder of the temple
+having been Rameses II, that the sculpture refers to the circumcision of
+two of his children. The knife appears to be a stone implement, and the
+operator kneels in front of the child, who is standing, while a matron
+supports him in a kneeling posture, and she holds his hands from behind
+him.<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a>
+In this <i>bas-relief</i> we can see the great difference that existed
+between the two forms of the operation, that of the Hebrews being
+performed, as a rule, on the eighth day after birth, while in the
+<i>bas-relief</i> they are ten or twelve years old.</p>
+
+<p>Although tradition and mythology veil past events in more or less
+obscurity, they do, in regard to circumcision, furnish considerable
+explanatory light on matters which would be otherwise hard to reconcile.
+Circumcision has been performed by the Chippeways, on the Upper
+Mississippi, and its modifications were performed among the Mexicans,
+Central Americans, and some South American tribes of Indians, as well as
+among many of the natives dwelling among the islands of the Pacific
+Archipelago. There is a tradition, mentioned by Donnelly in connection
+with the sunken continent of Atlantis, that Ouranos, one of the
+Atlantean kings, ordered his whole army to be circumcised that they
+<span class='pagenum'><a name="Page_24" id="Page_24">[24]</a></span>
+might escape a fatal scourge then decimating the people to their
+westward.<a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a>
+This tradition tells us that the hygienic benefits of circumcision were
+recognized antediluvian facts, as it also points out the way by which
+circumcision traveled westward across to the Western World. As Donnelly
+has pointed out, many of the Americans possessed not only traditions,
+habits, and customs that must have come from the Old World, but the
+similarity of many words and their meaning that exists between some of
+the American languages and those of the indigenous inhabitants that have
+still their remains in spots on the southwestern shores of
+Europe&mdash;the ancient Armorica whose colony in Wales still retains
+its ancient words&mdash;leaves no room for doubt that at one time a
+landed highway existed between the two worlds. The Mandans, on the Upper
+Missouri, have many words of undoubted Armorican origin in their
+vocabulary,<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a>
+just as the Chiapenec, of Central America, contains its principal words
+denotive of deity, family relations, and many conditions of life that
+are identically the same as in the Hebrew,<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a>
+the name of father, son, daughter, God, king, and rich being essentially
+the same in the two languages. It must have been more than a passing
+coincidence that gives the Mandans some of their most expressive words
+from the Welsh, or that gave to Central America many cities bearing
+analogous names with the cities of Armenia.<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a>
+Canadian names of localities, as well as those of the Mississippi
+Valley, denote the French origin of their pioneers, as well as the names
+of Upper California denote the nationality and creed of its first
+settlers. So that there is nothing strange in asserting that American
+civilization and many of the customs as found in the fifteenth century
+by the early Spanish discoverers were nothing more <span class='pagenum'><a name="Page_25" id="Page_25">[25]</a></span>
+than the remains of ancient and modified Ph&oelig;nician civilization,
+among which figured circumcision.</p>
+
+<p>Dr. A. B. Arnold, of Baltimore, argues that, with the present state of
+our anthropological knowledge and the material that research has been
+able to furnish, we need no longer be surprised to find customs, laws,
+and morals, among nations living in regions of the world widely apart
+from each other, which betray an identity of origin and development, and
+that beliefs and institutions, whether wise or aberrant, grow up under
+apparently dissimilar circumstances, circumcision forming no
+exception.<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a>
+Dr. Arnold leaves too much to chance. It is hardly likely that the
+similarity that existed between the architecture of the Ph&oelig;nicians
+and the Central Americans, as evinced in their arches; in the beginning
+of the century on the 26th of February; the advancement and interest
+taken in astronomical science; the coexistence of pyramids in Egypt and
+Central America; that five Armenian cities should have their namesakes
+in Central America, should all be a matter of accident. The
+historiographer of the Canary Islands, M. Benshalet, considers that
+those islands once formed a part of the great continent to its west;
+this has been verified by the discovery of many sculptured symbols,
+similar in the Canaries and on the shores of Lake Superior, as well as
+by the discovery of a mummy in the Canaries with sandals whose exact
+counterparts were found in Central America.<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a>
+A compound word used to signify the Great Spirit being found identical
+in the Welsh and Mandan languages, each requiring five distinct sounds
+to pronounce, words as intricate as the passwords of secret societies,
+can hardly be said to be the result of chance.<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a>
+There must, at some remote period, have existed some communication
+between the ancestors of these Missouri<span class='pagenum'><a name="Page_26" id="Page_26">[26]</a></span>
+Mandans and the shores of ancient Armorica; the ancestors of these
+Mandans may have then been living farther to the east; they even may
+have then been a tribe of since lost Atlantis; but the analogy, not only
+in regard to the word just mentioned,&mdash;<i>Maho-peneta</i>, of the Welsh
+and Mandan,&mdash;but in the similarity of the pronouns of both
+languages, and the existence of the idea of the counterpart of the
+sacred white bull of the Egyptians being found among the Dakotas, or
+Sioux, all point to the fact that these people, in common with the rest
+of the Americans, originally came from the East; from whence came their
+languages, manners, customs, rites, and what civilization they
+possessed, among which circumcision has, through the mist of centuries,
+held its own in some shape or other.</p>
+
+<p>That some terrible catastrophe occurred to divide the hemispheres is
+evident; the Western World remaining stationary in its civilization and
+retaining the customs and rites of the times as evidence of their
+origin. With this view of the case, the existence of circumcision as
+found among the inhabitants of the West can easily be traced to its
+origin among the hills of Chaldea. The ancient traditions and
+mythological relations of the Egyptians in regard to the great nation to
+the West are amply verified by the deep-sea soundings of the
+&ldquo;Challenger,&rdquo; the &ldquo;Dolphin,&rdquo; and the
+&ldquo;Gazelle,&rdquo; which plainly indicate the presence of a
+submarine plateau that once formed the continent of Atlantis, whose only
+visible evidence above the waves of the boisterous Atlantic is the
+Azores and the remains of Ph&oelig;nician civilization among the Americans.</p>
+
+<p>Professor Worman, of Brooklyn, scouts the idea that circumcision was
+ever connected in any way or that it originated in any of the rites
+connected with phallic <span class='pagenum'><a name="Page_27" id="Page_27">[27]</a></span>
+worship.<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a>
+Bergmann,<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a> of Strasburg, however, not only claims circumcision to be
+a direct result of phallic worship, but looks upon the rite as something
+that has been reached by what may be termed a gradual evolutionary
+process of manners, customs, and society, from the time of what is
+termed the hero-warrior period of traditional history, when war and the
+clashing of shields and sword or spear were the main delights and
+occupations of man. It is strange to note what difference must have
+existed between these hero-warriors in regard to their ideas of
+manliness; some were brutal and fiendish, whilst others were
+magnanimous. McPherson, the historiographer of early Britain, cannot
+help but contrast the superior manliness of the heroes of Ossian in his
+graphic description of the ancient Caledonians, when compared to the
+brutality of Homer&rsquo;s Greek heroes. The traditions upon which
+Bergmann undertakes to found the origin of the rite of circumcision are
+all connected with the inhuman and brutish passions that animated our
+barbarous ancestry. The first incident given is the Egyptian traditional
+tragedy, which was, in all probability, the initial point of that
+phallic worship which, with increasing debauchery, assisted in the final
+demoralization of Rome and Greece, after its introduction into those
+countries.</p>
+
+<hr /><p class='pagenum'><a name="Page_28" id="Page_28">[28]</a></p>
+<h2><a name="CHAPTER_II" id="CHAPTER_II"></a>CHAPTER II.<br />
+<span class='sc sf75'>Theories as to the Origin of Circumcision.</span></h2>
+
+<p>We are told that in battle man looked upon the vanquished as unfit to
+bear the name of man, looking upon the weakness or want of skill which
+contributed to their defeat as something effeminate. The victor then
+proceeded by a very summary and effective mode, done in the most
+primitive and expeditious manner, to render his victim as much like a
+female as possible to all outward appearances; this was accomplished by
+a removal at one sweep of <i>all</i> the organs of generation, the phallus
+being generally retained as a trophy,&mdash;a practice which was also carried
+into effect with dead enemies, to show that the victor had vanquished
+<i>men</i>. It has been the practice from time immemorial for a victor to
+carry off some portion of the body of his victim or defeated enemy, as a
+mark or testimony of his prowess; it was either a hand, head or scalp,
+lower jaw, or finger. The carrying off of the phallus or virile member
+was considered the most conclusive proof of the nature of the
+vanquished, and, as it established the sex, it conferred a greater title
+to bravery and skill than a mere collection of hands or scalps, which
+would not denote the sex. In conformity with this custom, we find that
+Osiris, when he returned to Egypt and found that Typhon had fomented
+dissension in his absence, being vanquished by the latter in the
+conflict that followed, was dismembered and cut into pieces, the
+followers of Typhon each securing a piece and Typhon himself securing
+the phallus or generative member. Isis, the spouse of Osiris, seems in
+turn to have secured the control of government, and, <span class='pagenum'><a name="Page_29" id="Page_29">[29]</a></span>
+having secured all the pieces of the dissected Osiris except the
+phallus,&mdash;Typhon having fled with that, and, according to some
+traditions, having thrown it into the sea,&mdash;Isis ordered that
+statues should be constructed, each to contain a piece of the
+unfortunate Osiris, who should thereafter be worshiped as a god, and
+that the priesthood should choose from among the animals some one kind
+which should thereafter be considered sacred. The phallus which was
+missing was ordered special worship, with more marked solemnities and
+mysteries; from this originated the phallic worship and the sacredness
+of the white bull, Apis, among the Egyptians, which was chosen to
+represent Osiris.</p>
+
+<p>By gradual evolution and the progress of society, the cultivation of the
+ground and the need of menials, warriors found some other use for their
+prisoners taken in strife besides merely cutting off the phallus as a
+trophy; these prisoners began to have some intrinsic value. From this a
+change came about; the warrior instinct, however, still claimed that the
+vanquished, even if a slave, should still convey or carry some sign of
+servitude. The original idea of the ablation of the phallus was to
+emasculate the victim; investigation developed the idea that the same
+object could be accomplished by castration, an operation which also
+finally reached a tolerable state of perfection through different stages
+of evolution, it first being performed by a complete removal of the
+whole scrotum and contents. This operation, with the ignorance of the
+times in regard to stopping h&aelig;morrhage, was, however, accompanied by a
+large mortality, and it finally evolved into the simple removal of the
+gland, or its obliteration by pressure or violence. Bergmann conveys the
+idea that circumcision was at one time the indestructible marking and
+<span class='pagenum'><a name="Page_30" id="Page_30">[30]</a></span>
+the distinctive feature of the slave, the mind of the period not being
+able to emancipate itself from the idea that the genitals must in some
+manner be mutilated, not being able to conceive any other degrading mark
+of manhood which barbarians felt they must inflict on slaves.</p>
+
+<p>The generally accepted idea in regard to the physical mutilation of
+captives taken in war, or that some token from the body of the
+vanquished must be carried off by the victor, has not only the support
+of tradition and monumental sculptured evidence, but its practice is
+still in vogue among many races. Among the ancient Scythians, only the
+warriors who returned from the battle or foray with the heads of the
+enemy were entitled to a share in the spoils. Among the modern Berbers
+it is still a practice for a young man, on proposing marriage, to
+exhibit to his prospective father-in-law the virile members of all the
+enemies he has overcome, as evidence of his manhood and right to the
+title of warrior. The Abyssinians and some of the negro tribes on the
+Guinea coast still follow the custom of securing the phallus of a fallen
+foe. However barbarous this practice may seem, its actual performance is
+only secondary, the primary motive being that the warrior wished to
+prove that he had been there, engaged in actual strife, and that his
+enemy had been overcome. The writer remembers that, after one of the
+battles in the West during the late war, many letters arrived in his
+locality with pieces of the garments or locks of the hair of the
+unfortunate Confederate general, Zollikoffer, who had been slain in the
+battle; a disposition in the warrior, seemingly still existing, such as
+animated the old Egyptians. On an old Egyptian monument,&mdash;that of
+Osymandyas,&mdash;Diodorus noticed a mural sculpture, <span class='pagenum'><a name="Page_31" id="Page_31">[31]</a></span>
+a <i>bas-relief</i> representing prisoners of war, either in chains or bound
+with cords, being registered by a royal scribe preparatory to losing
+either the right hand or the phallus, a pile of which is visible in one
+corner of the foreground; from this sculpture we learn that the practice
+was not only an individual performance, but that it was a national usage
+among the Egyptians as well, who subjected, at times, their vanquished
+foes to its ordeal in a wholesale but business-like manner.</p>
+
+<p>Bergmann argues that the Israelites were given to like practices, and
+cites the incident wherein David brought two hundred prepuces&mdash;as
+evidence of his having slaughtered that number of Philistines&mdash;to Saul,
+as a mark of his being worthy to be his son-in-law. He argues that,
+whereas many have made that Old Testament passage to read &ldquo;two
+hundred prepuces,&rdquo; it should have read &ldquo;two hundred virile
+members&rdquo; which David and his companions had cut off from the
+Philistines, the word <i>orloth</i> meaning the virile member, and not the
+prepuce. That Israelitish circumcision could have originated from either
+phallic worship or any of the hero-warrior usages is untenable as a
+proposition, as regards the living prisoners, and is contrary to the
+monotheistic idea which ruled Israel, or to the benign nature of their
+God. The strict opposition of the religion of Judaism to any other
+mutilation except that of the covenant is also antagonistic to the views
+advanced by Bergmann, as it is well known that even emasculated animals
+were considered imperfect and unclean, and therefore unfit to be
+received or offered as a sacrifice to their deity. No emasculated man
+was allowed to enter the priesthood or assist at sacrifices. The whole
+idea of Judaism being opposed to such mutilations, their observance of
+circumcision and its <span class='pagenum'><a name="Page_32" id="Page_32">[32]</a></span>
+performance can in no way have developed from either phallic or other
+warlike rites or usages; but we must accept its origin as a purely
+religious rite,&mdash;a covenant of the most rigid observance,
+coincident in its inception with the formation of the Hebraic creed in
+the hills of Chaldea.</p>
+
+<p>What Herodotus or Pythagoras may have written concerning the practice
+among the Egyptians was written, as already remarked, some nine
+centuries after Moses had recorded his laws; Moses himself having come
+some centuries after Abraham. Herodotus is quoted as representing that
+the Ph&oelig;nicians borrowed the practice from the Egyptians, in support
+of the theory that Egypt was the central nucleus from whence the
+practice started, and not that it traveled toward Egypt from
+Ph&oelig;nicia. The difference in the ages, already mentioned, at which the
+rite was practiced&mdash;that of Ph&oelig;nicia and Israel being at one time
+identical&mdash;shows that the testimony of Herodotus in this one particular
+was the result of faulty judgment, as we find the people who have
+borrowed the practice from the Egyptians, as well as their descendants,
+closely follow their practice in regard to the age at which the
+operation should be performed. Another evidence of the strictly
+religious nature of the rite, as far as the Hebrews are concerned, lies
+in the fact that, with all their skill in surgery and medical
+sciences,&mdash;they being at one time the only intelligent exponents of our
+science,&mdash;they never made any alteration or improvement in the manner of
+performing the operation. It is evident that even Maimonides, a
+celebrated Jewish physician of the twelfth century, who furnished some
+rules in regard to the operation, was held under some constraint by the
+religious aspect of the rite. As a summary of this part of the subject,
+it <span class='pagenum'><a name="Page_33" id="Page_33">[33]</a></span>
+may be stated that the Old Testament furnished the only reliable and
+authentic relation prior to Pythagoras and Herodotus. From its evidence,
+Abraham was the first to perform the operation, which he seems to have
+performed on himself, his son, and servants,&mdash;in all, numbering
+nearly four hundred males; he then dwelt in Chaldea. In absence of other
+as reliable evidence we must accept this testimony in regard to its
+origin, causes, and antiquity.</p>
+
+<p>Voltaire, in his article on circumcision in his &ldquo;Philosophical
+Dictionary,&rdquo; seems more intent on breaking down any testimony that
+might favor belief in any religion than to impart any useful light or
+information. He bases all his arguments on the book
+&ldquo;Euterpe,&rdquo; of Herodotus, wherein he relates that the Colchis
+appear to come from Egypt, as they remembered the ancient Egyptians and
+their customs more than the Egyptians remembered either the Colchis or
+their customs; the Colchis claimed to be an Egyptian colony settled
+there by Sesostris and resembled the Egyptians. Voltaire claims that, as
+the Jews were then in a small nook of Arabia Petrea, it is hardly likely
+that, they being then an insignificant people, the Egyptians would have
+borrowed any of their customs. To read Voltaire&rsquo;s
+&ldquo;Herodotus&rdquo; is somewhat convincing, but Voltaire&rsquo;s
+&ldquo;Herodotus&rdquo; and Herodotus writing himself are two different
+things, and the book &ldquo;Euterpe&rdquo; says quite another thing from
+what M. Voltaire makes it say. A perusal of Voltaire and a study of his
+Jewish critics on this subject, as found in the &ldquo;Jews&rsquo;
+Letters to Voltaire,&rdquo; will convince any reader that as to
+circumcision M. Voltaire is an unreliable authority.</p>
+
+<hr /><p class='pagenum'><a name="Page_34" id="Page_34">[34]</a></p>
+<h2><a name="CHAPTER_III" id="CHAPTER_III"></a>CHAPTER III.<br />
+<span class='sc sf75'>Spread of Circumcision.</span></h2>
+
+<p>From Chaldea, then, in the mountains of Armenia and Kurdistan, the
+practice of circumcision was, in all probability, first adopted by the
+Ph&oelig;nicians, who finally relinquished the Israelitish rite as to age
+of performance and exchanged it for the Egyptian rite. From Ph&oelig;nicia
+its spread through the maritime enterprises of this race to foreign
+parts was easy. Egypt was the next place to adopt its practice; at first
+the priesthood and nobility, which included royalty, were the only ones
+who availed themselves of the practice. The Egyptians connected
+circumcision with hygiene and cleanliness; this was the view of
+Herodotus, who looked upon the rite as a strictly hygienic measure.
+History relates of the existence of circumcision among the Egyptians as
+far back as the reign of Psamm&eacute;tich, who ruled toward the end of the
+sixth century <span class='sc lc'>B.C.</span> The practice must then have been of a very religious
+and national nature, as we are told that Psamm&eacute;tich, having admitted
+some noted strangers, whom he allowed to dwell in Egypt without being
+circumcised, brought himself into great disfavor among his subjects, and
+especially by the army, who looked upon an uncircumcised stranger as one
+undeserving of favors. During the next century Pythagoras visited Egypt,
+and was compelled to submit to be circumcised before being admitted to
+the privilege of studying in the Egyptian temples. In the following
+century these restrictions were removed, for neither Herodotus nor
+Diodorus, who visited the country, were obliged to be <span class='pagenum'><a name="Page_35" id="Page_35">[35]</a></span>
+circumcised, either to dwell among the people or to follow their
+studies. There is one curious habit that is mentioned in connection with
+the rite of circumcision among these people, this being its relation to
+the taking of an oath or a solemn obligation. Among the Egyptians the
+circumcised phallus, as well as the rite of circumcision, seemed to be
+the symbol of the religious as well as of the political community, and
+the circumcised member was emblematical of civil patriotism as well as
+of the orthodox religion of the nation. To the Egyptian, his circumcised
+phallus was the symbol of national and religious honor; and as the
+Anglo-Saxon holds aloft his right hand, with his left resting on the
+holy Bible, while taking an oath, so the ancient Egyptian raised his
+circumcised phallus in token of sincerity,&mdash;a practice not
+altogether forgotten by his descendants of to-day. It was partly this
+custom of swearing, or of affirming, with the hand under the thigh, by
+the early Israelites, that caused many to believe that their
+circumcision was borrowed from the Egyptians, especially by M. Voltaire,
+who insists that it was the phallus that the hand was placed on, and
+that the translation has not the proper meaning, as given in the Bible.</p>
+
+<p>Among the Arabs it was the practice to circumcise at the age of thirteen
+years, this being the age of Ishmael at his circumcision by his father,
+Abraham. The Arabs practiced circumcision long before the advent of
+Mohammed, who was himself circumcised. Pococke mentions a tradition
+which ascribes to the prophet the words, &ldquo;Circumcision is an
+ordinance for men, and honorable in women.&rdquo; Although the rite is
+not a religious imposition, it has spread wherever the crescent has
+carried the Mohammedan faith. Uncircumcision and impurity are to a
+Mohammedan synonymous terms.<span class='pagenum'><a name="Page_36" id="Page_36">[36]</a></span>
+Like the Abyssinians, the Arabs also practice female
+circumcision,&mdash;an operation not without considerable medical
+import, as will be explained in the medical part of the work. This
+practice is also common in Ethopia. Some authorities argue, from this
+association of female circumcision among the Southern Arabs, Ethiopians,
+and Abyssinians, that they did not derive their rite from the
+Israelites; but there is not much room for doubt but that the operation
+came down to the Arabians from Abraham through his son Ishmael.
+Considering the occupancy of Syria, Arabia, and Egypt by the French, and
+the intercourse with these countries by the British, it is surprising
+that the profession in the early part of the present century had not
+full information regarding the nature and objects of female circumcision
+as practiced in these countries. Delpesh observes, in relation to the
+Oriental practice, that his information was too vague to determine
+whether it was the nymph&aelig; or the clitoris that were removed, or
+whether it was only practiced in cases of abnormal elongations of these
+parts. M. Murat, however, writes at length on the subject, very
+intelligently, as well as Lonyer-Villermay, who, writing in the same
+work with Delpesh, thinks it is certainly the clitoris that is
+removed.<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a>
+In Arabia, the trade or profession of a <i>resectricis nympharum</i> or
+she-circumciser is as stable an occupation with some matrons as that of
+cock-castration or caponizing is the sole occupation of many a matron in
+the south of Europe. It is related by Abulfeda that, in the battle of
+Ohod, where Mohammedanism came very near to a sudden end by the crushing
+defeat of the prophet and his followers, Hamza, the uncle of the
+prophet, seeing in the opposing ranks a Koreish chief, whom he knew,
+thus called out: &ldquo;Come on, you son of a she-circumciser!&rdquo;
+<span class='pagenum'><a name="Page_37" id="Page_37">[37]</a></span>
+As Hamza was among the slain, it is most likely that he met his death
+from the hands of the chief, whose mother really followed that
+occupation. So extensive is the practice, that these old women sometimes
+go through a village crying out their occupation, like itinerant tinkers
+or scissors-grinders.</p>
+
+<p>The present ceremonies attending the performance of the rite among the
+Arabians are well described by Dr. Delange, a surgeon of the French
+army, as witnessed by him in the province of Constantine, in Algeria.</p>
+
+<p>With these Arabs, circumcision is performed on a whole class, so to
+speak, at the same time, regardless of the trifling differences in their
+ages. It is preceded by feasting, the total length of the feast being
+for eight days. For the first seven days, all the Arabs of the quarter
+where the candidates for circumcision reside dress in their best. The
+poor have their mantles and clothes carefully washed, and the rich deck
+themselves out in their gold and silver brocaded vests and pantaloons.
+During these seven days there is general rejoicing, and the Arabs spend
+most of this time in the village street, racing, firing guns, or
+engaging in sham battles between the different camps, during which one
+carries the green, or sacred banner, which is supposed to render the
+bearer invulnerable. The battle ends by the standard-bearer being fired
+at by all parties, and falling, but quickly rising again and waving the
+flag in token of its protecting power. The Arabs now adjourn to another
+public place, where the notables and strangers are furnished seats on
+carpets; here a dance to the music of tumtums and the singing of
+invisible females takes place, the dancers being only males.<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a>
+In the evening the women sing, to which the men listen in silence, this
+concert being kept up until midnight. On the seventh day, the <span class='pagenum'><a name="Page_38" id="Page_38">[38]</a></span>
+women, decked out in their best, and with all their personal ornaments,
+accompanied by all the young men, armed with their guns and pistols,
+repair to the extremity of the oasis, where they gather plates of fine
+sand. With this sand they return to the village, where it is exposed
+overnight to the glare of the full moon on the terraces of the house.
+This last day closes with a grand banquet, given by the rich whose
+children are about to be circumcised, to which all the people are
+invited.</p>
+
+<p>The next morning all the relatives of the candidates repair to the house
+where the rite is to be performed; the women going up into the second
+floor, wherefrom they can look down into the court from a porch screened
+with lattice-work, without themselves being seen. The men gather
+together on the ground-floor, together with the operator and his
+assistants and the children about to be circumcised, who are dressed in
+yellow, silken gowns. The child to be operated upon is seated in a pan
+of sand, while an assistant fixes his arms and holds the thighs well
+separated from behind. The circumciser then examines the prepuce, the
+glans, and removes any sebaceous collection. This done, a compress with
+an aperture to admit of the passage of the glans is slipped over the
+organ; a small piece of leather, some six centimetres in diameter, with
+a small hole in the centre, is now used, the free end of the prepuce
+being drawn through the aperture; a ligature of woolen cord is then tied
+on to the prepuce next to the front of the leather shield, and, the
+knife being applied between the thread and the leather, the prepuce is
+removed at one sweep; the mucous inner layer is then lacerated with the
+thumb-nails and turned back over to join the other parts. The surface is
+then sprinkled with <i>arar</i> or <i>genevriere</i> powder and dressed with a
+small cloth bandage, <span class='pagenum'><a name="Page_39" id="Page_39">[39]</a></span>
+the subsequent dressings consisting of <i>arar</i> powder and oil. During
+the operation the women in the gallery keep up an unearthly music by
+means of tumtums, cymbals, and all the kettles and saucepans of the
+neighborhood, which are brought into requisition for the occasion. This
+music is accompanied with songs and chants, each woman striking out with
+an independent song of her own, either improvised or suggested by the
+occasion. This not only serves to drown the cries of the children, but
+it must, in a manner, assist to draw them away from the immediate
+contemplation of their sufferings. The prepuces are now gathered
+together and carried to the end of the oasis, where they are buried with
+ceremony and rejoicings. This circumcision only takes place once in
+three or four years, and the children are from four to eight years of
+age; of fifteen circumcised at the feast witnessed by M. Delange, only
+two had passed their eighth year.</p>
+
+<p>In a very interesting old book,<a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a>
+&ldquo;The Treaties of Alberti Bobovii,&rdquo; who was attached to the
+court of Mohammed IV, published with annotations by Thomas Hyde, of
+Oxford, in 1690, there is a description of the Turkish performance of
+the rite which leads one to infer that they circumcised the children
+quite young: &ldquo;Et cum puer pr&aelig; dolore exclamat, imus ex
+duobus parentibus digitis in melle ad hoc comparato os ei obstruit;
+c&aelig;teris spectatoribus acclamantibus. O Deus, O Deus, O Deus.
+Interim quoque Musica perstrepit, tympana et alia crepitacula
+concutiuntur, ne pueri planctus et ploratus audiatur.&rdquo; Bobovii
+says that the age at which circumcision is performed is immaterial
+provided the candidate is old enough to make a profession of
+faith,&mdash;which, however, is made for him by the godfather,&mdash;in
+the following words: &ldquo;There is no God but God, and Mohammed is his
+Prophet,&rdquo; or, as rendered by our <span class='pagenum'><a name="Page_40" id="Page_40">[40]</a></span>
+author, &ldquo;Non esse Deum nisi ipsum Deum, et Mohammedem esse
+Legatum Dei.&rdquo; To which he adds that the child must not be an
+infant, but that he must be at least eight years of age. Like to the
+Arabs, the Turks celebrated the occasion by feasts, plays, and a general
+good time; the child was kept in bed for fifteen days to allow complete
+cicatrization to take place. The circumcision was performed with the boy
+standing.</p>
+
+<p>Michel Le Feber, writing in 1681,<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a>
+speaks of the tax levied on the Christians by the Turks, that they, the
+Christians, may enjoy liberty of conscience, and observes that,
+circumcision not being compulsory among the Turks, it often led to
+trouble and annoyances, as many of the Turks evaded the operation. The
+tax-gatherers in Turkey are very industrious, and, as being circumcised
+was, as a rule, sufficient evidence of not being a Christian, he often
+witnessed on the streets scenes wherein strangers, arrested by these
+tax-collectors, were compelled to show their circumcision as an
+indisputable sign of their exemption from the tax. He also relates that
+in their zeal for converts to Mohammedanism the Turks often resorted to
+presents to induce Christians to embrace their faith. While in Aleppo,
+he saw a Portugese sailor, who, through presents, had forsaken his
+religion, but who had repented in the most emphatic manner when brought
+to face circumcision. Finding entreaties in vain, the Cadi ordered the
+immediate administration of a stupefying draught, and the sailor was
+then seized and circumcised without further ceremony.</p>
+
+<p>In cases where the new Mohammedan is reasonable and submits like a hero,
+the ceremonies are more elaborate. Le Feber relates that if the
+candidate is a man of note or wealth he is mounted on a horse and
+exhibited all over the city; he is dressed in the richest of Turkish
+<span class='pagenum'><a name="Page_41" id="Page_41">[41]</a></span>
+robes and in his hand he holds an arrow with the point directed to the
+sky; he is followed by a great concourse of people, some dressed in
+holiday attire and others in fantastic costumes; and general feasting
+and enjoyment is the rule over the course of the march, where all the
+people run to swell the crowd. If the man happens to be a poor man, he
+is simply hurriedly marched about on foot, with a simple arrow in his
+hand pointed skyward, to distinguish him from ordinary mortals; before
+him a crier proclaims in a loud voice that the new religionist has
+ennobled himself by professing the faith of the prophet in this solemn
+manner. A collection for his benefit is taken up among the booths and
+shops, which is mostly appropriated by the conductor, circumciser, and
+his assistants, after which he is circumcised without further ado.</p>
+
+<p>The same author describes the operation as performed on the young Turks
+and the accompanying ceremonies. They differ in some respects from those
+employed in circumcising a convert. The parents of the child give a
+feast in proportion to their means, to which are invited the relatives
+of the family and personal friends; if of the upper ranks, he is
+promenaded about the town to the music of drums and cymbals, dressed in
+rich attire; two warriors lead the procession with drawn swords, and a
+troop of females who sing songs of joy bring up the rear; the procession
+now and then stops, when the two gladiators in the front indulge in a
+fierce set-to, hacking at each other in the most determined and
+murderous manner, but so studiedly shammy that neither is injured; on
+the return to the house, the child, who is usually eight or ten years of
+age, is bound hand and foot to prevent his causing any injury to
+himself, laid on a bed, and circumcised with a razor, the operation
+being performed either by a surgeon or the chief of a mosque.</p>
+
+<hr /><p><span class='pagenum'><a name="Page_42" id="Page_42">[42]</a></span></p>
+<h2><a name="CHAPTER_IV" id="CHAPTER_IV"></a>CHAPTER IV.<br />
+<span class='sc sf75'>Circumcision Among Savage Tribes.</span></h2>
+
+<p>E. Casalis,<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a>
+who, in the capacity of missionary, for a very long time resided among
+the Bassoutos, tells us that among that nation the operation is
+performed at the age of from thirteen to fifteen years. The ceremony is
+gone through once in three or four years. So important an event is it
+considered by the Bassoutos that they date events from one of these
+observances, as the Romans dated events from a certain consulship, or
+the Greeks from an Olympiade. At the time fixed, all the candidates go
+through a sham rebellion and escape to the woods; the warriors arm and
+give chase, and, after a sham battle, capture the insurgents, whom they
+bring back as prisoners, amidst dancing and great rejoicings, which are
+the preludes to the feast. The next day the huts of mystery (<i>mapato</i>)
+are erected, where, after the circumcision, the young men are to reside
+for some eight months, under the tutorship of experienced teachers, who
+drill them in the use of the spear, sword, and shield, teaching them to
+endure hunger, thirst, blows, and all manner of hardships; prolonged
+fasts and cruel flagellations being regarded as pastimes between the
+exercises. The severity of the regulations may be judged from the fact
+that the instructors have a right to put to death any one who may try to
+escape from these ordeals. The women are rigorously excluded from these
+camps, but the men are allowed to visit them, when they have the
+privilege of assisting the teachers by adding additional blows and
+precepts to the backs of the unlucky candidates.<span class='pagenum'><a name="Page_43" id="Page_43">[43]</a></span>
+After eight months of such training, the young men are oiled from head
+to foot and dressed in a garment, and are now given the name which they
+are to bear for the rest of their lives. The <i>mapato</i>, or mystery hut,
+is now burned to the ground and the young men return to the village. The
+maternal uncle of the youth here presents him with a javelin for his
+defense, and a cow that is to furnish him with nourishment. Until the
+time of his marriage, the newly circumcised dwell together; their duties
+being of a menial character, such as gathering wood and attending to the
+flocks and droves.</p>
+
+<p>M. Paul Lafargue looks upon circumcision among the negro races as being
+a rite commemorating their advent to manhood; Livingstone, who has also
+observed the above, related incidents in relation to the performance of
+<i>boguera</i>, or circumcision, among the Bassoutos, believes that with them
+the rite has a purely civil significance, being in no way connected with
+religion.</p>
+
+<p>Among many of the African tribes the young maids have an ordeal
+approaching to circumcision that they must pass when near the age of
+thirteen, this rite bearing precisely the same relation regarding their
+entrance into the state of womanhood that male circumcision denotes the
+entrance into manhood on the part of the males among the Bassoutos. At
+the appointed time the maids are gathered together and conducted to the
+riverbank; they are placed under the care of expert matrons. They here
+reside, after having undergone a kind of baptism; they are maltreated,
+punished, and abused by the old women, with a view of making them hardy
+and insensible to pain; they are also schooled in the science and art of
+African household duties. Among the Gallinas of Sierra Leone, in
+addition to the other observances, the clitoris of the young maid is
+excised at midnight, <span class='pagenum'><a name="Page_44" id="Page_44">[44]</a></span>
+while the moon is at its full, after which they receive their name by
+which they are to be known through life. The initiation of each sex into
+these mysteries is exclusively for the sex engaged, and it would be as
+fatal for a man to steal into the camp of the women during the
+performance of these ceremonies as it would be fatal for a woman to
+enter a <i>mapato</i> where the young men are undergoing their ordeal. After
+their initiation into womanhood, the maids live by themselves, similarly
+to the young men, until they marry.</p>
+
+<p>Lafargue relates that among the Australians circumcision is held in such
+importance that tribes at war will suspend all hostilities and meet in
+peace during the observance or performance of the rite. Here, again, we
+have a repetition, with a slight variation, of the practices of the
+Bassoutos,&mdash;something which gives some countenance to the hero-warrior
+idea of the origin of circumcision advanced by Bergmann. The Australian
+warriors go through a mimic battle, and, after a series of combats,
+finally capture the boys aged about from thirteen to fourteen years,
+whom they bear away amidst the cries and lamentations of the mothers and
+other female relatives, who, in their excess of grief, mutilate
+themselves by cutting gashes into their thighs, so that they bleed
+profusely. The boys are, in the meantime, carried to some out-of-the-way
+place, where an old man, perched on a tree or some rising ground,
+through the means of a musical instrument made of a deal-board and human
+hair, announced that the rite is in process of performance, so that
+neither women nor children might approach. Tufts of moss are placed in
+the axilla and on the pubis, to represent puberty, and among some tribes
+the skin of the penis is divided to the scrotum with a stone knife,
+while others content themselves <span class='pagenum'><a name="Page_45" id="Page_45">[45]</a></span>
+with simply making a circular incision, which removes the prepuce,
+after the Jewish manner, the excised portion being placed as a ring on
+the median finger of the left hand. The circumcised then takes himself
+to the hills or woods, and there remains until healed, carefully
+guarding himself against the approach of any female. After this the
+third part of the ceremonies takes place: the godfather of the youth
+opens a vein in his own arm, the circumcised youth is placed on
+all-fours, and an incision is made from the neck down as far as the
+lumbar region, and the blood of the godfather is made to flow and mingle
+with that of the godchild; this being in reality a bloody baptism, and a
+near relation to the blood-compacts of the Arabs.</p>
+
+<p>The Malays, as well as the men of Borneo, are circumcised. The Battos
+likewise perform the rite. Among the Islanders they sometimes ligate the
+prepuce so that it drops off. Among the Battos the same object is
+reached by small bamboo sticks, between which the prepuce is fastened.
+In New Caledonia and Tidshi the boys are circumcised in their seventh
+year. The Tonga Islanders split the prepuce on the dorsum with a piece
+of bamboo or of shell. In the Marquesas and Sandwich Islands the
+operation is superintended by the priests.<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a></p>
+
+<hr /><p class='pagenum'><a name="Page_46" id="Page_46">[46]</a></p>
+<h2><a name="CHAPTER_V" id="CHAPTER_V"></a>CHAPTER V.<br />
+<span class='sc sf75'>Infibulation, Muzzling, and other Curious Practices.</span></h2>
+
+<p>It seems a matter of controversy as to whether the Mexicans did or did
+not circumcise their children. That they had a blood-covenant is
+admitted by the historians, as well as the fact that this blood was
+taken from the prepuce; but that the prepuce was actually removed is
+something that is not agreed upon by all authorities. Las Casas and
+Mendieta state that it was practiced by the Aztecs and Totonacs, while
+Brasseur de Bourbourg found traces of its practice among the Mijes. Las
+Casas states that on the twenty-eighth or the twenty-ninth day the child
+was presented to the temple, when the high-priest and his assistants
+placed it upon a stone and cut off the prepuce, the excised part being
+afterward burnt in the ashes. Girls of the same age were deflowered by
+the finger of the high-priest, who ordered the operation to be repeated
+at the sixth year; and once a year, at the fifth month, all the children
+born during the year were scarified on the breast, stomach, or arms, to
+denote their reception as servants of their god. Clavigero, on the other
+hand, denies that circumcision was ever practiced. It was customary in
+Mexico, according to most authorities, to take the children while
+infants to the temple, where the priests made an incision in the ear of
+the females, and an incision in the ear and prepuce of the males.<a name="FNanchor_18_18" id="FNanchor_18_18"></a><a href="#Footnote_18_18" class="fnanchor">[18]</a></p>
+
+<p>Grotins and Arias Montan at one time advanced the idea that the western
+coast of South America was <span class='pagenum'><a name="Page_47" id="Page_47">[47]</a></span>
+peopled by some mutinous sailors from the fleets of King Solomon, who,
+in their endeavor to go away far enough to be out of reach, were driven
+by winds and chance to the Peruvian coast. Others have imagined that
+some of the lost tribes of Israel found their way eastward to America,
+by the way of China, to the Mexican coast. The same ideal tradition has
+made the lost tribes the fathers of the Iroquois Nation in the
+northeastern parts of the United States. An author, who will be quoted
+in another part of this work, scouts the idea that the rite, as
+performed in America, had any connection or common origin with the rite
+performed in Asia and Africa; but, true to his theory of the climatic
+causes of the origin of circumcision, he maintains that it originated
+here as it did elsewhere, being a performance born of climatic
+necessity. He is, however, dissatisfied with Father Acosta for not being
+more explicit in relation to the <i>modus operandi</i> of the Mexican
+circumcision. The want of being explicit, and its consequences in this
+particular regard, may be inferred from a &ldquo;Diatribe on
+Circumcision,&rdquo; by a Mr. Mallet, in an encyclop&aelig;dic
+dictionary of the last century, in which Mr. Mallet informs his readers
+that Mexicans were in the habit of <i>cutting off the ears and prepuces</i>
+of the newly born. Herrera and Acosta agree with Clavigero in asserting
+that the Mexicans simply <i>bled</i> the prepuce. Pierre d&rsquo;Angleria and
+other contemporary writers are as emphatic in asserting that in the
+island of Cosumel, in Yucatan, on the sea-board of the Gulf of Mexico
+and on the Florida coast, they have observed circumcision by the
+complete removal of the prepuce with a stone knife. The Spanish monk,
+Gumilla, relates that the Saliva Indians of the Orinoco circumcised
+their infants on the eighth day. These Indians also included <span class='pagenum'><a name="Page_48" id="Page_48">[48]</a></span>
+the females in the observance of the rite. The same author tells us of
+the barbarous and bloody performances, in relation to the rite, of the
+nations on the banks of the Quilato and the Uru, as well as those
+dwelling along the streams that empty into the Apure. The same is said
+of the Guamo and of the Othomacos Indians; according to Gumilla, many of
+these Indians, in addition to the rite of circumcision, inflicted a
+number of cuts on the arms, legs, and over the body, to a degree that
+amounted to butchery, the child being reserved for this inhuman
+treatment until the age of ten or twelve years, that he might, by his
+greater powers of resistance and of recuperation, stand some chance of
+escaping alive from the ordeal. The friar mentions that in 1721 he found
+a child dying from this treatment, the wounds having become gangrenous
+and the child dying of py&aelig;mia; prior to the operation the children
+were stupefied with some narcotic drink, and were insensible during its
+performance.<a name="FNanchor_19_19" id="FNanchor_19_19"></a><a href="#Footnote_19_19" class="fnanchor">[19]</a></p>
+
+<p>Besides circumcision, the Americans practiced several other operations
+that bore an analogy to the operation of infibulation, a procedure
+common to the Orient and to early Europe, and so ancient that, like
+circumcision, its source is in the misty clouds of antiquity. It
+consisted in introducing a large ring, either of gold, silver, or iron,
+through an opening made into the prepuce, the free ends being then
+welded together. Females were treated likewise, the ring including both
+labia. In some countries an agglutination of the parts induced by some
+irritant or a cutting instrument answered the purpose among females.
+Dunglison mentions that the prepuce was first drawn over the glans, and
+then that the ring transfixed the prepuce in that position; that the
+ancients so muzzled the gladiators to <span class='pagenum'><a name="Page_49" id="Page_49">[49]</a></span>
+prevent them from being enervated by venereal indulgence. The ancient
+Germans lived a life of chastity until their marriage, and to their
+observance of a chaste life can be attributed the superior physical
+development of the race, as both males and females were not only fully
+developed, but were not enervated by either sexual excess or
+inclinations before having offspring, which were necessarily robust and
+healthy. To obtain the same results in a nation given to indolence and
+luxury, and lax in its morality, some physical restraint was required,
+and we therefore find the practice of infibulation coming from the warm
+countries to the East. The ancients not only infibulated their
+gladiators to restrain them from venery, but they also subjected their
+chanters and singers to the same ordeal, as it was found to improve the
+voice; comedians and public dancers were also restrained from ruining
+their talents by the means of infibulation. In an old Amsterdam edition
+of Locke&rsquo;s &ldquo;Essay on the Extent of the Human
+Understanding,&rdquo; there is a quotation from the voyages of
+Baumgarten, wherein he states having seen in Egypt a devout dervish
+seated in a perfect state of nature among the sand-hillocks, who was
+regarded as a most holy and chaste man for the reason that he did not
+associate with his own kind, but only with the animals. As this was by
+no means an uncommon case, it led the Greek monks, in Greece and Asia
+Minor, to resort to every expedient to protect their chastity; in some
+of the monasteries not only were the monks muzzled by the process of
+infibulation, but they even had rules that excluded all females, either
+human or animal, from within their convent,&mdash;a habit that still
+prevails among many of the convents of the Orient to this
+day,&mdash;that on Mount Athos especially, omitting the infibulation of
+the ancients.</p>
+
+<p><span class='pagenum'><a name="Page_50" id="Page_50">[50]</a></span>
+Readers living in the climates of extreme ranges and of seasonal change
+cannot understand the physical temptations that beset mortals in certain
+climates, any more than they can imagine the faultless condition of the
+climate itself. The subject of climatic influences will be more fully
+discussed further on; but climate, as a factor of habits and usages in
+one part of the world, that are incomprehensible to those living in
+others, plays a part that is but little appreciated or understood;
+whether it be the question of diet, dress, or custom, climate exerts its
+influence in no uncertain manner. As Sulpicius Severus remarked to the
+Greek monks, when they accused the Gaulish monks with voracity and
+gluttony, &ldquo;That which you of Greece consider as superfluous, the
+climate of Gaul renders into a positive necessity.&rdquo; So of all
+physical needs and passions,&mdash;they are subject to a similar law. Those
+who have read Canon Kingsley&rsquo;s small work on the &ldquo;Hermits of
+Asia, Africa, and Europe&rdquo; will appreciate the above remarks; and
+it may be incidentally mentioned that his description of the climate
+that is common to the hilly country bordering on the eastern half of the
+Mediterranean Sea gives as vivid and as graphic a description of the
+physical condition of the climate and of its effects as can well be
+written. It occurs in the life of the hermit Hilarion, and the
+description given relates to his last home in the ruins of an old
+temple, situated on a cliff in the island of Cyprus, where the air is so
+invigorating that &ldquo;man needs there hardly to eat, drink, or sleep,
+for the act of breathing will give life enough.&rdquo; The work gives
+the best insight also into origin and causes that led to monachism, as
+well as it tells the benefit that the condition conferred on humanity,
+showing a phase in the march of civilization that is but little
+understood.</p>
+
+<p><span class='pagenum'><a name="Page_51" id="Page_51">[51]</a></span>
+But, to return to the subject of infibulation, which has, in a manner,
+necessitated this digression from the main topic. Thwing<a name="FNanchor_20_20" id="FNanchor_20_20"></a><a href="#Footnote_20_20" class="fnanchor">[20]</a>
+informs us that in ancient Germany woman was considered the moral equal
+of man, and that woman might traverse the vast stretches of country
+unprotected and unharmed. Woman never held such a position in the
+Oriental countries; neither has man, under the sub-tropics, a like
+self-command as shown by those ancient Gauls. So that, with the advent
+of Christianity and the moral revolution that followed, primitive
+methods, either inflicted on others or self-inflicted, were adopted to
+insure a chaste life. Infibulation was known, as already stated, for
+centuries, and in those rude times it seemed as the most natural and
+effective mode of accomplishing the object. It was not as barbarous an
+operation as emasculation on the male, as it only temporarily interfered
+with his functions.</p>
+
+<p>In the Old World the practice is still performed in various manners. In
+Ethiopia, when a female child is born the vulva is stitched together,
+allowing only the necessary passage for the needs of nature. These parts
+adhere together, and the father is then possessed of a virgin which he
+can sell to the highest bidder, the union being severed with a sharp
+knife just before marriage. In some parts of Africa and Asia, a ring, as
+before stated, transfixed the labia, which, to be removed, required
+either a file or a chisel; this is worn only by virgins. Married women
+wear a sort of muzzle fastened around the body, locked by means of a key
+or a padlock, the key being only in the possession of the husband. The
+wealthy have their seraglios and eunuchs, that take the place of the
+belt and lock. Another method is a mailed belt worn about the hips, made
+of brass wire, with a secret combination of fastenings, known only to
+the <span class='pagenum'><a name="Page_52" id="Page_52">[52]</a></span>
+husband. In the museum in Naples are to be seen some of these belts,
+studded with sharp-pointed pikes over the abdominal part of the
+instrument, which was calculated to prevent even innocent familiarity,
+such as nest-hiding, to say nothing of greater evils.</p>
+
+<p>In the &ldquo;Les Femmes, Les Eunuchs, et Les Guerrieres du
+Soudan,&rdquo; Col. Du Bisson mentions a very peculiar custom invented
+by the careful jealousy that is inseparable from harem life. He had
+noticed that many of the harem inmates, contrary to the general Oriental
+custom, were allowed to go about unattended by the usual guard of
+eunuchs, but that they walked in a painful, hesitating, and impeded
+manner. This walk was not the conventional, short, shuffling step that
+peculiarity of dress and shoe-wear imposes on the Japanese beauty, nor
+the willowy, swaying gait produced in the Chinese beauty by the lack of
+a sufficiency of foot; neither could it be ascribed to the presence of
+the ancient jingling chain of bells which induced the mincing steps of
+the virgins of Judea,&mdash;an invention which confined the lower limbs
+within certain limits by being worn just below the knees, and calculated
+to prevent the rupture of the hymen by any undue length of step or
+violent exercise; hence a tinkling noise and a mincing step always
+denoted a virgin. In Du Bisson&rsquo;s cases, however, virgins were out
+of the question; they might be the victims of enforced continence, but a
+Soudanese harem contains no virgins. On inquiry he learned that the very
+peculiar and unmistakably painful gait was due to the fact that each
+woman carried a bamboo stick, about eight inches in length, three inches
+or more being inserted in the vagina so as to effectually fill the
+opening, the balance projecting beyond, between the thighs of the
+person; this bamboo stick, or guardian of female virtue, <span class='pagenum'><a name="Page_53" id="Page_53">[53]</a></span>
+was held in place by a strap with a shield that covered the vulva, the
+whole apparatus being strapped about the hips and waist, and the whole
+being held in an undisplaceable position by a padlock. This was affixed
+to the woman whenever she was allowed outside the harem grounds, being
+placed in position by the eunuch, who carried the key at his girdle. In
+such a harness virtue can be considered perfectly safe; even safe from
+any mental depredation or revolution, as, with the plug causing such
+uncomfortable sensations, it is perfectly safe to infer that the
+imagination could not be seduced by any Don Juanic or other Byronic
+unvirtuous revelry. The physical ills that this contrivance must cause
+are necessarily without number, as the instrument is not as lightly
+constructed as our modern stem pessaries; but to the Oriental who can
+replace a woman at any time and who prizes the virginity, continence,
+and chastity of his slaves, even if enforced, more than their health or
+their lives, these are matters of secondary importance. In the Soudan
+there are no divorce courts, hence the probable necessity of the
+apparatus, and, as the woman is not obliged to wear it unless she
+chooses to go out unattended, it can hardly be considered as a
+compulsory barbarity. In the United States such a practice might do away
+with considerable divorce proceedings.</p>
+
+<p>Celsus gives a detailed description of the manner of infibulating as
+practiced among the Romans. According to this authority, it was employed
+by them on the youth attending the public schools, as well as upon the
+actors, dancers, and choristers, who were sold to the directors of the
+plays and spectacles. In the cabinet of the Roman College there are to
+be seen two small statues representing two infibulated musicians, which
+are remarkable for the excessive size of the ring and the leanness
+<span class='pagenum'><a name="Page_54" id="Page_54">[54]</a></span>
+of the persons to which they are attached. The mode of applying this
+ring did not differ much from the usual method of preparing the ear for
+pendants.<a name="FNanchor_21_21" id="FNanchor_21_21"></a><a href="#Footnote_21_21" class="fnanchor">[21]</a></p>
+
+<p>Among the Greek monks mentioned, the infibulation serves a manifold
+purpose; it not only is a sure badge of chastity, but its weight and
+size is very often increased so as to render it an instrument of
+penitence, and considerable rivalry exists at times in this regard.
+Virey notices that the Hindoo bonze, or fakir, at times submits to
+infibulation at the same time that he takes his vows of eternal
+chastity. This ring is at times enormous, being sometimes six inches in
+diameter; so that it is a burden. These saints are held in great esteem
+and veneration.</p>
+
+<p>Nelaton, in the sixth volume of his &ldquo;Surgery,&rdquo; mentions the
+case of a man who presented himself at Dupuytren&rsquo;s clinic with a
+tumefied, thickened, and somewhat dilapidated and ulcerated prepuce;
+this prepuce had worn a couple of golden padlocks for five years, a
+woman having thus infibulated his organ.</p>
+
+<p>In an elaborate work on the subject of circumcision,<a name="FNanchor_22_22" id="FNanchor_22_22"></a><a href="#Footnote_22_22" class="fnanchor">[22]</a>
+de Vanier du Havre relates, on the authority of M. Martin Flaccourt,
+that with the Mad&eacute;casses the children are circumcised on the
+eighth day after birth; and that in some portions of the country the
+mother swallows the removed portion of the prepuce, while in others the
+father loads the prepuce in some form of fire-arm, which is afterward
+fired in the air. In the neighborhood of Djezan, in Arabia, as reported
+by M. Fulgence Fresnel in the <i>Revue de Deux Mondes</i> of 1838, courtship
+and matrimony are not so great social events as they are with our
+society beaux. The occasion is probably considered social enough by the
+rest of the invited guests, but it can hardly be called an agreeable
+<span class='pagenum'><a name="Page_55" id="Page_55">[55]</a></span>
+episode in the life of the groom. Those whose bashfulness prevents them
+from contracting marriage in civilized communities can have the
+consolation of knowing that in far-off Arabia, among the fierce
+followers of the conquerors of Spain and of the Eastern Empire, they
+have sympathizing fellow-sufferers whom the conventionalities of the
+country deter from rushing into matrimony. In this region, circumcision
+is performed on the adult at the time of his candidacy for matrimonial
+bliss. A more inauspicious occasion could not possibly have been chosen,
+unless as in another Mohammedan tribe, who circumcise the bridegroom on
+the day after his marriage and sprinkle the blood that falls from the
+cut onto the veil of the bride. The bride is present, and the victim is
+handed over to what might be called the executioner of the holy office,
+who proceeds to circumcise the victim in what might be called its utmost
+degree of performance and barbarity. This attention does not stop at the
+pendulous and loose prepuce. He devotes himself to the skin of the whole
+organ; beginning at the prepuce he gradually works backward, removing
+the whole skin of the penis&mdash;a flaying alive, and nothing more.
+Should the victim betray any sign of weakness, or allow as much as a
+sigh or groan to escape him, or even allow the muscles of the face to
+betray the fact that he is not immensely enjoying the occasion, the
+bride elect at once leaves him for good, saying that she does not wish a
+woman for a husband. A large proportion of the male population annually
+die from this operation. So that the Arabs of the Djezin can be likened
+to those spiders who lose their life while in the act of
+copulation,&mdash;the female making a dinner from off the
+male,&mdash;only the spider is said to die a happy death, while that of
+the Arab is one of misery.</p>
+
+<p><span class='pagenum'><a name="Page_56" id="Page_56">[56]</a></span>
+Margrave and Martyr have recorded a very peculiar practice common among
+some South American tribes: A kind of a tube is fastened onto the
+prepuce by means of threads of the <i>tacoynhaa</i>, the latter being the
+bark of a certain kind of a tree. Cabras brought one of the natives, so
+muzzled, to Lisbon, on the return from his first voyage. Some tribes
+were observed to wear an apparatus like the old-fashioned
+candle-extinguisher, the virile member having been forced into this
+receptacle, which was strapped about the loins.</p>
+
+<p>The travelers Spix and Martius found the practice of circumcision of
+both sexes in the region of the upper Amazon River and among the Tuncas.
+Squires mentions a curious custom of the aborigines of Nicaragua. They
+wound the penis of their little sons and let some of the blood flow on
+an ear of corn, which is divided among the assembled guests and eaten by
+them with great ceremony.</p>
+
+<p>On the fifth day after birth it is the custom among the Omaha Indians of
+North America to christen the infant, the child being stripped and
+spotted with a red pigment; considerable ceremony accompanies the
+act.<a name="FNanchor_23_23" id="FNanchor_23_23"></a><a href="#Footnote_23_23" class="fnanchor">[23]</a></p>
+
+<p>Among the cannibals of Australia, Lumholtz<a name="FNanchor_24_24" id="FNanchor_24_24"></a><a href="#Footnote_24_24" class="fnanchor">[24]</a>
+observed a practice that seems to have no analogue in the wide world,
+either as an operation or in regard to its purposes. About ninety-five
+per cent. of the children are subjected to the ordeal. This is no less
+than the formation of an artificial hypospadias; this abnormality is
+formed through the penis into the urethra, near its junction with the
+scrotum; the wound is about an inch in length and is made with a flint
+knife which serves for no other purpose; the edges of the wound are
+burned with a hot stone, and the wound is subsequently kept open by the
+introduction of a small piece of wood, which, on <span class='pagenum'><a name="Page_57" id="Page_57">[57]</a></span>
+healing, leaves a permanent opening. These cannibals undoubtedly are
+inspired by some Malthusian spirit which impels them thus to
+functionally eunuchize themselves in one sense, as during copulation the
+seminal discharge flies out backward through this opening, being thereby
+a most effectual check on further procreation. By some, this practice
+has been attributed to the unreliability of the seasons in regard to
+food-production; but Lumholtz observes that where the practice is most
+in vogue&mdash;among the tribes to the west of the Diamantina River and
+west and north of the Gulf of Carpentaria&mdash;the food-supply is not
+deficient, the region being full of rats, fish, and vegetables. All the
+tribes are not subject to the practice of the operation at the same time
+of life; in some, the hypospadias is not produced until in adult life
+and after the person has married and has become the father of one or two
+children, when he must submit to the requirements of the law; the
+operation seems to be invested with some civil or religious
+significance, as a palisade or stockade of trees is placed around the
+place where it is performed. A native, aged about twenty years, informed
+Lumholtz that the operation was performed because the blacks did not
+like to hear the children cry about the camp, and, further, that they
+were not desirous of having many children; this native had not yet
+become a father and had not yet been subjected to the operation. The
+natives were observed to be fat and in good physical condition.</p>
+
+<p>There is something mysterious in this operation. It can easily be
+conceived how circumcision might at times have been suggested by its
+spontaneous and natural performance without any assistance from man.
+Cullerier reports one case of partial circumcision <span class='pagenum'><a name="Page_58" id="Page_58">[58]</a></span>
+through the means of an accident happening to a painter. The man was at
+work on a ladder, with a small bucket of paint hooked into one of the
+rounds above him; through some means the bucket lost its hold and in
+falling struck the penis on its dorsum with such force that the <ins
+class='corr' title="Transcriber&rsquo;s Note: The original showed
+&lsquo;prepuse&rsquo;.">prepuce</ins> was cut through on a parallel with the
+corona of the glans for fully two-thirds of its circumference, the glans
+slipping through the opening and gathering in a fleshy bunch underneath
+the frenum. This man carried this abnormality for some years, when,
+desiring to marry and seeing that this appendage would be as much of an
+impediment as one of the huge rings worn by the Hindoo devotee, he
+applied to Cullevier for advice, who promptly removed it with the
+knife.<a name="FNanchor_25_25" id="FNanchor_25_25"></a><a href="#Footnote_25_25" class="fnanchor">[25]</a>
+The writer has seen three cases, during his practice, of spontaneous
+circumcision, all resulting from phymosis as a secondary affection to
+venereal disease. The first case occurred when he first entered into
+practice; it was in a young, stout, and full-blooded man with a violent
+gonorrh&oelig;a. There was much swelling and tumefaction of the whole
+organ, which seemed to be very rebellious to all treatment. At one of
+his morning visits he was horrified to observe a transverse, livid mark
+at what seemed to be the middle of the organ; by noon this had gained
+ground to the right and left and there was no mistaking that it meant
+nothing less than mortification. Never having seen a case, the natural
+uncomfortable conclusion was that, through some cause or other or the
+natural result of excessive congestion, the man was about to lose
+one-half of his organ; and Burnside at Fredericksburg was in no greater
+state of suspense and uncertainty with the fate of the Army of the
+Potomac on his hands than the writer must acknowledge he was with this
+man and his organ apparently liquefying under <span class='pagenum'><a name="Page_59" id="Page_59">[59]</a></span>
+his treatment. The surprise can be better imagined than described when,
+on the following morning, the glans made its appearance safe and sound
+out of its imprisonment, and at right angles with the organ there hung
+the prepuce, thick and as large and as long as the penis itself,
+inflammatory deposit and infiltration having brought it to that shape
+and consistence; the glans became completely uncovered; the parts
+gathered underneath, where, in the course of some weeks, they had shrunk
+to the size of a walnut, which was afterward removed by the knife. In
+this case, as in the other two cases observed, the corona was very
+prominent and acted as an internal tourniquet by its upward pressure,
+the line of demarkation being on the dorsum in the three cases noted.</p>
+
+<p>That such cases would suggest circumcision is not only probable but
+possible, as it would point out the manner of performing the operation;
+but, in the cases of the Australian savages, who performed an artificial
+hypospadias on themselves for a specific purpose, requiring a knowledge
+of the anatomical relation of the parts as well as of their
+physiological functions, it is hard to speculate how the operation was
+first suggested or how it came at first to be performed. As a Malthusian
+agent it is certainly an operation of the highest merit, and it should
+be introduced, by all means, in the United States, where the wealth and
+luxury in which the people dwell is fast drifting them toward the same
+whirlpool that engulfed Rome, which was preceded by a dislike to have
+children. Whenever the writer sees the poor an&aelig;mic, broken-down victim
+of many miscarriages, he cannot help but feel that, if the laws of the
+Damiantina River savages were enforced on their husbands, it would be a
+blessing to the poor women <span class='pagenum'><a name="Page_60" id="Page_60">[60]</a></span>
+without materially injuring the husbands, who, in case of need of a
+re-establishment of the functions of procreation, might be fitted with a
+vulcanite plate for the occasion,&mdash;something like our cleft-palate
+patients are supplied with a plate that enables them to articulate.</p>
+
+<p>It was the custom among the Hottentots, when first discovered or known
+to the whites, to remove one of their testicles. This was supposed to
+enable them to run more swiftly and to be lighter-footed in the race.
+The real reason, afterward found, was a mixture of pure humanitarianism
+and Malthusianism boiled down to Hottentot ethics. With them a monorchid
+was not supposed to beget twins; when twins are born in the family, the
+mother generally smothers the female, if one happens to be such; if not,
+then the feeblest of the two is sacrificed. In their migratory and
+nomadic life the mother finds it impossible to either carry or care for
+the two children. The male Hottentot, rather than have any avoidable
+infanticide in his family, or that his wife should go through and suffer
+the annoyance and pangs of an unnecessary and unprofitable pregnancy,
+generously has one testicle removed; this is something that the ordinary
+civilized white man would not do, even if his legitimate wife and all
+his outside concubines were to have twins or triplets every nine months;
+so that, even as strange as it may appear, civilization must need go to
+the wild Bushmen in search of that grand old Quixotic chivalry that was
+in ancient times always ready to sacrifice itself for the welfare of
+woman.</p>
+
+<p>The old Greek and Roman statues, representing the gods and athletes of
+ancient Greece and Rome, are a puzzle to many, owing to the diminutive
+and phimosed virile organ that the artists have attached to them. Galen
+represents that the disuse of the organ by the <span class='pagenum'><a name="Page_61" id="Page_61">[61]</a></span>
+athletes was the cause of its undeveloped form, and that as the organ
+of these did not figure in the worship of Venus, or participate in the
+festivals of Bacchus, but was used solely and simply for micturating
+purposes, impotence was often the result, citing the case of a patient
+who came to consult him for an obstinate priapism resulting from
+venereal excess, who met, in his anteroom, an athlete who was being
+treated for the opposite condition, due to the too rigid continence to
+which he had been for years subjected. Acton does not believe that
+continued continence has that effect, quoting Dr. Bergeret, who had long
+been physician to a number of religious societies, as saying that he had
+never seen serious troubles of the organs of generation in these
+communities, which denotes that if they indulged in proper fasting and
+prayer they were in the same condition of flaccid impotence as the
+athlete in Galen&rsquo;s anteroom. Louis VII, of France, tried fasting
+and prayer in connection with rigid continence, and, as a result, his
+wife, Queen Eleonore, was divorced from him and married Henry II, of
+England, who had not been continent. Hence, we see that the old
+sculptors, whether wishing to represent Jupiter or Plato,
+&AElig;sculapius or Mars, a strongly knit and muscular frame was
+desired, an athlete, gladiator, or soldier being used as a model; the
+small, puerile, funnel-prepuced organ belonged to all these muscular or
+well-trained classes, was a natural appendage, as enforced continence
+and the most absolute chastity was the rule, to enforce which they even
+resorted to infibulation. This enforced continence often resulted in
+impotence, even before the prime of life was passed, accompanied by an
+inevitable atrophy of the male organ, with the resulting prepuce in the
+shape in which it is found in a boy of from eight to twelve years,
+precisely <span class='pagenum'><a name="Page_62" id="Page_62">[62]</a></span>
+as they are found on the statues. How faithful the sculptors and
+artists were to nature and life in their representations can well be
+imagined by a critical examination of the Apollo Belvidere, where the
+difference of the scrotal position that exists between the right and
+left testicles is carried out to the minutest anatomical detail. In our
+age it is hard to conceive why their most masculine men should be
+deified, and all their gods represented as the most perfect of bodily
+development, while at the same time the finest physical specimens of
+manhood were doomed to a life of the most rigorous continence. It is
+also astonishing that all this should be done not from any principle or
+consideration of morality or virtue, but simply as a means subservient
+in producing at its maximum the highest degree of physical development
+and endurance.</p>
+
+<hr /><p class='pagenum'><a name="Page_63" id="Page_63">[63]</a></p>
+<h2><a name="CHAPTER_VI" id="CHAPTER_VI"></a>CHAPTER VI.<br />
+<span class='sc sf75'>Attempts to Abolish Circumcision.</span></h2>
+
+<p>Probably no rite or practice of a custom has been such a long-standing
+bone of contention as circumcision; nor does the Sphynx surpass this
+relic of bygone ages in mystery. From time immemorial its practice has
+been the subject of disputes, and its literature finds oftentimes its
+friends and foes ranged side by side. At one time a noted Israelite and
+Voltaire, the scoffer of Judaism, may be consulted on the question as to
+whether Israelite or Egyptian is entitled to priority as to its original
+practice with a like answer; and, again, Christians are found who, after
+a careful investigation, will accord this to the Israelites. In Rome,
+the persecuted Hebrew was stopped on the street and compelled to show
+the mark of circumcision, that he might be taxed, and in Turkish parts
+the Christian was subjected to the same indignity to enable the
+tax-gatherer to harvest the impost which he paid for his liberty of
+conscience and not being circumcised. When the monkish missionaries of
+the Catholic faith first entered Abyssinia, they were shocked to find
+their converts insisting on their time-honored practice of circumcision;
+and later, when the Propaganda sent its own missionaries, they were
+scandalized to see Christians practicing what they looked upon as an
+infidel rite; and nothing but the most earnest confession of faith, with
+the assurance that the rite of circumcision was only a physical remedy,
+and that in their conscience it in no wise possessed any religious
+significance, and that neither did they, in any sense, hold it in any
+connection with the sacrament of baptism, permitted these Abyssinians to
+save themselves from excommunication.<span class='pagenum'><a name="Page_64" id="Page_64">[64]</a></span>
+Later still, when an Abyssinian bishop was present in Lisbon, the
+clergy of the city refused him the right of celebrating the sacrifice of
+the holy mass in the Cathedral of Lisbon, on the ground that he, having
+been circumcised, was no better than a heretic. The Abyssinian
+Christians still practice the rite at the present day.</p>
+
+<p>The Turks, although very fanatical and greater proselyters than the
+Christians of Rome, seem now and then to relax in favor of general
+utility, as we find Bajazet II writing to the Pope, Alexander VI,
+supplicating his Holiness to confer a cardinal&rsquo;s hat on the
+Archbishop of Arles as a special favor to the Turkish emperor, as he
+knew that the archbishop <i>had a secret leaning toward Mohammedanism</i>. As
+the clergy of those days, from the Holy Father down, were more
+politicians than followers of the humble Nazarene, the heaven of
+Mohammed had probably more attractions for their taste than the ideal
+Christian paradise, and it is possible that the good archbishop would
+have submitted to a cardinal&rsquo;s hat and circumcision at the same
+time to secure the good things of this world and of those in the world
+to come. History also relates that his most Christian majesty, Henry
+III, of France, as a relaxation to the interminable squabble between two
+Christian religious factions which were rending France, and which in the
+end cost him his life, actually wrote a letter to the Sultan, asking the
+favor to be allowed to stand as godfather at the circumcision of his
+son. When it is remembered that the godfather at a Turkish circumcision
+has to make a strong profession of Moslem faith and the answers as
+sponsor for the child, and must promise that the child will be faithful
+to the Koran and Mohammed, it will be seen that, however much the lower
+levels of humanity may quarrel over trifles, the heads of the people
+easily <span class='pagenum'><a name="Page_65" id="Page_65">[65]</a></span>
+accommodated themselves to any existing circumstances. Friar Clemens
+might as well have let such a liberal-minded monarch live, as any of the
+existing churches could easily have got along with him.</p>
+
+<p>On the other hand, we have the remarkable tenacity to custom and habit
+in this regard, as exhibited by the Moslems, who, although having
+neither ordinance nor authority for its performance, either in their
+law, creed, or in any order from their prophet, still no more zealous
+circumciser exists than the son of Islam, who exacts from all proselytes
+the excision of the prepuce. Mohammed was circumcised in his boyhood,
+and, although he did not order its performance to his followers, he did
+not see fit to proscribe a custom so general to the Arabians, where the
+greater development of the prepuce probably renders circumcision a
+necessity. From the same reason it is easy to perceive why the rite has
+found such general observance among the Africans, who are as noted for
+long and leathery prepuces as for their slim shanks. One author, writing
+in 1772, in a work entitled &ldquo;Philosophical Researches on the
+Americans,&rdquo; treats the subject in a very intelligent manner. His
+arguments are both ingenious and plausible. This author looks upon
+circumcision as of purely climatic origin in its inceptive causes. From
+a careful survey of the natural history of man in his general
+distribution over the globe, he finds that circumcision may be said to
+be restricted to within certain boundaries of latitude, equidistant on
+both sides of the line. No circumcised people have ever inhabited
+northern regions, and the bulk of the circumcised races are found within
+certain climates. From this reasoning it is easy to see why the rite
+should lose its standing under certain climatic conditions, unless
+bolstered up by some religious significance, as it is <span class='pagenum'><a name="Page_66" id="Page_66">[66]</a></span>
+equally easy to foresee why it should flourish elsewhere, even without
+any religious backing or ordinance. It is well known that in Ethiopia
+and the neighboring countries, excrescences and elongation of either the
+prepuce or nymph&aelig; are as probable as the existence of an enlarged
+thyroid gland or goitre among the inhabitants of some of the valleys of
+Switzerland or of those of the Tyrol. According to the author of the
+treatise just quoted, circumcision would be nothing more than a remedy
+to repair the evils that a faulty construction of the human body
+developed in certain climatic conditions.</p>
+
+<p>With the Israelites it is observed as a religious rite, although they
+are not strangers to the physical benefits that circumcision confers
+upon them; the fact that even where no prepuce exists, as sometimes
+happens, the circumciser nevertheless goes on with the rite, being
+satisfied with drawing a few drops of blood from the skin near the
+glans, stamps the operation essentially as being a religious rite.
+Persecutions have signally failed to suppress its performance by those
+of the Hebrew faith. Beginning with the decree of Antiochus, 167 <span class='sc lc'>B.C.</span>,
+which consigned every Hebrew mother to death who dared to circumcise her
+offspring, they have not ceased to suffer in defense of their rite.
+Adrian, among other repressive measures, forbade circumcision; under
+Antonine this edict was still enforced, but he afterward recalled it and
+gave to the Hebrews the right of observing their religious rites. Marcus
+Aurelius, however, revived the edict of Adrian. Heliogabalus, who
+ascended the Roman throne in the year 218 <span class='sc lc'>A.D.</span>,
+was himself circumcised. During the reign of Constantine all the laws
+that interfered with Hebraic rites were renewed, with the addition that
+any Hebrew who should circumcise a slave should suffer death. Under the
+sway of Justinian, <span class='pagenum'><a name="Page_67" id="Page_67">[67]</a></span>
+in the sixth century, the persecutions against these people were so
+oppressive that a Hebrew was not allowed to raise or educate his own
+child in the faith of his fathers. In the seventh century, the augurs
+having prophesied the ruin of the Roman Empire by a circumcised race to
+the emperor Heraclius, the persecutions were renewed against these
+unfortunate people. In this century, Hebrews refusing baptism suffered
+banishment and confiscation of all their property; they were obliged to
+renounce the Sabbath, circumcision, and all Hebraic rites if they wished
+to remain. About this period the success of the Saracens induced
+persecutions of the Hebrews in Spain, where their children were taken
+away from them that they might be raised in the Christian religion. In
+the fifteenth century they suffered the greatest persecution and
+martyrdom at the hands of the Spanish Inquisition. The persecutions
+above cited were national and governmental persecutions levelled
+directly at the Jewish nation and creed; the persecutions that they
+momentarily suffered at other times had no signification beyond the
+exhibition of popular spite and fury, but those above cited were moves
+calculated to extirpate the creed, if not the people, from off the face
+of the globe. If repressive measures are of any avail, circumcision as
+an Hebraic rite should now have no existence. Its present existence and
+observance show a vitality that is simply phenomenal; its resistance and
+apparent indestructibility would seem to stamp it as of divine origin.
+No custom, habit, or rite has survived so many ages and so many
+persecutions; other customs have died a natural death with time or want
+of persecution, but circumcision, either in peace or in war, has held
+its own, from the misty epochs of the stone age to the present.</p>
+
+<p>There is something pathetic and soul-appealing in <span class='pagenum'><a name="Page_68" id="Page_68">[68]</a></span>
+contemplating the early Christians forced to worship in the catacombs
+of Rome, hunted like wild animals in their subterranean burrows, and
+then given the choice of making offerings to the heathen gods or being
+thrown into the arena as prey to wild beasts; so are we stirred when we
+think of the Spanish Jew, who had made Spain his home for centuries,
+being driven into exile in such droves that no country could receive
+them; we see them perishing of hunger by the thousands on the African
+coast, and dying of starvation on the quays of the ports of civilized
+Italy. That many, through all these trials, were forced to embrace other
+religions is not astonishing. In Spain apostacy was to no purpose, as
+the Inquisition could not be expected to split hairs in regard to an
+apostate Jew, when it sent the best of Gothic blood, raised in the
+Catholic faith, to the <i>auto da f&eacute;</i> or the scaffold,&mdash;the
+rack respecting neither faith nor profession that fell into its
+clutches. In milder persecutions, however, he escaped by outwardly
+conforming to the demands of his oppressors and history tells us of the
+circumcisions secretly performed on the dead Jew, that the spirit of the
+law of their fathers might be carried out.</p>
+
+<p>In other cases, threatened exile, confiscation, or exorbitant taxation
+drove them to adopt every possible expedient to eradicate the sign of
+their Israelitism and make attempts to reform a prepuce. The first
+attempts in this line were made during the reign of Antiochus, when a
+number of Hebrews wished to become as the people about them who were not
+persecuted&mdash;<i>fecerunt cibi pr&aelig;putia</i>. This is no easy operation, and in
+later times by the aid of appliances, both in Rome and in Spain, they
+undertook to cause the skin to recover the glans. Martial, in speaking
+of the instrument used in Rome, a sort of a long funnel-shaped copper
+tube in <span class='pagenum'><a name="Page_69" id="Page_69">[69]</a></span>
+which the Hebrew carried his virile organ, terms it <i>Jud&aelig;m
+Pondum</i>, the weight of which, by drawing down the skin, was supposed in
+time to draw it down far enough to answer the purpose. The apostle Paul,
+in his epistle to the Corinthians, refers to these practices when he
+says, &ldquo;Was any one called being circumcised, let him not be
+uncircumcised.&rdquo; The operation of reforming a prepuce, or of
+obliterating the marks of circumcision, does not appear to have been a
+success.</p>
+
+<p>The writer had one experience that was interesting. On one occasion he
+advised circumcision for the relief of a reflex nervous disease, in a
+tall, athletic Austrian sailor from the Adriatic; although the nature of
+the operation was explained to the man, he evidently did not appreciate
+its full nature and importance until <ins class='corr'
+title="Transcriber&rsquo;s Note: The original showed &lsquo;a
+a&rsquo;.">a</ins> sweeping cut with a scalpel left the excised prepuce in the
+operator&rsquo;s hand. Most Adriatic sailors have sailed up the
+Bosphorus and are more or less familiar with both the Greek and Turkish
+nations; the latter they despise with gusto, &ldquo;<i>porchi di
+Turci</i>&rdquo; being the affectionate appellation they bestow on their
+national neighbors. No sooner did he perceive the real condition of
+affairs than he began to beat his head, saying that he was disgraced
+forever, as he never would dare to associate with his countrymen again,
+as he would be liable to be taken for a <i>porcho di Turco</i>; his frenzy
+increased to such a pitch that to spare any unpleasantness it was deemed
+advisable to replace the prepuce, which was done accordingly, the man
+making a tolerable good recovery, as far as the grafted prepuce was
+concerned. It required a secondary operation to overcome some
+cicatricial contraction, and, on the whole, he had a very serviceable
+prepuce; but, what was more to the point, it prevented his ever being
+mistaken for a Turk.</p>
+
+<hr /><p class='pagenum'><a name="Page_70" id="Page_70">[70]</a></p>
+<h2><a name="CHAPTER_VII" id="CHAPTER_VII"></a>CHAPTER VII.<br />
+<span class='sc sf75'>Miracles and the Holy Prepuce</span>.</h2>
+
+<p>What strange fancies have circled themselves about the subject of
+generation or its organisms during the different stages of moral
+civilization since the world has existed! The efforts in this regard
+among different creeds have been something peculiar. Neither Mohammedans
+nor Hebrews&mdash;both zealous circumcisers&mdash;ever went to the lengths reached
+by Christian churches and their followers in some particulars concerning
+this rite; this being especially strange when it is considered that the
+new creed was the one that abolished the rite and through which the Jews
+suffered such cruel and unjust persecutions. The early Christian Church
+celebrated and continues to celebrate the Feast of Circumcision, and
+history relates some strange events in connection with this
+circumcision. Having abolished and repudiated the rite, it would seem
+inconsistent that it should celebrate its performance on any occasion
+and consider such an event sufficiently memorable that its occurrence
+should excite the veneration of the church and be the means of exciting
+the pious zeal of the faithful. The strangest events in this connection
+are still more mysterious and incomprehensible, if not amusing, the only
+excuse for the occurrence being the greedy thirst for relics of any and
+all kinds that in the middle ages pervaded Europe.</p>
+
+<p>At some remote period&mdash;in the thirteenth or fourteenth century&mdash;the
+abbey church of Coulombs, in the diocese of Chartres, in France, became
+possessed in <span class='pagenum'><a name="Page_71" id="Page_71">[71]</a></span>
+some miraculous manner of the holy prepuce. This holy relic had the
+power of rendering all the sterile women in the neighborhood
+fruitful,&mdash;a virtue, we are told, which filled the benevolent monks
+of the abbey with a pardonable amount of pride. It had the additional
+virtue of inducing a subsequent easy delivery, which also added to the
+reputation and pardonable vanity of the good monks. This last virtue,
+however, we are told, came near causing the loss to the abbey of this
+inestimable prize, for, as a French writer observes, a too great
+reputation is at times an unlucky possession; at any rate, the royal
+spouse of good and valiant King Henry V&mdash;he of Agincourt, whom
+England waded up to its knees in the sea at Dover to meet on his return
+from that campaign&mdash;had followed the example of all good dames and
+was about to give England an heir. Henry then governed a good part of
+France. Having heard of the wonderful efficacy of the relic of Coulombs,
+he early one morning threw the good monks into consternation by the
+arrival at the convent gate of a duly equipped herald and messenger from
+his kingship, asking for the loan of the relic with about as much
+ceremony as Mrs. Jones would ask for the loan of a flat-iron or saucepan
+from her neighbor, Mrs. Smith. The queen, Catherine of France, was of
+their own country and Henry was too powerful to be put off or refused;
+there was no room for evasion, as the holy prepuce could not be
+duplicated; so the poor monks with the greatest reluctance parted with
+their precious relic, entrusting it into the hands of the royal envoy,
+which wended its way to London, where it in due time, being touched by
+the queen, insured a safe delivery. Honest Henry then returned the relic
+to France; but so great was its reputation that royalty caused a special
+sanctuary to be <span class='pagenum'><a name="Page_72" id="Page_72">[72]</a></span>
+erected for its reception, and a full period of twenty-five years
+occurred before the monks of Coulombs again regained possession of their
+prize, during which period the population of the neighborhood must have
+suffered from the natural increase of sterility and the physicians must
+have reaped a rich harvest owing to the increased difficulty and
+complications of labor induced by the absence of the relic. On its
+return, the relic was found to have lost none of its virtues, and the
+good people and monks were all correspondingly made happy; in 1870, when
+the writer was in France, it was still working its miracles. Balzac
+found ample facts to found his famous &ldquo;Droll Stories&rdquo;
+without straining his imagination.</p>
+
+<p>So great an attraction was not to go without attempted rivalry or
+imitators; hence we find in the &ldquo;Dictionary of Moreri,&rdquo;
+edition of 1715, in the third volume, at page 108, that several other
+establishments claim the honor of a like relic,&mdash;namely, the Cathedral
+of Puy, in Velay; the collegial church of Antwerp; the Abbey of our
+Saviour, of Charroux; and the Church of St. John Lateran, in Rome. All
+of these have had very adventurous histories. The Abbey of Charroux was
+founded by Charlemagne in 788, and among the relics with which that
+monarch endowed the abbey the principal one was a fragment of the holy
+prepuce. This abbey enjoyed great reputation, and indulgences were
+granted by Papal bull to all those who assisted at the adoration of the
+relics. In the internecine wars of the sixteenth century the abbey fell
+into the hands of the godless and heretical Huguenots and the holy relic
+disappeared. In 1856, while some workmen were at work demolishing an
+ancient wall on the abbey site, they discovered some relic cases. The
+bishop was at once notified, who immediately proceeded to investigate,
+when, lo and <span class='pagenum'><a name="Page_73" id="Page_73">[73]</a></span>
+behold! there, sure enough, was a piece of desiccated flesh, with marks
+of coagulated blood; nothing more or less than the lost
+prepuce&mdash;long lost, but now found. It was placed in charge of the
+Ursuline Sisterhood, where it has remained ever since undisturbed,
+except by a controversy in regard to the propriety of the relic, in
+which the good bishop ambled about in the most ambiguous manner, the
+only clearly defined portion of his dissertation being the one wherein
+he laments &ldquo;the decadence of that truly Christian spirit which
+animated the laity of the middle ages with a radiant zeal. A piety also
+pervaded those gentle Christians of former times, who were possessed of
+a religious instruction which determined for them the tenets of the
+creed and its practices,&mdash;a happy state or condition of affairs,
+which prevented the intelligence of the faithful from wandering into the
+sloughs of unprofitable skepticism.&rdquo; This settled the question as
+to the propriety of the prepuce being converted into a miracle-working
+relic; at least, as far as the good bishop was concerned.</p>
+
+<p>It would be an injustice not to mention the other shrines in detail
+after the prominence that has been given to the abbeys of Coulombs and
+Charroux; so the history of another will be given. We are not told just
+how the Church of St. John Lateran in Rome first became possessed of
+<i>its</i> holy prepuce, but it nevertheless had one; also the only authentic
+one in existence, like all the others. It disappeared at one of the
+periodical sackings that Rome has repeatedly suffered at the hands of
+Goth, Vandal, or Christian. This time it was the soldiery of the eldest
+son of the church&mdash;- Charles V&mdash;who did the sacking; it was in the year
+1527, a soldier&mdash;probably some impious, heathenish mercenary&mdash;broke into
+the holy sanctuary of the church and stole therefrom <span class='pagenum'><a name="Page_74" id="Page_74">[74]</a></span>
+the box that contained the holy relics, among them the holy prepuce.
+These impious wretches, as a rule, came to grief in short order; hence
+we are told that this mercenary and sacrilegious soldier was compelled
+to secrete his box, when only a short distance from Rome, where the box
+remains and the mercenary wretch disappears, probably carried off bodily
+by the devil, as he deserved. Thirty years afterward the box is
+discovered by a priest, who, ignorant of its contents, carries it to the
+lady on whose domain it was found. On being opened it was found to
+contain a piece of the anatomy of Saint Valentine, the lower jaw of
+Saint Martha, with one tooth still in place, and a small package upon
+which the name of the Saviour was inscribed. The lady picked up the
+package, when immediately the most fragrant odor pervaded the apartment,
+being exhaled by the miraculous packet, while the hand that held it was
+seen perceptibly to swell and stiffen; investigation proved it to be the
+holy prepuce stolen by the miscreant mercenary from St. John Lateran. It
+is related that in 1559, a canon of the church of St. John Lateran,
+impelled by a worldly curiosity untempered by piety, undertook to make a
+critical examination of this relic, in the process of which, to better
+satisfy himself, he had the indiscretion to break off a small piece;
+instantly the most dreadful tempest broke over the place, followed by
+crashing peals of thunder and blinding flashes of lightning; then a
+sudden darkness covered the country, and the luckless priest and his
+assistants fell flat on their sacerdotal noses, feeling that their last
+hour had arrived.<a name="FNanchor_26_26" id="FNanchor_26_26"></a><a href="#Footnote_26_26" class="fnanchor">[26]</a></p>
+
+<p>Wonderful and miraculous cures are performed at these shrines, and some
+of the cures are of a nature that would baffle the intelligence of the
+most learned <span class='pagenum'><a name="Page_75" id="Page_75">[75]</a></span>
+mind to ascertain the intricate and devious way that nature must at
+times journey to accomplish some of these changes. The writer well
+remembers seeing, in the Church of Corpus Christi, in Turin,<a name="FNanchor_27_27" id="FNanchor_27_27"></a><a href="#Footnote_27_27" class="fnanchor">[27]</a>
+a long hall, covered, from marble pavement to ceiling, with votive
+tablets, after the manner inaugurated in the old temples of Greece.
+Modern votaries have the advantage of being able to record their cure,
+safe venture or escape from peril, by means of faithful representation
+of the event in painting or drawing, as the material and art is more
+common now than in the days of ancient Greece, who recorded its cures by
+simple inscription in laconic terms. Modern medicine labors under the
+disadvantage of presuming that the people are endowed with an
+intelligence that was unknown to ancient or medi&aelig;val people, when,
+in fact, the people are as credulous and as subject to imposition as
+they were in the earlier centuries of the present era. With all its
+supposed superior intelligence, there is no fatter pasture for quacks
+and impostors than that presented by the people of the United States.
+Whenever I see the poor, intelligent, broad-minded physician struggling
+along, barely able to procure for himself the necessaries required to
+maintain himself with proper books and appliances, while the itinerant
+quack or dogmatic practitioner rolls in undeserved affluence, I question
+the wisdom of our ethical code. Braddock, at the Monongahela, scorned to
+have his regulars, who had fought under Marlborough and Eugene, break
+ranks before a lot of breech-clouted savages, and take shelter that the
+nature of the ground and the trees could afford, thinking it an unfit
+action for men who had faced the veterans of Louis XIV on many a
+hard-fought European field. I sometimes think that if <i>our</i> regulars
+were, for only a season, <span class='pagenum'><a name="Page_76" id="Page_76">[76]</a></span>
+to follow the example of the provincial militia at that battle, it
+would be better for the country, the people, science, and last, but not
+the least, for the profession. The theory that we should not counsel
+with quacks is altogether mischievous and fallacious, although right and
+rigidly orthodox in its intent; were we to counsel and meet these
+gentry, we should expose their ignorance and assumption, and we should
+not be exposed to the charge of jealousy and of fear to meet them in
+consultation. I remember on one occasion a client went to a lawyer for
+advice as to how he might dispossess some parties who had some adverse
+claim to some property which he owned, after due deliberation and a
+protracted siege of the house, in the vain hope of gaining admittance;
+the lawyer advised his client to go and nail up all exits and fasten
+them in, which had the effect of driving them out. So with our
+profession&mdash;we should not neglect an opportunity of meeting a quack
+in consultation, regardless of the nature of the case; it is the only
+way to nail them up; as it is, we have simply chained up the
+shepherd-dog and given the wolves full play.</p>
+
+<p>The French Guards at Fontenoy, who out of courtesy refused to fire first
+on the English, may have been very ethical and chivalrous, but they were
+very foolish, as the English discharge nearly swept them from the field,
+and but for the Irish Brigade, who knew no ethics, Louis XV would in all
+likelihood have followed the example of King John, who, after Crecy,
+visited England for a season. A disregard of ethics gave Copenhagen to
+Lord Nelson, who insisted on looking at Admiral Parker&rsquo;s signal to
+withdraw from action with his sightless eye, which could not see it. A
+fear of disregarding ethics lost to Grouchy the chance of assisting
+Napoleon at Waterloo.<span class='pagenum'><a name="Page_77" id="Page_77">[77]</a></span>
+In our strife against ignorance and quackery the profession should
+follow the general plan of action usually adopted by Lord
+Nelson&mdash;lie alongside of whom you can and sink or capture your
+enemy; let each man do his duty; never mind any general plan. A reverse
+to this mode of fighting invariably lost the battle to the French and
+Spaniards, who were, as a rule, all tied up in ethical red tape. Our
+profession is broad, intelligent, and fearless; we do not profess any
+exclusive dogma, and should not, therefore, exclude persons; as a large
+ship throws its grappling-irons on to its adversary, we should always
+seek an opportunity to meet these gentry when practicable. As it is, we
+have placed them on the vantage-ground of appearing as being persecuted;
+our ethics need circumcising in this regard, and the prepuce of
+exclusion should be buried in the sands of the desert.</p>
+
+<p>Moreover, we often are apt to learn something from even the most
+ignorant of these men. Rush investigated the nature of a cancer-cure by
+not refusing to meet and talk with one of this kind;<a name="FNanchor_28_28" id="FNanchor_28_28"></a><a href="#Footnote_28_28" class="fnanchor">[28]</a>
+Fothergill learned from an old, unlicensed practitioner that there was a
+knowledge important to the physician beyond that picked up in the
+pathological laboratory or the study of microscopy; and that the
+practiced eye of an otherwise unlearned man could detect that there were
+general physical signs that negatived the unfavorable prognosis
+suggested by the presence of tube-casts.<a name="FNanchor_29_29" id="FNanchor_29_29"></a><a href="#Footnote_29_29" class="fnanchor">[29]</a>
+It is related of Sir Isaac Newton, that while riding homeward one day,
+the weather being clear and cloudless, in passing a herder he was warned
+to ride fast or the shower would wet him. Sir Isaac looked upon the man
+as demented, and rode on, not, however, without being caught in a
+drenching shower. Not being able to account for the source of
+information through which the rustic had gained his <span class='pagenum'><a name="Page_78" id="Page_78">[78]</a></span>
+knowledge, he rode back, wet as he was, to learn something. &ldquo;My
+cow,&rdquo; answered the man, &ldquo;always twists her tail in a certain
+way just before a rain, your Worship, and she so twisted it just before
+I saw you.&rdquo;<a name="FNanchor_30_30" id="FNanchor_30_30"></a><a href="#Footnote_30_30" class="fnanchor">[30]</a>
+Although twisting cow-tails do not figure in his &ldquo;Principia,&rdquo;
+it is very probable that such a lesson was not without its remote
+effects on a mind like Newton&rsquo;s. A spider taught a lesson to one
+of Scotland&rsquo;s kings; so that one man may learn something from
+another.</p>
+
+<p>Professor Letenneur, of the Medical School of Nantes, in his
+&ldquo;Causerie &agrave; propos de la Circoncision,&rdquo; mentions that the
+Convent of Saint Corneille, in Compi&egrave;gne, claims to possess the
+identical instrument with which the Holy Circumcision was performed.
+Such a holy relic must have been unusually potential in performing many
+miracles.</p>
+
+<p>In this connection it will not be amiss to notice the lapping over that
+the old phallic worship and idea has made on the new religions. It is
+also as interesting to observe how the human mind still leans toward
+observances and ideas which are believed to belong to a solely pagan
+people. Hargrave Jennings, in a chapter devoted to phallic worship among
+the ancient Gauls, gives many interesting and curious examples, the
+first example that he notices being that of Saint Foutin (from whom the
+very expressive French word &ldquo;<i>foutre</i>&rdquo; is taken). Foutin was
+the first Christian bishop of Lyons, and after his death, so intimately
+was priapic worship intermingled with the religion or theology of the
+Gauls, that somehow the memory of St. Foutin and the old, dethroned
+Priapus became commingled, and finally the former was unconsciously made
+to take the place of the latter. St. Foutin was immensely popular. He
+was believed to have a wonderful influence in restoring fertility
+<span class='pagenum'><a name="Page_79" id="Page_79">[79]</a></span>
+to barren women and vigor and virility to impotent men. It is related
+that, in the church at Varages, in Provence, to such a degree of
+reputation had the shrine of this saint risen, it was customary for the
+afflicted to make a wax image of their impotent and flaccid organ, which
+was deposited on the shrine. On windy days the beadle and sexton were
+kept busy in picking up these imitations of decrepit and penitent male
+members from the floor, whither the wind wafted them, much to the
+annoyance and disturbance of the female portions of the congregation,
+whose devotions are said to have been sadly interfered with. At a church
+in Embrun there was a large phallus, which was said to be a relic of St.
+Foutin. The worshippers were in the habit of offering wine to this
+deity,&mdash;after the manner of the early Pagans,&mdash;the wine being
+poured over the head of the organ and caught underneath in a sacred
+vessel. This was then called &ldquo;holy vinegar,&rdquo; and was
+believed to be an efficacious remedy in cases of sterility, impotence,
+or want of virility.</p>
+
+<p>Near the city of Bourges, at Bourg Dieu, there existed, during the Roman
+occupation of Gaul, an old priapic statue, which was worshipped by the
+surrounding country. The veneration in which it was held and the
+miracles with which it was accredited made it impolitic as well as
+impossible for the early missionaries and monks to remove it; it would
+have created too much opposition. It was therefore allowed to remain,
+but gradually changed into a saint,&mdash;St. Guerluchon,&mdash;which, however,
+did not detract any from its former merit or reputation. Sterile women
+flocked to the shrine, and pilgrimages and a set number of days of
+devotion to this saint were in order. Scrapings from this statue infused
+in water were said to make a miraculous drink <span class='pagenum'><a name="Page_80" id="Page_80">[80]</a></span>
+which insured conception. Similar shrines to this same saint were
+erected at other places, and we are told that the good monks, who must
+have had an intense and lively interest in seeing that the population
+was increased, were kept busy supplying the statues with new members, as
+the women scraped away so industriously, either to prepare a drink for
+themselves or for their husbands, that a phallus did not last long. At
+one of these shrines, so onerous became the industry of replacing a new
+phallus to the saint, that the good monks placed an apron over the
+organ, informing the good women that thereafter a simple contemplation
+of the sacred organ would be sufficient; and a special monk was detailed
+to take special charge of this apron, which was only to be lifted in
+special cases of sterility. By this innovation the good monks stole a
+march on their brothers in like shrines in other localities, such as
+those of St. Gilles, in Brittany, or St. Rene, in Anjou, where the
+old-fashioned scraping and replacing still was in vogue. Near the
+seaport town of Brest, in Brittany, at the shrine of St. Guignole, the
+monks adopted a new expedient. They bored a hole through the statue,
+through which a phallus was made to project horizontally; as fast as the
+devotees scraped away in front the good monks as industriously pushed
+forward the wooden peg that formed the phallus, so that it gave the
+member the miraculous appearance of growing out as fast as scraped off,
+which greatly added to its reputation and efficacy. The shrine continued
+in great vigor until the middle of the last century. Delaure mentions a
+similar shrine at Puy, also in France, which existed up to the outbreak
+of the French Revolution. The scrapings in this case were immersed in
+wine, and the guardians of the statue saw to it that no amount of paring
+or scraping should remove <span class='pagenum'><a name="Page_81" id="Page_81">[81]</a></span>
+from the saint any of that appearance of vigor or virility which his
+great reputation demanded, this being done by a similar procedure as
+followed at the church near Brest, one of the attendants having been
+sent to investigate into the marvelous growth of the Brest phallus.</p>
+
+<hr /><p class='pagenum'><a name="Page_82" id="Page_82">[82]</a></p>
+<h2><a name="CHAPTER_VIII" id="CHAPTER_VIII"></a>CHAPTER VIII.<br />
+<span class='sc sf75'>History of Emasculation, Castration, and Eunuchism</span>.</h2>
+
+<p>For the earliest records in regard to emasculation we must go back to
+mythological relations. In the old legendary lore of ancient Scandinavia
+or of Germany, the loves and hatreds of their semi-mythological heroes
+and heroines space over many romantic incidents before reaching a
+culmination. The swiftly flowing Rhine, with its precipitous banks,
+eddies, and rapids; the broad and more majestic Danube or Elb; the broad
+meadows and Druidical groves on its hilly slopes and stretches of dark
+and gloomy forest,&mdash;all conspired to people the fancy with elfs, gnomes,
+fairies, and goblins, who were more or less intermingled in all the
+episodes that engaged their semi-mythological heroes. This helped to
+fill in all their deeds with entertaining incidents; their halls and
+castles were made necessary accessories by the rigors of the climate, as
+well as were the beery feasts and carousals with the inspiration of
+monotonous song also rendered necessaries by the same element; hence, we
+have various incidents, either entertaining or exciting, connected with
+their legendary tales, acting like periods of intermission between their
+love scenes, spites, hatreds, murders, and general cremations. From such
+material and such opportunities it was comparatively easy for Wagner to
+construct the thrilling and interesting incidents that compose his opera
+on the legend of the Nibelungenlied.</p>
+
+<p>The Grecian landscape and topography does not permit of such richness of
+romantic incidents or details, <span class='pagenum'><a name="Page_83" id="Page_83">[83]</a></span>
+any more than the love-making of the unfortunate spider who is devoured
+by his spidery Cleopatra at the end of his first sexual embrace could
+furnish any incidents for one of Amelie Rives&rsquo;s spirited novels;
+so that neither minstrel nor bard have recorded the details of the first
+emasculating tragedy, which from all accounts was a kind of an Olympian
+Donnybrook-fair sort of a paricidal-ending tragedy.</p>
+
+<p>Unfortunately, Homer was not there to describe the event, or we might
+have had a Wagnerian opera with its Plutonic music to illustrate all its
+incidents; or even a Virgil could have made it into interesting verses;
+but, as it is, we must content ourselves with the laconic recitals that
+have been handed down by tradition, and, as all the Greek performances
+of those days were marked by an intense decisiveness, with an utter lack
+of circumlocution, it is probable that there was not much to relate
+beyond the bare facts.</p>
+
+<p>In Smith&rsquo;s &ldquo;Dictionary of Greek and Roman Biographies and
+Mythology&rdquo; we find it related that Uranos, or C&oelig;lus, was the
+progenitor of all the Grecian gods. His first children were the
+Centimanes; his next progeny were the Cyclops, who were imprisoned in
+Tartarus because of their great strength. This so angered their mother,
+G&auml;a, that she incited her next-born children, the Titans, into a
+rebellion against their father, Uranos. In the general turmoil that
+followed Uranos was deposed, and, so that he would be incapable of
+begetting any more children, Saturnus, the youngest of his sons, with a
+sickle made from a bright diamond, successfully emasculated poor old
+Uranos. The records are not clear whether the operation only included
+the penis, or the scrotum and contents, or whether, like the Turkish or
+Chinese <i>taill&egrave; &agrave; fleur de ventre</i>, Saturnus made a clean
+<span class='pagenum'><a name="Page_84" id="Page_84">[84]</a></span>
+sweep of all the genitals; it is probable that he did, however, as the
+members fell into the sea, and in the foam caused by the commotion from
+their contact with the element Venus was born. Meanwhile, the blood that
+dripped from the wounded surface caused the Giants, the Furies, and the
+Melian nymphs to spring into life. Uranos is also represented as being
+the first king of Atlantis; so that the first eunuch was a god and a
+king, more unfortunate than any of Doran&rsquo;s heroes, in his
+&ldquo;Monarchs Retired from Business,&rdquo; because he was more
+effectually retired from business than any monarch that Doran records.</p>
+
+<p>After this the practice seems to have been adopted in a general way; and
+the fact that the future proceedings of men and things on earth do not
+much interest these unfortunate members of society in any great degree,
+interest in worldly affairs and testicles seemingly having been as
+intimately connected in those early and remote days as with us of the
+present, it very naturally followed that this disinterestedness, as well
+as the docility and pliability which emasculation engenders, first
+suggested their use as servants or in position of trust, as a eunuch,
+having no incentive either to run away or to embezzle, would naturally
+be a valued and trusted servant. In the days of eunuchism there were no
+defaulting bank, city, or county cashiers,&mdash;a circumstance which would
+suggest that such a condition should form one of the qualifications for
+eligibility to such offices, the very opposition to any such proposal
+that the class would make showing in itself the benefits that would
+follow such an innovation, as it would show that the class is not
+possessed with that total spirit of abnegation requisite in the
+guardians of public funds. The requirement might be extended to
+bank-presidents with <span class='pagenum'><a name="Page_85" id="Page_85">[85]</a></span>
+benefit, if some Cincinnati episodes are any criterion. It is safe to
+assume that the bank that could advertise, in connection with its
+attractive quarterly or semi-annual statement, that the president and
+cashier were properly attested and vouched-for eunuchs would find in the
+public such a recognition of the fitness of things that the patronage it
+would receive would soon compel other banks to follow the example. The
+procedure might, with national benefit, be extended as an ordeal to our
+legislators at the national capitol, as it would do away with the
+particular influential lobby so graphically described in Mark
+Twain&rsquo;s &ldquo;Gilded Age.&rdquo; These things or ideas are merely
+thrown out as suggestions to be used by those who write those
+interesting articles in the <i>Forum</i>, or the <i>North American</i> or
+<i>Fortnightly Reviews</i>, on government and social reforms, as a perusal of
+the many articles written in that direction will convince any one that,
+from a practical psychological view of the matter, they are sadly
+deficient. To make those articles effective the reflex impressions made
+by the animal on the psychological and moral nature of man should not be
+neglected.</p>
+
+<p>Semiramis, whose beauty and many accomplishments, assisted by the
+murders of several of her husbands by the hand of the succeeding one,
+had this subject in hand in a far more practical manner than it is
+generally forced on the understanding; hence we see that she was the
+first to introduce the use of eunuchs in the capacity of servants as
+well as in official positions in and about the palace, as well as
+trusting some of the positions of the highest importance to the class.
+From her epoch, eunuchism has become an inseparable attendant on
+Oriental despotism, and has so continued to the present day. Like yellow
+fever, phthisis, and some diseases, as well as <span class='pagenum'><a name="Page_86" id="Page_86">[86]</a></span>
+many other social afflictions and customs, eunuchism does not seem to
+flourish beyond certain degrees of north and south latitudes,&mdash;a
+fact that probably assisted Montesquieu to arrive at the conclusion that
+climate was a powerful factor in all things.</p>
+
+<p>Bergmann, of Strasburg, quotes the ancient traditions, wherein it is
+stated that man was taught the art of castration by the brute creation.
+The hyena is cited as having so instructed man by the habit it exhibited
+of castrating its infant males in removing the testicles with its teeth,
+the habit being instigated by a jealousy, for fear of future competition
+in the exercise of the procreative act on the part of the young males.
+Another tradition attributes its origin to the castor. Bergmann here
+traces out the etymological relation existing between the name of the
+operation and that of the animal with that of a Greek verb that forms
+the root of <i>castrum</i>, or camp; <i>casa</i>, or house; <i>castigare</i>, to
+arrange; from whence also is traced <i>cosmos</i>, the world; <i>kastorio</i>, the
+Greek for wishing to build, and the Latin <i>kasturio</i> having the same
+relative but a more imperative signification; <i>kastor</i>, signifying as
+loving to build; <i>castitiator</i>, Latin for architect, and <i>casticheur</i>,
+old French for constructor. The tale or tradition in regard to the
+self-mutilation inflicted by the castor is traced to the Arabian
+merchants who purchased the castoreum, which was imported from the
+shores of the Persian Gulf and from India. It was called, also, by the
+Arabs, <i>chuzyalu-l-bahhr</i>, or testicles from beyond the sea; or, in
+French, <i>testicules d&rsquo;outre mer</i>. These terms and the tradition
+that the castor on being pursued, knowing the reason of the chase, was
+in the habit of tearing out his testicles and throwing them at his
+pursuers, were invented by these merchants to heighten the price and
+value of the article <span class='pagenum'><a name="Page_87" id="Page_87">[87]</a></span>
+intrinsically, as well as to make it more interesting by this peculiar
+individuality of adventure. The Latins, believing and adopting the
+tradition as a matter of fact, coined the word <i>castorare</i>, or doing
+like the castor. Bergmann uses in this connection a number of terms in
+French to denote different forms or degrees of this mutilation which
+have no equivalents in English,&mdash;for instance, <i>chatrure</i>, as
+applied to animals, making also a distinctive difference between the
+meaning of the French words <i>castration</i> and <i>chatrement</i>. Bergmann is a
+decided evolutionist as regards circumcision being evolved from prior
+forms of physical mutilation, as will be more fully explained in the
+next chapter; the shaving of the head of a conquered people by the
+Hindoos, or the shearing the royal locks of the ancient Frankish kings;
+the blinding of one eye of their slaves by the old Scythians, or
+crippling one foot by the division of a tendon in a captive by the
+Goths, he considers as on the same line with the idea that led to
+castration, the different forms of eunuchism, and circumcision.<a name="FNanchor_31_31" id="FNanchor_31_31"></a><a href="#Footnote_31_31" class="fnanchor">[31]</a></p>
+
+<p>From a purely materialistic and utilitarian view of the subject, he
+observes that what we call moral progress and civilization owe their
+advancement more to material interest and cold, selfish calculation than
+to any development of the humanitarian sentiments, and that neither
+morality nor justice has much to do with it. The evolution of the slave
+and the marks inflicted upon him by his fellow humans are the most
+emphatic evidences of the justness of the above proposition. The study
+of the subject is equally interesting when considered in connection with
+the evolutions of the Christian Church. In its divergence from Judaism
+and its beneficent laws, both social and moral, the Christian Church was
+but illy fit to cope with its persecutors of Pagan <span class='pagenum'><a name="Page_88" id="Page_88">[88]</a></span>
+tendencies, or to enforce an unwritten law or code of morality or
+hygiene among an idolatrous, barbarous, and ignorant population such as
+it had to encounter. To its professors, the formation of that monachism
+which has been so much misunderstood and abused was but an inevitable
+condition.<a name="FNanchor_32_32" id="FNanchor_32_32"></a><a href="#Footnote_32_32" class="fnanchor">[32]</a>
+These men had not the steady compass to guide them in the path that was
+possessed by the Jewish people. The martyrdom of Christ and many of his
+apostles, and the teachings of the early church, pointed to physical
+denials, castigations, humiliations, and sufferings as the only way to
+salvation; all pleasures were sin and all denials and pain were looked
+upon as steps to heaven. The climate pointed to sexual indulgence as the
+sum of all happiness, as can readily be inferred from the Mohammedan
+idea of heaven; so, with the early Christians who were born in the same
+climates, the denials of sexual pleasures were looked upon as the most
+acceptable offering that man could make to the Deity. Continence,
+celibacy, infibulation, and even castration were the conditions looked
+upon by many of these men as the only means of living a life on earth
+that would grant them an eternal life in the next. This view of the
+situation peopled the deserts with a lot of men dwelling in caves and in
+huts, living on such a scarce diet that they barely existed. That many
+went insane, and in their frenzy died while roaming in these solitudes,
+we have ample evidence. The tortures and impositions of the Pagan rulers
+also drove many to this life or death.</p>
+
+<p>Religious mania has caused many cases of self-mutilation, either to
+escape continued promptings and desires, or simply from a resulting
+species of insanity. Of the first, Sernin<a name="FNanchor_33_33" id="FNanchor_33_33"></a><a href="#Footnote_33_33" class="fnanchor">[33]</a>
+reported to the Medical Society of Paris the case of a young priest who
+had castrated <span class='pagenum'><a name="Page_89" id="Page_89">[89]</a></span>
+himself with the blade of a pair of scissors, and who nearly lost his
+life with the subsequent h&aelig;morrhage. The writer saw an analogous
+case on board an American war-vessel, of which Dr. Lyon was surgeon, in
+the harbor of Havre, in the spring of 1871, the subject being the
+ship&rsquo;s cobbler, a religious fanatic, who was driven insane by
+self-imposed continence. We are not surprised, from the lack of
+intelligence of the times, the extreme but undefined views as to
+religion that then ruled men, that self-imposed castration should have
+been sanely considered and carried into effect by Origines and his
+monks. The Cybelian priesthood had formerly set the example in their
+Pagan worship, and when we are told that the monks of Mount Athos
+accused the monks of the convent of a neighboring island with falling
+away from grace, because they allowed <i>hens</i> to be kept within the
+convent inclosure, we may well believe that Origines and his monks felt
+that they were gradually ascending in grace when they submitted to this
+sacrifice. As strange as it may sound, self-castration is still
+practiced by the Skoptsy, a religious sect in Russia. In justice to the
+Church, however, it must be said that she neither asked for nor did she
+sanction these performances, although she was not quick enough in
+asserting that she recognized the same law in regard to her presbytery
+that controlled that of the Hebraic priesthood.</p>
+
+<p>Eunuchism presents many contradictory conditions; eunuchs have not
+always been the fat and sleek attendants on Oriental harems as tradition
+and custom places them or would have us believe; neither does the loss
+of virility, in a procreative sense, seem to have always robbed them of
+their virility in other senses, as we find eunuchs holding the highest
+offices in the State under <span class='pagenum'><a name="Page_90" id="Page_90">[90]</a></span>
+the reigns of Alexander, the Ptolemys, Lysimachus, Mithrades, Nero, and
+Arcadius. The eunuch Aristonikos, under one of the Ptolemys, and
+another, Narces, under Justinian, led the armies of their sovereigns.
+These are, however, exceptional cases; as a rule, the result is as we
+observe in the domestic animals,&mdash;loss of spirit, vim, and
+ambition. The Church recognized this result, and, while the Hebraic law
+excluded eunuchs from participating in the priesthood as being imperfect
+and unclean, the Church reproached Origines and his monks and excluded
+eunuchs from its presbytery on the ground that such beings lack the
+moral and physical energy requisite in a calling that is supposed to
+guide or lead men; moreover, there are many reasons for doubting that
+the ministers of state and the generals of the reigns above mentioned
+were actually eunuchs in the full acceptance of the word. Among the
+ancients there were several methods of performing the operations that
+made the eunuchs; some were more effectual than others. From the removal
+of <i>all</i> the genitals, or the penis alone, or the scrotum and testicles,
+or removing only the testicles, down to compression or to distorting the
+spermatic vessels, or, as in the case of the Scythians, who often became
+eunuchs from bareback riding, as Hammond describes a eunuchism
+manufactured by our southwestern Indians of New Mexico and Arizona, are
+performances that left many degrees of eunuchism; as we find some
+eunuchs that not only contracted marriage, but engendered children.
+Voltaire mentions Kislav-aga, of Constantinople, a eunuch <i>&agrave;
+outrance</i>, with neither penis, scrotum, nor anything, who owned a large
+and select harem. Montesquieu, in his &ldquo;Persian Letters,&rdquo;
+admits this class of marriages as being practiced, but doubts the
+resulting conjugal felicity, especially <span class='pagenum'><a name="Page_91" id="Page_91">[91]</a></span>
+on the part of the wife. Potiphar&rsquo;s wife was one of these
+unfortunate wives; no wonder that she tore Joseph&rsquo;s cloak in her
+desire. Juvenal mentions that some eunuchs were held in high esteem by
+the Roman matrons; it possibly could have been some of this kind of a
+eunuch that led armies or ruled in the palaces. Among the sultans and
+Oriental potentates those who had every exterior evidence of virility
+removed, so as to be obliged to micturate through the means of a
+catheter, were considered the safest guards, as well as they were the
+highest-priced eunuchs, for in their manufacture fully 75 per cent. of
+those operated upon died as a result. It is related that the Caribs made
+eunuchs of their prisoners of war on the same principle that caponizing
+is resorted to for our kitchens,&mdash;the prisoners were easier to
+fatten and were more tender when cooked. The Italians allowed their
+children to be eunuchized for chorister purposes in church services,
+their soprano voices after this treatment being simply perfect. It was
+considered that, in the year prior to the papal ordinance of Pope
+Clement XVI forbidding the practice or the employment of eunuchs in
+choirs, four thousand boys, mostly in the neighborhood of Rome, were
+castrated for chorister purposes.</p>
+
+<p>In China eunuchs were in use during the reign of the Emperor Yen-Wang,
+in 781 <span class='sc lc'>B.C.</span> The Chinese make their eunuchs by a complete ablation of all
+genitals. In India the followers of Brahma never placed their women in
+charge of eunuchs. In Italy it was customary to emasculate boys that
+they might grow up with the faculty of taking the female parts in
+comedies, their voices thereby assimilating to that of the other sex,
+this being on the same principle that the <i>basso-profundos</i> were
+infibulated that they might retain their bass.</p>
+
+<p><span class='pagenum'><a name="Page_92" id="Page_92">[92]</a></span>
+Eunuchism resulting from an operation owing to disease has at times
+given queer and unlooked-for results, as, for instance, in the case of
+the old man that Sprengle mentions, in whom castration did not remove an
+inordinate sexual desire. Sir Astley Cooper mentions a case in his
+&ldquo;Diseases of the Testes&rdquo; that is somewhat unique. After
+castration Sir Astley&rsquo;s patient showed the following results:
+&ldquo;For nearly the first twelve months he stated that he had
+emissions <i>in coitu</i>, or that he had the sensations of emission; that
+then he had erections and coitus at distant intervals, but without the
+sensation of emission. After two years he had excretions very rarely and
+very imperfectly, and they generally ceased immediately upon the attempt
+at coitus. Ten years after the operation he said he had during the past
+year been only once connected. Twenty-eight years after the operation he
+stated that for years he had seldom any excretion, and then that it was
+imperfect.&rdquo; In regard to the mortality from castration done in a
+professional manner and for disease, Curling, in his work on
+&ldquo;Diseases of the Testis,&rdquo; observes that he saw or performed
+some thirty operations without a death, and that in a table of like
+operations performed at the H&ocirc;tel Dieu, in Paris, it appeared that the
+mortality was one in four and a quarter.</p>
+
+<p>J. Royes Bell, in the sixth volume of the &ldquo;International
+Encyclop&aelig;dia of Surgery,&rdquo; has the following in regard to the
+practice among the Mohammedans in India: &ldquo;Young boys are brought
+from their parents, and the entire genitals are removed with a sharp
+razor. The bleeding is treated by the application of herbs and hot
+poultices; h&aelig;morrhage kills half the victims, and at times brings
+the perpetrators of the vile proceeding within the clutches of the law.</p>
+
+<p><span class='pagenum'><a name="Page_93" id="Page_93">[93]</a></span>&rdquo;
+The <i>taill&egrave; &agrave; fleur de ventre</i> of the Chinese is a somewhat primitive
+procedure. According to Dr. Morache, in his account of China in the
+&ldquo;Dic. Ency. des Sciences M&eacute;dicales,&rdquo; the operation is as
+follows: &ldquo;The patient, be he adult or child, is, previous to the
+operation, well fed for some time. He is then put in a hot water bath.
+Pressure is exercised on the penis and testes, in order to dull
+sensibility. The two organs are compressed into one packet, the whole
+encircled with a silk band, regularly applied from the extremity to the
+base, until the parts have the appearance of a long sausage. The
+operator now takes a sharp knife, and with one cut removes the organ
+from the pubis; an assistant immediately applies to the wound a handful
+of styptic powder, composed of odoriferous raisins, alum, and dried
+puffball powder (boletus-powder). The assistant continues the
+compression till h&aelig;morrhage ceases, adding fresh supplies of the
+astringent powders; a bandage is added and the patient left to himself.
+Subsequent h&aelig;morrhage rarely occurs, but obliteration of the canal of
+the urethra is to be dreaded. If at the end of the third or fourth day
+the patient does not make water, his life is despaired of. In children
+the operation succeeds in two out of three cases; in adults, in one-half
+less. Poverty is the cause which induces adults to allow themselves to
+be thus mutilated. It is said to be difficult to distinguish these last
+from ordinary Chinese men. Adult-made eunuchs are much sought after, as
+they present all the attributes of virility without any of its
+inconvenience.&rdquo;</p>
+
+<p>The study of the evolutionary moves or processes passed by eunuchism in
+its relation to music and the drama tends to rob these otherwise
+civilizing and enlightened arts of the aureoles of poetry and gentility
+<span class='pagenum'><a name="Page_94" id="Page_94">[94]</a></span>
+with which they have been surrounded. From Bergmann we learn that the
+practice originated in the Orient, where female voices were held in
+higher esteem in singing, and where the profane songs that accompanied
+the dance were chanted by women. The Hebraic regulations permitted
+neither women nor eunuchs to sing in their temples. With the
+establishment of the early Christian Church in Oriental countries, more
+or less of the ancient Judaic customs were retained, and in addition a
+too literal interpretation of the words of St. Paul was adhered to,
+which said that women should not be <i>heard</i> in the Church. The Oriental
+Church from these reasons long remained in a quandary; according to the
+ceremonials, it was deemed requisite to imitate as near as possible the
+voices of the angelic seraphims, and this could not be done by the
+rasping bass voices of the well-fed monks; women were out of the
+question in the then social stage of church evolution; so that at last a
+compromise was effected by admitting the eunuch, who could chant in a
+most seraphic soprano, as his prototype, the mendicant priests of
+Cybele, had done before him.</p>
+
+<p>Constantinople became the centre of learning for Greek music, and the
+fine soprano solos which now form the attraction of many of our modern
+churches were sung by the eunuchs. Eunuchs were not only the chief
+singers, but they cultivated the art into a science, and Constantinople
+furnished through this class the music-teachers for the world, as we
+learn that in 1137 the eunuch Manuel and two other singers of his order
+established a school of music and singing in Smolensk, Russia. There is
+no doubt but that in a moral sense, considering that women are generally
+the pupils, this was a most meet and an appropriate arrangement; for,
+<span class='pagenum'><a name="Page_95" id="Page_95">[95]</a></span>
+as St. Alphonsus M. Liquori observed, man was a fool to allow his
+daughters or female wards to be taught letters by a man, even if that
+man were a saint, and, as real saints were not to be found outside of
+heaven, it can well be imagined how much more dangerous it might be to
+have them taught music and singing by a man not a eunuch,&mdash;elements
+which have a recognized special aphrodisiac virtue, as was well known to
+the ancient Greeks, who only allowed their wives to listen to a certain
+form of music when they (the husbands) were absent from home.</p>
+
+<p>There is not much room for doubt but that both morality and medicine
+have too much neglected the study and contemplation of the natural
+history of man, and relied altogether too much on the efficacy of church
+regulations and castor-oil and rhubarb. There are other things to be
+done besides simply framing moral codes and pouring down mandrake into
+the stomach; the old conjoined service of priest and doctor should never
+have been discontinued, as, by dividing duties that are inseparable,
+much harm has resulted. Herein dwelt the great benefit of the early
+practice of medicine among the Greeks, and to the physical understanding
+and supervision of human nature by the Hebraic law may be said that the
+creed owes its greatness and stability, and the Hebrew race its sturdy
+stamina. The wisdom of the Mosaic laws is something that always
+challenges admiration, the secret being that it did not separate the
+moral from the physical nature of man. Bain, Maudsley, Spencer, Haeckle,
+Buckle, Draper, and all our leading sociologists base all their
+arguments on the intimate relations that exist between the physical
+surrounding and the physical condition of man and his morality. Churches
+foolishly ignore all this.</p>
+
+<p><span class='pagenum'><a name="Page_96" id="Page_96">[96]</a></span>
+From Constantinople the fashion or custom gradually invaded Italy; and
+as Rome was the centre of the new religion, so it also became the centre
+of music, and Rome and Naples were soon the home of the eunuch devoted
+or immolated to the science of music. The eunuchs reached the height of
+their renown in music, as well as what might be termed their golden era,
+with the establishment of the Italian opera, in the seventeenth century.
+At this period all the stages of Italy were the scenes of the lyric
+triumphs of this otherwise unfortunate class, some of whom accumulated
+vast fortunes. In the following century, as has been seen, Clement XVI
+abolished the practice as far as the church was concerned, and in the
+present century the first Napoleon abolished the practice secularly and
+socially. Mankind cannot sufficiently appreciate the benefits it
+received from the results of the French Revolution; we are too apt to
+look at that event simply from the unavoidable means which an uneducated
+class&mdash;rendered desperate by long suffering and brutalization under an
+organized system of oppressive misrule&mdash;had adopted to remedy existing
+evils. After the dissolution of the Directory France cannot be said to
+have been in a state of anarchy, and the long and bloody wars with which
+Napoleon is usually blamed should rather be charged to that government
+and imbecile ministerial policy that lost to England the American
+colonies. The series of battles from Marengo to Waterloo are as much the
+creation of the cabinet of George III as those from Concord to Yorktown.
+Waterloo involved more than the simple defeat of Napoleon; it meant the
+defeat of moral and intellectual progress, as well as the suppression of
+the rights of man. The suppression of the Inquisition in Spain, and of
+eunuchism in Italy; <span class='pagenum'><a name="Page_97" id="Page_97">[97]</a></span>
+the Code Napoleon; the Imperial highways of France; the construction of
+its harbors,&mdash;notably that of Havre; and the political and social
+emancipation of the Jews in France, Italy, and Germany are monuments to
+this great man that have not their equals to crown the acts of any other
+French monarch. Like the Phrygian monk who leaped into the arena in Rome
+to separate the maddened gladiators, and who was stoned to death by the
+angry and brutal mob of spectators whose amusement he stopped,
+Napoleon&rsquo;s work has had its results, in spite of Waterloo and St.
+Helena. The martyrdom of the poor monk caused an abolishment of the
+brutal sports of the Colosseum, which henceforth crumbled to pieces.
+Little did the people look for this result who trampled the monk under
+foot. Neither did Blucher, debouching on the English left with
+Bulow&rsquo;s battalions on the evening of Waterloo, foresee, some fifty
+years later, Prussia extending its hand to make a united Italy, which
+with Napoleon&mdash;who was by blood, nature, instinct, and education an
+Italian&mdash;had been the dream and ambition of his life.</p>
+
+<p>Eunuchism as a punishment is an old practice, as the ancient Egyptians
+inflicted it at times upon their prisoners of war; so it formed part of
+their penal code, and we are told that rape was punished by the loss of
+the virile organ; a like punishment for the same offense was in vogue
+with the Spaniards and Britons; with the Romans at different times and
+with the Poles the punishment was castration. The difficulty of proving
+the crime, as well as the ease with which the crime could be charged
+through motives of revenge, spite, or cupidity on innocent persons,
+should never have allowed this form of punishment to be so generally
+used as history relates that it was; rape being one of the most
+<span class='pagenum'><a name="Page_98" id="Page_98">[98]</a></span>
+complex and intricate of medico-legal subjects, unless we take M.
+Voltaire&rsquo;s summary and Solomonic judgment, who relates that a
+queen, who did not wish to listen to a charge of rape made by one person
+against another, took the scabbard of a sword and, while she kept the
+open end in motion, asked the accuser to sheath the sword.</p>
+
+<p>Count Raoul Du Bisson, <i>Dedjaz de l&rsquo;Abyssinie</i>, gives some very
+interesting information in regard to eunuchism in his work entitled
+&ldquo;The Women, the Eunuchs, and the Warriors of the Soudan.&rdquo;
+Count Bisson has looked on the question from its moral, physical, and
+demographic stand-points, and, having seen eunuchism in its different
+aspects, from his landing at Alexandria and Cairo, down through his
+different expeditions into Arabia, the Soudan, and Abyssinia, his
+observations are well worth repeating.</p>
+
+<p>From a demographic and statistical view of the subject, its truly
+Malthusian results become at once shockingly and persistently
+prominent,&mdash;not alone in the interference that the condition induces in
+arresting any further procreation on the part of the unfortunate victim,
+but in the unparalleled mortality that, in the gross, is made necessary
+by the results of the operative procedures. The Soudan alone furnished,
+according to reliable statistics, some 3800 eunuchs annually, the
+material coming from Abyssinia and the neighboring countries, it being
+gathered by war and kidnapping parties, or by purchase, from among the
+young male population of those regions. These children are brought to
+the Soudan frontier and custom duties are there paid for their passage
+across the border, the duty being about two dollars per head. At
+Karthoum they are purchased by pharmacists, apothecaries, and others
+engaged in the manufacture of eunuchs, who generally perform simple
+<span class='pagenum'><a name="Page_99" id="Page_99">[99]</a></span>
+castration; the mortality among these amounts to about 33 per cent.
+These simply castrated eunuchs bring about $200 apiece. The great eunuch
+factory of the country, however, is to be found on Mount Ghebel-Eter, at
+Abou-Gergh&egrave;; here a large Coptic monastery exists, where the
+unfortunate little African children are gathered. The building is a
+large, square structure, resembling an ancient fortress; on the
+ground-floor the operating-room is situated, with all the appliances
+required to perform these horrible operations. The Coptic monks do a
+thriving business, and furnish Constantinople, Arabia, and Asia Minor
+with many of their complete, much-sought-for, and expensive eunuchs.
+They here manufacture both grades,&mdash;those who are simply castrated
+and those on whom complete ablation of all organs has been performed,
+the latter bringing from $750 to $1000 per head, as only the most robust
+are taken for this operation, which nevertheless, even at the monastery,
+has a mortality of 90 per cent.</p>
+
+<p>The manner of performing the operation is as barbarous and revolting as
+the nature of the operation itself, and the cruel and ignorant
+after-treatment is as fully in keeping with the whole. The little,
+helpless, and unfortunate prisoner or slave is stretched out on an
+operating-table; his neck is made fast in a collar fastened to the
+table, and his legs spread apart and the ankles made fast to iron rings;
+his arms are each held by an assistant. The operator then <ins
+class='corr' title="Transcriber&rsquo;s Note: The original showed
+&lsquo;siezes&rsquo;.">seizes</ins> the little penis and scrotum and with one
+sweep of a sharp razor removes all the appendages. The resulting wound
+necessarily bares the pubic bones and leaves a large, gaping sore that
+does not heal kindly. A short bamboo cannula or catheter is then
+introduced into the urethra, from which it is allowed to project for
+about two inches, <span class='pagenum'><a name="Page_100" id="Page_100">[100]</a></span>
+and no attention is paid to any arterial h&aelig;morrhage; the whole
+wound is simply plastered up with some h&aelig;mostatic compound and the
+little victim is then buried in the warm sand up to his neck, being
+exposed to the hot, scorching rays of the sun; the sand and soil is
+tightly packed about his little body so as to prevent any possibility of
+any movement on the part of the child, perfect immobility being
+considered by the monks as the main element required to promote a
+successful result. <i>It is estimated that 35,000 little Africans are
+annually sacrificed to produce the Soudanese average quota of its 3800
+eunuchs.</i></p>
+
+<p>When this immense sacrifice of life, the useless barbarity, and the
+really unnecessary needs of such mutilated humanity existing are fully
+considered, it would seem as if Christian nations might, with some
+reason, interfere in this horrible traffic, by the side of which
+ordinary slavery seems but a trifle. When we further consider that, in
+some instances, the child is also made mute by the excision of part of
+the tongue,&mdash;as mute or dumb eunuchs are less apt to enter into
+intrigues, and are therefore higher prized,&mdash;the barbarity, cruelty, and
+extremes of inhumanity that these poor children have to suffer cannot be
+overestimated. Neither must we be astonished at the stolid indifference
+that is exhibited by the eunuchs in after life to any or all sentiments
+of humanity, or that they should hold the rest of humanity in continual
+execration.</p>
+
+<p>Often-occurring accidents in harems make <i>complete</i> eunuchs a
+desideratum. Bisson mentions that on one occasion he saw the chief
+eunuch of the Grand Cherif of Mecca&mdash;a large, finely-proportioned,
+powerful black&mdash;on his way to Stamboul for trial and sentence; he was
+heavily chained and well guarded. It appears that the <span class='pagenum'><a name="Page_101" id="Page_101">[101]</a></span>
+eunuch had only been partly castrated, and that the operation had been
+performed during infancy; his testicles had not fully descended, so that
+in the operation the sac was simply obliterated, which gave him the
+appearance of a eunuch. In this condition he seemed to have kept a
+perfect control of himself and passions until made chief eunuch of the
+Cherif, who possessed a well-assorted harem of choice Circassian,
+Georgian, and European beauties. The <i>n&eacute;glig&eacute;</i> toilet of
+the harem bath and the seductive influence of this terrestrial Koranic
+seventh heaven was too much for the warm Soudanese blood of the chief;
+his forays were not suspected until a blonde Circassian houri presented
+her lord and master, the Cherif, with a suspiciously mulatto-looking son
+and heir. A consultation of the Koran failed to explain this
+discrepancy, and suspicion pointed to the chief eunuch, who was
+accordingly watched; it was found that he had not only corrupted the
+fair Circassian, but every inmate of the harem as well. The harem was
+promptly sacked and drowned and the false eunuch shipped to the Sultan
+for sentence, the Cherif having the right to sentence and drown the
+harem, but having no such rights over such a high personage as the chief
+eunuch.</p>
+
+<p>There are physiological facts and pathological conditions brought forth
+for our contemplation, while investigating the subject of eunuchism in
+all its details, that cause us to feel that, after all, the old
+Hippocratic principle of inductive philosophy, upon which our study and
+practice of medicine is founded, with rational experience and
+observation for its corner-stone, is, even if commonplace, the only
+proper avenue of knowledge. To exemplify this proposition we have in
+this particular subject the practical observations and experience of<span class='pagenum'><a name="Page_102" id="Page_102">[102]</a></span>
+M. Mondat, of Montpellier; in his interesting work on &ldquo;De la <ins
+class='corr' title="Transcriber&rsquo;s Note: The original showed
+&lsquo;St&egrave;rilit&egrave;&rsquo;.">St&eacute;rilit&eacute;</ins> de
+l&rsquo;Homme et de la Femme,&rdquo; published in 1840, he details some
+instructive information on the subject of eunuchs, giving some
+explanation as to why many simply castrated eunuchs are, like the
+much-prized eunuchs of the Roman matrons, still able to acquit
+themselves of the copulative function. He mentions that while in Turkey
+he studied the subject in its details, and, having found some of these
+copulating eunuchs, he secured some of the ejaculated fluid and
+subjected it to a careful examination. The discharge was lacking the
+characteristic seminal odor; it was in other respects, to the palpation
+especially, very much like the seminal fluid. He found that these
+eunuchs were much given to venereal enjoyment, but that either
+legitimate intercourse or masturbation, to which many were addicted, was
+apt to be followed by a marasmus ending in galloping consumption. Mondat
+personally knew the opera-singer Velutti, who died in London; Velutti
+was, when a child, castrated by his parents, having both testicles
+removed, being intended by his father, who had himself performed the
+operation, for the choir of the Papal Chapel at Rome. Velutti was as
+much of a favorite in his day as our present tenors and handsome actors.
+The admiration of the opposite sex was fatal to him; he formed a
+<i>liaison</i> with a young English lady residing in London, and the
+resulting excesses in which he indulged quickly brought him to his
+grave. He was passionately fond of women and was able to acquit himself
+perfectly; at least, as far as the copulative act&mdash;barring
+fecundation&mdash;was concerned.</p>
+
+<p>In a previous part of this chapter I have alluded to the very
+appropriate arrangement which formerly <span class='pagenum'><a name="Page_103" id="Page_103">[103]</a></span>
+existed when music-teachers were eunuchs, and that our higher circles
+of society would do well to employ eunuchized coachmen, especially if
+possessed of susceptible and elopable daughters; but, from the accounts
+given by Mondat, it would seem that they are not as safe as might at
+first be imagined. However, they could not be as dangerous as the chief
+eunuch of the Grand Cherif of Mecca and increase the population to the
+same extent; but I should judge that they might be a very demoralizing
+moral element if introduced into modern society. If eunuchs must be
+employed, it can easily be understood why the Turk and Chinese prefer
+the real, clean-cut article. The New York &ldquo;Four Hundred&rdquo;
+should make a note of this, as in their present thirst for European
+aristocratic notions, coats of arms and titles, there is no telling how
+soon they may cross over into Oriental customs and run a harem, in which
+case it would be sad to have them make any mistakes in the quality and
+ability of the eunuch.</p>
+
+<p>Dr. Gardner W. Allen has furnished the American profession with a
+faithful translation of the valuable work of Professor Ultzmann on
+&ldquo;Sterility and Impotence.&rdquo; In this, we have a clear and
+intelligent dissertation that explains the above conditions, and I am
+only surprised that the observations of Mondat have not developed such
+explanations before, as the principle was fully explained in practice
+fifty years ago by the Montpellier physician. According to Ultzmann,
+there is a form of fecundating impotence in persons otherwise well
+provided with an apparent complete apparatus, an impotence which he
+terms <i>potentia generandi</i>. He states, however, that this form of
+impotence was not recognized until a few years ago, citing the fact that
+females have had, as a rule, to bear all of the blame for the
+unfruitfulness <span class='pagenum'><a name="Page_104" id="Page_104">[104]</a></span>
+of the family, and that they have been accordingly subjected to all
+manner of operations, general and local treatment, even to being sent to
+watering places and sanatoria where red-headed male attendants are
+employed, to say nothing of the prayers, intercessions, pilgrimages, and
+novenas to the holy shrines, as mentioned in the chapter on the holy
+prepuce. Ultzmann observes that a man may be perfectly able to go
+through the procreative or, rather, the copulative act, even to the
+great satisfaction of all parties concerned, and yet be perfectly
+impotent; he even goes further, by observing that there are cases in
+which copulation may take place without any fluid whatever being
+ejaculated. He mentions two such cases at pages 87 and 116 of his book.
+In the first instance the ejaculated fluid is precisely as that observed
+in such cases as those of the eunuchs and of Velutti, mentioned by
+Mondat, and consisted of an azo&ouml;spermic discharge, made up mainly
+from the secretion of the seminal vesicles, the accessory glands of the
+urethra, the prostate, and Cowper&rsquo;s glands, as well as the
+discharge from the secretory glands distributed along the course of the
+urethral mucous membrane. Some of the cases of this form of impotence
+have exhibited wonderful copulating desire and power of endurance, and,
+even if unfecundating, they must be said to be better off than the
+victims of that other form of male impotence, the <i>potentia coeundi</i> of
+Ultzmann, where, with a normal semen, either the power of erection or
+that of ejaculation may be entirely absent.</p>
+
+<hr /><p class='pagenum'><a name="Page_105" id="Page_105">[105]</a></p>
+<h2><a name="CHAPTER_IX" id="CHAPTER_IX"></a>CHAPTER IX.<br />
+<span class='sc sf75'>Philosophical Considerations Relating to Eunuchism and Medicine.</span></h2>
+
+<p>Eunuchism does not always subdue the animal passions; this is the view
+that the church took in connection with the emasculation of Origenes and
+his monks; the church here held that not only was it possible for them
+to still sin in heart or imagination, but that, even were the complete
+eradication of the sexual idea possible, they had by their act lost the
+main glory of a Christian,&mdash;that of successfully striving against
+temptation, and by a force born of triumphant virtue overcome all the
+wiles of the devil. It is related that among the eunuchs at Rome there
+were some who, having been made so late in life, still retained the
+power of copulation, although the final act of the performance was
+absent. Montfalcon relates that Cabral reported dissecting a soldier who
+was hanged for committing a rape, but who on dissection showed not the
+least trace of testicles, either in the scrotum or abdomen, although the
+seminal vesicles were filled with some fluid.<a name="FNanchor_34_34" id="FNanchor_34_34"></a><a href="#Footnote_34_34" class="fnanchor">[34]</a>
+Sprengle, in his &ldquo;History of Medicine,&rdquo; relates of the
+complete removal of both testicles from an old man of seventy years of
+age, on account of inordinate sexual desire, the operation having no
+perceptible effect in subduing the disease.<a name="FNanchor_35_35" id="FNanchor_35_35"></a><a href="#Footnote_35_35" class="fnanchor">[35]</a>
+These cases are analogous to those exceptionable cases in which, after
+extirpation of the ovaries, both menstruation and fecundation have still
+taken place.</p>
+
+<p>Modern civilization and its unnatural mode of dressing inflict great
+harm on men by keeping these parts <span class='pagenum'><a name="Page_106" id="Page_106">[106]</a></span>
+too warm and constricted. Much of the irritability of these organs, as
+well as their <i>decadence</i> at an age some generation or two before the
+time when they should still possess all their virile attributes, can be
+directly attributed to this cause. A more intelligent way of dressing
+would result in less moral and physical wreckage, and require less
+galvanic belts and aphrodisiacs in men under fifty. If those who
+habitually swath their scrotums in the heavy folds of their flannel
+shirts, to which are superadded the cotton shirts, drawers, and outer
+clothes in which civilized man incases himself, would cast a backward
+eye into the dim and misty past, and see the priest of some of the old
+Pagan gods soaking the scrotum in hot water, and then gradually rubbing
+the testicles within, by gentle but firm friction, <i>to make the
+testicles disappear</i>, a process by which many of the heathen priests
+prepared themselves for the discharge of their sacerdotal duties and the
+strict observance of those rules of chastity and celibacy which they
+were henceforth to live up to, they would find <i>one</i> explanation of why
+civilized man does not possess that vigor and retain that procreative
+power into advanced age that was one of the characteristics of our
+ancient progenitors in the days that breeches were as abbreviated as
+those now worn by the Sioux Indians. These are really but leggins, which
+run only to the perineum and are simply tied by outer points to a strap
+from each hip. Finely and comfortably cushioned chairs may be a luxury
+to sit on, but they will have, on the man who uses them in youth and in
+his prime, a wonderful sedative and moral influence later on, about as
+effectual as the miniature warm baths for the scrotum and gentle
+pressure to the testicles that were used by the heathen priests of old,
+who preferred a gradual disappearance of <span class='pagenum'><a name="Page_107" id="Page_107">[107]</a></span>
+the glands to the too sudden and summary methods of the Cybelian
+clergy, who used a piece of shell and an elaborately-performed
+castration. According to Paulus &AElig;gineta, this was a common
+practice of making eunuchs out of young boys in the Orient, the
+mortality being hardly any; whereas the <i>taill&egrave; &agrave; fleur de
+ventre</i>, the favorite method for making eunuchs for harem guards and
+attendants, and more suited to the jealous disposition of the Turk, has
+a mortality of three out of every four, according to Chardin, and of two
+out of every three, according to Clot Bey, the chief physician of the
+Pasha,<a name="FNanchor_36_36" id="FNanchor_36_36"></a><a href="#Footnote_36_36" class="fnanchor">[36]</a>
+and of nine out of ten, according to Bisson. So prone to reach high
+offices were intelligent eunuchs that it is related that parents were at
+times induced to treat their boys in the manner above stated, that they
+might be on the highway to royal favor, honor, and rank; such is the
+ennobling tendency of Oriental despotism, polygamy, and harem life. On
+the same principle Europeans subjected their boys to a like operation to
+fit them for a chorister life or the stage, where fame and honor and
+wealth were to be found.</p>
+
+<p>Medicine has been the butt of wits and philosophers, as well as of the
+men who, from the profession, have gone into the ranks of literature.
+Smollet, himself a physician, gives us an insight into our wandering and
+erratic misapplication of our knowledge on therapeutics in
+&ldquo;Peregrine Pickle,&rdquo; where the poor painter, Pallet, is
+believed to be a victim of hydrophobia. The learned opinion of the
+doctor, who explains the many and various reasons by which he arrives at
+his diagnosis, the various physical signs exhibited by the patient as
+being pathognomonic of the disease, and his final venture with the
+contents of the <i>pot de chambre</i>, as a diagnosis verifier, which he
+dashes in the patient&rsquo;s face in preference <span class='pagenum'><a name="Page_108" id="Page_108">[108]</a></span>
+to ordinary water on account of the medicinal virtues contained in
+urine, which in the case seemed to him to have a peculiar therapeutic
+value, is something worth reading, however ludicrous it all sounds.
+There are few intelligent physicians but who have seen as ridiculous
+performances, in what might be called medical gymnasts, that equal, if
+not surpass, those of Smollet&rsquo;s doctor. Rabelais was also a
+professional brother, who, equally with Smollet, attempted to waken up
+the profession by his satires. Smollet was not only a physician, but in
+his early life had seen some very active and practical work, having
+participated in and been a witness to the ills and misfortunes that
+follow any attempts to &ldquo;lock horns&rdquo; with nature through
+ignorance of physical laws and preventive medicine,&mdash;having been a
+surgeon&rsquo;s mate in the fleet which assisted the land forces in the
+murderous and ill-fated Carthagena expedition which cost England so many
+lives, ignorantly and needlessly sacrificed to ministerial disregard of
+physical laws and its consequences,&mdash;lessons which, unfortunately,
+seem to have but little effect on cabinets, owing to their shifting
+<i>personelle</i>, England following up the disasters of Carthagena with the
+still greater blunder of the Walcheren expedition, where, out of
+England&rsquo;s small available physical war material, nearly forty
+thousand men were either left to fatten the swamps of Walcheren, or to
+wander through England in after years on the pension-list, physical
+wrecks and in bodily and financial misery.<a name="FNanchor_37_37" id="FNanchor_37_37"></a><a href="#Footnote_37_37" class="fnanchor">[37]</a>
+Again, the same disregard, born of ignorance and red tape, crippled the
+British army in the Crimea, causing in its ranks the greatest mortality.
+It has seemed as if it would be of advantage if all the blunders, either
+philosophical or of statesmanship, committed by a cabinet, should be
+written in large letters of gold, to be hung <span class='pagenum'><a name="Page_109" id="Page_109">[109]</a></span>
+in the council-halls of the nations, that similar blunders at least
+might not occur again.</p>
+
+<p>Dumas, in his &ldquo;History of the Two Centuries&rdquo; and his
+&ldquo;History of the Century of Louis the XIV,&rdquo; gives some very
+interesting medical touches. Le Sage, in his &ldquo;Adventures of Gil
+Blas,&rdquo; gives us food for speculating on medical philosophy in
+connection with the interesting subject of how to make the profession
+remunerative. Dickens&rsquo;s ideas of the doctor, as given in his
+works, are life touches. Witness his description of the little doctor
+who superintended little David Copperfield&rsquo;s advent into the
+world, or of Dr. Slammer of the army; they represent his view of the
+professional character. Fontenelle, probably, was right in ascribing the
+fact of his becoming a centenarian, and maintaining a stomach with the
+force and resistance that are the peculiar characteristics and
+attributes of a chemical retort, to the fact that when sick it was his
+practice to throw the doctor&rsquo;s physic out of the window as the
+doctor went out of the door, as in his day a man required the
+constitution of a rhinoceros and the stomach of an ostrich, with the
+external insensibility of a crocodile, to withstand the ordinary doctor
+of the period and his medications. Napoleon believed that Baron Larrey
+was the most virtuous, intelligent, useful, and unselfish man in
+existence; in fact, it is doubtful if any man of his time commanded from
+this truly great man so much admiration or respect, either for bravery,
+courage, intelligence, or activity, as the great and simple-minded
+Larrey. As observed by Napoleon of his bravest general,&mdash;poor Marshal
+Ney, the bravest of the brave, the rear guard of the grand army, the
+last man to leave Russian soil,&mdash;Ney was a lion in action, but a fool in
+the closet. All his generals had some great distinguishing
+characteristic, beyond which was a barren waste, a <span class='pagenum'><a name="Page_110" id="Page_110">[110]</a></span>
+vacuity, but too apparent to a man of Napoleon&rsquo;s discernment. But
+the cool, unflinching bravery of Larrey, that did not require the
+stimulus of the fight or the phrenzy of strife to bring it to the
+surface and keep it alive; bravery and intelligence alike active under
+showers of shot and shell or in the thunders of charging squadrons; in
+the face of infective epidemics or contagiousness, walking about in
+these scenes in which his own life was as much at stake as that of the
+meanest soldier, with the same cool exercise of his intelligence that he
+exhibited in the organization and superintendence of his hospitals in
+the time of peace; always the same, untiring, unmurmuring, brave,
+studious, observing, unflinching in his duties, unselfish; whether in
+the burning sands of Egypt or in the snowy steppes of Russia, in the
+marshy plains of Italy or in the highlands of Spain, he always found him
+the same, and his notes and observations, from his first government
+service on the Newfoundland coast to his last, always showed him the
+same laborer and student in the field of medicine. And yet at St. Helena
+we find Napoleon refusing to take remedies for internal disease whose
+real nature was unknown, and only toward the end did he consent to take
+anything, and then only when seeing that the end was approaching, and
+more from a kindly desire to express his appreciation of the services of
+his attendants, and not to wound their feelings, than from any hope of
+assistance. Napoleon had not neglected the study of medicine any more
+than he had the study of every other science. This is evident from the
+instance related as taking place during the march of the grand army from
+the confines of Poland into Russia, in 1812, when dysentery became very
+prevalent, of his inviting several of his favorite guard to his own
+table, where he experimented <span class='pagenum'><a name="Page_111" id="Page_111">[111]</a></span>
+on each particular grenadier with a specific form of diet, so as to
+determine its cause and possible remedy. He did not look upon our
+knowledge of pathology and our skill in diagnosis as being sufficiently
+advanced or perfect to make him feel but that a treatment for an obscure
+disease like his own would be pretty much a matter of guess-work.
+Charles Reade, in his &ldquo;Man and Wife,&rdquo; shows an intimate
+knowledge of medical science where he philosophizes on the effects of an
+irregular life and of over-physical training. His logic is sound
+science. Defoe and Cervantes show a like intelligent insight as to
+medicine; and it was not without reason that Sydenham, the English
+Hippocrates, advised a student of medicine who entered his office as a
+student to begin the study of medicine by the careful study of
+&ldquo;Don Quixote,&rdquo; remarking that he found it a work of great
+value, which he still often read. The works of Bacon and of Adam Smith
+on &ldquo;Moral Sentiments;&rdquo; the famous treatise on the
+&ldquo;Natural History of Man,&rdquo; by the Rev. John Adams; the later
+works of Buckle, Spencer, Darwin, Draper, Lecky, and other robust
+wielders of the Anglo-Saxon pen, as well as the works of Montaigne,
+Montesquieu, La Fontaine, and Voltaire, are all works that the medical
+man could probably read with more profit than loss of time. In fact,
+either Hume, Macaulay, or any philosophical work on history will furnish
+to the physician additional knowledge of use in his profession. No
+physician can afford to neglect any study that in any manner adds to his
+knowledge of the natural history of man, as therein is to be found the
+foundation of our knowledge as to what constitutes health, and as to
+what are the causes that lead humanity to diverge from the paths of
+health into those of physical degeneracy and mental and bodily disease.</p>
+
+<p><span class='pagenum'><a name="Page_112" id="Page_112">[112]</a></span>
+We have in medicine many sayings which pass for truisms, which are,
+after all, misleading. We say, for instance, keep the feet warm and the
+head cool; this will not always either keep you comfortable or well, as
+we know that in neuralgias it is absolutely necessary, either for
+comfort or to get well, to keep the head warm. While so much stress is
+laid on the necessity of keeping the head cool, a thing a person is sure
+to look after whenever the head becomes uncomfortably warm, and to which
+can be ascribed but few ailments or deaths, we hear comparatively
+nothing about the thermometric condition of the perineum, which, from
+the varying temperatures in which it is at times plunged, produces more
+beginnings for diseases in the future, during youth and our prime, as
+well as it quite often causes the sudden ending of life in more advanced
+periods. People who carefully observe the rule of keeping their heads
+cool and their feet warm will stand with outspread legs and uplifted
+coat-tails with their backs to a blazing grate, and then, going outside,
+incontinently sit down on a stone or iron door-step, or, stepping into a
+carriage or other vehicle, they sit down on a cold oil-cloth or leather
+cushion, without the least knowledge of the harm or danger that they are
+liable to incur. They little dream of the prostatic troubles that lie in
+wait for the unwary sitter on cold places, ready to pounce upon him like
+the treacherous Indian lying in ambush,&mdash;troubles that carry in their
+train all the battalions of urethral, bladder, kidney disease and
+derangments, and subsequent blood disorganization, which often begin in
+a chilled perineum, and, in conjunction with the local disease that may
+result, end in handing us over to Father Charon for ferriage across the
+gloomy Styx long before our life&rsquo;s journey is half over. It is
+true, neither the savage <span class='pagenum'><a name="Page_113" id="Page_113">[113]</a></span>
+of Africa or America nor the nomads of Asia are subject to any of these
+troubles; but with us, hampered with all the benefits of the dress,
+diet, habits, and luxuries of civilization, and with a civilized
+prostatic gland, it is quite otherwise. Herein, again, comes that
+connection between religion, morality, and medicine, that existed with
+so much benefit to mankind, but from which we of later days have, in our
+greater wisdom, seen fit to separate; although, inconsistently as it may
+seem, the present age has done more than any previous epoch in
+practically demonstrating the intimate and inseparable relation existing
+between the physical and moral nature of man. The persistent priapism
+which oftentimes results from riding with a wet seat and the inordinate
+morbid sensibility of the sexual organs that may result from the same
+cause or from spinal irritation are not to be allayed by any homily on
+morality or on the sanctifying attempts at keeping the animal passions
+under subjection, any more than will prayers or offerings to all the
+gods of Olympus restore the eunuchized, either through foolish civilized
+dress and customs or through excessive indulgence. We must mix medicine
+with our religion and make the clergy into physicians, or ordain our
+physicians into full-fledged clergymen.</p>
+
+<p>The science of medicine, or what might be called the natural ways of
+nature through its physical laws, is true to itself; the fault lies in
+our interpretation of its phenomena, which we fail to study with
+sufficient discriminative precision and nicety. We have repeatedly
+mistaken causes and results from this want of close observance and of
+precision, attributing results to causes which did not exist. As an
+example, when the early disciples of hom&oelig;opathy in ancient Palestine
+undertook to revive poor, old, withered King David, by <span class='pagenum'><a name="Page_114" id="Page_114">[114]</a></span>
+putting him to bed with a young and caloric-generating Sunamite maid,
+when it was by like incontinent practices that he had brought himself to
+that state of decrepitude, it is plain that they misunderstood the
+principle. Boerhaave&mdash;who, as a true eclectic practitioner,
+followed these ancient and Biblical hom&oelig;opaths in their practice
+in a similar case, the subject being an old Dutch burgomaster, whom he
+sandwiched between a couple of rosy Netherland maids&mdash;also failed
+to grasp the true condition of the nature of things, or the true
+philosophical explanation. The exhalations from the aged are by no means
+an elixir of health or life to the young, and the fact that the young
+were apt to lose health by sleeping with the aged was wrongly attributed
+to their loss being the <ins class='corr' title="Transcriber&rsquo;s
+Note: The original showed &lsquo;others&rsquo;.">others&rsquo;</ins> gain, and
+the result of its passing into the bodies of their aged companions, and
+not to its true cause,&mdash;the deteriorating influence to which they
+were subjected; and, further, when we analyze the subject still more, we
+can understand how a full-blooded and active, lithe-bodied, thin, and
+active-skinned Sunamite maid might and would impart caloric to King
+David; but, from our knowledge (not altogether practical) of the
+difference that exists between differently constitutioned and
+differently built maids in imparting caloric, and from our knowledge of
+the physique of the Netherland maids, who are cold and impassive, with a
+layer of adipose tissue that answers the same purpose as that of the
+blubber in the whale,&mdash;that of retaining heat and resisting
+cold,&mdash;we can well believe that the poor, shriveled burgomaster
+could receive but little heat, even when sandwiched between the two;
+but, on the contrary, he was, in fact, more liable to lose the little he
+had, unless we look at the subject in another light, and consider that
+sentiment that is common to both animals and <span class='pagenum'><a name="Page_115" id="Page_115">[115]</a></span>
+men of spirit, a sentiment that has furnished the subject for more than
+one canvas in the hands of the true and sympathetic artist, as seen on
+the awakening and alert attitude of the worn-out and old decrepit
+war-horse, browsing in an inclosed pasture, as he hears from afar the
+familiar bugle-notes of his early youth, or some cavalry regiment with
+prancing steeds and jingling accoutrements, with bright colors and
+shining arms, going past the pasture, restoring for a time to the
+stiffening joints and dim eyes the suppleness and fire of bygone times,
+with visions of gallant charges and prancing reviews; or, how the same
+sentiment erects once more the bowed and withering frame of the old
+veteran, and once again fires his soul with the martial zeal of his
+prime as he sees the passing colors and active-stepping regiment which
+he followed in the bright sunshine and flush of his youth. Aside from
+these sentiments, which might possibly have inspired David and the Dutch
+burgomaster with an infusion of a new and transient good feeling, it is
+unquestionable but that some heated brickbats or stove-lids, curocoa
+jugs or old stone Burton ale-bottles filled with hot-water, would have
+been more effectual in imparting warmth than either Sunamite or
+Netherland maids.</p>
+
+<p>It is hard to reconcile the beliefs of some people or nations with their
+manners and customs. For instance, there is the Turk; when a Jew becomes
+a Mohammedan he is made to acknowledge that Jesus Christ, the son of
+Mary, is the expected Messiah, and that none other is to be expected;
+they know of Christ&rsquo;s speech on the cross, made to the repentant
+thief; they believe in a heaven full of houris, with large black eyes
+and faces like the moon at its full, in which all good Moslems are to
+have continual rejoicings, and yet they go on performing <span class='pagenum'><a name="Page_116" id="Page_116">[116]</a></span>
+the most barbarous and inhuman forms of castration imaginable, which
+not only deprives its victims of their virility, but subject more than
+three-fourths of those operated upon to a painful death, and the
+remaining to a life of continual misery. Have these poor subjects no
+right to future bliss, or in what shape will they reach there? If the
+heavens of these eunuchisers were like the heaven of Buddhism, or, as
+the Chinese call it, the Paradise of the West, where, although all forms
+of sensual gratifications are to be enjoyed, no houris are to be
+supplied to the saints of Buddhism,&mdash;as even the women who enter
+this paradise must first change their sex,&mdash;we might understand
+that, the genitals not being needed in the eternal world, it might be
+considered a matter of small moment to compel a man to go through this
+short and transient life without them; but where a robust condition of
+the sexual organs is suggested as one of the heavenly requisites, it
+would seem as if the Turk would look upon the suffering, misery, and
+death that they cause, in connection with the inhuman mutilation they
+inflict, with horror. Doctrinal theology, whether in the East or West,
+is something incomprehensible.</p>
+
+<hr /><p class='pagenum'><a name="Page_117" id="Page_117">[117]</a></p>
+<h2><a name="CHAPTER_X" id="CHAPTER_X"></a>CHAPTER X.<br />
+<span class='sc sf75'>Hermaphrodism and Hypospadias.</span></h2>
+
+<p>There exists a class of human beings whose description is connected with
+the subject of this work. They date back to mythological times, and the
+confusion incident to the misapplication of names and the want of proper
+observation on the part of the narrators has tended to carry the
+uncertainty of their real existence to the present day. One reason that
+this part of the subject would be incomplete without their description
+is on account of the origin of their existence being intimately
+connected with eunuchism, being, in fact, an outgrowth of this
+condition; and any history of eunuchism would be but half told, without
+the additional information concerning these persons.</p>
+
+<p>Hermaphrodites, as stated, date back to mythology. Tradition tells us
+that Hermaphroditus, a son of Venus and Mercury, was educated by the
+Naiades dwelling on Mount Ida. At the age of fifteen years, he began his
+travels; while resting in the cool shades on the woody banks of a
+fountain and spring near Caira, he was approached by the presiding nymph
+of the fountain, Talmacis, who, becoming enamored of him, attempted to
+seduce him. Hermaphroditus, like Joseph, was the pattern and mirror of
+continence, and would not be seduced. Talmacis then, like
+Potiphar&rsquo;s wife, seized on the unlucky pattern of virtue, and
+prayed to the gods that they should so amalgamate poor Hermaphroditus to
+her body as to make them one. The prayer was heard on Olympus, and
+forthwith the two became one, <span class='pagenum'><a name="Page_118" id="Page_118">[118]</a></span>
+but with the distinctive characteristics of each sex unchanged. Thus
+began that fabled race of the <i>androgynes</i> of the ancients. Another
+tradition, which is probably correct, affirms that ancient Carnia, or
+Halicarnassus, was in those days the Baden-Baden of Asia Minor; that
+thither repaired all the victims of gluttony, debauchery, and general
+physical bankruptcy. Its name in ancient Caria denotes its
+seaside-resort location, Hali-Karnas-Sos meaning literally
+&ldquo;Karnassus-by-the-sea,&rdquo; like Boulogne-sur-mer. The city was
+under the protection of Hermes and Aphrodite, whose temples were near
+each other. Human nature in the days of Halicarnassus did not much
+differ from human nature at Monte Carlo or Baden-Baden. The baths had a
+number of young and handsome eunuchs who waited on the old, debauched,
+and nervous wrecks, and the nymph who presided over the whole was
+Talmakis, a name derived from the salty nature of the springs which fed
+the baths; this nymph was worshiped as Aphrodite. Pederasty was one of
+the practices at these baths. From these conjoined conditions the place
+was said to be peopled with hermaphrodites,&mdash;meaning, at first,
+simply that they were under the protection of Hermes and Aphrodite; and
+latterly the name was attached to the passive agent in the pederastic
+art,&mdash;a name that has followed the class and crossed the ocean into
+the interior wilds of America, as in Powell&rsquo;s history of the
+manners and customs of the Omahas, an Indian tribe of the Missouri, we
+find that they at times practiced pederasty, the passive agent being
+called by the Indians an hermaphrodite, or double sexed.<a name="FNanchor_38_38" id="FNanchor_38_38"></a><a href="#Footnote_38_38" class="fnanchor">[38]</a></p>
+
+<p>The relations that from eunuchism led to pederasty are very easy of
+explanation. Eunuchism induces an effeminate form, softer body, and
+prevents the growth <span class='pagenum'><a name="Page_119" id="Page_119">[119]</a></span>
+of the beard; the voice is softer and more melodious; and their
+timidity renders them also more effeminate, obedient, and dependent. The
+peculiar commingling of the female form with that of the male furnished
+to the sculptors the models for those wonderfully well-made forms which
+are yet to be seen, representing in statuary the forms of Androgynes and
+Hermaphrodites; that of the favorite eunuch of the emperor Adrian being
+remarkable for the symmetry of its form and grace of pose.</p>
+
+<p>Europe must have been astonished at the tales that were carried back by
+the early explorers and voyagers, in relation to the New World. The
+story of the immensity of the quantity of gold and silver, of great
+stores of hidden treasures, of the quantities of precious gems and
+priceless crystals was fully discounted when, from the Florida coast and
+the explorers of the Lower Mississippi, men returned with the tale that
+in the everglades and in the trackless forests, intersected by navigable
+sloughs, there dwelt a people half of whom were hermaphrodites. Neither
+the explorers nor their European historiographers seem able to have
+grasped the true state of affairs. Many believed in the actual existence
+of such numbers of these monstrosities, while others, arguing from what
+was then known regarding the extraordinary development of the nymph&aelig; and
+clitoris, as well as of the great labia, of the women in the African
+regions, concluded that these supposed <i>androgynes</i>, or hermaphrodites,
+must be women, the dress assumed by these and the menial labors to which
+they were consigned assisting to favor this opinion. The early
+Franciscan missionaries to California found the men who were used for
+pederasty dressed as women.<a name="FNanchor_39_39" id="FNanchor_39_39"></a><a href="#Footnote_39_39" class="fnanchor">[39]</a>
+Hammond mentions the practice as in <span class='pagenum'><a name="Page_120" id="Page_120">[120]</a></span>
+vogue among the Indians of the southwest, which in a measure greatly
+resembled that of the ancient Scythians in its operation, the men being
+dressed as women, associating with women, and used for pederastic
+purposes during the orgies of their festivals. These men had previously
+been eunuchised by a process of continued and persistent onanism, which
+caused at the end a complete atrophization of the testicle.</p>
+
+<p>In regard to the great number of hermaphrodites observed in Florida and
+on the Mississippi, the accounts are only reliable as far as they were
+present in female garb and in an apparent state of slavery, being
+compelled to do all the menial labor of the villages and camps, besides
+being used for pederasty, no examination having been made by any
+traveler. Their lot was different from those described by Hammond in his
+work on &ldquo;Male Impotence,&rdquo; where the whole transaction seems
+to have some sort of religious and civil significance. In Florida,
+however, they tilled the ground, extricated and carried off the dead
+during a battle, and did all the work generally, being used for beasts
+of burden and not allowed to cut their hair; but all authorities are
+silent or in complete ignorance as to whether they had suffered
+castration. Pere Lafiteau, however, gives an explanation which was in
+the last century considered ridiculous, but which, in the light that has
+been thrown on the existence of a former continent, and of the
+undisputable relation that must, some ages in the past, have existed
+between Ph&oelig;nicia and Central America, seems a strongly probable
+solution of these customs. The Father accounts for the presence of these
+American <i>androgynes</i> in the following manner: The Carribeans, or
+Caribs, were originally a colony from Carnia; with these colonists was
+brought over the worship of their<span class='pagenum'><a name="Page_121" id="Page_121">[121]</a></span>
+Pagan gods of Caria and Phrygia; these two localities were the homes of
+the Cybelian priesthood, who dressed in female garb, as did the
+sacrificial priests of the Temple of Venus Urania. It is true that the
+Java or Floridian priest had nothing in common with the priests of
+Cybele or of Venus Urania; but, still, Lafiteau gave as lucid an
+explanation for the existence of these conditions as any of his
+contemporaries. Charlevoix observed the same practices among the
+Illinois, which he attributed as being due to some principle of
+religion. The Baron de la Hontan insists that the missionary,
+Charlevoix, was mistaken; that the persons whom he saw in female attire,
+whom he took to be men, were not men. Hontan asserts that they were
+veritable hermaphrodites. The missionaries were, however, correct, as
+what has since been observed confirms their opinion. M. du Mont, who
+ascended the Mississippi for a distance of nine hundred leagues, also
+reported meeting Indians at different places attended by these
+petticoated androgynes.<a name="FNanchor_40_40" id="FNanchor_40_40"></a><a href="#Footnote_40_40" class="fnanchor">[40]</a></p>
+
+<p>As strange as it may seem, many intelligent men were loth to part with
+their belief in the existence of these double-sexed individuals; the
+logic used by many of these insisters of hermaphrodism, although now
+very ridiculous, was no doubt sensible logic one hundred and fifty years
+ago. As a matter of curiosity, some of this reasoning will bear
+repeating. It is taken from a Latin edition of an ancient description of
+Florida, originally in the English, but translated into the Latin by the
+geographer, Mercator. In this book we find the roots of some of the
+myths that led Ponce de Leon and his steel-clad warriors to wander
+through Florida in a vain search of that spring or fountain of the
+waters of perpetual youth and of everlasting life which they were
+<span class='pagenum'><a name="Page_122" id="Page_122">[122]</a></span>
+never to find. We there learn that, in the days of the good old Spanish
+knight, the inhabitants of Florida lived to a very old age, and that
+they did not marry until very late in life, as before that period it was
+very difficult to determine the sex of the individual.</p>
+
+<p>From what has since been seen among the Indians, the probability is that
+these were really eunuchs, and probably in slavery, as the result of the
+fortunes of war, as their great number and servile condition will hardly
+admit of the belief that they belonged to the same tribe as their
+masters and oppressors. Pederasty was an old, very old practice, being
+mentioned before circumcision; it prevailed among many of the Orientals,
+and among the many peoples by whom the early Jews were surrounded, who
+were, according to the Old Testament, about as an immoral, dissolute,
+and bestial a set as one could well imagine. Their religions were
+nothing but a gross mixture of stupid superstition and blind idolatry,
+pederasty, fornication, and general cussedness. In the then state of the
+Jewish nation, to have allowed them to mingle freely with these people
+would have ended in having the Jews adopt all their customs and habits.
+The aim of the Jewish leaders was to prevent any too free intercourse of
+their people with these nations, that they might remain uncontaminated
+even while dwelling near them. To accomplish this it was necessary to
+raise a barrier that would be the distinguishing mark of the Jewish
+nation. Jahns, in his learned work on the &ldquo;History of the Hebrew
+Commonwealths,&rdquo;<a name="FNanchor_41_41" id="FNanchor_41_41"></a><a href="#Footnote_41_41" class="fnanchor">[41]</a>
+lays down the idea that circumcision, as well as many articles in their
+laws,&mdash;which to us appear trivial,&mdash;were in reality intended
+to separate the Jews farther and farther from their idolatrous, bestial,
+and heathenish neighbors, while at the same time these same ordinances
+were intended <span class='pagenum'><a name="Page_123" id="Page_123">[123]</a></span>
+to preserve a constant knowledge of the true and only God, and maintain
+their moral and physical health.</p>
+
+<p>Although hermaphrodism on a large scale, as an existing condition, was a
+matter of serious belief at the end of the eighteenth century, it has
+occupied no little attention in this. Courts have been called to decide
+on cases to invalidate marriages, or to decide the sex, more than once;
+and physicians are often asked the question, Do hermaphrodites really
+exist? Dr. Debierre, of Lyons, published in 1886 a valuable paper,
+entitled &ldquo;Hermaphrodism Before the Civil Code: its Nature, Origin,
+and Social Consequences,&rdquo; which was published in the <i>Archives of
+Criminal Anthropology</i> of Lyons, France. In this short but very concise
+treatise, Debierre gives us a complete review of the subject from
+mythological times to 1886. It must be quite evident to all that there
+exists no logical reasons why the sexual or generative organs should be
+exempt from, at times, being subject to variations from the normal,
+either through the commingling of two conceptions or of faulty
+development affecting other parts of the body,&mdash;conditions that go to
+form monstrosities. Debierre gives one peculiar case of a duplication of
+vagina and uterus in a girl of nineteen, the appearance of the parts and
+the septum between the vagin&aelig; giving to the whole an appearance
+precisely similar to that of a double-barreled shot-gun. These
+monstrosities are as likely to happen as the different forms that
+affect&mdash;either by arrested development or some abnormality of excessive
+development&mdash;the head, which is a very prolific subject of anomalies.</p>
+
+<p>Hermaphrodism is a common attribute in the vegetable kingdom, where
+fixed habitation or position makes such a condition necessary; it is
+also common to many <span class='pagenum'><a name="Page_124" id="Page_124">[124]</a></span>
+of our lower forms of animal life, and even in the human f&oelig;tus
+the presence of the Wolfian bodies and the canal of M&uuml;ller in the
+same individual attest a primitive case or condition of hermaphrodism.
+In other words, humanity begins its existence in a state of
+hermaphrodism. This condition is found up to the end of the second month
+of f&oelig;tal life in the human being, in common with all mammals, as
+well as all the vertebrates, where, however, it is subject to variations
+as to time of development and limit of existence in the normal
+condition. In the chick, it is only after the fourth day that the
+genital gland begins to determine whether it will turn into an ovary or
+a testicle; in the rabbit it is on the fifteenth day, and in the human
+embryo on the thirtieth day. Hermaphrodism does not occur, however, from
+this at first uncertain state of affairs, but rather from subsequent
+developments of the external organs that by their abnormality of
+formation simulate one or the other sex, while the internal organs may
+belong without any equivocation of structure to its definite sex; as it
+has often happened that some of these cases, having been the subject of
+differences of opinion among experts during life, were, after death,
+unanimously assigned to one sex by all of the same experts, the organs
+readily defining the sex being completely of the one sex. As observed by
+Debierre, where the subject is really a female, even where the vagina or
+uterus is unperceived, the presence of the menstrual function or some
+physical disturbance at its stated periods are sufficient evidences, as
+a rule, by which to determine the sex. The case of Marzo Joseph, or
+Josephine, reported by Crecchio in 1865, had rudiments of an hypospadic
+penis ten centimetres in length and a prostate of the male sex, with a
+vagina 6 centimetres in length and 4 in circumference, ovaries,
+oviducts, and <span class='pagenum'><a name="Page_125" id="Page_125">[125]</a></span>
+uterus of the female; it was not until her death, at the age of
+fifty-six, that her sex was fully determined. The case reported by
+Sippel in 1880, supposed to be a male from external evidences, was at
+death found to be a female. Guttmann reported a like case in 1882. The
+celebrated case of Michel-Ann Dronart is remarkable; this case was
+declared a male by Morand Pere and a female by Burghart, as well as by
+Ferrein; declared asexual or neutral by the Danish surgeon, Kruger; of
+doubtful sex by Mertrud. The case of Marie-Madeleine Lefort, to which
+Debierre devotes four figures, is full of interest. One of the figures
+is her portrait at the age of sixteen, and another is from her
+photograph at the age of sixty-five. She has a man&rsquo;s head in every
+particular of physiognomy and expression, having in the latter figure a
+full beard and the peculiar intellectual development of a male sage; she
+has the hairy breast of the man, with the mammary development of the
+female, and an abnormally-enlarged clitoris, which was often mistaken
+for the male organ. The vagina at its lower end was narrow, and the
+urethral aperture opened into it some distance from its outer opening;
+otherwise she was sexually a perfect woman, and menstruated regularly.
+Debierre quotes the case which Duval gives in his work on
+hermaphrodites, wherein a man asked for a dissolution of marriage,
+claiming that his wife had a male organ, which, although she was a woman
+in every other sense, prevented by its interference the consummation of
+the marriage act. The court had the case examined, when it was found
+that the erection of the clitoris, which was large, was enough to
+interfere as the husband had stated. It decreed that the young woman
+should have the objectionable and interfering member amputated, and on
+the refusal to have this done the marriage should be <span class='pagenum'><a name="Page_126" id="Page_126">[126]</a></span>
+dissolved. She refused, and the divorce was consequently granted to the
+man.</p>
+
+<p>From the history of Marie Lefort, it can well be conceived how the
+popular mind, in ignorant times, could easily be imposed upon. Montaigne
+relates the history of a Hungarian soldier who was confined of a
+well-developed infant while in camp, and of a monk brought to a
+successful accouchement in the cell of a convent; while Duval reports
+the case of a priest in Paris who was found to be pregnant with child,
+who was in consequence imprisoned in the prison of the ecclesiastical
+court. These cases were strongly females in every sense, but with some
+male characteristic sufficiently developed, like in the case of Marie
+Lefort, to allow them to believe themselves men and to pass for such.</p>
+
+<p>On the other hand, males have had some female characteristics so well
+pronounced that they have passed for females. Debierre mentions a number
+of cases, to wit: Ambroise Par&eacute; reported such a case in his time;
+Ladowsky, of Reims, reports the case of Marie Goulich, who, up to the
+age of thirty-three, was believed to be a female, at which time the
+descent of the testicles removed all doubts as to sex. Sheghelner and
+Cheselden have reported analogous cases, and Girand&rsquo;s case&mdash;who
+was happily married to a man with whom he lived until the death of the
+husband, in which the only female attribute was a blind vagina, which,
+in his case, seems to have answered all purposes&mdash;was a most remarkable
+case. As a rule, the cases of males who have been mistaken for
+hermaphrodites have been cases of hypospadic urethr&aelig; in a greater or
+lesser sense of deformity.</p>
+
+<p>Debierre, however, mentions some cases of true hermaphrodism. He quotes
+a number of cases, the <span class='pagenum'><a name="Page_127" id="Page_127">[127]</a></span>
+earliest being from the writings of C&oelig;lius Rhodigin, who claimed
+to have seen in Lombardy a case in which the organs of the two sexes
+were side by side; Ambroise Par&eacute; records that in 1426 a pair of
+twins were born, joined back to back, wherein both were hermaphrodites.
+Among the many reporters that he quotes, he mentions Rokitansky, who
+reported a case in 1869, at Vienna, this being the autopsy of Hohmann,
+who had two ovaries and oviducts, a rudimentary uterus, and a testicle,
+with a sperm-duct containing spermatozoa. This individual menstruated
+regularly, and it is an interesting question as to what the result would
+have been had some of the spermatic fluid come in contact with some of
+the ovules that were periodically discharged. Hohmann had an imperforate
+penis and a bifide scrotum. Ceccherelli, who gives a more minute
+description of this interesting case, relates that Hohmann, who died at
+the age of forty, had menstruated regularly to the age of thirty-eight.
+The penis was imperforate but hypospadic, from whence came the urinary
+and spermatic discharges, and Hohmann could in turn copulate as either
+male or female. Odin is also quoted in relation to the case seen at the
+H&ocirc;tel-Dieu-de-Lyon, during the service of M. Bondet. The subject
+was aged sixty-three, and named Mathieu Perret. The case greatly
+resembled that of Hohmann, at the autopsy being found to be double
+sexed. So that, while most of the cases mentioned are fictitious and
+only apparent, the fact remains that the existence of true
+hermaphrodites is indisputable.<a name="FNanchor_42_42" id="FNanchor_42_42"></a><a href="#Footnote_42_42" class="fnanchor">[42]</a></p>
+
+<p>If the subject of either apparently or true hermaphrodism is one of
+unhappiness, and oftentimes of discomfort and misery, history relates
+that this unfortunate class has suffered additionally, from the laws and
+action of ignorant and barbarian times, as such freaks of <span class='pagenum'><a name="Page_128" id="Page_128">[128]</a></span>
+nature must of necessity have occurred at all times; only in the then
+ignorant state of medicine and anatomy they must have been considered as
+occurring much oftener&mdash;every deviation from the normal being
+considered as hermaphroditic. Opmeyer relates that in excavating in the
+neighborhood of the capitol in Rome, the laborers discovered the bronze
+tables on which were inscribed the twenty-two laws of Romulus, termed by
+many historians &ldquo;The Double Decalogue of Romulus.&rdquo; Article
+XV of this law, as well as Articles IX and X, seem to be directed
+against the life of these androgynes. In Roman history, however, we have
+an event which would seem to contradict that there existed any laws in
+actual force against this unfortunate class. It happened during the
+existence of the Punic wars, when the people were more or less laboring
+under fear and excitement, which would readily prepare them to accept
+any superstitious notion. It was during these times that three of these
+androgynes were known to exist in Italy. Titus Livius mentions that the
+existence of one of these was denounced during the consulships of C.
+Claudius Nero and of Marcus Livius. Etruscan soothsayers and seers were
+summoned to Rome, that they might consult the signs and the conditions
+of the constellations that accompanied the nativity of this
+hermaphrodite, or androgyne. These impostors, after a careful
+consultation of all attending circumstances, gave it as their opinion
+that the occurrence was an unfortunate impurity, and that it could only
+result to the disadvantage of Rome, unless she at once took steps to
+purify herself of such a monstrosity, with the conclusion that the
+androgyne should be first exiled from Roman soil, and then drowned in
+the depths of the sea. The unfortunate being was accordingly inclosed in
+a chest and put on <span class='pagenum'><a name="Page_129" id="Page_129">[129]</a></span>
+board a galley, which put immediately to sea; when the vessel was out
+of sight of land the chest was thrown into the Mediterranean.<a name="FNanchor_43_43" id="FNanchor_43_43"></a><a href="#Footnote_43_43" class="fnanchor">[43]</a></p>
+
+<p>A hermaphrodite born in Umbria during the consulship of Messalus and C.
+Lucinius was condemned to death, as well as was the one born at Luna
+during the consulship of L. Matellus and Q. Fabius Maximus. Debierre
+states that in the reign of Nero this barbarous custom was discontinued,
+as this emperor admired these freaks of nature from their novelty, as it
+is related that his chariot was drawn by four hermaphroditic horses.<a name="FNanchor_44_44" id="FNanchor_44_44"></a><a href="#Footnote_44_44" class="fnanchor">[44]</a></p>
+
+<p>In connection with hermaphrodism it has been shown that the males who
+have been supposed to be so malformed were really, in most instances,
+but cases of hypospadias. It may not be uninteresting to observe that,
+while during nearly four thousand years circumcision has been practiced
+without the habit or condition ever having become transmissible or
+hereditary, hypospadias has shown a decided tendency to being
+transmitted. In Virchow&rsquo;s <i>Archives</i>, Lesser reports having
+treated eight subjects during one generation in a family.<a name="FNanchor_45_45" id="FNanchor_45_45"></a><a href="#Footnote_45_45" class="fnanchor">[45]</a>
+Fod&eacute;r&eacute; records the case of hypospadias reported by
+Schweikard, in a person of forty-nine years of age, whose urethral
+orifice was near the junction of the penis and scrotum, but who,
+nevertheless, had three fine children. The same author records the
+remarkable case reported by Hunter to the Royal Society of London, also
+so deformed, who successfully impregnated his wife by receiving the
+spermatic fluid in a warm spoon and immediately injecting it into the
+vagina.<a name="FNanchor_46_46" id="FNanchor_46_46"></a><a href="#Footnote_46_46" class="fnanchor">[46]</a>
+Another interesting case is taken from <i>L&rsquo;Union M&eacute;dicale</i>
+of August 26, 1856. It instances both the heredity connected with
+hypospadias and the peculiar circumstances under which impregnation at
+times takes place; it is <span class='pagenum'><a name="Page_130" id="Page_130">[130]</a></span>
+reported by Dr. Trexel, of Kremsier, and is as follows: &ldquo;On April
+1, 1856, a newborn infant was brought to Dr. Trexel, that he might
+determine its sex. The father and mother were servants of a peasant. On
+an examination of the alleged father, he was found to have all the
+external characters of a male; the urethra, which was rather shorter
+than ordinary, but of large size, was imperforate; the scrotum was
+divided into two pouches, each containing a testicle. The apposed
+surfaces of the scrotal pouches were covered with a red skin, and the
+division extended through their entire length. At the root of the penis,
+in the anterior angle of these pouches, was an opening of the size of a
+lentil; this was the orifice of the urethra. The lower surface of the
+penis was grooved from the above-mentioned orifice to the end of the
+glans. There was no prepuce. Almost in a line behind the corona of the
+glans, and in the groove, were two elliptical openings, which readily
+admitted a large hog-bristle; there was a third smaller opening two
+lines from the orifice of the urethra. This man had always passed for a
+woman. He lay in the same room with the mother of the child; and they
+acknowledged having had frequent connection. The woman declared that she
+had had no commerce with any other man for three years, and the man did
+not deny this assertion. The idea of cohabitation with another man was
+further negatived by the circumstance that the infant had the same
+conformation of the genital organs as the father. How did fecundation
+take place? The three openings in the penis were probably the orifices
+of the excretory ducts of Cowper&rsquo;s glands. But might not these
+have been the openings of the ejaculatory ducts? It is to be regretted
+that Dr. Trexel did not examine these canals; their length and direction
+would have thrown light on <span class='pagenum'><a name="Page_131" id="Page_131">[131]</a></span>
+the subject. The fact of fecundation may also be explained by supposing
+that during coition the posterior wall of the vagina supplied the place
+of the absent floor of the urethra, thus forming a complete canal. This
+is the most probable explanation.&rdquo;<a name="FNanchor_47_47" id="FNanchor_47_47"></a><a href="#Footnote_47_47" class="fnanchor">[47]</a></p>
+
+<p>The above case, as stated, had passed for a woman; these cases are by no
+means such rarities. The case of Marie Dorothee, mentioned by Debierre
+in his work, was as peculiar. Hufeland and Marsina had pronounced Marie
+a woman, while Stark and Martens pronounced her a man, and Metzger could
+not determine on the sex. The case of Valmont, noticed by Bouillaud and
+Manee, is on a par with that of Giraud, in which the party was married
+as belonging to one sex and where it was not until after death
+ascertained that the person belonged to the other sex. Valmont had a
+hypospadic urethra and penis; a scrotum without testicles; ovaries with
+the Fallopian tubes; a uterus opened into a vagina of two inches in
+length, which, gradually narrowing, ended in the male urethra, to which
+was attached a prostate gland. Valmont contracted marriage as a man and
+was not discovered to have been a female until the autopsy revealed her
+to be a woman. The relation does not state anything in regard to
+menstruation; so that her condition in that regard is unknown.<a name="FNanchor_48_48" id="FNanchor_48_48"></a><a href="#Footnote_48_48" class="fnanchor">[48]</a></p>
+
+<p>There has also been reported a number of cases in the male analogous to
+the double organed female mentioned by Debierre. Geoffrey St. Hilare
+reports a case where the penis was double, one being above the other,
+urine and semen flowing through both urethras. Gor&egrave; mentioned a like
+case to the Academy in 1844. Dr. Vanier (Du Havre) records the case
+reported by Huguier to the Academy, where the organs in the anatomical
+preparation which he exhibited were so anomalous <span class='pagenum'><a name="Page_132" id="Page_132">[132]</a></span>
+that it was impossible to decide the sex. Aside from the medico-legal
+aspects that these cases present, there is an interesting Jewish
+theological question connected with them. The law is explicit as to
+circumcision; the cases presenting, if males, should be circumcised, but
+how to determine the sex where an autopsy alone will decide the question
+is not defined. It has been decided, in such cases where the presumption
+is that the child is of the male sex, that, like in cases of absence of
+prepuce, a suppositious circumcision should be performed, so that the
+covenant should be observed; this being in keeping with the sentiment
+shown by the Jews when persecuted by the Romans, or, later, by the
+Spaniards, who often were not able to circumcise until after death; but
+they never fail to comply with the covenant as far as it is possible.</p>
+
+<p>Cases are liable to occur, however, which, without leaving the question
+as to sex in doubt, if reasoned by exclusion, would not furnish any
+possible opportunity for circumcision. Such a case is reported in
+Virchow&rsquo;s <i>Archives</i>, vol. cxxi, No. 3; also in the <i>British
+Medical Journal</i> of December 6, 1890, and in the <i>Satellite</i> for
+January, 1891. It is one of congenital absence of penis. &ldquo;Dr.
+Rauber records very briefly the case of a shoe-maker, aged 38, who
+complained of pain and trouble in the anus. On examining him, Rauber
+found a well-formed scrotum containing two testicles, each with a vas
+deferens and spermatic cord, but no trace of a penis. The urethra opened
+apparently into the anterior wall of the rectum. The man occasionally
+experienced sexual excitement, followed by an emission into the rectum.
+The burning pain complained of in the rectum and about the anus was due
+to the irritation caused by the urine. The man would not allow an ocular
+inspection <span class='pagenum'><a name="Page_133" id="Page_133">[133]</a></span>
+of the interior of the rectum. Unfortunately, the details of this very
+rare condition are incomplete.&rdquo;</p>
+
+<p>It would be interesting to know where the seat of his sexual desire is
+situated, unless an aching testicle is such. I once knew a Spiritualist
+who claimed to feel the pains suffered by any friends with whom he was
+in sympathy; he once tried to argue with me that a certain lady
+patient&mdash;a warm personal friend of my questioner and a Spiritualist&mdash;had
+ovaritis, because he felt an intense burning pain in his <i>right ovarian
+region</i> whenever he went near to her. I tried to reason with him that
+that pain should be in his right testicle, but he would insist on having
+the sympathetic pain in <i>his</i> ovarian region.</p>
+
+<hr /><p class='pagenum'><a name="Page_134" id="Page_134">[134]</a></p>
+<h2><a name="CHAPTER_XI" id="CHAPTER_XI"></a>CHAPTER XI.<br />
+<span class='sc sf75'>Religio Medici.</span></h2>
+
+<p>Sir Thomas Browne, in his &ldquo;Religio Medici,&rdquo;<a name="FNanchor_49_49" id="FNanchor_49_49"></a><a href="#Footnote_49_49" class="fnanchor">[49]</a>
+alludes to the scandal that is generally attached to our profession, we
+being accused of professing no religion. That this opinion is still
+prevalent at the present day is undeniable,&mdash;philosophers and
+physicians are believed to be atheists and
+non-religionists,&mdash;while, at the same time, by that strange
+contradiction that is so common, philosophers and physicians are the
+known and recognized sources of religions, such is the intimate relation
+existing between physical and moral hygiene. Confucius, the contemporary
+of Pythagoras, whose religion was said to be nothing more than the
+observance of a certain moral and political ethical code, and he who
+first formulated the text &ldquo;that one should do unto others as one
+wishes others to do unto him,&rdquo; the founder of the Confucian
+religion, the orthodox religion of China, was a philosopher. Buddha, the
+founder of the second creed recognized in China, and which forms the
+religion of a great part of eastern Asia, was also a philosopher who was
+endeavoring to reduce the Brahminical religion to the simple principles
+of philosophical religion, based on morality. Moses not only was the
+greatest philosopher of his time, but also had an insight into medicine
+that to us of the present day is simply incomprehensible. The Great
+Master was both a philosopher and a physician, his disputes with the
+learned and his attention to the sick having given him the titles of
+Great Master and Divine Healer.</p>
+
+<p><span class='pagenum'><a name="Page_135" id="Page_135">[135]</a></span>
+To use the words of the &ldquo;Religio Medici,&rdquo; the great body of
+the medical profession can, without usurpation, assume the name of
+Christians; for no monk of the desert convents of Asia Minor or
+religious knight of the middle ages, either in their care of the sick,
+or giving food and shelter to the weary, or protection of sword and
+shield to the oppressed pilgrim plodding his way to the Holy Land, were
+more deserving of the name of Christian than the medical man unwearily
+and unselfishly practicing his profession. To the true student of his
+art there is that in medicine which makes of the physician a practical
+Christian. Nor is there aught in medicine, either in its traditions,
+history, study, or practice, that in the lover of his art should ever
+make him anything but a philosophical and practical religionist. The
+physician, such as is actively engaged in the daily practice of his
+profession, instead of having no religion, is really a practical
+religionist, and, although he may subscribe to no outer ceremonial form
+or dogma, his life is such that a Confucian, a Buddhist, a Christian, or
+a Hebrew can behold in him the practitioner of the essence of either of
+their religions,&mdash;a conception carried out by Lessing, in his play
+of &ldquo;Nathan the Wise,&rdquo; where the Jew, the Saracen, and
+Crusader teach the impressive lesson that nobleness is bound by no
+confession of faith or religion; showing the principle that should guide
+true religion.</p>
+
+<p>The Rev. Dr. Townsend, of Boston University, has given a very
+interesting and intelligent relation of the connections that exist
+between medicine and the Old Testament, in the light of
+nineteenth-century science.<a name="FNanchor_50_50" id="FNanchor_50_50"></a><a href="#Footnote_50_50" class="fnanchor">[50]</a>
+The article in question is interesting in its logical reasons as to why
+the Bible was inspired by a superior power, as well as in the
+comparisons it lays before us <span class='pagenum'><a name="Page_136" id="Page_136">[136]</a></span>
+of the medicine of the Pagans and that of the Bible, during the early
+history of the world. After reviewing the false, crude, and senseless
+vagaries and superstitious notions that passed for medicine from the
+period of the Trojan war, in 1184 <span class='sc lc'>B.C.</span>, to the dissolution of the
+Pythagorean Society, 500 <span class='sc lc'>B.C.</span>&mdash;periods which existed after the
+writing of the books of Moses,&mdash;and the period between 500 <span
+class='sc lc'>B.C.</span> and 320 <span class='sc lc'>B.C.</span>, or the philosophic era of medicine,
+during which flourished the father of our present system of medicine, an
+era of advancement, but which in our eyes is still full of errors and
+unscientific conclusions. From these two periods we span over centuries
+of darkness for science and medicine to the ages of Ambroise Par&eacute;
+and the more modern fathers of our art, who by perseverance finally
+extricated medicine from the mass of magical and superstitious rubbish
+which, like barnacles, had clung to it during its passage through the
+dark and ignorant ages. After this review our author turns to the Bible
+and discourses in this wise:&mdash;</p>
+
+<p>&ldquo;Turning our attention to the Bible, we take the position that,
+though it was not designed to teach the science of medicine, still,
+whenever by hint, explicit statement, or commandment there is found in
+it anything relating to medicine, disease, or sanitary regulation, there
+must be no error; that is, provided the Bible, in an exceptional sense,
+is God&rsquo;s book. Now, what are the facts in this case? They are
+these: though the Bible often speaks of disease and remedy, yet the
+illusions, deceptions, and gross errors of anatomy, physiology, and
+pathology, as formerly taught, nowhere appear upon its pages. This, it
+must be acknowledged, is at least singular. But more than this: the
+various hints and directions of the Bible, its sanitary regulations, the
+<span class='pagenum'><a name="Page_137" id="Page_137">[137]</a></span>
+isolation of the sick, the washing, the sprinkling, the external
+applications, and the various moral and religious injunctions in their
+bearing upon health are confessed to be in harmony with what is most
+recent and approved. To be sure, the average old-school physician of a
+century ago would have blandly smiled at our simplicity, had it been
+suggested to him that his methods would be improved by following Bible
+hints. &lsquo;What did Moses know about medical science?&rsquo; would
+have been his reply. But Moses, judged by recent standards, seems to
+have known much, or, at least, to have written well.&rdquo;</p>
+
+<p>The above statement is a truthful relation of facts, from which it can
+well be conceived that even in the Bible the physician finds something
+to inspire him with the idea of its divine inspiration, as the very
+history of medicine, with which it is connected, and with which he is
+familiar, only lends him further support in that direction. Most
+intelligent physicians are also lovers of philosophical history. None is
+more entertaining than Rawlinson, either in his &ldquo;Seven Great
+Monarchies&rdquo; or his &ldquo;Ancient Egypt.&rdquo; In his
+&ldquo;Ancient Religions,&rdquo; in his concluding remarks, he observes
+as follows, in regard to the Hebraic religion: &ldquo;It seems
+impossible to trace back to any one fundamental conception, to any
+innate idea, or to any common experience or observation, the various
+religions which we have been considering. The veiled monotheism of
+Egypt, the dualism of Persia, the shamanism of Etruria, the pronounced
+polytheism of India are too contrariant to admit of any one explanation,
+or to be derivative of one single source.... It is clear that from none
+of the religions here treated of could the religion of the ancient
+Hebrews have originated. The Israelite people, at different periods
+<span class='pagenum'><a name="Page_138" id="Page_138">[138]</a></span>
+of its history, came and remained for a considerable time under
+Egyptian, Babylonian, and Persian influence, and there have not been
+wanting persons of ability who have regarded Judaism as a mere offshoot
+of the religion of one or the other of these three peoples. But, with
+the knowledge that we have now obtained of the religions in question,
+such views have been regarded as untenable, if not henceforth
+impossible. Judaism stands out from all other ancient religions as a
+thing <i>sui generis</i>, offering the sharpest contrast to the systems
+prevalent in the rest of the East, and so entirely different from them
+in its essence that its origin could not but have been distinct and
+separate.... The sacred books of the Hebrews cannot possibly have been
+derived from the sacred writings of any of these nations. No contrast
+can be greater than that between the Pentateuch and the &lsquo;Ritual of
+the Dead,&rsquo; unless it be that between the Pentateuch and the
+Zendavesta, or between the same work and the Vedas.... In most religions
+the monotheistic idea is most prominent <i>at the first</i>, and gradually
+becomes obscured, and gives way before a polytheistic corruption....
+Altogether, the theory to which the facts appear on the whole to point
+is the existence of a primitive religion, communicated to man from
+without, whereof monotheism and expiatory sacrifice were parts, and the
+gradual clouding over of this principle everywhere, unless it were among
+the Hebrews.&rdquo;<a name="FNanchor_51_51" id="FNanchor_51_51"></a><a href="#Footnote_51_51" class="fnanchor">[51]</a></p>
+
+<p>Medicine is indebted for its advancement to the Hebraic religion to a
+greater extent than is generally believed. In the early Christian
+centuries there existed three great creeds: the Christian, Hebraic, and
+Mohammedan. The Christian Church was in a perplexing condition. As
+observed by Draper,<a name="FNanchor_52_52" id="FNanchor_52_52"></a><a href="#Footnote_52_52" class="fnanchor">[52]</a>
+it was impossible <span class='pagenum'><a name="Page_139" id="Page_139">[139]</a></span>
+to disentangle her from the principles which had, at the beginning,
+entered into her political organization. For good or evil, right or
+wrong, her necessity required that she should put herself forth as the
+possessor of all knowledge within the reach of the human intellect. But
+the monk and priest were prohibited from studying medicine,<a
+name="FNanchor_53_53" id="FNanchor_53_53"></a><a href="#Footnote_53_53" class="fnanchor">[53]</a>
+as by so doing the church saw that she would have to relinquish the
+spiritual control of disease were medicine a matter of scientific
+research; she preferred to hold on to her spiritual dominion, and let
+science slumber in darkness. On the other hand, the Mohammedans,
+recognizing the principle of fatalism in their religion, it was not to
+be expected that they should cultivate an art entirely opposed to that
+principle. In this state of affairs the Jewish physician, led by the
+teachings of his religion, alone presented the study of medicine in a
+scientific manner, and its practice and its result taught the Moslems
+that medical science placed it within the power of man to keep himself
+out of the grave, when either assailed by disease or laid low by the
+wounds of war. The Arabs were not slow to avail themselves of this
+discovery; and to the learning and skill of the Jewish physician, guided
+by the light of an intelligent Deity and a liberal religion, does
+medicine owe the existence of those able and learned Arabian physicians
+that flourished during the eleventh and twelfth centuries.</p>
+
+<p>There has been more or less of fault-finding in regard to certain rules
+and ordinances being sacramental, which, from the nature of things,
+should have been merely advisory or suggestive, as they pertained more
+to the hygienic welfare of the people than to the spiritual. Thus to
+reason, is neither philosophical nor in concert with our knowledge of
+the structure of man, and of the <span class='pagenum'><a name="Page_140" id="Page_140">[140]</a></span>
+intimate relations that exist between mind and body, or of good health
+and good morals. The writer has seen violent catharsis produced by bread
+pills, after podophyllin, castor-oil, and phosphate of soda in the most
+generous doses&mdash;administered as one would drop a letter in a
+mail-box&mdash;had completely failed; it is all in the manner and way we
+give a medicine or treat a disease. Certain narcotic and irritant
+poisons or powerful sedative agents have a physical action uninfluenced
+by the mind, but an intelligent physician is hardly supposed to drive at
+the small tack of disease with such powerful sledge-hammers. Charcot,
+recognizing the power of and availing himself of such a remedial agent
+as the pilgrimages to the Notre Dame de Lourdes, is an evidence of the
+intelligent and enlightened practitioner, who has learned, what the
+Bible taught, long, long ago, that human nature must be taken as it is
+found, and that, like the homely saying of Mohammed, as the mountain
+would not come to him, he must go to the mountain. Moses and all the
+Scriptural writers were well aware of this state of affairs, and their
+manner of using their knowledge was adapted and timed to the general
+intellectual development of the times.</p>
+
+<p>There is one point in connection with the above that should not escape
+our attention, this being that, while the Hebraic creed and the people
+still subscribed to the theological doctrine of the origin of disease,
+in common with the religions then in vogue, here the connection stopped.
+All other creeds&mdash;not excepting Christianity&mdash;looked forward to a
+theological doctrine of the cure of disease. With the Hebrew, disease
+was looked upon as the result of some infraction on his part of some of
+the laws, and the consequent expression of displeasure on the part of
+the Deity. He was taught, however, <span class='pagenum'><a name="Page_141" id="Page_141">[141]</a></span>
+that the observance of certain ordinances were both conducive to health
+and to the prevention of disease, and acceptable to God, as well as to
+rely upon his study and skill to cure disease. This was equivalent to
+teaching them that diseases arose from physical causes, and that
+physical means were to be used to combat them. From this arose the
+practice of exposing the sick in public places, that they might receive
+the benefit of the advice of such who might have had experience in a
+like case. It is from their religion that Hebraic medicine has received
+its foundation of intelligent philosophy that carried it in its purity
+through all ages, free from magic, superstition, and imposture. With
+other creeds and religions, medicine, disease, as well as the physical
+phenomena affecting nature, were believed to be the arbitrary expression
+of anger of their gods, and that the cure of disease, or alterations in
+physical phenomena, were to be as arbitrarily effected, regardless of
+the existence or action of physical laws. It is to be regretted that one
+of the sects which has sprung from the Hebraic creed, and which worships
+the same God, has been unable to emancipate itself or its people from
+the idea of an arbitrary theological doctrine of the origin and control
+of disease. It is this creation of a narrow-minded theology of a
+vaccilating, unintelligent, unphilosophical, and arbitrary God, who
+would neither respect nor regard the laws of his own creation, that has
+led the great body of physicians out of the modern churches. They do not
+deny the existence of the Deity, but the god of their conception is a
+higher and nobler god,&mdash;the Deity of Religio Medici.</p>
+
+<p>When the prize for the best essay on &ldquo;<i>the power, wisdom, and
+goodness of God, as manifested in creation</i>&rdquo;&mdash;a series of
+publications known as the Bridgewater<span class='pagenum'><a name="Page_142" id="Page_142">[142]</a></span>
+Treatises&mdash;has been nearly every other time won by physicians,
+among whom we may mention Sir Charles Bell, Dr. John Kidd, Dr. Peter M.
+Roget, and Dr. William Prout,&mdash;not only won on their own merit, but
+in competition with learned theologians and noted divines,&mdash;we may
+truly say that physicians are by no means atheists or agnostics, but
+that, on the contrary, they are the real exponents of a practical and
+intelligent religion, which they not only practice, but fully and
+intelligently comprehend.</p>
+
+<hr /><p class='pagenum'><a name="Page_143" id="Page_143">[143]</a></p>
+<h2><a name="CHAPTER_XII" id="CHAPTER_XII"></a>CHAPTER XII.<br />
+<span class='sc sf75'>Hebraic Circumcision.</span></h2>
+
+<p>The first mention that we meet concerning circumcision is in Genesis. It
+is the command of God to Abraham; in establishing the covenant with him,
+He said to him: &ldquo;This is my covenant, which ye shall keep between
+me and you, and thy seed after thee: every man-child among you shall be
+circumcised. And ye shall circumcise the flesh of your foreskin; and it
+shall be a token of the covenant betwixt me and you&rdquo; (Gen. xvii,
+10, 11). It was also ordained that this should be extended to servants
+belonging to Abraham and his seed, as well as to their own children; and
+that in case of children it should be done on the eighth day after
+birth.<a name="FNanchor_54_54" id="FNanchor_54_54"></a><a href="#Footnote_54_54" class="fnanchor">[54]</a>
+This was appointed as an ordinance of perpetual obligation on the
+Hebraic family, and its neglect or omission entailed being cut off from
+the people (12, 14). In compliance with this ordinance, Abraham,
+although in his ninety-ninth year, circumcised himself and all his
+slaves, as well as his son Ishmael. Slaves by purchase were
+circumcised,<a name="FNanchor_55_55" id="FNanchor_55_55"></a><a href="#Footnote_55_55" class="fnanchor">[55]</a>
+as were any strangers, who were also circumcised before being allowed to
+partake of the passover or to become Jewish citizens. It was to be
+observed by all heathens who became converted to the Jewish faith.
+During the wanderings in the wilderness circumcision was not practiced,
+but Joshua caused all to be circumcised before they entered the promised
+land.<a name="FNanchor_56_56" id="FNanchor_56_56"></a><a href="#Footnote_56_56" class="fnanchor">[56]</a></p>
+
+<p>The old Hebrews strictly followed the injunction to circumcise on the
+eighth day, and of such importance in <span class='pagenum'><a name="Page_144" id="Page_144">[144]</a></span>
+a religious sense was this rite in their estimation that even when the
+eighth day fell on the Sabbath the eighth day ordinance was observed.
+The ordinance, however, was not blindly arbitrary, as rules were laid
+down for exception. For instance, whenever a family had lost two
+children through circumcision it did not become obligatory on that
+family to circumcise the third child, who was however considered as
+entitled to all the benefits of the congregation or of the Hebraic
+religion, just the same as if he had been circumcised. Again,
+Maimonides, or Moussa Ben Maimon, a celebrated physician and rabbi, born
+in Cordova in the year 1135 <span class='sc lc'>A.D.</span>, among his works on medicine, has left
+directions in regard to circumcision which have been the guides of the
+<i>mohels</i>. Among the Hebraic physicians it was considered that the child
+partook of the constitutional strength or feebleness of the mother;
+hence the rule above mentioned, in regard to exemption to circumcision,
+only was in operation when the two who had formerly died belonged to the
+same mother as the third one, who would thereby be exempt; but if the
+two children had belonged to another woman, and this third child of the
+father was not from the same mother, the rule did not exempt. The third
+child of the mother who had previously lost two infants at the rite was,
+however, to be circumcised when arrived at adult age, provided no
+further counter-indication occurred. The opinion that the mother gave
+the constitution to the child was promulgated by Maimonides and became
+general.</p>
+
+<p>The eighth day is believed to refer to the eighth day after full term;
+thus, a child born prematurely is not supposed to be circumcised until
+eight days after it would have reached its full term, and only then if
+its general good condition is settled. Maimonides looked <span class='pagenum'><a name="Page_145" id="Page_145">[145]</a></span>
+upon infantile jaundice, general debility, and marasmus as
+contra-indications to the performance of the rite; any erysipelatous
+inflammation, ophthalmia, an&aelig;mia, eruption of any kind, fever,
+tendency to convulsive movements&mdash;in fact, any observable departure
+from normal health should be allowed to pass before performing the rite.
+Aside from these general conditions that denoted that the operation was
+contra-indicated, the local condition of the organ itself also was to be
+examined, and if certain conditions existed the operation was to be put
+off. These conditions consisted in any irritation or red appearance of
+the prepuce, due to either inflammation or to the irritative action of
+the sebaceous matter underneath the prepuce, the acrid nature of these
+secretions being at times sufficiently virulent to produce an
+ulceration, even in the newborn.<a name="FNanchor_57_57" id="FNanchor_57_57"></a><a href="#Footnote_57_57" class="fnanchor">[57]</a></p>
+
+<p>Among the Hebrews themselves there are those who do not look upon
+circumcision in a favorable light, but on something that has served its
+time in its own day, and within the past year a proselyte has been
+accepted into one of the New York synagogues without previous or
+subsequent circumcision, these reformed Jews looking upon adult
+circumcision as too painful an operation to be gone through, as they
+claim, unnecessarily. It must be said, however, that these persons look
+upon circumcision purely in a sacramental light, and simply as an
+arbitrary ordinance of God in the remote ages of antiquity, but which in
+the present century has not enough practical significance to warrant its
+performance on the occasion of an adult joining the congregation. These
+persons look upon it, as has been said, in a purely theological light,
+and ignore any and all considerations of hygiene in connection with it,
+claiming that if it is a simple matter of hygiene, then it is not a
+sacrament, <span class='pagenum'><a name="Page_146" id="Page_146">[146]</a></span>
+and that, if it is sacramental, then the subject of hygiene has nothing
+whatever to do with it. The force of their reasoning and logic is very
+obscure and clouded, to say the least. The covenant either exists or it
+does not; to do away with one ordinance in any arbitrary manner is to
+gradually begin to crumble down the whole fabric of Judaism; for when
+exceptions are begun, one tenet as well as another is liable to topple
+over. If the rite is a sacrament, then it should be performed on all,
+and a proselyte should not be admitted without being circumcised, and,
+if a hygienic measure only, the same rule holds. These Jews evidently
+ignore the rationalism that governed the promulgation of the Mosaic law,
+and its recognition of the inseparability of the moral from the physical
+nature of man.</p>
+
+<p>Montaigne has left us a description of the performance of the rite, as
+witnessed by him in the city of Rome in the sixteenth century. He
+relates it as follows: &ldquo;On the thirtieth of January was witnessed
+one of the most ancient ceremonies of religion practiced by mankind,
+this being the circumcision of the Jews. This is performed at the
+dwelling, the most commodious chamber being chosen for the occasion. At
+this particular time, by reason of the incommodity of the house, the
+rite was performed at the door of the domicile. The godfather sat
+himself on a table, with a pillow on his lap. The godmother then brought
+the child, after which she retired. The godfather then undressed the
+child&rsquo;s lower part so as to expose his person, while the operator
+and his assistant began to chant hymns. This operation lasts at least a
+quarter of an hour. The operator may or may not be a rabbi, as it is
+considered a great blessing to perform this operation; so that it
+follows that many are found who are anxious to exercise their faculty in
+this <span class='pagenum'><a name="Page_147" id="Page_147">[147]</a></span>
+regard, there being a tradition that those who have circumcised a
+certain number do not suffer putrefaction in their mouth, nor does their
+mouth become food for worms after death; so that it often happens that
+they make presents of value to the child for the privilege of operating
+upon it. On the same table on which the godfather is seated all the
+required instruments and apparatus are placed, while an assistant stands
+by with a flask of wine and a glass. A warming-pan full of coals is on
+the floor, at which the operator warms his hands. The child being now
+ready, with its head toward the godfather, the operator, seizing the
+member, draws the foreskin toward him with one hand, while with the
+fingers of the other he pushes back the glans; he then places a silver
+instrument, which fixes the skin, and which at the same time holds back
+the glans so that the knife may not cut it. The foreskin is then cut off
+and buried in the little basin of soil that forms one of the
+appurtenances to the operation. The operator then tears with his nails
+the skin which lies on the glans, which he turns back over the body of
+the member. This seems the hardest and most painful part of the
+operation, which, however, does not seem dangerous, as in four or five
+days the wound has healed. The crying of the child resembles that of an
+infant undergoing baptism. No sooner is the glans uncovered than the
+operator takes a mouthful of wine; he then places the glans in his mouth
+and sucks the blood out of it; this he repeats three times. This done,
+he applies a powder of dragons&rsquo; blood, with which he covers up all
+the wound, the parts being then done up in expressly-cut bandages. He is
+then given a glass of wine, over which he says some prayers; of this he
+takes a mouthful, and, after moistening his fingers in the same, he
+applies the wine three times to the child&rsquo;s mouth.<span class='pagenum'><a name="Page_148" id="Page_148">[148]</a></span>
+The wine is then sent to the mother and the women, who are in some
+other apartment, who all take a sip. An assistant then takes a silver
+instrument, pierced with little holes like a small strainer, which he
+first applies to the nose of the officiating minister, then to that of
+the child, and afterward to the nose of the godfather.&rdquo;<a name="FNanchor_58_58" id="FNanchor_58_58"></a><a href="#Footnote_58_58" class="fnanchor">[58]</a>
+The above description of the performance of the rite in the sixteenth
+century answers to the method of its performance as was witnessed some
+years ago in France.</p>
+
+<p>In the &ldquo;Biblical, Theological, and Ecclesiastical
+Cyclop&aelig;dia&rdquo; of Drs. McClintock and Strong the following
+description of the rite, as taking place in our modern synagogues, is
+given:&mdash;</p>
+
+<p>&ldquo;The ceremony of circumcision, as practiced by the Jews in our own
+times, is thus: If the eighth day happens to be on the Sabbath, the
+ceremony must be performed on that day, notwithstanding its sanctity.
+When a male child is born the godfather is chosen from amongst his
+relatives or near friends; and if the party is not in circumstances to
+bear the expenses, which are considerable (for after the ceremony is
+performed a breakfast is provided, even amongst the poor, in a luxurious
+manner), it is usual for the poor to get one amongst the richer, who
+accepts the office, and becomes a godfather. There are also societies
+formed amongst them for the purpose of defraying the expenses, and every
+Jew receives the benefit if his child is born in wedlock.</p>
+
+<p>&ldquo;The ceremony is performed in the following manner, in general:
+The circumciser being provided with a very sharp instrument called the
+circumcising-knife, plasters, cummin-seeds to dress the wound, proper
+bandages, etc., the child is brought to the door of the synagogue by the
+godmother, when the godfather receives it from her and carries it into
+the synagogue, <span class='pagenum'><a name="Page_149" id="Page_149">[149]</a></span>
+where a large chair with two seats is placed; the one is for the
+godfather to sit upon, the other is called the seat of Elijah the
+Prophet, who is called the angel or messenger of the covenant. As soon
+as the godfather enters with the child, the congregation say,
+&lsquo;Blessed is he that cometh to be circumcised, and enter into the
+covenant on the eighth day.&rsquo; The godfather being seated, and the
+child placed on a cushion in his lap, the circumciser performs the
+operation, and, holding the child in his arms, takes a glass of wine
+into his right hand, and says as follows: &lsquo;Blessed be Thou, O Lord
+our God, King of the Universe, Creator of the fruit of the vine! Blessed
+art Thou, O Lord our God! who hath sanctified His beloved from the womb,
+and ordained an ordinance for His kindred, and sealed His descendants
+with the mark of His holy covenant; therefore, for the merits of this, O
+living God! our rock and inheritance, command the deliverance of the
+beloved of our kindred from the pit, for the sake of the covenant which
+He hath put in our flesh. Blessed art Thou, O Lord, the Maker of the
+Covenant! our God, and the God of our fathers! Preserve this child to
+his father and mother, and his name shall be called in Israel, A, the
+son of B. Let the father rejoice in those that go forth from his loins,
+and let his mother be glad in the fruit of her womb, as it is written:
+&ldquo;Thy father and mother shall rejoice, and they that begat thee
+shall be glad.&rdquo;&rsquo; The father of the child then says the
+following grace: &lsquo;Blessed art Thou, O Lord our God, King of the
+Universe! who hath sanctified us with His commandments, and commanded us
+to enter into the covenant of our holy father, Abraham.&rsquo; The
+congregation answer: &lsquo;As he hath entered into the law, the canopy,
+and the good and virtuous deeds.&rsquo;&rdquo;<a name="FNanchor_59_59" id="FNanchor_59_59"></a><a href="#Footnote_59_59" class="fnanchor">[59]</a></p>
+
+<hr /><p class='pagenum'><a name="Page_150" id="Page_150">[150]</a></p>
+<h2><a name="CHAPTER_XIII" id="CHAPTER_XIII"></a>CHAPTER XIII.<br />
+<span class='sc sf75'>Mezizah, the Fourth or Objectionable Act of Suction.</span></h2>
+
+<p>Biblical and rabbinical traditions throw no light on the origin of the
+details of the operation as now performed. That it was anciently
+performed with a knife of stone is certain; an event common in its
+general observance, and which seems to have pervaded all nations or
+races, howsoever remote or scattered, that it has induced Tylor<a name="FNanchor_60_60" id="FNanchor_60_60"></a><a href="#Footnote_60_60" class="fnanchor">[60]</a>
+to ascribe the origin of the rite to the stone age. We are told that
+when Moses was returning to the land of Egypt he had neglected
+circumcising his son, and that because of that neglect he nearly lost
+his son&rsquo;s life; his wife, Zipporah, the daughter of the Midian
+king and priest, Jethro, seeing the danger and knowing its cause, took
+her little son Gershom and circumcised him with a stone knife, and
+offered the foreskin to God as a peace-offering. Just where the wine was
+first used we are not told. Wine, however, was an emblem of
+thanksgiving, and, being one of the fruits of the earth, was considered
+an acceptable offering to God. It has since, in some form or other,
+either as wine or as the representative of either divine or human blood,
+been used in both the Catholic and Protestant Churches in their
+ceremonials or vicarious sacrifices, or imitations of old customs.
+Circumcision was by many connected with a blood sacrifice; it was so
+suggested by the words of Zipporah at the circumcision of Gershom:
+&ldquo;And Zipporah, his Midianitish wife, took up a sharp stone and cut
+off the foreskin of her son, and cast it at his feet and said,
+&lsquo;Surely <span class='pagenum'><a name="Page_151" id="Page_151">[151]</a></span>
+a <i>Khathan</i> of blood art thou to me.&rsquo;&rdquo; Much speculation has
+followed the use of this word <i>Khathan</i>, which, in the ordinary Arabian,
+may mean either husband or son-in-law; it also means a newly-admitted
+member of a family; a similar word means &ldquo;to provide a wedding
+feast,&rdquo; and one other word from the same root and branch means
+&ldquo;to give or receive a daughter in marriage.&rdquo; In our own day,
+the <i>mohel</i>, or ministerial circumciser, makes it a practice to draw a
+little blood from the skin of such as are presented for the rite, but
+whom nature has not furnished with sufficient foreskin for the
+operation. The application, thrice repeated, of the blood and wine to
+the lips of the child, is probably used as a sign of the sealing of the
+compact. Wine is mentioned in connection with the High-Priest
+Melchisedeck as the wine of thanksgiving at his meeting with Abraham;
+wine was presented to Aaron by the angel, who, giving him a crystal
+glassful of good wine, said to him: &ldquo;Aaron, drink of this wine
+which the Lord sends you as a pledge of good news.&rdquo; Originally,
+circumcision must have consisted of the simple removal of the foreskin,
+and the elaboration of the ceremonial details must have been a
+subsequent occurrence; persons wounding their fingers will instinctively
+carry them to their mouth, and it may be that the suction practiced by
+the Hebrews had its origin in this natural h&aelig;mostatic suggestion.
+Wine as a h&aelig;mostatic and as an emblem of thanksgiving and an
+acceptable offering naturally came in as an accessory.</p>
+
+<p>This practice&mdash;which, in the old, patriarchal days of the simple
+shepherds, when men only lived on the flesh of their own flocks, their
+diet, however, consisting mostly of cakes of flour, milk, honey, a few
+herbs, or the flesh of the goat or sheep&mdash;could not have been as
+<span class='pagenum'><a name="Page_152" id="Page_152">[152]</a></span>
+objectionable as it is at the present day, with blood and secretions in
+a continued ferment through diet and habits. Man, living in the open air
+of Armenia, Palestine, or Arabia, sleeping in the open tents of our
+Biblical forefathers, living on the simple diet of a shepherd&rsquo;s
+camp, with the abstemiousness that those climates naturally induce in
+man, could not help but be healthy. In those early days, when neither
+passion, anxiety, nor worry disturbed either digestion or sleep, man had
+no vitiated secretions, wine was then a rarity, and water was the drink.
+One of the early patriarchs on such diet would have furnished a dainty
+and savory dish to the most fastidious cannibal, who is now tormented by
+the <i>komerborg kawan</i>, this being a term used by the Australian
+cannibals to designate the peculiar nausea that is induced in them when
+they recklessly eat of white man,<a name="FNanchor_61_61" id="FNanchor_61_61"></a><a href="#Footnote_61_61" class="fnanchor">[61]</a>&mdash;something
+which they do not experience from feasting on the savages who live on
+the simple diet of a pastoral tribe. This primitive gastronomic science
+in regard to cannibalism even reached such a pitch of refinement that,
+as has been previously mentioned, some tribes even resorted to
+emasculation to improve the flavor of the animal juices, which by this
+procedure became less acrid. The Arabian and Oriental traditions bring
+us down tales of how, on the same principles, human beings intended to
+grace the festive platter were fed exclusively on rice. The salivary and
+buccal secretions, under such a simple diet as that indulged in by our
+Biblical forefathers, become bland and harmless; not only harmless, but
+even antiseptic and positively beneficial, acting on the same principle
+as local applications of pepsin. So that the practice, at the time of
+the patriarchs and in their own family, of this part of the rite could
+not have offered the <span class='pagenum'><a name="Page_153" id="Page_153">[153]</a></span>
+same objection that it does at the present day. The modern
+house-dweller, living on a mixed diet and in a climate that induces him
+to eat grossly, both as to quality and quantity, partaking more or less
+of vinous, spirituous, or fermented liquors, as well as indulging in
+tobacco, is quite another being from the Arabian or Armenian shepherd of
+former days. Business anxieties and worry also have a very pronounced
+effect; so that, with the change in the conditions of man and the
+inception and multiplication of diseased conditions, as well as the
+creation of constitutional and transmissible diseases, this practice of
+suction should have been stopped.</p>
+
+<p>Intelligent rabbis, devoted to their religion, are necessarily prone to
+defend any of the details in its ceremonials that age and practice have
+sanctioned, and even some of the later writings of Israelism seem to
+make the mezizah, or suction, a necessary and ceremonial detail. In the
+&ldquo;Guimara,&rdquo; composed in the fifth century, Rabbi Rav Pop&egrave;
+uses these words: &ldquo;All operators who fail to use suction, and
+thereby cause the infant to run any risk, should be destituted of the
+right to perform the ceremony.&rdquo; In the &ldquo;Mishna&rdquo; it
+says, &ldquo;It is permitted on the Sabbath to do all that is necessary
+to perform circumcision, excision, denudation, and suction.&rdquo; The
+&ldquo;Mishna&rdquo; was composed during the second century. The
+celebrated Maimonides lent it his sanction, as in his work on
+circumcision he advises suction, to avoid any subsequent danger. Our
+modern Israelites are supposed, as a rule, to have taken their
+authority, aside from previous usage and custom, from the &ldquo;Beth
+Yosef,&rdquo; which was written by Joseph Karo, and subsequently
+annotated by the Rabbi Israel Isserth. In all of these sanctions,
+however, there is no reason expressed why it <span class='pagenum'><a name="Page_154" id="Page_154">[154]</a></span>
+should be performed.<a name="FNanchor_62_62" id="FNanchor_62_62"></a><a href="#Footnote_62_62" class="fnanchor">[62]</a>
+Maimonides undoubtedly looked upon this act as having a decided tendency
+or action in depleting the immediate vessels in the vicinity of the cut
+surface, and that the consequent constriction in their calibre would
+prevent any future h&aelig;morrhage. That this is the natural result of
+suction is a fact readily understood by any modern physician. The
+depletion of the vessel for some distance in its length, with the
+contraction in the coat that follows, is certainly a better preventive
+to consequent h&aelig;morrhage than the simple application of any
+styptic preparation that can only be placed at the mouth of the vessel,
+but which leaves its calibre intact. Hot water, or an extreme degree of
+cold, will answer to produce this contraction and depletion, but there
+is here a local physical reaction that is more liable to occur than when
+the contraction has taken place naturally, as when induced by depletion,
+instead of by the stimulus of either heat or cold. So that if, in the
+light of modern civilization and changed conditions of mankind, and the
+existence of diseases which formerly did not exist, we are now convinced
+that suction is dangerous, we should not judge the ancients too hastily
+or rashly for having adopted the custom, as it is certainly not without
+some scientific merit; although, authorities are not wanting who hold
+that suction or depletion increases the danger of h&aelig;morrhage.</p>
+
+<p>It can be understood that the results of suction would be in some
+measure analogous to those left by the application of an Esmarch bandage
+on a limb. The ancients, performing the operation with rude implements
+and having no h&aelig;mostatic remedies or appliances, naturally followed the
+best means at their command; they evidently feared h&aelig;morrhage, and their
+rule in regard to exemption shows us that they recognized the existence
+<span class='pagenum'><a name="Page_155" id="Page_155">[155]</a></span>
+of h&aelig;morrhagic diathesis or other transmissible peculiarities of
+constitution. This same fear of h&aelig;morrhage probably suggested the
+second step of the operation being performed, as it is by laceration
+instead of by cutting instruments, showing in this an evident desire to
+limit the cutting part of the operation to as small a limit as possible.
+Against an infant who has decided h&aelig;morrhagic tendency, we are
+about as helpless as were the ancient Hebrews, and, while the Turkish or
+some of the Arabian methods of performing the operation may be said in
+ordinary cases&mdash;by the application of cord and the consequent
+constriction&mdash;to limit the danger from subsequent h&aelig;morrhage,
+still, in the h&aelig;morrhagic diathesis this would not be of any
+avail; so, as already observed, we must not too rashly judge those old
+shepherds of the Armenian plains for adopting a practice which to them
+was calculated to avert subsequent dangers, or their descendants
+following in their footsteps, until having learned better, even if that
+practice is to us disgusting, primitive, and useless.</p>
+
+<p>Cases occur,&mdash;happily not frequently,&mdash;of alarming and uncontrollable
+h&aelig;morrhage. The following case is suggestive of the alarming extent and
+persistence that may attend one of those h&aelig;morrhagic cases, even when
+recovery eventually takes place. It is reported by Dr. Sannanel in the
+<i>Gazetta Toscana delle science medicale e fisiche</i> of 1844. The case was
+that of a Jewish infant circumcised on the eighth day. Some hours after
+the operation the child was observed to be bleeding; the h&aelig;mmorrhage
+would only cease for a few moments, and then come on with increased
+force, and which proved rebellious to ordinary remedies. Dr. Sannanel
+was called during the night of the third day after the operation. A
+number of physicians had been in attendance, <span class='pagenum'><a name="Page_156" id="Page_156">[156]</a></span>
+and neither ice, astringents, pressure, nor any usual h&aelig;mostatic
+means had had the least effect; cautery with nitrate of silver,
+sulphuric acid, and the actual cautery by means of heated iron were
+tried in succession, without any good results. Ten days passed in this
+manner, the h&aelig;mmorrhage only ceasing for a few moments at a time,
+and the child was nearly exsanguinated from the continued serous seepage
+and the paroxysmal h&aelig;morrhages, when a lucky application of
+caustic potassa almost immediately stopped the h&aelig;morrhage. This
+case was seen by nearly all the leading medical men of Leghorn, who lent
+their aid and counsel to save the little life. The case is interesting
+from the length of time it persisted, and that even after all the loss
+of blood and suffering that the little fellow endured he survived.<a
+name="FNanchor_63_63" id="FNanchor_63_63"></a><a href="#Footnote_63_63" class="fnanchor">[63]</a></p>
+
+<p>Dr. Epstein, of Cincinnati, in a letter of March 29, 1872, to the
+<i>Israelite</i> of that city, mentions a nearly fatal case from h&aelig;morrage
+after the rite of &ldquo;<i>Milah</i>,&rdquo; and gives the result of his
+experience in such cases. He argues that <i>Hitouch</i> or <i>Hitooch</i> alone,
+or the first step or cutting off of the prepuce, performed with ordinary
+care, could hardly be followed up with any more serious results than can
+be controlled with the application of a little acidulated water. The
+second act, or <i>Periah</i>, the act of laceration, he looks upon as one
+that calls for coolness, judgment, and skill, as the membrane should
+only be torn so far and no farther, the thin, inner fold of the prepuce
+being vascular only in the sulcus back of the corona and at its lower
+attachment, where it forms the frenum, or bridle; any carelessness or
+over-anxiety on the part of the operator in tearing this membrane too
+far back results in danger of h&aelig;morrhage; especially is this part of the
+operation liable to be <span class='pagenum'><a name="Page_157" id="Page_157">[157]</a></span>
+badly done if the inner preputial fold is thick and resisting, as in
+that case undue force may carry the laceration back into the vascular
+tissue. The means suggested by Dr. Epstein to arrest h&aelig;morrhage
+are those ordinarily used in h&aelig;morrhagic cases, such as will be
+given presently. The doctor regrets that the operators are not as they
+should be, physicians, and that, when <i>mohels</i> are employed, persons are
+not sufficiently exacting as to their qualifications.<a name="FNanchor_64_64" id="FNanchor_64_64"></a><a href="#Footnote_64_64" class="fnanchor">[64]</a></p>
+
+<p>In France the government has managed to secure more safety in the
+operation. By a royal decree of date of May 25, 1845, in compliance with
+a desire expressed by the Hebrew Consistory, it was ordered that no one
+should exercise the functions of a <i>mohel</i> or of <i>schohet</i>, without
+being duly authorized to perform said functions by the Consistory of the
+Circonscription; and that all <i>mohels</i> and <i>schohets</i> shall be governed
+in the exercise of their functions by the Departmental Consistory and
+the General Consistory. By virtue of this decree a regulation was passed
+by the Consistories on the 12th of July, 1854, ordering that thereafter
+circumcision should only be performed in a rational manner, and by a
+properly qualified person. Suction was likewise abolished, and the wound
+directed to be sponged with wine and water. This decree and the
+resulting regulations have been of the greatest benefit to the French
+Israelites, and some attention to the matter would not be amiss in the
+United States.</p>
+
+<p>This reformation has met with the approval of the leading French Jews,
+whose General Consistory decided that suction was not necessarily a part
+of the religious rite, and that, as it was undoubtedly introduced into
+the rite on the days of primitive surgery, it was perfectly rational to
+suppress this operative accessory, now <span class='pagenum'><a name="Page_158" id="Page_158">[158]</a></span>
+that that same science, in its enlightenment, pronounced it unsafe. The
+whole body of the Congregation did not tamely submit to what they
+considered an innovation, and from some of the mohels all possible
+resistance was opposed to prevent the abolishment of this part of the
+operation from becoming a law. So determined was this opposition in some
+instances that the Consistory of Paris found it necessary to impose on
+all the mohels an obligation, bound by an oath, that they would respect
+the law. Those who refused to take the obligation gave up their
+vocation.</p>
+
+<p>The Grand Rabbi of Paris, at the time of this reformation, M. Ennery,
+was one of the most zealous supporters of the new departure. The
+influence of the French pervaded northward, and the <i>mezizah</i> was
+abolished in Brunswick, Dr. Solomon, a learned Hebrew of that State,
+being instrumental in having it done legally. The discussion of this
+subject, in 1845, had one very happy effect,&mdash;the supporters of the
+reformed idea of the rite issued a circular letter to all the leading
+continental surgeons and medical men asking for their opinion on several
+points in relation thereto, especially, however, on this part of the
+rite. The opinions of many of these will be referred to in the medical
+part of this work.</p>
+
+<p>The after-treatment of the circumcised infant is governed more or less
+by local habits and the individual intelligence of the mohel and his
+experience. After turning back the inner fold of the prepuce, the parts
+are covered with a small, square bandage, with an aperture to admit the
+passage of the glans. This, and the subsequent small bandage of old
+linen, which is calculated to hold it in place, are slightly coated with
+a powder composed of lycopodium, with the slight <span class='pagenum'><a name="Page_159" id="Page_159">[159]</a></span>
+addition, at times, of Monsel&rsquo;s salts, alum-powder, or some
+vegetable astringent. Over these another compress is placed, to prevent
+the friction of the clothes of the infant or of the bedding. The infant
+then receives a final benediction, and the godmother then receives the
+child in her arms and carries it to its cot or crib. The operator
+generally visits the infant in the afternoon of the operation, and
+carefully inspects the dressings, to see that no h&aelig;morrhage has
+supervened.</p>
+
+<p>It is customary to place the child in a bath, either the same evening or
+on the following morning, the object of this being to remove and to
+facilitate the removal of the dressings, which are more or less
+saturated and clotted with blood. After the removal of these, the wound
+is redressed, as previously, except that some cerate&mdash;ointment of roses
+or some other mild ointment&mdash;is used. Some prefer the simple water
+dressing from beginning to end. Since the introduction of creasote, acid
+ph&eacute;nique, and carbolic acid, many mohels are in the practice of washing
+the parts with water impregnated with one of these before performing the
+operation, and using subsequently the same form of lotion at every
+dressing. In case of h&aelig;morrhage there is an h&aelig;mostatic water or lotion,
+which has been long used by the German and Polish mohels with
+considerable success, and which, in ordinary cases, has been found to be
+all that was required. This water, called by the French &ldquo;Mixture
+d&rsquo;arguesbusade,&rdquo; &ldquo;Eau vulneraire spiriteuse de
+Theden,&rdquo; and by the Germans as &ldquo;Spritzwasser&rdquo; and
+&ldquo;Schusswasser,&rdquo; is composed as follows:&mdash;</p>
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Acetic acid,</td><td align='right'>10</td><td align='center'>grammes.</td></tr>
+<tr><td align='left'>Rectified spirits of wine,</td><td align='right'>5</td><td align='center'>&rdquo;</td></tr>
+<tr><td align='left'>Diluted sulphuric acid,</td><td align='right'>2½</td><td align='center'>&rdquo;</td></tr>
+<tr><td align='left'>Clarified honey,</td><td align='right'>8</td><td align='center'>&rdquo;</td></tr>
+</table></div>
+
+<p><span class='pagenum'><a name="Page_160" id="Page_160">[160]</a></span>
+This mixture is well mixed and filtered, and is then kept in a
+tightly-stoppered vial.</p>
+
+<p>Dr. Bergson uses a mixture composed of diluted sulphuric acid, 1 part;
+alcohol, 3 parts; honey, 2 parts; and 6 parts of wine vinegar.</p>
+
+<p>H&aelig;mostatic powders are also used by the Hebrews, being more conveniently
+kept or carried than the h&aelig;mostatic waters. In Russia and in Poland they
+are composed of decomposed or decayed hawthorn-wood powder and
+lycopodium. That of Berlin is composed of Armenian bole, red clay,
+dragons&rsquo; blood, powdered rose-leaves, powdered galls, and powdered
+subcarbonate of lead. In France a h&aelig;mostatic fluid, composed of
+dragons&rsquo; blood digested in turpentine, is in vogue. The Eau de
+Pagliari is also used; it is composed of a mixture of tincture of
+benzoin, 8 ounces; powdered alum, 1 pound; and 10 pounds of water,
+boiled together for six hours, and is considered a powerful styptic. In
+addition to these, burnt linen, spiders&rsquo; webs, starch-powder,
+powdered alum, and plaster-of-Paris powder are used by different mohels.
+Touching the bleeding points with a pointed pencil of nitrate of silver
+is also a practice understood by the Jewish circumcisers.</p>
+
+<hr /><p class='pagenum'><a name="Page_161" id="Page_161">[161]</a></p>
+<h2><a name="CHAPTER_XIV" id="CHAPTER_XIV"></a>CHAPTER XIV.<br />
+<span class='sc sf75'>What are the Benefits of Circumcision?</span></h2>
+
+<p>There are those, even among the Hebrews, who are so imbued with the
+purely theological idea of the origin, performance, and causes of
+circumcision, that they cannot see any moral nor hygienic value in the
+operation. Among many Christians the idea still prevails that
+circumcision is the relic of some barbarous rite, practiced in some
+epoch away in the remote ages of the world, grafted on to the Jewish
+religion by some accident or other; but that beyond the clinging of the
+Jews to this custom, as being a remnant of their old religion, they
+neither see in the rite any other significance, moral results, nor
+hygienic precaution; and the fact of a Jew being circumcised is too
+often made a subject of merriment among the unthinking portion of the
+Christian world. Neither are physicians all of one accord on the subject
+as to whether circumcision is a benefit, or, being useless, a dangerous
+and an unnecessary operation. The writer is most emphatically in favor
+of circumcision, and has the fullest faith in the positive moral and
+physical benefits that mankind gains from the operation.</p>
+
+<p>It may well be asked: What does the Jew receive in return for all the
+suffering that he inflicts through circumcision on himself and his
+little children? What is there to repay him or his for all the risks and
+annoyances, besides branding himself and his with an indestructible
+mark, which has been more than once the sign by which they have suffered
+persecution, spoliation, <span class='pagenum'><a name="Page_162" id="Page_162">[162]</a></span>
+expatriation, and death? Are there any benefits enjoyed by the Jew that
+the uncircumcised does not enjoy in equal proportion?</p>
+
+<p>The relative longevity between the Hebrew race and the Christian nations
+that dwell together under like climatic and political conditions
+indicates a stronger tenacity on the part of the Jewish part of the
+nations to life, a greatly less liability to disease, and a stronger
+resistance to epidemic, endemic, and accidental diseases. By some
+authorities it has been held that the occupations followed by the Jew
+are such as do not compel him to risk his life, as he neither follows
+any labor requiring any great and continued exertion, nor any that
+subjects him to any great exposure; that, as a rule, when in business,
+by some intuition he follows some branch that has neither anxiety, care,
+nor great chance of loss connected with it; that he does not follow any
+occupation that is attended with any risk of accident for either life or
+limb. Besides all these, it is also urged that in cities the careful
+inspection of their meat, and the peculiar social fabric of the family,
+the love and veneration for their aged, as well as their proverbial
+charity to their own poor and sick, and their provident habits and
+hygienic regulations imposed upon them by the Mosaic law, are all
+conditions that conspire to induce longevity.</p>
+
+<p>That the Hebrew is generally found in such conditions as above described
+is undisputed; but it is questionable if all these conditions are
+necessarily such as are favorable to health and long life, and that,
+therefore, the longevity of the Jewish race cannot altogether be
+ascribed to the above conditions. Looking at the subject of occupation,
+if we consult Lombard, Thackrah, and the later works on the effects of
+occupation on life, we must admit that the Jew has no visible <span class='pagenum'><a name="Page_163" id="Page_163">[163]</a></span>
+advantage in that regard, as he follows hardly any out-of-door
+occupation, being often in-doors in a confined and foul atmosphere. To
+those who have closely observed the race in this country,&mdash;coming
+as they do from the cold-wintered climates of Germany, Austria, or
+Poland, bringing with them the habit of living in small, close rooms,
+for the sake of economy and comfort,&mdash;it must be admitted that
+among the lower classes and the poorer of the race, their shops being
+connected, as they usually are, with their living-rooms, the <i>toute
+ensemble</i> is anything but conducive to a long life. Their an&aelig;mic
+and undeveloped physical condition and weak muscular organization are
+sufficient evidence that their surroundings are not calculated to
+improve health. In England, statistics sufficiently prove that the
+fisherman on the coast, exposed to all kinds of weather, is not as prone
+to disease as is his brother Englishman who deals out the groceries in
+his snug shop. Exercise has been held an important element in the
+factory of the long-lived. From the time of Hippocrates down to Cheyne,
+Rush, Hufeland, Tissot, Charcot, Humphry, and all authorities on the
+factors of old age, exercise has been looked upon as favoring long life.
+Exercise cannot be said to enter in any way as a factor in the longevity
+of the Jew; but, on the contrary, his in-door life is known to be very
+productive of phthisis in other races. His recreations are, as a rule,
+of the home social order. They visit and spend the time allotted to
+recreation in social intercourse, which their hospitality always insists
+on accompanying with a generous lunch, which, to say the least, is not
+an element that is conducive to either health or long life; for no
+people excel the Jew in home hospitality, and even among the poorer
+classes a stranger is never allowed to depart without some refreshment
+<span class='pagenum'><a name="Page_164" id="Page_164">[164]</a></span>
+being offered him. Among the class better able to extend hospitality,
+social reunions and card parties, with lunches of fruits, cakes, cold
+meats and coffee, or wines, are among their regular occurrences. Their
+great affection for the family and for their youth and aged suggests
+these means of recreation, as then they are enjoyed by all alike; but,
+as observed, the hygiene of all this is very doubtful; it produces too
+much irregularity.</p>
+
+<p>It is related that after the Roman conquest of Palestine many of the
+Jews, becoming more or less accustomed to Roman manners and customs,
+often joined in the games which the Romans held in imitation of the old
+Olympic games of the Grecians. Not to be ridiculed, many resorted to the
+practices described in a previous chapter, to efface all the marks of
+their circumcision, that they might enter the games with as much freedom
+as the Romans or other uncircumcised nations; so that the present
+aversion to out-of-door sports evinced by the Jew is not necessarily a
+racial trait; the persecutions and political inequality that until
+lately he has been made to suffer have driven him into retirement and
+seclusion. Although seeking neither converts nor political power and
+influence, he has been hunted down, massacred, and chased about as a
+dangerous beast. As the children of the great Rabbi Moses Mendelssohn
+asked of their father: &ldquo;Is it a disgrace to be a Jew? Why do
+people throw stones at us and call us names?&rdquo; It may well be
+asked, why? These actions have forced them into the social and retired
+habits for which they are noted; although it cannot be said that it is
+from a lack of spirit, as one of the Rothschilds is well known to have
+been present at the battle of Waterloo, where from a spot in the
+vicinity <span class='pagenum'><a name="Page_165" id="Page_165">[165]</a></span>
+of the British right-centre he observed the events of the battle; and
+when, with the failure of Ney&rsquo;s last desperate charge with the
+formidable battalions of the Old Guard, he saw the advance of the
+Prussians closing in on the French right, he galloped to the sea-shore,
+and, crossing the Channel in a frail boat, reached London twenty-four
+hours in advance of the news of the battle,<a name="FNanchor_65_65" id="FNanchor_65_65"></a><a href="#Footnote_65_65" class="fnanchor">[65]</a>
+but long enough for him to clear several millions from off the panicky
+state of the money market. Marshal Massena, one of Napoleon&rsquo;s
+bravest generals, the defender of Genoa and the hero of Wagram, was of
+Jewish origin.</p>
+
+<p>Athletic sports are not of necessity conducive to long life, even if
+they are to temporary robust health; but there is no mistaking the fact
+that the sedentary and in-door life of the average Jew is a deteriorator
+to health and life, and especially among that class of families who are
+poor and keep no servant; from heredity and home education having
+adopted unhygienic customs, in which they have grown up,&mdash;in these a
+total disregard for all ventilation forms a part. Were an uncircumcised
+race so to live, scrofula and phthisis would be the inevitable result.
+This difference of results I have witnessed more than once as existing
+among the two races coming from the same European nationality, where
+their disregard to ordinary rules of hygiene, induced by climatic
+causes, especially ventilation, were alike in both the Semitic and
+European descendants of the one nation, the purely European being more
+prone to consumption and scrofula. It is interesting to note the
+difference in the moral, mental, and physical conditions induced by
+creeds; it would seem as if it should not make any difference. The
+generally accepted idea of religion is that it should raise the moral
+standard of all <span class='pagenum'><a name="Page_166" id="Page_166">[166]</a></span>
+those nations who practice religion; but the results are very peculiar,
+as we are forced to admit that reformation in religion has not always
+been a reformation in morals. Take Great Britain for example; if
+illegitimacy is any criterion of the moral state of those professing
+creeds, we find the least among the Jew; next among the Catholic; next
+comes the Episcopalian; then last the Presbyterian,&mdash;the oldest
+creed showing the greatest moral tendency, and that of poor Knox, which
+is the youngest, showing the least. This has certainly its physical
+effects, that are not without its influence in producing a greater or
+lesser length of life. The evolution of religion has here induced a
+lower moral tone and a resulting physical degeneracy.</p>
+
+<p>As observed by alienists, religions of different creeds have different
+tendencies in inducing insanity, both as to ratio of population and as
+to manifestations;<a name="FNanchor_66_66" id="FNanchor_66_66"></a><a href="#Footnote_66_66" class="fnanchor">[66]</a>
+the Protestant, when unbalanced by religious cause, is generally
+controlled with some idea that shows itself in wild and erratic attempts
+at scriptural interpretation, caused by want of fixed dogmas and the
+unending splittings that are forever taking place in the new faith, and
+the persistent, intrusive, and belligerent spirit of proselytism that
+controls each new branch as it buds into existence. The Catholic has a
+fixed dogma, which the church attends to, and he neither feels called
+upon to make his neighbors miserable or himself insane in hunting up new
+interpretations. When he does go insane on the subject of religion, the
+cause, as a rule, can be traced to some real or imagined moral
+delinquency, which has brought all the terrors of the punishment of the
+damned forcibly and persistently to his disordered imagination. In the
+insane-asylums of Cork, in Ireland, with its overwhelming Catholic
+population, the ratio of inmates in regard to <span class='pagenum'><a name="Page_167" id="Page_167">[167]</a></span>
+creeds is as that of one Catholic to ten of the Reformed religion,
+showing in the most conclusive manner the influence exerted by religion
+in this direction. On the other hand, the Jew has the simplest of
+religious creeds; he neither wastes useful time, robs himself of sleep,
+nor becomes dyspeptic in hunting for hidden meanings in some ambiguous
+scriptural phrase; he is satisfied with his creed, his dogmas are firmly
+anchored, and the nature of his religion being a sort of family
+congregation, he is not called upon to go out in search of proselytes,
+any more than the father of an already large family feels called upon to
+go out and hunt up the homeless, that he may convert his home into a
+promiscuous orphan-asylum. As before remarked, his creed is of the
+simplest, and there exists a complete and explicit understanding between
+his God and himself. There are no mystical, hidden meanings in Scripture
+for the Jew; nor does he dread any eternal, unheard-of, and inexplicable
+torments. His laws are very clear, and the punishments for their
+infraction very explicit. To the Jew it is a straight and well-lighted
+road, as far as religion is concerned. The writer has always felt that
+it took a mind that was incapable of appreciating simple truths, but
+that loved to hover on that mystical border-land on the confines of
+gloomy insanity that would allow its owner to seriously wander through
+and behold any theological beauties in Bunyan. To the Jew there is none
+of the gloomy, weird, mystical, mind-racking, ungodly theology that some
+of our creeds torture the poor brains of their professors with. As the
+wild Indian of the plains runs sticks through his anatomy and capers
+wildly about to torture his body, so some of the creeds delight in
+torturing their devotees. The Jewish religion is the one best suited to
+tranquilize the mind; it is very philosophical <span class='pagenum'><a name="Page_168" id="Page_168">[168]</a></span>
+and rational. Were he to acknowledge Christ, he would not have to
+change his course of life to become a most exemplary Christian. The
+celebrated letter of Moses Mendelssohn to the Swiss clergyman, Lavater,
+in answer to a dedication of the latter to Mendelssohn, is probably the
+best exposition of the essence of the Jewish faith that can be found.
+Therein he says: &ldquo;We believe that all other nations of the earth
+have been commanded by God to adhere to the laws of nature. Those who
+regulate their conduct according to this religion of nature and of
+reason are called <i>virtuous men of other nations</i>, and are the children
+of eternal salvation.&rdquo; Such a religion does not unsettle
+man&rsquo;s mind.</p>
+
+<p>These apparent digressions are made to show what additional factors
+exist, besides circumcision, to induce longevity in the Jewish race, and
+that the subject may be better understood; for these reasons the above
+comparisons have been made. Students of demographic science are well
+aware that form of government, religion, climate, diet, habit, and
+custom,&mdash;all have an important bearing on the mental and physical as
+well as on the moral nature of man. To the true student of his art all
+these conditions are but factors in the physical scale, and should so be
+considered without fear or favor; to him the whole world is but a unit,
+and the people upon its surface are but as one people, alike subject to
+the leveling laws of nature, which recognize neither royalty nor
+vagrant, nationality nor creed, color, condition, nor station in life or
+society.</p>
+
+<p>Professor Bernoulli, of Bale, found the Israelite less prolific than the
+Christian;<a name="FNanchor_67_67" id="FNanchor_67_67"></a><a href="#Footnote_67_67" class="fnanchor">[67]</a>
+subject to less mortality, greater longevity, less still-born, less
+illegitimacy, less crime against the person, and less insanity and
+suicide, when compared with his Christian brother&mdash;all <span class='pagenum'><a name="Page_169" id="Page_169">[169]</a></span>
+of which he attributes not to a superior physique or organism, but
+solely to the observance of the laws of their religion and to the nature
+of the same, which exercises a beneficial influence on the mind.</p>
+
+<p>B. W. Richardson, in his &ldquo;Diseases of Modern Life,&rdquo; in
+speaking of the relation of race to disease, says: &ldquo;Through the
+valuable labors of MM. Legoyt, Hoffmann, Neufville, and Mayer, we have
+obtained, however, some curious facts relative to the most widely
+disseminated of all races on the earth, the Jewish. These facts show
+that, from some cause or causes, this race presents an endurance against
+disease that does not belong to other portions of the civilized
+communities amongst which its members dwell. The distinctness of the
+Jews in the midst of other and mixed races singles them out specially
+for observation, and the history they present of vitality, or, in other
+words, of the resistance to those influences which tend to shorten the
+natural cycle of life, is singularly instructive.</p>
+
+<p>&ldquo;The resistance dates from the first to the last periods of life.
+Hoffmann finds that in Germany, from 1823 to 1840, the number of
+still-born among the Jews was as 1 in 39, while with other races it was
+1 in 40. Mayer finds that in Furth children from one to five years of
+age die in the proportion of 10 per cent. among the Jewish, and 14 per
+cent. among the Christian population. M. Neufville, dealing with the
+same subject, from the statistics of Frankfurt, gives even a more
+favorable proportion of vitality to the Jewish child population.
+Continuing his estimates from the ages named into riper years, the value
+of life is still in favor of the Jews, the average duration of the life
+of the Jew being forty years and nine months and that of the Christian
+being thirty-six years and eleven months. In <span class='pagenum'><a name="Page_170" id="Page_170">[170]</a></span>
+the total of all ages, the half of the Jews born reach the age of
+fifty-three years and one month, whilst half of the Christians born only
+reach the age of thirty-six years. A quarter of the Jewish population
+born is found living beyond seventy-one years, but a quarter of the
+Christian population is found living beyond fifty-nine years and ten
+months only. The Civil State extracts of Prussia give to the Jews a
+mortality of 1.61 per cent.; to the whole kingdom, 2.62 per cent. To the
+Jews they give an annual increase of 1.73 per cent.; to the Christian,
+1.36 per cent. The effective of the Jews require a period of forty-one
+years and a half to double themselves; those of other races, fifty-one
+years. In 1849, Prussia returned one death for every forty-one of the
+Jews and one for every thirty-two of the remaining population.</p>
+
+<p>&ldquo;The Jews escaped the great epidemics more readily than the other
+races with whom they lived. Thus, the mortality from cholera amongst
+them is so small that the very fact of its occurrence has been disputed.
+Lastly, that element of mortality, suicide, which we may look upon
+philosophically as a phenomenon of disease, is computed by Glatter, from
+a proportion of one million of inhabitants of Prussia, Bavaria,
+W&uuml;rtemburg, Austria, Hungary, and <ins class='corr'
+title="Transcriber&rsquo;s Note: The original showed
+&lsquo;Tranyslvania&rsquo;.">Transylvania</ins>, to have been committed by
+rather less than one of the Jewish race to four of the members of the
+mixed races of the Christian population. Different causes have been
+assigned for this higher vitality of the Jewish race, and it were indeed
+wise to seek for the causes, since that race which presents the
+strongest vitality, the greatest increase of life, and the longest
+resistance to death must in course of time become, under the influences
+of civilization, dominant. We see this truth, indeed, actually
+exemplified <span class='pagenum'><a name="Page_171" id="Page_171">[171]</a></span>
+in the Jews; for no other known race has ever endured so much or
+resisted so much. Persecuted, oppressed by every imaginable form of
+tyranny, they have held together and lived, carrying on intact their
+customs, their beliefs, their faith, for centuries, until, set free at
+last, they flourish as if endowed with new force. They rule more
+potently than ever, far more potently than when Solomon in all his glory
+reigned in Jerusalem. They rule, and neither fight nor waste.&rdquo;<a name="FNanchor_68_68" id="FNanchor_68_68"></a><a href="#Footnote_68_68" class="fnanchor">[68]</a></p>
+
+<p>Richardson attributes the great benefits enjoyed in this regard by the
+Jewish race to the soberness of their lives. This position is, however,
+not altogether tenable, if by that we mean abstemiousness; they are
+extremely temperate, but not abstemious. Tissot, Cornaro, Lessius,
+Hufeland, Humphry, Sir Henry Thompson, as well as the older Greek and
+Roman authorities, all are agreed that an abstemious life is the one
+that is most conducive to long life. There is no race that is more
+proverbial for their good cheer and indulgence in the good things of the
+table than the Jewish; no race enjoys feasting any more than they, and
+from childhood they are accustomed to a generous and nutritious diet, as
+well as to their share of the wines with which their tables are
+supplied. Their greater thrift and application to business, their habits
+of economy and carefulness in business affairs enable them to better
+supply their tables. In California there is no class that lives better
+or whose tables are supplied so well either as to quality or quantity as
+those of the Jews, and yet no class is more exempt than they from the
+class of diseases that originate in too good living. As before remarked,
+in relation to the poor of that faith, who are unable to keep a servant,
+and who live in a combination of shop and home in the most unhygienic
+condition, disregarding ventilation <span class='pagenum'><a name="Page_172" id="Page_172">[172]</a></span>
+and every other sanitary needs, but who, nevertheless, escape the evil
+results that would and do attend such social conditions among those of
+other races, so in this instance of good living: the better class of
+Jews do not suffer in anything near a like proportion to the better
+class Christians from diseases incident to too full habits and an
+inactive life. Richardson observes that he drinks less and that he eats
+better food than his Christian brother. In regard to the drinking habit,
+overindulgence is not a Jewish failing; they do not drink to excess, but
+total abstinence is not in their vocabulary. It is inconsistent with
+their idea of wine as being a gift of God, and something that is
+symbolical of good faith and thanksgiving. Nor is total abstinence
+consistent with their idea of generous hospitality. On the eighth day
+after birth the Jew tastes wine, and from the time he is able to sit at
+table he becomes familiar with its use. To him wine is not symbolical of
+either moral depravity, mental or physical deterioration, or of death.
+Their females are all accustomed to its use from childhood, but it does
+not cause them to become either immoral or unchaste; so that in neither
+sex does wine produce that moral and mental wreckage which abbreviates
+the length of human existence among those of other creeds. Radical
+fanaticism, that drives a tack with a maul and a twenty-penny spike with
+a tack-hammer, cannot be expected to study this or any other question in
+any rational manner; but to the sociologist, the question as to what
+produces this remarkable soberness, in the midst of the habitual and
+continued use of wine in the race from the time of its earliest history,
+is something worthy of calm and careful consideration. How much
+circumcision may have to do with this will be discussed in the medical
+part of the volume.</p>
+
+<p><span class='pagenum'><a name="Page_173" id="Page_173">[173]</a></span>
+In London, according to Dr. Stallard, the mortality among Jewish
+children from one to five years is only ten per cent., while among the
+children of the Christians it is fourteen per cent., the rate being
+analogous to that observed by Mayer among those of these ages in Furth.
+Among the London adults the average duration of life among the Jews is
+forty-seven years, while among the Christians it is only thirty-seven.</p>
+
+<p>Dr. Hough<a name="FNanchor_69_69" id="FNanchor_69_69"></a><a href="#Footnote_69_69" class="fnanchor">[69]</a>
+has gathered some interesting historical and statistical matter bearing
+on the subject of Jewish resistance to disease and the benefit possessed
+by the race in relation to the immunity enjoyed by them in prevailing
+epidemics. The plague of 1346 did not affect them; according to
+Fracastor they escaped the typhus of 1505; Rau remarks their immunity to
+the typhus of 1824; Ramazzini noticed their exemption to the fatal
+intermittents of Rome, in 1691; and Degner says that they escaped the
+epidemic dysentery at Nimegue, in 1736. Richardson truly observes that
+&ldquo;from epidemics the Jews have often escaped, as if they possessed
+a charmed life.&rdquo; This racial difference and benefit, when compared
+to other races, has more than once cost them dear. In the dark and
+ignorant ages, when men reasoned nothing from a physical basis, but
+attributed all and every phenomena to some supernatural agency, either
+heavenly or diabolical, it was but natural for such minds to associate
+this exemption with some purchased compact made with the devil, who was
+often also held accountable for the existence of the epidemics. The
+rational and law-of-nature observing Jew supposed to be in league with
+his satanic majesty could neither be seen nor heard in his own defense;
+consequently, massacres, pillaging, and such other barbarities that an
+insane popular fury could suggest, were the humane manifestations <span class='pagenum'><a name="Page_174" id="Page_174">[174]</a></span>
+with which a Christian people visited their Jewish brothers, whose only
+sin consisted in worshiping the God of their fathers, and in strictly
+observing His laws and commandments.</p>
+
+<p>In France, Dr. Neufville found that, of one hundred children in the
+first five years of life, among the Jewish population, 12.9 die; while
+from the same number of the same aged class of Christians 24.1 die.
+One-half of all the Christians die at thirty-six years, and one-half of
+all the Jews at fifty-three years and one month.</p>
+
+<p>Dr. John S. Billings has gathered statistics relating to 10,618 Jewish
+families, consisting of 60,630 persons,<a name="FNanchor_70_70" id="FNanchor_70_70"></a><a href="#Footnote_70_70" class="fnanchor">[70]</a>
+living in the United States in December, 1889, mostly descendants of
+Jews from the northern or middle nations of Europe. For our purpose only
+the deductions as to death-rate and tendency to longevity will be given.
+In this valuable paper Dr. Billings says: &ldquo;When we come to examine
+the reports of deaths for five years furnished by these Jewish families,
+we find that they give an average annual death-rate of only 7.1 per
+1000, which would be about one-half of the annual death-rate among other
+persons of the same average social class and condition living in this
+country.&rdquo; To this he adds that, provided the deaths at different
+ages among the Jews have been correctly reported, this race will, on
+comparison with those of other races, show a greater tendency to
+longevity, as the Jewish expectation of life is at each age markedly
+greater than that of the class of people who insure their lives, the
+average excess being a little over twenty per cent.</p>
+
+<p>In speaking of the death-rate among children, Dr. Billings makes the
+following comparisons: &ldquo;The low death-rate among the Jews is
+especially marked among the children, and this corresponds to European
+experience.<span class='pagenum'><a name="Page_175" id="Page_175">[175]</a></span>
+Thus in Prussia, in 1887, the death-rate of the Jews under fifteen
+years of age was 5.63 for 1000, while among the remainder of the people
+it was 10.46 per 1000.&rdquo; This result he accounts for partly to the
+fact that among the Jews illegitimacy is comparatively rare and to the
+high rate of mortality among the illegitimate born, which raises the
+average of the other classes.</p>
+
+<p>In regard to the immunity of the race from consumption or tubercular
+disease, the statistics of the above Jewish families gives to the Jews
+less than one-third of the number of deaths from these diseases than
+what occurs among the others as to the male population, and less than
+one-fourth as to the female population. These statistics coincide with
+the observations of the writer on this part of the subject, and are even
+more than corroborated by the French War-Office Reports from Algeria,
+where the deaths from consumption among the Christians amount to 1 for
+each 9.3 deaths, and among the Jews to 1 in 36.9, while among the
+Mohammedans it is only 1 in 40.7 deaths. In Algeria the relative
+mortality from all causes is only about three-fifths of that of the
+Christian, and the Turk, although seeming to enjoy a greater exemption
+from phthisical or tubercular diseases than the Jew, falls below the Jew
+in exemption from deaths due to general causes, as his mortality is
+one-eighth greater than that of the Jew. Dr. Billings gives us some
+interesting food for thought in the course of his article and some more
+particularly bearing on the subject of immunity from consumption. He
+asks: &ldquo;Are these differences due to race characteristics, properly
+so-called, to original and inherited differences in bodily organization,
+or are they, rather, to be attributed to the customs, habits, and modes
+of life of the two classes of people?&rdquo;</p>
+
+<p><span class='pagenum'><a name="Page_176" id="Page_176">[176]</a></span>
+Some years ago, Henry I. Bowditch, of Boston, put on foot an extended
+system of inquiry in regard to ascertaining the causes or antecedents of
+consumption in the State of Massachusetts. In answer to some of the
+questions of the circular, Rabbi Dr. Guinzburg, of Boston, answered as
+follows, under date of October 29, 1872:&mdash;</p>
+
+<p>1st. The number of Jews living in Boston is about 5000.</p>
+
+<p>2d. There certainly have not died of consumption, during the last five
+years, more than eight or ten Jews in the various congregations.</p>
+
+<p>To this Dr. Bowditch adds, as follows:&mdash;</p>
+
+<p>&ldquo;If Dr. Guinzburg&rsquo;s data be correct, they show a very great
+immunity from consumption on the part of the Jews, compared with the
+citizens generally, as will be seen by the following comparison between
+these numbers and those procured from the Registration Reports,
+published by the State. In the report published in 1869, page 64, we
+find that for the five years preceding 1869 the annual average of deaths
+by consumption was 338 for every 100,000 living. These data from Dr.
+Guinzburg and the State Report give the following table:&mdash;</p>
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td></td><td align='center'>Proportion of Deaths to<br />100,000 of Living.</td></tr>
+<tr><td align='left'>All religions,</td><td align='center'>338</td></tr>
+<tr><td align='left'>Jews,</td><td align='center'>&nbsp;40</td></tr>
+</table></div>
+
+<p>&ldquo;These statements from Dr. Guinzburg are confirmed by the
+following letter from Dr. A. Haskins, of this city. Dr. Haskins is
+connected with one of the Jewish benevolent associations for the benefit
+of the sick. I sent to him similar questions and make the following
+extracts from his reply:&mdash;</p>
+
+<p>&ldquo;&lsquo;I am generally employed in about sixty families<span class='pagenum'><a name="Page_177" id="Page_177">[177]</a></span>
+(Jewish). I have had these families under my care for two and a half
+years. During this time I have seen but one case of consumption. I have
+averaged among these sixty families about two visits daily. In my other
+Jewish practice, which is not inconsiderable, I have in this time (two
+and a half years) seen two cases of consumption.... I am sorry I have no
+statistics whereby I could compare the two peoples, viz., Jews and
+Christians. I can, therefore, give you only my impressions. I should say
+that I find consumption less frequent among the Jews than among
+Christians. This would be my own impression without any data to fortify
+it.&rsquo;</p>
+
+<p>&ldquo;Dr. Waterman also sustains the same idea. The following extract
+will give some idea of his opportunities for observation and the sources
+of his deductions:&mdash;</p>
+
+<p>&ldquo;&lsquo;<span class='sc'>Boston</span>, November 2, 1872. Dear Sir,&mdash; ... First, I have
+attended four charitable associations; number about forty, fifty, sixty,
+and one hundred families. At present I only attend one, containing one
+hundred families, and on which I average a fraction over one visit a
+day. I have, besides, many private families among the Jews. I have
+attended but few cases of consumption, and I think the disease is not so
+prevalent as among Christians.&rsquo;&rdquo;</p>
+
+<p>The same report of Dr. Bowditch quotes from Stallard&rsquo;s
+&ldquo;London Pauperism Amongst Jews and Christians,&rdquo; as saying
+that there is no hereditary syphilis, and scarcely any scrofula to
+augment the mortality in the Jewish families.</p>
+
+<p>In relation to the liability of the Hebrew race to phthisis, Richardson
+has the following at page 22 of his &ldquo;Diseases of Modern
+Life&rdquo;: &ldquo;The special inroads on vitality made on other races
+by disease are not easily determined, because of the difficulties
+arising from temporary <span class='pagenum'><a name="Page_178" id="Page_178">[178]</a></span>
+admixture of race. I tried once to elicit some facts from a large
+experience of a particular disease, phthisis pulmonalis, and, as the
+results of this attempt may be useful, I put them briefly on record.</p>
+
+<p>&ldquo;At a public institution at which large numbers of persons
+afflicted with chest diseases applied for medical assistance, and at
+which I was for many years one of the physicians, I made notes during a
+short portion of the time of the connection that existed between race
+and the particular disease I have instanced&mdash;phthisis pulmonalis, or
+pulmonary consumption. The number of persons observed under the disease
+was three hundred, and no person was put on the record who was not
+suffering from a malady pure and simple; I mean without complication
+with any other malady. They who were thus studied were of four classes:
+(<i>a</i>) those who were by race distinctly Saxon; (<i>b</i>) those who were of
+mixed race, or whose race could not be determined; (<i>c</i>) those who were
+distinctly Celtic; (<i>d</i>) those who were distinctly Jewish.</p>
+
+<p>&ldquo;The results were, that of the three hundred patients, one hundred
+and thirty-three, 44.33 per cent., were Saxon; one hundred and eighteen,
+39.33 per cent., were of mixed or undetermined race; thirty-one, 10.33
+per cent., were Celtic; and eighteen, 6 per cent., were Jewish.&rdquo;</p>
+
+<p>Although Dr. Richardson admits it would be unfair to accept the above
+figures as a basis for general application, he argues that they are, on
+the average, sufficiently suggestive, as among the Saxons it was noticed
+that there were more cases in whom the disease was hereditary, while
+among the others it was generally acquired.</p>
+
+<p>In going over the subject of this question in regard to phthisis, we
+must admit that, although the Jew in his own home, synagogue, or in his
+social reunions, is not <span class='pagenum'><a name="Page_179" id="Page_179">[179]</a></span>
+exposed to tubercular emanations, and that he has less chance of
+contracting the disease from tuberculous meats, he is, after all, a
+theatre-goer; a pretty constant inhabitant of the sleeping-car and
+hotel, as a commercial traveler and general merchant; and that, on the
+whole, he eats the same food, breathes the air and dust of the same
+streets, and drinks the same milk and water as the Christian, and, as
+observed by Dr. Billings, cooking destroys the bacillus in meats. So
+that the comparative exposure in this country&mdash;where the practice
+is not as prevalent as in Germany of eating raw minced-meat
+sandwiches&mdash;existing between the Jew and the Christian to
+tubercular infection from meat are about equal. The records of the
+Jewish Hospital of New York gives, out of 28,750 persons admitted, only
+44.17 per 1000 of its admissions as being due to consumption; while
+those of the Roosevelt Hospital, out of 25,583 admissions, gives a per
+1000 of 67.93.</p>
+
+<p>From what is known of the relation of syphilis to consumption, not only
+as affecting the primary individual, but the subsequent generations of
+the same, and the known greater exemption of the Jew to syphilitic
+infection, owing to the protecting influence of circumcision, it is safe
+to assert that therein is to be found one of the main reasons of the
+exemption of that race to consumption. If we but look at the
+geographical distribution of phthisis and the history of its progress,
+we shall find that it has had syphilis as its <i>avant courrier</i> on more
+than one <ins class='corr' title="Transcriber&rsquo;s Note: The original
+showed &lsquo;occasian&rsquo;.">occasion</ins>. Lancereaux, in his
+&ldquo;Distribution of Pulmonary Phthisis,&rdquo; points to the fact
+that where consumption has made its greatest ravages, and where it has
+nearly depopulated one of the great divisions of the globe,&mdash;namely, the
+groups of islands in the Pacific Ocean,&mdash;the disease had no existence at
+the <span class='pagenum'><a name="Page_180" id="Page_180">[180]</a></span>
+beginning of the present century. Syphilis, scrofula, and a quick,
+galloping consumption have, since the last ninety years, taken off the
+greater part of the population. The same course of transition from the
+best of physical conditions to racial deterioration and extinction from
+the same relative condition of causes&mdash;syphilis, scrofula, and
+phthisis&mdash;has been observed among the open-air dwellers of the New
+Mexican Plains, in the mountains of Arizona, and on the arid wastes of
+the Colorado Desert, where the appearance of consumption cannot be
+attributed to housing or incipient civilization, as it is attributed to
+housing among the Chippeways, Sioux, or Mandans in the regions that
+formerly formed the Northwest Territory. The question is very plainly
+answered as to how consumption was introduced or whence it sprung that
+has so ravaged the Oceanic Islands. The sailors who first visited those
+islands were not, as a rule, a batch of consumptive tourists on a voyage
+in search of health or recreation; but we can well understand that the
+proverbially improvident mariner has not always had his health looked
+after by an Anson or a Cook, and that many a festive tar who induced the
+unsophisticated Indian maid to join him in worship at the shrine of
+Venus Porcina carried in the innermost recesses of the folds of his
+pendulous and sea-beaten prepuce the remnants of former Bacchanalian
+festivities performed in the questionable temples of Venus and Bacchus
+in Portsmouth or London. Consumption, as such, was neither imported nor
+propagated by Europeans into those islands, its original entry being in
+the shape of syphilis. Had it been the ancient mariners of old
+Ph&oelig;nicia in the days of its circumcision, or the circumcised
+marines of the ancient Atlantean fleets from the sunken continent of
+Plato, instead of the uncircumcised <span class='pagenum'><a name="Page_181" id="Page_181">[181]</a></span>
+sailors of modern England, that first and since visited those islands,
+it is safe to say that consumption would not now exist there. From this,
+it may be well to inquire what would be the relation between the Jewish
+race and consumption; were circumcision among them to be done away with,
+would it not be greatly on the increase?</p>
+
+<p>The weight of testimony is evidently convincing that the Jew has a
+greater longevity and stronger resistance to disease, as well as a less
+liability to physical ills, than other races; that all these exemptions
+or benefits are not altogether due to social customs is evident; how
+much circumcision may have to do in inducing these favorable conditions
+can be better appreciated by a consideration of how circumcision affects
+those of other races, and more particularly how its performance works
+changes in the individual in his general health and condition, and in
+doing away with many physical ailments that the individual was
+previously subjected to. So that the Jew cannot be said to be a loser by
+his observance of this rite, and he and his race have been well repaid
+for all the sufferings and persecutions that its observance has
+subjected them to. As observed by John Bell, &ldquo;The preservation of
+health and the attainment of long life are objects of desire to every
+man, no matter in what age or country his lot is cast, nor by what
+arbitrary tenure he holds his life. They are the wish of the master and
+the slave, of the illiterate and the learned, of the timid Hindoo and
+the warlike Arab, of the natives of New Zealand not less than of the
+inhabitants of New England,&mdash;an indispensable condition for the greatest
+and longest enjoyment of the senses and propensities; for the widest
+range and exercise of intellect and gratification of the sentiments,
+whether these be lofty or <span class='pagenum'><a name="Page_182" id="Page_182">[182]</a></span>
+ignoble, health, in any special degree, has ever been a fit subject of
+contemplation and instruction by the philosopher and legislator. Their
+advice and edicts on the means of preserving it have frequently been
+enforced as a part of religious duty, and, at all times, civilization,
+even in its elementary forms, has been marked by laws on this head. With
+the numerous and minute hygienic enactments of the great Jewish lawgiver
+for the guidance of the people of Israel we are all familiar. Prompted,
+we may suppose, in part by the example of Moses, and also by
+considerations growing out of the nature of the climate in which he
+lived, Mohammed incorporated with the mingled reveries, ethics, and
+blasphemies, which composed his Koran, dietetic rules and observances of
+regimen that are to this day implicitly obeyed by his zealous
+followers.&rdquo;<a name="FNanchor_71_71" id="FNanchor_71_71"></a><a href="#Footnote_71_71" class="fnanchor">[71]</a></p>
+
+<p>If circumcision is not a factor in the difference that exists between
+the Jewish race and other races, if it goes for nothing as an exemptor
+of disease and the promoter of longevity, then there must exist some
+other factor or cause that induces these conditions. What this factor
+is, the legislator, the sociologist, and the physician should make it
+their business to find out.</p>
+
+<hr /><p class='pagenum'><a name="Page_183" id="Page_183">[183]</a></p>
+<h2><a name="CHAPTER_XV" id="CHAPTER_XV"></a>CHAPTER XV.<br />
+<span class='sc sf75'>Predisposition to and Exemption and Immunity from Disease</span>.</h2>
+
+<p>The peculiar differences that exist between different animals in regard
+to their susceptibility to the action of drugs is even more remarkable
+than the differences that exist in their susceptibility to certain forms
+of disease. We can understand and appreciate what Koch tells us in
+regard to the different susceptibilities exhibited by the house-mice and
+the field-mice to the anthrax bacillus, or why a nursing child should
+offer different results, when exposed to the diphtheria bacillus or the
+contagious poison of any of the exanthemata, from those witnessed in the
+meat or promiscuously dieted child. We can also appreciate that
+different individuals have different susceptibilities to disease, as
+well as we understand that the same degree is not always in an unvarying
+point of resistance or susceptibility in the same individual. The
+investigation and study of these conditions teach us, however, that
+there is a cause, or that there are causes that induce and modify this
+susceptibility. But there are conditions that are as yet beyond our
+comprehension. Take, for instance, two animals, both vertebrates,
+mammals, and dwelling together, eating the same food, and even having a
+mutual understanding or sympathy of mind and affections, having a like
+circulation, a like brain and nervous system, it would naturally be
+supposed that these two would exhibit a like susceptibility to the
+actions of narcotic poisons; but when we are told that one <span class='pagenum'><a name="Page_184" id="Page_184">[184]</a></span>
+dog has taken 21 grains of atropia with impunity we are staggered.
+Atropia may not affect rabbits (as it does not), but the rabbit does not
+approach man in the same close relationship as the dog. Richardson
+administered to a healthy young cat 7 drachms of Battley&rsquo;s
+solution of opium, then 10 grains of morphia, and a little later 20
+grains more of morphia without rendering the cat unconscious. The same
+experimenter gave to a pigeon 21, 30, and 40, then 50 grains of powdered
+opium on succeeding days with no bad effect. S. Weir Mitchell gave to
+three pigeons, respectively, 272 drops of black drop, 21 grains of
+powdered opium, and 3 grains of morphia without any effect.<a name="FNanchor_72_72" id="FNanchor_72_72"></a><a href="#Footnote_72_72" class="fnanchor">[72]</a>
+On the other hand, horses show a like susceptibility to man to the
+action of drugs. In the island of Ceylon, a sloth can take 10 grains of
+strychnia with safety,&mdash;chickens presenting a like immunity to the
+poisonous effects of this alkaloid. While the dog offers such a contrast
+to the action of drugs as compared to man, he is as subject to goitre,
+and they have been seen in a true state of cretinism.<a name="FNanchor_73_73" id="FNanchor_73_73"></a><a href="#Footnote_73_73" class="fnanchor">[73]</a></p>
+
+<p>An Apache, or Colorado Indian, will prefer a dessert of decomposed
+gophers to one composed of the best canned peaches or Bartlett pears; he
+will devour the mass without any resulting evil, while a German&mdash;after
+many generations of training on all forms of sausages in every degree of
+age and ripeness, and on every form of cheese, from the refreshing
+cottage cheese from curdled milk and the delicious cream cheese, down
+through to all and every grade as far as Limburgher, or maggoty, common
+cheese&mdash;has not, in every case overcome the tendency of the civilized
+intestine and constitution to the action of sausage poison, something
+that has no effect on the ordinary Indian, or on the uncivilized
+<span class='pagenum'><a name="Page_185" id="Page_185">[185]</a></span>
+dweller north of the arctic circle. Even the house-dog, that faithful
+companion of man, in many cases living on exactly the same fare as his
+master, is insensible to the action of this poison. An Indian will gorge
+and gormandize, after a prolonged fast, on such quantities and qualities
+of food that, if the ordinary white man were to indulge in a like feast,
+he would be in imminent danger of literal rupture or explosion, or
+liable to end in sudden apoplectic seizures, or, in case of a too
+healthy and active digestion, liable, owing to a lack of a
+correspondingly active condition of the excretory organs, to go off in
+ur&aelig;mic coma. This sporadic and fitful feasting has no perceptible
+effect on the Indian, who either simply works it off in exercise, or
+sleeps it off in a long and prolonged period of sleep, during which his
+lungs work with the deep and steady pull and persistence that a tug-boat
+exhibits when towing in a large ship against the tide and a head
+wind,&mdash;working in and out more air in one respiration than the
+ordinary white man will in a dozen. All these different conditions are
+more or less plain to us and as easy of explanation,&mdash;just as plain
+as to how and why some birds eat gravel to improve their digestion. In
+the cases of different susceptibility to the action of strychnia or of
+narcotics, the explanation must of necessity, for the present, be more
+or less speculative. But how are we to account, even in the way of
+speculation, for the peculiar immunity, lack of predisposition and
+hereditary tendencies to disease exhibited by the Hebrew, who, since the
+history of the world, has been a civilized and rational
+being,&mdash;even for decades of centuries before the civilization of
+Europe? Living under the same forms of government, climate, and shelter,
+practically using the same varieties of food and drink, he exhibits
+<span class='pagenum'><a name="Page_186" id="Page_186">[186]</a></span>
+an entirely different vitality and resistance to disease, decay, and
+death,&mdash;being, in fact, a puzzle to the demographic student. The
+only really marked difference that exists between this race and the
+others lies in the fact that the Hebrew is circumcised, other
+differences not being sufficiently constant to be accounted as factors.
+Circumcision is, in the opinion of the writer, the real cause of the
+differences in longevity and faculty for the enjoyment of life that the
+Hebrew enjoys in contrast to his Christian brother. Christian and
+uncircumcised races may individually, or in classes, develop some
+peculiar immunity or exemption, as, for instance, the tolerance to
+arsenic exhibited by some German mountaineers, or the peculiar safety
+enjoyed by the butcher class from attacks of continued fever;<a name="FNanchor_74_74" id="FNanchor_74_74"></a><a href="#Footnote_74_74" class="fnanchor">[74]</a>
+but these exemptions are purchased at the expense of the future, the
+effects of arsenic, long continued, finally having its morbid effects,
+and the very plethora which is the bulwark of resistance in the butcher,
+this plethora being in the end a treacherous foe, diseases result from
+it which make a sudden ending to this class when it is least expected.</p>
+
+<p>For an all around long-liver the Hebrew holds a pre-eminence, and, as
+the factor in this pre-eminence, circumcision has no counter-claimant.
+Circumcision is like a substantial and well-secured life-annuity; every
+year of life you draw the benefit, and it has not any drawbacks or
+after-claps. Parents cannot make a better paying investment for their
+little boys, as it insures them better health, greater capacity for
+labor, longer life, less nervousness, sickness, loss of time, and less
+doctor-bills, as well as it increases their chances for an euthanasian
+death.</p>
+
+<hr /><p class='pagenum'><a name="Page_187" id="Page_187">[187]</a></p>
+<h2><a name="CHAPTER_XVI" id="CHAPTER_XVI"></a>CHAPTER XVI.<br />
+<span class='sc sf75'>The Prepuce, Syphilis, and Phthisis</span>.</h2>
+
+<p>It is not alone the tight-constricted, glans-deforming,
+onanism-producing, cancer-generating prepuce that is the particular
+variety of prepuce that is at the bottom of the ills and ailments, local
+or constitutional, that may affect man through its presence. The loose,
+pendulous prepuce, or even the prepuce in the evolutionary stage of
+disappearance, that only loosely covers one-half of the glans, is as
+dangerous as his long and constricted counterpart. If we look over the
+world&rsquo;s history, since in the latter years of the fifteenth
+century syphilis came down like a plague, walking with democratic tread
+through all walks and stations in life, laying out alike royalty or the
+vagrant, the curled-haired and slashed-doubleted knight, or the tonsured
+monk, we must conclude that syphilis has caused more families to become
+extinct than any ordinary plague, black death, or cholera epidemic.
+Without wishing to enter into a history of syphilis, it is not outside
+of the province of this book to allude to its frequency and spread.</p>
+
+<p>Syphilis is not restricted to classes by any means; it is not those of
+the lower class alone who are its victims. Dr. Fr. J. Behrend, in his
+work, &ldquo;Die Prostitution in Berlin,&rdquo; observes that abolition
+of the brothels in that city in 1845, &rsquo;46, &rsquo;47 and
+&rsquo;48, trebled the number of cases of syphilis treated at the Der
+Charit&eacute;; in the year 1848 the cases of syphilis treated at that hospital
+numbered over 1800. It was also remarked during this period of
+legally-enforced virtue, that, as inconsistently <span class='pagenum'><a name="Page_188" id="Page_188">[188]</a></span>
+as it might appear, the disease invaded the best of families. From Dr.
+Neumann, in his brochure entitled &ldquo;Die Berliner
+Syphilisfrage,&rdquo; published in 1852, we learn that, in the Trades
+and Mechanics&rsquo; Benevolent Union of Berlin, in 1849, 13.51 per
+cent. of the sick were so from syphilis.</p>
+
+<p>In the thirteenth volume of the <i>British and Foreign Medico-Chirurgical
+Review</i>, we find, in a review of the control of prostitution, an
+estimate in regard to the syphilization of a nation. The estimates are
+made on the most conservative figures, as, in the desire of the reviewer
+not to overestimate, he starts by figuring out the actual number of
+prostitutes in England, Wales, and Scotland to be only 50,000, when they
+were estimated, by those who had carefully studied the subject, as being
+more than double that number; the conservative estimate is, however,
+suitable for our purpose; so that we cannot be accused of overestimating
+the results. The portion of the review to which we wish to call
+attention is as follows:&mdash;</p>
+
+<p>&ldquo;Though the result of the evidence contained in the first report
+of the commissioners on the constabulary force of England and Wales was
+that at that time about 2 per cent. of the prostitutes of London were
+suffering under some form of venereal disease, yet we will descend even
+lower, and presume that of one hundred healthy prostitutes, taken
+promiscuously from England and Scotland, if each submits to one
+indiscriminate sexual act in twenty-four hours, not more than one would
+become infected with syphilis, an estimate which is without doubt far
+too low; yet, if admitted to be correct, the necessary consequence will
+be, <i>that of the fifty thousand prostitutes five hundred are diseased
+within the aforesaid twenty-four hours</i>.</p>
+
+<p><span class='pagenum'><a name="Page_189" id="Page_189">[189]</a></span>
+&ldquo;If we next admit that a fifth of these five hundred diseased
+women are admitted to hospital on the day on which the disease appears,
+it follows <i>that there are every day on the streets four hundred
+diseased women</i>. Let it be supposed that the power of these four hundred
+to infect be limited to twelve days, and that of every six persons who,
+at the rate of one each night, have connection with these women, five
+become infected, it will follow <i>that there will be four thousand men
+infected every night, and consequently one million four hundred and
+sixty thousand in the year</i>. Further, as there are every night four
+hundred women diseased by these men, one hundred and eighty-two thousand
+five hundred <i>public prostitutes will be syphilized during the year;
+hence, one million six hundred and fifty-two thousand five hundred cases
+of syphilis in both sexes occur every twelve months</i>.</p>
+
+<p>&ldquo;If, then, the entire population had intercourse with prostitutes
+in an equal ratio, <i>the gross population of Great Britain, of all ages
+and sexes, would, during eighteen years, have been affected with primary
+syphilis</i>. Be it remembered, we do not assert that more than a million
+and a half of <i>persons</i> are attacked every year, but that that number of
+<i>cases</i> occurs annually in England, Wales, and Scotland, though the same
+individual may be attacked more than once. Although it is evident that
+all the estimates used for these calculations are (we know no other word
+that expresses it) ridiculously low, yet we find that more than a
+million and a half of cases of syphilis occur every year,&mdash;an amount
+which is probably not half the actual number. How enormous, then, must
+be the number of children born with secondary disease! How immense the
+mortality among them! How vast an amount of public <span class='pagenum'><a name="Page_190" id="Page_190">[190]</a></span>
+and private money expended on the cure of this disease!&rdquo;</p>
+
+<p>The same reviewer (P. S. Holland), in another article on the
+&ldquo;Control of Prostitution,&rdquo; observes that among the British
+troops syphilis is one of the most frequent of diseases, about one
+hundred and eighty cases occurring annually among every one thousand
+soldiers.</p>
+
+<p>The effect of syphilis in depopulating the islands of the Pacific has
+been pointed out in a former chapter; the nature and origin of the
+disease that takes them off is unmistakable. Scrofula and rapid phthisis
+are taking off the inhabitants at a rate that, in those islands most
+affected, the native population will soon become extinct. According to
+Lancereaux, in the Marquesas group the women do not live beyond the age
+of thirty to thirty-five years, three or four months being the duration
+of the disease. Ellis, in his &ldquo;Polynesian Researches,&rdquo;
+published in 1836, remarks that at that date the disease, as above
+described, had but recently appeared. In the nineteenth volume of the
+&ldquo;Archives de M&eacute;decine Navale,&rdquo; Rey mentions that at the
+Easter Island pulmonary phthisis is the dominant affection with the
+adults, and that scrofula is very prevalent with the children.<a name="FNanchor_75_75" id="FNanchor_75_75"></a><a href="#Footnote_75_75" class="fnanchor">[75]</a></p>
+
+<p>The effect of syphilization in inducing a scrofulous taint and the
+appearance of a rapidly-marching consumption among savage races has been
+well observed among the Indians in the southwestern parts of the United
+States, where the appearance of these fatal diseases can easily be
+traced to that as a cause. There is something peculiar about the
+Anglo-Saxon race that is fatal to the Indian; wherever they come in
+contact, the savage race begins physically and morally to crumble; the
+habits of the Anglo-Saxon in the matter of intemperance and his lust
+soon end the poor Indian; <span class='pagenum'><a name="Page_191" id="Page_191">[191]</a></span>
+while, on the other hand, the Latin races mix with them without any
+physical detriment to the Indian. In what was formerly the Northwest
+Territory the French and Indian intermarried, and syphilis did not begin
+to tell on the Indian until the Americans settled the country. From
+these observations it is very evident that in the Polynesian Archipelago
+syphilis must have been the precursor of the phthisis and scrofula, as
+we know it to have been that which induced those diseases among the
+Indians of the Mississippi or Missouri Valleys, or of the Colorado and
+Mojave Deserts, or in the mountains and valleys of Arizona.</p>
+
+<p>On the other hand, circumcised races, whose women have not carried a
+syphilitic taint into the race, are as a class free from any syphilitic
+taint. Neither their teeth, physiognomy, skin, nor general condition
+denote any syphilitic inheritance. This is true of the Jewish
+descendants of Abraham, who have more strictly adhered to the
+non-intercourse or marriage with other races, and whose women have
+abstained from vice; the Arabian descendants of Ishmael have, in a great
+measure, also retained their marked family individuality, except it be a
+few tribes, who, by contact with the soldiery of European nations, have
+had their women corrupted and syphilis introduced into the tribe through
+this channel.</p>
+
+<p>Richardson, in his &ldquo;Preventive Medicine,&rdquo; observing on the
+effects of syphilis in inducing deterioration of the organs of
+circulation and their degenerative changes, says that, in his opinion,
+syphilis is the progenitor of various diseases, and that those who give
+this opinion the greatest range are, unfortunately, nearest the truth.
+The breathing organs, he remarks, are distinctly susceptible to injury
+from this hereditary cause.</p>
+
+<p>In 1854, at the Metropolitan Free Hospital, situated <span class='pagenum'><a name="Page_192" id="Page_192">[192]</a></span>
+in the Jews&rsquo; quarter in London, Hutchinson observed that the
+proportion of Jews to Christians among the out-patients was as one to
+three; at the same time the proportion of cases of syphilis in the
+former to the latter was one to fifteen. Now, this result was not due to
+any extra morality on the part of the Jews, as fully one-half of the
+gonorrh&oelig;a cases occurred among those of that faith. J. Royes Bell
+also observes the less syphilization among circumcised races.<a name="FNanchor_76_76" id="FNanchor_76_76"></a><a href="#Footnote_76_76" class="fnanchor">[76]</a></p>
+
+<p>The absence of the prepuce and the non-absorbing character of the skin
+of the glans penis, made so by constant exposure, with the necessary and
+unavoidably less tendency that these conditions give to favor syphilitic
+inoculation, are not evidently without their resulting good effects. Now
+and then syphilitic primary sores are found on the glans, or even in the
+urethra or on the outside skin of the penis, or outer parts of the
+prepuce; but the majority are, as a rule, situated either back of the
+corona or on the reflected inner fold of the prepuce immediately
+adjoining the corona, or they may be in the loose folds in the
+neighborhood of the frenum, the retention of the virus seemingly being
+assisted by the topographical condition and relation of the parts, and
+its absorption facilitated by the thinness of the mucous membrane, as
+well as by the active circulation and moisture and heat of the parts. It
+must be evident that but for these favoring conditions the inoculation
+or infection would and could not be either as sure or as frequent. Any
+protecting mechanical aid that interferes with these favoring conditions
+grants an immunity to the individual, even when he is freely exposed;
+this protection has often been obtained by applying to the glans and
+penis a substantial coat of some tenacious oil like castor-oil, which
+was afterward gently washed off, first <span class='pagenum'><a name="Page_193" id="Page_193">[193]</a></span>
+in a shower of tepid water and afterward in a tepid bath of warm water
+and borax.</p>
+
+<p>Horner, formerly of the navy, in his interesting little work on
+&ldquo;Naval Practice,&rdquo;<a name="FNanchor_77_77" id="FNanchor_77_77"></a><a href="#Footnote_77_77" class="fnanchor">[77]</a> relates that it was customary, in the
+older navy of the United States, to allow public women to come on board
+at some of the ports and to go down to the men between decks, the
+Department of the Navy being probably actuated by the same humane
+principle that used to induce some of the West Indian cannibals to lend
+their wives to their prisoners of war who were intended, in the shape of
+roast or <i>fricandeau</i>, to grace the festive board, as it was deemed
+inhuman by these philanthropists to deprive a man of his necessary
+sexual intercourse, even if they were soon to roast him and pick his
+bones. They may, however, have been selfish in the matter, as by some
+authorities it is represented that this was done to improve the flavor
+of the prisoner, who was said to offer a more savory dish through this
+considerate treatment, the strong flavor that the semen gives to flesh
+being well eradicated by free fornication. Whether it was through these
+motives of humanitarianism, or the feeling that an American tar was the
+equal of the British tar, whose praises and equality Sir Joseph Porter,
+K.C.B., writes a song about in &ldquo;Pinafore,&rdquo; who had as much
+right to contract a left-handed marriage as any Prince of Wales or any
+other prince or crowned head of Europe, the women were, nevertheless,
+allowed to go down between decks in preference to giving the men
+indiscriminate liberty on shore, the government further providing for
+their welfare by causing the assistant surgeon to examine the women at
+the gangway or hatchway, to see that they were not diseased. Horner
+relates the ludicrous appearance presented by a near-sighted assistant
+<span class='pagenum'><a name="Page_194" id="Page_194">[194]</a></span>
+at one of the hatchways while making this professional examination,
+surrounded by the sailors and marines, who were greatly-interested
+spectators. Had the government provided a pot of castor-oil wherein the
+tar could dip his penile organ, as bridge piles are dipped into a
+creasoting mixture, these humiliations to our professional brother could
+have been avoided.</p>
+
+<p>In the conclusion to be reached, circumcision is not put forward as the
+only exempting element or preventive measure that deserves all the
+credit for the immunity that the Jews enjoy from syphilis, or to the
+absence of hereditary diseases that are secondary or due to the presence
+of that disease in the parents, as considerable credit is to be given to
+the well-known chastity of their females. This chastity is, in a great
+measure, due to the inseparable conditions of their religion,&mdash;moral and
+social fabrics which are welded into one. Their charity assumes the most
+practical form, so that it is not possible for one of their females to
+have to resort to a life of prostitution to save herself or her children
+from starvation, as, unfortunately, is too often the case in Christian
+communities, where religion is put on and off with Sunday clothes. The
+temperance and sobriety, as well as the economy and industry of the
+father, are not without a good moral as well as a hereditary effect on
+the daughters, who are neither rendered brutal nor demoralized through
+the example and instigation of drunken fathers. They have, therefore, a
+better average homelife, to which they cling and which protects them.
+The aid and benevolent associations of the Jews are among the most
+efficacious of charitable institutions, and no class gives more freely
+or generously for this purpose. The Home for Aged Hebrews in New York is
+an example of the character with which they dispense charity. We
+<span class='pagenum'><a name="Page_195" id="Page_195">[195]</a></span>
+need not, therefore, be <ins class='corr' title="Transcriber&rsquo;s
+Note: The original showed &lsquo;suprised&rsquo;.">surprised</ins> to find, in
+statistics of illegitimacy by religious denominations taken in Prussia,
+that the Jewish women are three times as chaste as the Catholics and
+more than four times as chaste as the Evangelists.<a name="FNanchor_78_78" id="FNanchor_78_78"></a><a href="#Footnote_78_78" class="fnanchor">[78]</a>
+The Jew has, therefore, two avenues of infection from syphilis cut
+off,&mdash;the lesser liability due to his circumcision and the chastity
+of the women.</p>
+
+<p>Richardson mentions the immunity of the Jewish race from tubercular
+disease, and notices the well-known relation existing between a
+syphilitic taint and a phthisical tendency. The comparative statistics
+offered by the Mohammedans, Jews, and Christians in regard to deaths
+from consumption have already been mentioned in a former chapter, they
+being as four Christians to one Jew, while the Mohammedan, from his
+greater abstemiousness and temperance to assist him, shows a still lower
+percentage than the Jew. There can be but little doubt that to this
+particular and well-marked less syphilization the Hebrew race owes much
+of its exemption from many other diseases and its greater resistance to
+ordinary ailments and epidemic diseases.</p>
+
+<p>The relative less frequency of syphilis among all circumcised people is
+noticed by Dr. Bernheim, in his brochure &ldquo;De la
+Circoncision,&rdquo; he being the surgeon of the Israelitish Consistory
+of Paris. His utterances on this subject are worthy of attention, he
+having not only paid particular attention to this, but having had
+unusual opportunities for the basis of his opinions. Dr. Bernheim looks
+upon coition as a frequent source of tubercular infection, and the
+sensitive and absorbing covering of the uncircumcised glans as a ready
+medium of transmission of the virus from one system to the other. He
+calls attention to the frequent granular condition <span class='pagenum'><a name="Page_196" id="Page_196">[196]</a></span>
+of the uterine os, in confirmed cases of tuberculosis, as something
+that is too much overlooked. This view of the case, from Dr.
+Bernheim&rsquo;s stand-point, is worthy of greater consideration than it
+has generally received at the hands of the profession.</p>
+
+<p>The great number of examples that have recently come to light in
+connection with the direct inoculability of tubercular consumption, both
+in the later works on phthisis and in the medical press, are not without
+interest or without a lesson. The case recorded within the past year of
+a healthy chambermaid, who was immediately inoculated with tubercular
+matter with rapidly-following constitutional effects through a scratch
+on the hand, received from the sharp edge of a broken china cuspidor
+that a consumptive was using, is one of these cases that are to the
+point; so it is evident that the uncircumcised need not always wait for
+the degeneration of syphilis into syphilitic phthisis or syphilitic
+scrofula to become a consumptive, but it is within the greatest range of
+possibility and probability that he may become at once a consumptive
+through an excoriation or abrasion received during coition with a
+tubercular woman. So many tubercular prostitutes ply their trade, or, to
+be more definite, so many prostitutes become tubercular, and in its
+different stages follow their occupation as the only means of keeping
+out of the poor-house, that man runs as much if not more risk, in
+consorting with the class, of contracting tuberculosis than that of
+contracting syphilis.</p>
+
+<p>There is something about syphilis that is not generally noticed; we are
+all well acquainted with the dire results that usually follow syphilitic
+infection, its course through every stage of suffering and misery, its
+transmission and effects in tubercular meningitis or in syphilitic
+<span class='pagenum'><a name="Page_197" id="Page_197">[197]</a></span>
+affections of the mesentery through heredity in children, and of the
+many horrible cases of destruction of tissue, in skin, mucous membrane,
+cartilage, or bone, with their attending mutilations and disfigurations;
+but there is no record of the great number of cases, and very few
+physicians of any extended practice but who can recall some such cases,
+where, after undoubted syphilitic infection, with the usual course of
+primary sores and secondary eruption, the patient has suddenly blossomed
+out into a state of robust health that his system was an entire stranger
+to before the infection. The writer has, in the course of a long
+practice, seen a number of such results follow both the infection
+attended with a miliary eruption and that followed by the large
+small-pox-appearing eruption, both kinds being preceded by the primary
+sore; and these results have been observed in cases of both what are
+called the soft and multiple and the hard or Hunterial initial sore.
+Some of these cases rapidly gained in flesh, with an evident increase in
+the redness of their blood, increasing in vigor and strength with a very
+perceptibly less tendency to attacks from accidental or previously
+subject-to diseases.</p>
+
+<p>The same result has been observed to follow an attack of small-pox with
+some individuals, and the writer well remembers a similar result
+following a very extraordinary event. The subject was a man well known
+among his old comrades of the First Minnesota Infantry as
+&ldquo;Duke,&rdquo; and to many of the older practitioners of Wabashaw
+County, of that State, as &ldquo;Old Duke.&rdquo; In early life he was
+sickly and weakly, never having fully recovered from a malarial fever
+contracted in the Mexican war. Coming to Minnesota, he adopted the life
+of a raftsman, with all the irregularities that <span class='pagenum'><a name="Page_198" id="Page_198">[198]</a></span>
+accompanied such a life. On one occasion, after a protracted spree,
+feeling the need of stimulation and not having the wherewith to procure
+it, he secured a jar in which a snake and several other reptiles were
+preserved in spirits, and drank the fluid contents. He was, some days
+afterward, taken violently ill with a high fever and racking pains,
+ending in an eruption of boils that covered him from head to foot; he
+made a slow and tedious recovery; but when recovered he seemed to have
+become imbued with a constitution resembling <i>lignum-vit&aelig;</i>, for a
+more stubborn-twisted constitution never existed than that of &ldquo;Old
+Duke.&rdquo; The power of resistance that this man developed was
+something wonderful. Dr. C. P. Adams, of Hastings, Minnesota, and the
+St. Paul physicians who were connected with the regiment well remember,
+though, wiry, precise, and soldierly &ldquo;Duke,&rdquo; who, even in
+the old Army of the Potomac, immersed up to his ears like the rest of
+the army in the mud and dirt of the encampment of Falmouth, above
+Fredericksburg, came out on general inspection as prim as if he had just
+stepped out of a bandbox, for which he received a medal for soldierly
+conduct and bearing.</p>
+
+<p>These apparent digressions are not made either to be tedious or to weary
+the reader, nor without an object. They are made to show that, whereas
+syphilis is looked upon as such a deadly disease, and it may be said to
+be the sole cause of fear to the assiduous worshiper at the shrine of
+Venus Porcina, there is another still more fatal danger awaiting him,
+ambushed in the folds of the vaginal mucous membrane, or coming along
+silently out of the cervical canal,&mdash;like the legions of Cyrus stealing
+along the dry bed of the Euphrates into ancient Babylon, to fall
+unawares on the feasting Nebuchadnezzar on that fatal night. So, in like
+manner, the <span class='pagenum'><a name="Page_199" id="Page_199">[199]</a></span>
+virus of tuberculosis, either extruding from a granular os or from its
+neighborhood, gradually moves down on the unsuspecting, uncircumcised,
+and easily inoculable-surfaced glans penis, to infect the system with a
+tubercular poison that has no such exceptions as those above noted, as
+at times are the followers of syphilis. It is not alone the individual
+himself that may be the sufferer from this poison, but his progeny for
+several generations may have to suffer for the infection thus received,
+just as much as they would were that infection to have been syphilitic.
+As before remarked, this has heretofore not sufficiently occupied the
+consideration of the profession, and, as it cannot certainly be denied
+that such a source of tubercular infection is both possible and
+probable, the subject is entitled to more serious and deliberate
+consideration than that which has heretofore been paid to it.</p>
+
+<p>Tuberculosis certainly has these two channels of entrance: either
+through direct infection or through an evolutionary process resulting
+from syphilis. The appearance and vital statistics offered by the French
+War Office in regard to the Algierine provinces, the report of the
+United States Census, the opinion of Dr. Billings deduced from the
+census reports, the opinions of Hutchinson, Richardson, Bernheim, and
+many other observers, as well as the personal but unrecorded
+observations of many practitioners, all tend to bear testimony to the
+remarkable difference that exists between circumcised and uncircumcised
+races in regard to the ravages of consumption. Is circumcision a factor
+in this difference, or is it not? If it is, then circumcision should
+receive more attention than it has; if it is not, then we should not be
+idle in hunting up the cause of difference, for an ounce of prevention
+is certainly worth in this regard a whole pound of Koch&rsquo;s lymph as
+a curative agent.</p>
+
+<hr /><p class='pagenum'><a name="Page_200" id="Page_200">[200]</a></p>
+<h2><a name="CHAPTER_XVII" id="CHAPTER_XVII"></a>CHAPTER XVII.<br />
+<span class='sc sf75'>Some Reasons for Being Circumcised.</span></h2>
+
+<p>The surgical and medical history of circumcision is intimately connected
+with the remotest ages, this being, in fact, the earliest surgical
+procedure of which we have any record. From the same records we obtain
+hints as to two conditions for which circumcision probably was
+suggested, either as a preventive or as a remedy.</p>
+
+<p>Jahn, in speaking of the people by whom the early Hebrews were
+surrounded, mentions their idolatrous practices, and that their peculiar
+forms of Pagan worship were accompanied by indulgence in fornication,
+lascivious songs, and unnatural lust. Others of their neighbors
+worshiped the &ldquo;<i>hairy he-goat</i>,&rdquo; with which they also
+practiced all manner of abominations. Sodomy, or pederasty, seemed a
+sort of religious ceremony with some of these heathen nations; from a
+religion it necessarily became a social practice; this, in connection
+with the phallic practices and worship, necessitated frequent exposure
+of the male member. The evil results, to say nothing of the disgusting
+and demoralizing tendency of these practices of the Pagan, were
+evidently well known to the Jews. The contrast between the physique and
+health of the pastoral habits, out-of-door life and simple diet of the
+Jews, and the necessary opposite condition of health and physique due to
+luxury and to these practices among their neighbors, could not have
+escaped their attention. How much onanism had to do with the
+establishment of circumcision may well be conjectured. Again, the other
+hint is in reference to procreation, <span class='pagenum'><a name="Page_201" id="Page_201">[201]</a></span>
+as some stress is laid to the connection between the conception of
+Sarah and the circumcision of Abraham. Here we have suggestions of a
+preventive to onanism, and a cure to male impotence when due to
+preputial interference.<a name="FNanchor_79_79" id="FNanchor_79_79"></a><a href="#Footnote_79_79" class="fnanchor">[79]</a></p>
+
+<p>Strange as it may seem, these two important results, due to
+circumcision, seem to have been lost sight of for some thousands of
+years, as even the able works of the physicians of the latter part of
+the last century have nothing to say connecting onanism and
+circumcision. Neither the works of Tissot on male onanism nor the
+pioneer work of Bienville on nymphomania speak of the presence of the
+prepuce in the male, or of the nymphar or clitorian prepuce in the
+female, as being causative of, or their removal curative of, either
+masturbation, satyriasis, or nymphomania; moral, hygienic, and internal
+medication being by both these authors considered to be all that our
+science could offer or do to alleviate or cure this unfortunate class.
+It is only of late years that circumcision, in its true relations to
+onanism, has received full consideration. In regard to its being a cure
+of impotence, its recognition has been of longer duration.</p>
+
+<p>It is related by Leonard, in his &ldquo;Memoires,&rdquo;&mdash;who, in his
+capacity of hair-dresser in ordinary to her Majesty, the unfortunate
+Marie-Antoinette, had ample opportunity for picking up all the domestic
+small talk of the royal family and their affairs,&mdash;that Louis XVI, in
+addition to all his troubles and the indignities which he suffered,
+besides finally being beheaded, was afflicted with a congenital phimosis
+which prevented the flow of semen from properly discharging itself. It
+appears that his Majesty was no little annoyed at not being able to
+procure an heir to his throne. His royal sister-in-law, <span class='pagenum'><a name="Page_202" id="Page_202">[202]</a></span>
+the Countess d&rsquo;Artois, had given birth to a prince, the Duke of
+Angouleme, who was the heir presumptive to the throne in case of the
+non-issue from Louis; another sister-in-law had been brought to bed with
+a royal princess, and here was the king himself without any prospective
+possibility of any heir. Like all kings, he was more or less
+unreasonable; so he blamed his first surgeon in ordinary for all these
+short-comings,&mdash;as if it were the duty of these court surgeons,
+among their many other tribulations, to furnish heirs to thrones. The
+surgeon finally informed his Majesty that if he wished to become a
+father it would be necessary for him to submit to the slight operation
+that was the subject of the church festival of the first day of January,
+namely, the Feast of the Circumcision. His most Christian Majesty
+entered a protest to this acknowledgment that there was anything in
+Judaism worth imitating. The surgeon insisted that the operation
+celebrated on the first of January would put him in a way to have the
+much-desired heir. The king finally waived all objections from any
+religious scruples, but could not be brought to look at the prospective
+operation with any sentiments of agreeable expectation.</p>
+
+<p>The king finally became good-natured, and a touch of that plebeian
+jollity which at times made him quite agreeable spread over his features
+as he imagined the ludicrousness of the spectacle that would be
+presented by a king of France in the hands of these handlers of the
+scalpel, treating him like an African savage. He took some days to
+consider the matter. On the next day he informed M. Louis, his first
+surgeon in ordinary, that he had decided on submitting to the operation,
+and the day and hour were fixed. The royal circumcision, however, never
+took place, as it is most likely that <span class='pagenum'><a name="Page_203" id="Page_203">[203]</a></span>
+in the privacy of his chamber his Majesty worked, like many a plebeian
+or man of low degree had done before him and has done since, to bring a
+refractory prepuce to terms. The king was somewhat of a mechanic, as his
+skill as a locksmith has passed into history; so that it is not unlikely
+that, with what little information he had on the subject, he managed to
+sufficiently dilate, by scarification and stretching, the preputial
+opening, as from the year 1778 the queen had three children.</p>
+
+<p>Cases of attempted self-circumcision are not rarities, as people have
+some inexplicable idea that a self-inflicted cut is not as painful as
+one that is done by others. The writer well remembers being called to
+assist one of these domestic surgeons who had undertaken to circumcise
+himself with his wife&rsquo;s great scissors. The man had a very long
+but thin and narrow prepuce that had always been an annoyance to him.
+The writer had circumcised two of his children for the same
+malformation, and the father, seeing the benefit to these two,
+determined to share in the general benefit; but at the same time he
+arranged to do it all by himself, and give the family and the surgeon a
+sample of his courage and a simultaneous surprise party. Securing the
+scissors, he wended his way unperceived into the recesses of his
+wood-shed. The mental and physical anguish the poor man underwent, and
+what soliloquies he must have addressed to the rafters of the wood-shed
+while making up his mind and screwing up his physical courage for the
+last fell act with the scissors, can hardly be described, as, in all
+probability, they were of the most rambling and inconsistent order. At
+any rate, he must have reached a climax in time and grasped the fated
+prepuce with a revengeful glee, and, with all his powers concentrated in
+his good right hand, he must have closed the remorseless <span class='pagenum'><a name="Page_204" id="Page_204">[204]</a></span>
+blades of the scissors on the unlucky prepuce. When the surgeon arrived
+at the scene of carnage, he was directed to the wood-shed, on the
+outskirts of which hovered the family, frantic with fear and
+apprehension; within, in the darkest corner, with wildly dilated eyes,
+and performing a fantastic <i>pas seul</i>, was a man with a huge pair of
+scissors dangling between his legs, warning all hands as they valued his
+life not to approach or lay a hand on him. He had shut the scissors down
+so that it clinched the thin prepuce, and there his courage and
+determination had forsaken him; he lost his presence of mind, and was
+not even able to take off the scissors; he had simply given one wild,
+blood-curdling yell&mdash;like the last winding notes from
+Roland&rsquo;s horn at Roncevalles&mdash;that had brought his family to
+the wood-shed-door, and they had then sent for a surgeon. New terrors
+here awaited the unlucky victim for self-circumcision. He dreaded lest
+the surgeon should accidentally have it enter his mind to finish the
+operation with the scissors, and in that case he would be helpless, as
+the surgeon would, undoubtedly, have a sure and tender hold of it. After
+executing a number of <i>pas &agrave; deux</i> on the Magilton step, while
+the surgeon endeavored to reassure him and gain his confidence,
+promising to remove the scissors without inflicting any further harm, he
+was finally allowed to approach, and, while the patient assumed a
+Taglioni attitude on one foot, the other leg being extended at right
+angles with the body and his hands clawing the air, the scissors was
+removed. The patient, through the aid of lead lotions and a week&rsquo;s
+rest, made a good recovery with a whole prepuce, chagrined at his
+failure, but happy to have escaped immediate pain.<a name="FNanchor_80_80" id="FNanchor_80_80"></a><a href="#Footnote_80_80" class="fnanchor">[80]</a></p>
+
+<p>There is not much doubt but that the operation could <span class='pagenum'><a name="Page_205" id="Page_205">[205]</a></span>
+have been suggested by its, at times, spontaneous performance, a case
+of which, by Cullerier, and some other additional cases have been
+mentioned in a former chapter. Cases occur at times, also, wherein the
+person having a previously normal and uninterfering prepuce has, through
+either herpetic inflammations or through impure connection, spurious
+gonorrh&oelig;a, or the use of some venereal-disease preventing-wash
+after connection, produced some irritation resulting in the abnormal
+thickening of the inner fold, or an interstitial deposit at the <ins
+class='corr' title="Transcriber&rsquo;s Note: The original showed
+&lsquo;function&rsquo;.">junction</ins> of the skin and mucous membrane, with
+consequent constriction, this deposit finally forming a hard, inelastic
+ring, which prevented a free exposure of the glans and interfered in
+sexual connection. In such cases,&mdash;like in stricture of the
+meatus,&mdash;any mechanical interference short of cutting with a knife
+only aggravates the existing difficulty, and it is not uncommon to have
+such cases apply for assistance after they have in vain tried to dilate
+the constricting preputial orifice. In the early writings of the Greeks,
+it is mentioned that among the Egyptians circumcision exempted them from
+a certain form of disease that affected the penis. Philon mentions
+particularly the immunity that the operation conferred against a species
+of affection which Michel Levy asserts to have been a gangrenous
+disease. So that, outside of any religious significance, there is no
+doubt that, in individual cases, circumcision has more than once been
+suggested, although it cannot be said that such individual cases would
+ever, or could, lead to its becoming a national or racial, much less a
+sectarian, rite.</p>
+
+<hr /><p class='pagenum'><a name="Page_206" id="Page_206">[206]</a></p>
+<h2><a name="CHAPTER_XVIII" id="CHAPTER_XVIII"></a>CHAPTER XVIII.<br />
+<span class='sc sf75'>The Prepuce as an Outlaw, and its Effects on the Glans.</span></h2>
+
+<p>Ricord has well termed this appendage to civilized man &ldquo;a useless
+bit of flesh.&rdquo; Times were, however, when&mdash;man living in a wild
+state, and when in imitation of some of our near relatives with tails
+and hairy bodies; when he still found locomotion on all-fours handier
+than on his two feet; when in pursuit of either the juicy grasshopper or
+other small game, or of the female of his own species to gratify his
+lust, or in the frantic rush to escape the clutches, fangs, or claws of
+a pursuing enemy, he was obliged to fly and leap over thorny briars and
+bramble-bushes or hornets&rsquo; nests, or plunge through swamps alive
+with blood-sucking insects and leeches&mdash;Ricord&rsquo;s definition would
+certainly have been inapplicable. In those days, but for the protecting
+double fold of the preputial envelope that protected it from the thorns
+and cutting grasses, the coarse bark of trees, or the stings and bites
+of insects, the glans penis of primitive man would have often looked
+like the head of the proverbially duel-disfigured German university
+student, or the Bacchus-worshiping nose of a jolly British Boniface. So
+that in those days, unless primitive man was intended to have an organ
+that resembled a battle-scarred Roman legionary, a prepuce was an
+absolute necessity.</p>
+
+<p>With improvement in man&rsquo;s condition and his gradual evolution into
+a higher sphere, the assumption of the erect posture, and the great
+stride in civilization that <ins class='corr' title="Transcriber&rsquo;s
+Note: The original showed &lsquo;orginated&rsquo;.">originated</ins> the
+invention of the manufacture of the <span class='pagenum'><a name="Page_207" id="Page_207">[207]</a></span>
+perineal band, which not only protected the glans in its thorny passage
+through life, but also acted like a protecting &aelig;gis to the scrotum
+and its contents, the prepuce became a superfluity; not only a
+superfluity, but, now that its natural office had been replaced by the
+perineal cloth, it actually began to be a nuisance, as its former free
+contact with the air had retained it in a state of vigorous and
+disease-resisting health which was now fast departing. As Montesquieu
+observes, in the causes that led to the decline and fall of the Roman
+Empire, those seasons of trials, tribulations, and struggle for
+existence are those of health and progress and healthy life, and the
+periods of luxury and idleness are those of degeneracy and decay. So
+with the prepuce, the luxury and idleness, voluptuousness and consequent
+feasting incident to its being supplanted in its original functions by
+the perineal cloth, which left it thenceforth unemployed, led it in the
+pathway of disease and death. This first innovation in civilization was
+to the prepuce the beginning of its decay and fall. Like Belshazzar in
+his great banquet-hall in ancient Babylon, the prepuce might have read
+the hand-writing on the wall, &ldquo;<i>Mene, Mene, Tekel,
+Upharsin</i>,&rdquo; and foreseen the gory end that awaited it. Like to
+other human affairs, however, even in his fallen estate a kind word can
+be said for the prepuce. Puzey, of Liverpool, has found it of extreme
+value, and even unequaled by any other part of the body, for furnishing
+skin-grafts,<a name="FNanchor_81_81" id="FNanchor_81_81"></a><a href="#Footnote_81_81" class="fnanchor">[81]</a>
+these grafts showing a vitality that is simply phenomenal, considering
+the laxity of its tissues and its seemingly adipose character. There is
+no doubt, however, that for skin-transplanting there is nothing superior
+to the plants offered by the prepuce of a boy, and where any large
+surface is to be covered this should undoubtedly be chosen, as offering
+<span class='pagenum'><a name="Page_208" id="Page_208">[208]</a></span>
+the greatest and quickest success and the least chances of failure.
+This is really the only disadvantage that can be charged against
+circumcision, as in a strictly circumcised community they would be
+debarred from this great advantage. An uncircumcised individual could be
+procured, however, to supply the deficiency. It is related that in the
+latter part of 1890, a Knight Templar, in Cincinnati, required a great
+supply of grafts or skin-plants to cover a largely-denuded surface, and
+that the whole of his Commandery chivalrously and generously supplied
+the needed skin-plants in a body. A few healthy prepuces would have been
+more efficacious. In advising the use of the prepuce for these purposes
+it must not be overlooked that in case of a white man it would not do to
+use skin of any other color besides his own. We have no data to base any
+assertion as to the relative action of skin-grafts taken from Mongolians
+or Indians, but we have very reliable data in relation to the
+proliferating action of those of the negro,<a name="FNanchor_82_82" id="FNanchor_82_82"></a><a href="#Footnote_82_82" class="fnanchor">[82]</a>
+which induces a growth of epidermis of its own kind; so that preputial
+grafts from the negro, combining the extra vitality and proliferation of
+the preputial tissue with the strong animal vitality of the negro, if
+applied to a white man, might not produce the most desirable cosmetic
+effects, especially if on one side of the countenance.</p>
+
+<p>But, taken as a whole, when considered in its relation to onanism,
+nocturnal enuresis, preputial calculus, syphilis, cancer, and a lot of
+nervous and other ailments, or induced abnormal physical conditions, we
+can really conclude that the days of the prepuce are past and gone, that
+it has outlived its usefulness, and that those whom a religious or civil
+ordinance or custom happily makes them rid of it are people to be
+greatly envied. As<span class='pagenum'><a name="Page_209" id="Page_209">[209]</a></span>
+Sancho Panza remarked, &ldquo;God bless the man who invented
+sleep,&rdquo; so we may well join in blessing the inventor of
+circumcision, as an event that has saved some parts of the human family
+from much ill and suffering.</p>
+
+<p>Phimosis is an ancient attendant on our inheritance of the prepuce, we
+being, in fact, born with it; this is the rule. There are, however,
+exceptions to this rule, which, singularly enough, are found to be
+hereditary. The writer has met with a number of such instances, and they
+have always been found to have been family traits. Within the past year,
+after attending a confinement, his attention was called to the child by
+the nurse, who thought that the child was deformed; the nurse,
+singularly enough, never having seen a natural-looking glans penis in
+all her life, was astonished at the size and appearance of the member.
+On examination, the organ showed a complete absence of prepuce. On
+inquiry, the father and another son, born more than twenty years
+previously,&mdash;this comprising every male member of the family,&mdash;were
+found to have been thus born, with the glans fully exposed. The family
+is now residing in San Diego, and is naturally one of more than superior
+physical health and intelligence. I saw another family similarly
+affected in the north of France, and of individual cases, without
+knowing the history of the rest of the family, I have seen a large
+number. As the prepuce can be observed in every stage of disappearance
+among mixed races, it would seem that in time it would disappear
+altogether. Its effectual absence in so many cases evidently belongs to
+some evolutionary process, and shows beyond question that nature does
+not insist on its presence either as a necessity or as an ornament.</p>
+
+<p>The word or term &ldquo;phimosis&rdquo; is derived from two Greek roots,
+signifying &ldquo;string&rdquo; and &ldquo;to tighten,&rdquo; or<span class='pagenum'><a name="Page_210" id="Page_210">[210]</a></span>
+&ldquo;to tie with a string.&rdquo; Galen, from its signification,
+accepted the word, and from him it has been transmitted through the
+different epochs of medicine down to our own times. In virtue of its
+etymological significance, it was formerly applied to any stenosis or
+closure of duct or aperture, but at present the term is used simply to
+denote that constriction that affects the prepuce, and which prevents
+the glans from being passed through the preputial orifice. Phimosis is
+said to be congenital or natural and acquired. The first of these is the
+common lot of all, as a rule, and with some it remains so throughout
+life. As babyhood advances in boyhood and boyhood into youth, the
+prepuce gradually becomes lax and distensible, and in proportion to the
+existence of these conditions it also loses in its length. Where,
+however, the distal end persists in its constricted condition it is
+drawn forward as the penis increases in bulk.</p>
+
+<p>In many cases its tightness prevents the escape of the sebaceous matter
+that collects in the sulcus back of the corona, and the resulting
+irritation on the surface of the glans and the inner mucous fold of the
+prepuce ends in an inflammatory thickening of the latter, its inner
+surface becoming thick, undilatable, hard, and unyielding, all the
+natural elasticity that should be present having departed, with more or
+less inflammatory thickening and adhesions between the two layers of
+skin that form the prepuce. In this unyielding tube the glans is
+imprisoned and compressed, often suffering the tortures that the
+&ldquo;maiden&rdquo; of the dungeons of the Inquisition inflicted on the
+unhappy heretics. It becomes elongated, cyanosed, and hyper&aelig;sthetic; the
+meatus of the urethra is congested and hypertrophied, the corona is
+undeveloped and often absent, the glans having, on the whole, the
+long-nosed, conical appearance of the head <span class='pagenum'><a name="Page_211" id="Page_211">[211]</a></span>
+of a field-mouse. There are hardly five per cent. of the uncircumcised
+but who suffer in some degree from this constricting result of the
+prepuce, to a greater or less extent.</p>
+
+<p>On the other hand, the unconstricted glans penis assumes the shape and
+appearance that is seen in the circumcised. The head is shorter, the
+face flat and abrupt, and the meatus, instead of being at the end of a
+conical point, is situated on the smooth, rounded front of the glans,
+and does not differ in color from the covering of the glans itself. From
+the superior commissure of the meatus to the sulcus in the rear of the
+corona its topographical outline may be said to describe two opposite
+segments of a circle, as seen in the cuts representing the glans in its
+natural shape. The corona is prominent and well developed.</p>
+
+<p>The opponents of circumcision base much of their opposition to the fact
+that circumcision interferes with the natural condition of the parts.
+The question may well be asked, which of these two shaped glans is the
+natural product as nature intended it should be? It is a well-known fact
+that the most forlorn and mouse-headed, long-nosed glans penis will,
+within a week or two after its liberation from its fetters of preputial
+bands, assume its true shape. We may naturally inquire if nature made
+the glans of a certain shape, which seems to be the proper shape for
+copulative purposes, only to have the condition most effectually
+abolished by a constricting, unnatural band? How much the shape of this
+glans, from meatus to corona, may have to do with retaining the urethra
+to a healthy and normal calibre and condition has not been inquired
+into, but, as far as the writer has observed, a normal glans seems to
+have less abnormalities of the urethra, and in treating such <span class='pagenum'><a name="Page_212" id="Page_212">[212]</a></span>
+cases he has always found that when the urethra of one of these
+normal-glans subjects was affected it was far easier to manage; on the
+other hand, secondary and even a tertiary recurrence to an operation is
+often the fate of a long, narrow, conical-pointed penis.</p>
+
+<p>Phimosis is known to have been a cause of male impotence by its direct
+interference with the outward flow of the seminal fluid; but, although
+we have cases where impregnation has taken place by the aid of a warm
+spoon and a warm syringe, as in the case related in a former chapter, it
+must be admitted that the corona is not without some functional office
+in the act of procreation. Its shape indicates a valve action like that
+of the valve in a syringe-piston, and if we examine the two extremes of
+these conditions of glans&mdash;one devoid of corona, as many are, and the
+other with the corona in its most pronounced form, when in a state of
+erection&mdash;the difference, either in the appearance of the two organs or
+in the different philosophical action and results that must necessarily
+follow the use of these two differently shaped glans, will at once be
+apparent. Unfortunately&mdash;or, as many may consider it, most
+fortunate&mdash;the female organs are not always so shaped as to be in
+themselves wholly favorable to impregnation. The wearing of corsets, the
+habitual constipation of females, the relaxed and unnatural condition of
+the uterine ligaments and vagina in civilized women, all favor uterine
+displacement, with any or all forms of uterine ailments. To this we may
+add the effect of repeated miscarriages, application of astringent
+washes, irregular menstruation, etc., all of which conditions often
+result in an elongation of the neck, constriction of the cervical canal,
+with the external os placed on the depended point of the sharply pointed
+cervix, which is liable to point in any direction. Just <span class='pagenum'><a name="Page_213" id="Page_213">[213]</a></span>
+imagine one of these conditioned females and one of the mouse-headed,
+corona-deficient, long-pointed glans males in the act of copulation! The
+conical penis finds its way in the reflected fold of the vagina, while
+the point of the uterus may be two or three inches in some other
+direction, making impregnation wholly impossible; besides, in the
+normal-shaped penis, the corona acting as a valve, behind which the
+circular muscular fibres of the vagina close themselves, tends to retain
+the seminal fluid in front, while the very shape of the organ assists in
+straightening out the vaginal canal and to bring the uterus in proper
+position. In the long, thin, narrow and pointed glans, devoid of corona,
+there is no mechanical means to retain the seminal discharge. Some years
+ago some one introduced the idea of postural copulation, to be tried in
+cases of sterility, and it has been found that impregnation would take
+place in some cases where it had formerly appeared impossible, this
+position having the effect of righting malpositions during the act,
+which were the cause of the sterility; but it stands to reason that,
+where the shape of the organ is such that it further favors
+malpositions, as well as where it offers no obstacle to the vagina
+immediately expressing or dropping out all the seminal fluid,
+impregnation is more difficult, and that, where the uterine deformity is
+coincident with this condition of penis to assist, it becomes well nigh
+impossible. Foder&egrave; mentions a penis about the size of a
+porcupine-quill on an adult male, and Hammond mentions one of the size
+of a lead-pencil in diameter and two inches in length. From total
+absence of the penis, either through disease or accident, to the
+diminutive organs mentioned by Foder&egrave; and Hammond, and on up to
+the full-sized and normal-shaped organ, we have every degree of sizes
+and shapes, and with these <span class='pagenum'><a name="Page_214" id="Page_214">[214]</a></span>
+go every conceivable degree of ability or faculty for impregnation.</p>
+
+<p>Aside from the foregoing considerations, there are others equally
+important. Although Greece was involved for years in war and ancient
+Troy was destroyed and all its inhabitants slaughtered because of the
+seduction of one woman; and Semiramis, through her beauty, got all her
+successive husbands in chancery; and poor, susceptible Samson, from
+firing Philistine vineyards and killing lions bare-handed, and the
+Philistines by the thousands with the jaw-bone of an ass, was reduced
+through Delilah to bitter repentance and turning Philistine mill-stones;
+and we know that the familiar infatuation of Antony for Cleopatra ruined
+Antony; and we are familiar with the well-known maxim of the French
+police-minister, that to catch a criminal it was but necessary to first
+locate <i>the woman</i> and the man would soon be found,&mdash;society has
+determined to ignore the influence of the animal passions as factors in
+our every-day life, or factors in the estrangements, coldness, and the
+bickerings that end in divorces. Not to shock the reader with detailed
+accounts as to what an important factor the shape of the penis may be in
+the domestic economy, I will refer the reader to Brantome&rsquo;s works.</p>
+
+<p>Although the councils of the older church were not above giving these
+conditions their calm and deliberate consideration, which resulted in
+the foundation of the present physical considerations in relation to
+divorce laws, such studies or considerations are at present only touched
+upon gingerly and with apologies for doing so, as if the &ldquo;study of
+man&rdquo; was of any less importance to-day from what it was in the
+days of Moses, the elder church, or when Pope formulated his oft-quoted
+but little-followed maxim, that &ldquo;the proper study of mankind <span class='pagenum'><a name="Page_215" id="Page_215">[215]</a></span>
+is man.&rdquo; The present miscalled &ldquo;delicacy of
+sentiment&rdquo; is about as misplaced a condition of disastrous and
+misleading morality as was the out-of-place and untimely bravery of poor
+old Braddock when refusing Washington&rsquo;s advice at the Monongahela.
+The success and beauty of the Mosaic law is its squarely facing the
+conditions of actual life, and its absence from nonsense or nauseating
+sentimentality. Were our present churches to observe more of this plain
+talk, for which the good old Anglo-Saxon is as fully expressive and
+convincing as the old Hebrew, and deal less in rhetorical flourishes and
+figurative mean-nothings to tickle the ears of our modern Pharisees,
+mankind as well as womankind would be infinitely so much the better off,
+mentally, morally, and physically, and there would be less of the
+conflict between science and religion. Luther&rsquo;s dream of restoring
+religion to its primitive purity has come to but as poor realization at
+the hands of his so-called followers, which leads one to think that if
+the martyrs of the Reformation could come back and see the fruits of
+their martyrdom&mdash;suffered that pure religion might live&mdash;they
+would conclude that, for all the resulting good accomplished, they might
+as well have kept a whole skin and a whole set of bones.</p>
+
+<p>In cases of pronounced phimosis the aperture in the prepuce may not be
+in a line with the meatus, and the resulting discharge of urine or the
+ejaculations of seminal fluid may from this cause be unable to find an
+egress. The fluid escaping from the urethra will, in case the opening is
+at the side or upper part of the prepuce, cause it to balloon out until
+a sufficient quantity is thrown out so as to distend, the opening as
+well as the prepuce, before it can find its way out; in such cases
+impotency is liable to be as complete as in those cases <span class='pagenum'><a name="Page_216" id="Page_216">[216]</a></span>
+of stricture wherein the seminal fluid is forced backward into the
+bladder. Having given this general view of the effects of phimosis as it
+may affect man in the shape of his organ, which may have a serious
+result in his domestic relations or in becoming a father, we will
+proceed to the consideration of diseases and conditions that phimosis
+encourages and to which it renders man more liable. In the consideration
+of these cases it must not be forgotten that the sexual relations are
+much more to man or woman than is generally acknowledged. The days for
+the establishment of the Utopian republic of Plato are not yet with us.
+That Platonic love does exist is true, as it has in the past and will in
+the future. Scipio, refusing to accept the beautiful betrothed bride of
+an enemy as a present, or Joseph leaving his coat-tail in the hands of
+the amorous bride of the eunuch Potiphar, with the suicide of Lucretia,
+in the past, are events which virtue and modern continence probably
+duplicate every day; but these are exceptions to the rule. Physicians
+daily see evidences of the most devoted Platonic affection in either
+sex, but they also see enough of the opposite side of the question to
+convince them that in the majority of cases the sexual relations are the
+bond of union, as well as the mainspring of love. As observed by
+Montesquieu, the bride of a first-class Turkish eunuch has but a sorry
+time, and a woman of the same calibre of mind as that possessed by the
+ordinary Circassian or Armenian bride cannot be in a much happier
+condition with a husband partly eunuchised by a constricted prepuce.</p>
+
+<hr /><p class='pagenum'><a name="Page_217" id="Page_217">[217]</a></p>
+<h2><a name="CHAPTER_XIX" id="CHAPTER_XIX"></a>CHAPTER XIX.<br />
+<span class='sc sf75'>Is the Prepuce a Natural Physiological Appendage?</span></h2>
+
+<p>By many surgeons the idea of circumcision, unless connected with an
+immediate demand for interference,&mdash;such as a phimosis unmanageable by
+any other means, an induced phimosis from gonorrh&oelig;a or other
+irritation, syphilis in its initiatory sore, cancer or some such
+cause,&mdash;is looked upon as an unwarrantable operation, a procedure not
+only barbarous, painful, and dangerous, but one that directly interferes
+with the intentions of nature. The prepuce is by many looked upon as a
+physiological necessity to health and the enjoyment of life, which, if
+removed, is liable to induce masturbation, excessive venereal desire,
+and a train of other evils. The question then resolves itself, What is
+the real physiological status of this appendage, if it has any, and, if
+it is a physiological appendage, when does it merge into a pathological
+appendage? As by some it is held that the prepuce enjoys the same right
+to live and exist as the nose, ear, or a limb, which are only subject to
+amputation in case of a serious disease, they should be reminded that
+they are not taking into consideration that the nose and ear are
+calculated to warn us of danger, and that our legs are very useful; as
+even the great orator Demosthenes, by the timely and rapid use of his
+legs, was enabled to escape from a battle, where his oratory was of no
+avail against the illiterate javelins of the unscholarly Macedonians. If
+the prepuce only was endowed with an olfactory sense,&mdash;as, for instance,
+if a nervous filament from the first pair of nerves had <span class='pagenum'><a name="Page_218" id="Page_218">[218]</a></span>
+been sent down alongside of the pneumogastric and then, by following
+the track of the mammary and epigastric arteries, had at last reached
+the prepuce, where the olfactory sense could have been turned on at
+will, like an incandescent lamp,&mdash;it might have been a very useful
+organ, as in that sense it could have scented danger from afar, if not
+from near, and enabled man to avoid any of the many dangers into which
+he unconsciously drops. But, seeing that the prepuce, to say nothing of
+being neither nose, eye, nor ear to warn one away from danger, or a leg
+to run away on after once in it, having not even the precautionary
+sensitiveness of a cat&rsquo;s moustachios, it cannot, in any way that
+we can see, be compared to any other useful part of the body.</p>
+
+<p>All attempts to find reasons for its existence that are of real benefit
+to man have so far proved unsatisfactory, and, unlike the reasons for
+its removal, are, as a rule, founded on speculation. To further reason
+out the why and wherefore of its existence or of its summary surgical
+execution, we must consider its shifting positions as to the effects it
+produces, as well as to its conditions at different ages, sitting on its
+case like an impartial jury in the case of some unconvicted but
+diabolically-inclined criminal.</p>
+
+<p>As before remarked, we are, as a rule, born with this appendage, just as
+much as we are with the appendix vermiformis, which rises up, like
+Banquo&rsquo;s ghost, whenever we eat tomatoes or any small-seeded
+fruit. This prepuce is then long, and the penis is found at the end of
+an undilatable canal, which is formed by the constricted prepuce; at
+this early stage of our existence it is often additionally bound down to
+the glans by a greater or less number of adhesions. We are then in what
+many term a state of physiological phimosis, that <span class='pagenum'><a name="Page_219" id="Page_219">[219]</a></span>
+being a perfectly natural condition, and one consistent with health; at
+least, we imagine it is normal.</p>
+
+<p>Phimosis in childhood is generally considered a physiological state,
+only to be taken as a pathological condition under certain
+circumstances. Preputial adhesions may, according to many observers,
+also be classed as physiological at an early period of life, as it is by
+them considered as congenital, and common enough to warrant its being
+classed as normal. As to the first, or phimosis, it undoubtedly is a
+physiological condition during infancy; but why, we do not know; and it
+is also a fact that from birth to puberty it remains so in fully over
+one-half of the cases. Out of 98 children, from one week to sixteen
+years of age, examined by Dr. Packard, the prepuce was entirely
+unretractable in 54, partly so in 3, and wholly so in 36; while in 1 it
+only half-covered the glans and in 4 the glans was wholly uncovered, 1
+of these 4 being an infant only five weeks old.</p>
+
+<p>Dr. Packard also gives the result of 172 examinations by himself, of
+from twelve to seventy-three years of age, and 106 examinations by Dr.
+Maury, a total of 278, in whom 100 had a long prepuce, 97 a
+partly-covered glans, and 81 (of whom 2 had been circumcised) in whom
+the glans was exposed.<a name="FNanchor_83_83" id="FNanchor_83_83"></a><a href="#Footnote_83_83" class="fnanchor">[83]</a>
+As to adhesions, there is an unaccountable diversity of opinion as to
+their constancy as a natural condition, being frequent enough to class
+them as physiological occurrences. Dr. A. B. Arnold, of Baltimore,
+states that his experience in reference to preputial adhesions leads him
+to conclude that the frequency of its occurrence has been much
+overstated. In the number of children that he has circumcised, which
+exceeds 1000, he has met with it in less than four per cent. of the
+cases. He also mentions that in the adult the adhesions show greater
+firmness.<a name="FNanchor_84_84" id="FNanchor_84_84"></a><a href="#Footnote_84_84" class="fnanchor">[84]</a></p>
+
+<p><span class='pagenum'><a name="Page_220" id="Page_220">[220]</a></span>
+On the other hand, Dr. Bernheim, of the Paris Israelitish Consistory,
+observes that, of over 3000 newborn whom he has examined, with but few
+exceptions he found the presence of preputial adhesions. He remarks,
+however, that in the majority these are detached or broken by the first
+attempt at erection.<a name="FNanchor_85_85" id="FNanchor_85_85"></a><a href="#Footnote_85_85" class="fnanchor">[85]</a></p>
+
+<p>Bokai, out of 100 children, found 8 who were over seven years of age,
+who were perfectly free; while of the remaining 92 under that age 6 more
+showed no adhesions and 86 had various degrees of adhesions.<a name="FNanchor_86_86" id="FNanchor_86_86"></a><a href="#Footnote_86_86" class="fnanchor">[86]</a></p>
+
+<p>Dr. Holgate, of the out-door department of Bellevue, considered that all
+phimosic cases have adhesions; while Dr. Moses, of New York, out of some
+fifty circumcisions performed at the eighth day, found only adhesions
+three times.<a name="FNanchor_87_87" id="FNanchor_87_87"></a><a href="#Footnote_87_87" class="fnanchor">[87]</a></p>
+
+<p>These observations are, however, in perfect accord. If we connect the
+statement of Dr. Arnold, in regard to the increasing character of the
+firmness in the adhesions of the adult, with the statement of Dr.
+Bernheim, that the first erection is often sufficient to break up the
+existing adhesions in the infant, we must conclude that they are nothing
+more at first than a slight agglutination, which the slight manipulation
+required to properly locate the position of the glans, and to space out
+the prepuce preparatory to the operation of circumcision, must, in the
+majority of cases, be sufficient to liberate the prepuce from the glans;
+this is evident also from the statement of Dr. Moses, who only found six
+per cent. of the cases operated upon by him as being so affected.</p>
+
+<p>The writer has been present at a large number of Hebrew circumcisions
+performed on the eighth day, and from that up to the sixth month (as in
+many communities they wait until a number of children are collected,
+<span class='pagenum'><a name="Page_221" id="Page_221">[221]</a></span>
+so to speak, before sending for the mohel, who may reside at quite a
+distance), and in all of those witnessed he has never seen any
+complications from adhesions; but cases of adhesion have been often
+encountered from the second to the eighth year, and it has always been
+the case, as a rule, that the older the child the greater the firmness
+of the adhesion. In these cases the practice generally advised of using
+a probe is not practicable, as the person is more apt to wound the sound
+prepuce than to tear the adhesions; the practice most effectual is to
+hold the glans firmly but gently with the thumb and forefinger of the
+right hand, and then to draw the prepuce as firmly back with its fold
+held in the forefinger and thumb of the other. It is a more expeditious
+mode, and the least painful; by this method extensive adhesions can
+readily be broken up; vaselin and a piece of fine lint should then be
+interposed for a couple of days to prevent a re-adherence.</p>
+
+<p>Another co-existing condition with phimosis, very often found, is a
+shortening of the frenum. Dr. Jansen, out of 3700 soldiers of the
+Belgian army, found 12.3 per cent. with this pathological condition and
+2.5 per cent. with a narrow prepuce.<a name="FNanchor_88_88" id="FNanchor_88_88"></a><a href="#Footnote_88_88" class="fnanchor">[88]</a></p>
+
+<p>Take the three conditions above enumerated,&mdash;phimosis, preputial
+adhesions, and short frenum,&mdash;all are but a departure from a normal, in
+a greater or less degree; and whether the resulting discomfort consists
+in mere mechanical impediment to urination, erection, or as a factor in
+nocturnal enuresis, dysuria, impotence, either through reflex action or
+interference with emission, malposition of the urethral orifice during
+copulation owing to any of these conditions, or in any of the nervous
+derangements that may accompany this condition, or in the more serious
+results, ending in positive deformity <span class='pagenum'><a name="Page_222" id="Page_222">[222]</a></span>
+of body or limb, or in the warping of moral sentiments, or, even
+further, in inducing insanity, it cannot well be seen how the conditions
+that will certainly produce these results, in a more or less degree, can
+ever, in any logical sense, be considered a physiological condition.</p>
+
+<p>There are certain conditions to life, up to the time of birth, which,
+unless they then cease at once to exist, immediately become from a
+physiological into very serious pathological conditions. These are well
+understood, and have their reasons for existing during our pre-natal
+existence; but the prepuce has no known function during uterine life or
+subsequently; and there being no valid reason for its existence, there
+are certainly no logical grounds for its being considered a
+physiological condition, especially when the serious results attending
+the most accentuated form of the above three conditions are considered,
+and as its necessity, in cases of its entire absence, has not yet been
+demonstrated.</p>
+
+<p>It can well be said that about two-thirds of mankind are affected in a
+greater or less degree with these pathological conditions, causing them
+more or less annoyance. Of these, a certain percentage suffer a life of
+continued misery, as a direct or indirect result of these conditions.</p>
+
+<p>As to the actual necessity of a prepuce existing, or as to what
+annoyances or diseases persons are subjected to who are born without it,
+there is a most singular and expressive silence in medical literature.
+It stands to reason that, if it is a necessity, some one person should
+have found it out long ago, and there should then be some evidence to
+present in relation thereto. There are cases reported in some of the
+older surgeries wherein an attempt has been made, in the absence of a
+prepuce, to restore or manufacture one by means of a plastic <span class='pagenum'><a name="Page_223" id="Page_223">[223]</a></span>
+operation. Vidal describes such an operation,<a name="FNanchor_89_89" id="FNanchor_89_89"></a><a href="#Footnote_89_89" class="fnanchor">[89]</a>
+but there is no reason given as to why the operation was undertaken;
+there is no record of any diseased condition which it was intended
+either to cure or to alleviate; so that we are left to infer that the
+person simply submitted to the operation from purely cosmetic reasons.
+The Hebrews of Palestine, after the Roman conquest, or those in Italy or
+Spain, attempted a like operation, but not from any reason of lessened
+health or to restore any lacking physiological action, their aim having
+simply been to hide their identity, for the purpose of escaping
+persecutions, exactions, or annoyances, either from their rulers or
+their fellow-citizens.</p>
+
+<p>Dr. A. B. Arnold, in a paper on circumcision, read before the Academy of
+Medicine of Baltimore, argues that it is not difficult to divine the
+purposes of the prepuce, holding that it is necessary to protect the
+tactile sensibility of the glans, due to the presence of the Pacinian
+bodies which Schweigger Seidel discovered in the nerves, and that a
+better provision than the anatomy of the prepuce cannot be conceived for
+shielding the very vascular and sensitive structure of the glans from
+external sources of irritation and friction, that might rouse the
+sensibility of this organ, which, on physiological grounds, may cause
+early masturbation; further arguing that, the corona being undoubtedly
+the most excitable part of the glans, its denudation by circumcision
+leaves it more apt to be affected by chance titillations.<a name="FNanchor_90_90" id="FNanchor_90_90"></a><a href="#Footnote_90_90" class="fnanchor">[90]</a>
+In this latter view of the case the preponderance of views is, however,
+in the opposite direction. J. Royes Bell states that, owing to the
+induration of the glans through the means of circumcision, masturbation
+and syphilis are less rife amongst the circumcised than amongst the
+uncircumcised.<a name="FNanchor_91_91" id="FNanchor_91_91"></a><a href="#Footnote_91_91" class="fnanchor">[91]</a>
+M. Lallemand, whose <span class='pagenum'><a name="Page_224" id="Page_224">[224]</a></span>
+experience in the treatment of seminal emissions is of the greatest
+value, looked upon circumcision as one of the means of curing those
+diseases, looking on the diminished irritability of the glans resulting
+from the operation as the curative element.<a name="FNanchor_92_92" id="FNanchor_92_92"></a><a href="#Footnote_92_92" class="fnanchor">[92]</a>
+Dr. Cahen, in a &ldquo;Dissertation sur la Circoncision,&rdquo; in 1816,
+before the Faculty of Medicine of Paris, called the attention to the
+diminished sensibility of the glans induced by circumcision. Dr. Vanier,
+of Havre, looks upon the prepuce as the most frequent cause of onanism.
+&ldquo;If the prepuce is lax, its mobility produces an irritation to the
+highly irritable and sensitive nervous system of the child by the
+titillation in its movements on the glans; if too tight and constricted,
+then it compresses the glans, and by its irritation it leads the child
+to seize the organ.&rdquo;<a name="FNanchor_93_93" id="FNanchor_93_93"></a><a href="#Footnote_93_93" class="fnanchor">[93]</a>
+So that in either case he looks upon the prepuce, through the
+sensitiveness it retains and induces in the glans, as the principle
+cause of masturbation. M. Debreyne, the Trappist monk and physician of
+La Trappe, who has paid considerable attention to medicine as applied to
+morality, practically makes the same observations. In children who have
+not yet the suggestions of sexual desire imparted by the presence of the
+spermatic fluid, the presence of the prepuce seems to anticipate those
+promptings. Circumcised boys may, in individual cases, either through
+precept or example, physical or mental imperfection, be found to
+practice onanism, but in general the practice can be asserted as being
+very rare among the children of circumcised races, showing the less
+irritability of the organs in the class; neither in infancy are they as
+liable to priapism during sleep as those that are uncircumcised.</p>
+
+<p>Dr. Bernheim says that &ldquo;the prepuce may be said in general to be
+an appendage to man, if not positively <span class='pagenum'><a name="Page_225" id="Page_225">[225]</a></span>
+harmful in some cases, at least useless, requiring constant care, the
+neglect of which is liable to entail disease and suffering; the
+irritation it produces through the sebaceous secretion is a frequent
+cause of masturbation which nothing short of circumcision will
+remedy.&rdquo;</p>
+
+<p>Through middle life, unless the prepuce be the subject of some vicious
+conformation, little inconvenience may result from its presence, except
+it be from the dangers to infections already pointed out during this
+period of life; an ordinarily movable and retractable prepuce will not
+acquire the condition of phimosis, unless it be through disease or
+accident; but with our entrance into old age, or after having passed our
+vigorous prime, the torment of the days of our infancy and childhood
+come to harass us again. Persons given to corpulency, with a long
+prepuce, are apt to become affected with phimosis in their latter years,
+as such persons are more subject to loss of their sexual vigor and power
+of erection than lean and spare people; in these, the gradual diminution
+of the size of the erectile tissues of the organ and its retraction
+allows of the reconstriction of the preputial opening, which, in the
+end, will not allow the prepuce to be drawn back over the gland. These
+conditions are followed by the irritating affections incident to
+phimosis of our earlier life, with the modification that age has induced
+in making us subject to more serious and fatal ailments, both locally
+and generally.</p>
+
+<hr /><p class='pagenum'><a name="Page_226" id="Page_226">[226]</a></p>
+<h2><a name="CHAPTER_XX" id="CHAPTER_XX"></a>CHAPTER XX.<br />
+<span class='sc sf75'>The Prepuce, Phimosis, and Cancer.</span></h2>
+
+<p>In the <i>British Medical Journal</i> of January 7, 1882, there is an
+interesting article by Jonathan Hutchinson on the &ldquo;Pre-cancerous
+Stage of Cancer.&rdquo; In this article he states that, whereas, twenty
+years previously, his suggestion had been to treat all suspicious sores
+as being due to syphilis until a clearer diagnosis could be made out, he
+&ldquo;had more recently often explained and enforced the doctrine of a
+pre-cancerous stage of cancer. According to this doctrine, in most cases
+of cancer, either of penis, lips, tongue, or skin, there is a
+stage&mdash;often a long one&mdash;during which a condition of chronic
+inflammation only is present, and upon this the cancerous process
+becomes ingrafted. Phimosis and the consequent balanitis lead to cancer
+of the penis.... A general acceptance of the belief that cancer usually
+has a pre-cancerous stage, and that this stage is the one in which
+operations ought to be performed, would save many hundreds of lives
+every year.... Instead of looking on whilst the fire <ins class='corr'
+title="Transcriber&rsquo;s Note: The original showed
+&lsquo;smoulderd&rsquo;.">smouldered</ins>, and waiting till it blazed up, we
+should stamp it out on the first suspicion.... What is a man the worse
+if you have cut away a warty sore from his lip; and, when all is done, a
+zealous pathologist demonstrates to you that the ulcer is not cancerous,
+need your conscience be troubled? You have operated in a pre-cancerous
+stage, and you have probably effected a permanent cure of what would
+soon have become an incurable disease. I do not wish to offer any
+apology for carelessness, but I have not in this matter any fear for
+it.&rdquo;</p>
+
+<p><span class='pagenum'><a name="Page_227" id="Page_227">[227]</a></span>
+In view of the great frequency of the occurrence of cancer of the penis,
+and the facts pointed out by Roux, that, after the removal of the
+cancerous prepuce or a portion of the penis for cancer, in case of a
+recurrence the disease does not do so in the penis, but that it attacks
+the inguinal glands, showing conclusively that the prepuce is the
+inciting cause as well as the initial point of attack, the sentiments in
+the foregoing paragraph, taken from the words of Hutchinson, are worthy
+of our most careful consideration.</p>
+
+<p>M. Roux, Surgeon to the Charit&eacute;, during the second decade of the present
+century, first called the attention of the French profession to the
+intimate relation or dependence that cancer of the penis bears to
+phimosis. In England he was preceded in this field of surgical
+investigation by William Hey, whom Roux met in London in 1814. Hey had
+then operated by amputation of the penis on twelve cases of cancer, nine
+of whom had had phimosis at the time of the development of the cancer.
+Wadd at this time also published a work on the subject, but, although he
+noticed that phimosis was a cause of cancer, he did not fully grasp the
+subject as Hey and Roux had done, as he believed a cancerous diathesis a
+primary necessity, and did not then recognize that the primary cause was
+fully to be found in the prepuce itself.</p>
+
+<p>Roux was probably the first to point out the peculiarly local character
+of penile cancer, as there is no locality wherein a timely operation is
+less apt to be followed by a recurrence. He records a number of cases
+where the prepuce alone was affected when first seen, but none wherein
+the glans was attacked and where the prepuce <ins class='corr'
+title="Transcriber&rsquo;s Note: The original showed
+&lsquo;wes&rsquo;.">was</ins> exempt, giving ample evidence of the original
+starting-point of the disease.<a name="FNanchor_94_94" id="FNanchor_94_94"></a><a href="#Footnote_94_94" class="fnanchor">[94]</a></p>
+
+<p><span class='pagenum'><a name="Page_228" id="Page_228">[228]</a></span>
+Erichsen also remarks on the little liability to recurrence of cancer of
+the penis after a timely operation; he divides the cancer to which the
+penis is subject to as being of two distinct kinds,&mdash;scirrhus and
+epithelioma. The latter variety commences as a tubercle in the prepuce,
+and, according to Erichsen, does not occur in the body of the penis
+except as a secondary infiltration or deposit.<a name="FNanchor_95_95" id="FNanchor_95_95"></a><a href="#Footnote_95_95" class="fnanchor">[95]</a>
+Travers states that Jews who are circumcised are not subject to either
+form of cancer.<a name="FNanchor_96_96" id="FNanchor_96_96"></a><a href="#Footnote_96_96" class="fnanchor">[96]</a></p>
+
+<p>Repeated attacks of herpes preputialis and some consequent point of
+induration are looked upon by Petit-Radel, Chauvin, and Bernard as
+frequent starting-points for the cancerous affection of the prepuce. The
+aged or persons of lax fibre being more subject to these inflammatory
+attacks, are also the most frequent victims of cancer in this situation.
+The celebrated Lallemand, in regard to the tendency to cancer induced by
+the presence of the prepuce, observes as follows:&mdash;</p>
+
+<p>&ldquo;Besides simple balanitis ... there also result various
+indurations, which are proportionate in their degree to the length or
+time and intensity with which the inciting inflammatory conditions have
+existed. I have repeatedly found the mucous lining of the prepuce
+thickened, hardened, ulcerated, and nodulated; at other times converted
+into a fibrous or even into cartilaginous tissue of excessive thickness;
+in others, still, in which it had assumed a scirrhous and cancerous
+nature. I have repeatedly operated on such cases, wherein the
+prolongation of the prepuce was the only recognized primary cause, the
+subjects being often countrymen of from fifty to sixty years of age, who
+had never known any women except their own, but who had, nevertheless,
+been long sufferers from balanitic attacks, accompanied by abundant
+acrid discharges, swellings of the prepuce, with <span class='pagenum'><a name="Page_229" id="Page_229">[229]</a></span>
+more or less consequent excoriations and narrowing of the preputial
+orifice.&rdquo;<a name="FNanchor_97_97" id="FNanchor_97_97"></a><a href="#Footnote_97_97" class="fnanchor">[97]</a></p>
+
+<p>Clapar&egrave;de sums up the inconveniences and dangers to which the possessor
+of a prepuce is liable to suffer from, as follows: &ldquo;The retention
+of the sebaceous secretion is liable to alter its character, converting
+it into an acrid, irritating discharge, which induces more or less
+burning, smarting, itching, excoriations, and swelling, which, affecting
+the little glands situated about the corona and sulcus, induces them to
+secrete an altered and vicious secretion. In this manner a simple
+elongation of the prepuce will produce an inflammation of the surface of
+the glans (balanitis), or that of the prepuce itself (posthitis), or the
+two conjoined (balano-posthitis), complicated possibly with phimosis. By
+an extension to the mucous membrane of the urethra of the same condition
+of the inflammatory process, we have blennorrhagia; blennorrhagia is
+liable to be followed by inguinal swellings or tenderness, orchitis,
+stricture, and prostatic disease; the formation of preputial calculus,
+from retention of the urine in the prepuce; and cancer is apt to be the
+end of any of these conditions.&rdquo;<a name="FNanchor_98_98" id="FNanchor_98_98"></a><a href="#Footnote_98_98" class="fnanchor">[98]</a></p>
+
+<p>J. Royes Bell, in Ashhurst&rsquo;s &ldquo;International Encyclop&aelig;dia of
+Surgery,&rdquo; observes as follows: &ldquo;Carcinoma attacking the
+genital organs usually assumes the form of epithelioma; the other kinds
+are rarely met with. Epithelioma may invade the prepuce, or the whole
+penis, or any part of it. The most common age for it is fifty years or
+over. In the great majority of cases there has existed a congenital or
+acquired phimosis. A contusion or a urinary fistula may be the exciting
+cause. With a phimosis the parts are not kept clean, but the gland is
+macerated and rendered tender and excoriated by retained secretions, and
+the irritation causes an epithelioma <span class='pagenum'><a name="Page_230" id="Page_230">[230]</a></span>
+to grow in those predisposed to the disease, as is found to be the case
+when the tongue is irritated by a broken tooth, or the scrotum by the
+presence of soot in its folds. Syphilis has no direct influence in
+inducing the disease, but a syphilitic chap or ulcer may be the
+starting-point of an epithelioma. Two kinds of epithelioma affect the
+penis,&mdash;the indurated and the vegetating, or cauliflower growth....
+The nature of the disease, in either the prepuce or the glans, is masked
+by a phimosis.... The prognosis in these cases is much more hopeful than
+in epithelioma, in other situations.... Sir William Lawrence operated on
+a patient who was quite well years afterward, and Sir William Ferguson
+amputated the penis of a man of note in the political world, who lived
+many years after the operation, and died at an advanced age.&rdquo;</p>
+
+<p>Agnew, of Philadelphia, describes an epithelioma of the prepuce
+occurring in persons past middle life, beginning as a tubercle, crack,
+or wart, for which he advises an early circumcision; he admits, however,
+to not having sufficient data to determine whether Jews and circumcised
+persons are exempt from carcinoma of the penis; but as its usual
+starting-point he evidently admits to be in the prepuce, circumcision
+must certainly be a preventive to its appearance. Gross gives
+substantially the same opinion as Agnew in this regard. Dr. John S.
+Billings, in his article on the &ldquo;Vital Statistics of the
+Jews,&rdquo; in the January <i>North American Review</i>, of 1891, on the
+subject of cancer, observes as follows:&mdash;</p>
+
+<p>&ldquo;As regards cancer and malignant tumors, we find that the deaths
+from these causes among the Hebrews occur in about the same proportion
+to deaths from other diseases as they do in the average population.
+<span class='pagenum'><a name="Page_231" id="Page_231">[231]</a></span>
+But as the ratio of deaths to population is less among the Jews, so the
+ratio of deaths from malignant diseases to population is also less.
+Among the living population the proportion found affected with cancer
+among the Jews was 6.48 per 1000, while of those reported sick by the
+United States census of 1880, for the general population, the proportion
+was 10.01 per 1000.&rdquo;</p>
+
+<p>There are no convenient data as to the prevalence or percentage of cases
+of cancer among the Arabian or Mohammedan population of Asia and Africa,
+but the above comparison of 6.48 per 1000 among the Jews of the United
+States, against 10.01 per 1000 of the general population, shows that the
+circumcised race does, in the instance of cancer, certainly enjoy a
+certain amount of immunity, having in this regard not quite such an
+exemption as they enjoy from consumption, but still sufficient to assist
+in making them longer-lived and more able to enjoy life and die a less
+lingering and painful death.</p>
+
+<p>It is surprising that, in view of the fact that carcinoma of the penis,
+starting with such frequency in the prepuce, should have left any doubt
+but that with the absence of this appendage there would follow less
+liability to cancer. Cullerier informs us that he had several times
+amputated the penis for cancerous diseases, but that he is unable to
+tell us whether the persons were affected with phimosis, remarking that
+on the last case he had observed the indurated remains of the prepuce;
+he had, however, recognized the necessity of freely exposing the gland
+in cases where, from continued irritation and inflammation, there was
+danger of cancer formation.</p>
+
+<p>Nelaton describes two varieties of cancer that affect the penis,&mdash;that
+which attacks the integument and that <span class='pagenum'><a name="Page_232" id="Page_232">[232]</a></span>
+which attacks the glans. The first of these varieties he observes as
+generally beginning as a hardened nodule in the prepuce, which becomes
+at once more or less thickened and indurated. He gives Lisfranc the
+credit of pointing out the fact, that, even in the most hopeless-looking
+case, the glans and body of the penis may be simply pushed back and
+compressed, but otherwise sound, and that before resorting to an
+amputation of the whole organ it is better to make a careful exploratory
+dissection in search of the penis, as it oftentimes happens that the
+prepuce and integument can be dissected off, leaving the organ intact.
+He also mentions that elephantiasis of the penile integument generally
+begins in the prepuce.</p>
+
+<p>Baron Boyer believed that the vitiated preputial secretion allowed to
+remain beneath the prepuce was one of the causes of cancer of the penis,
+observing that it would be interesting to know whether cancer of the
+penis was a rarity among circumcised people, such as the Jews and
+Mohammedans.<a name="FNanchor_99_99" id="FNanchor_99_99"></a><a href="#Footnote_99_99" class="fnanchor">[99]</a></p>
+
+<p>It is easy to perceive why or how Agnew, Gross, Cullerier, and many of
+those who have written on the subject, have failed to appreciate the
+existence of the prepuce as an exciting cause, or as being, in the
+majority of instances, the part primarily attacked. The nodule,
+excoriation, or abrasion that develops into a cancer generally produces
+more or less local disturbance; in many it produces a phimosis that is
+only relieved by the ulcerative process that exposes the gland, which
+may by that time itself be attacked or even destroyed. They are then
+seen by either the rural practitioner or the family physician, but
+before submitting to an operation they run the gauntlet of many
+physicians, and, when it comes to operating, they generally apply to
+some one of great <span class='pagenum'><a name="Page_233" id="Page_233">[233]</a></span>
+skill and reputation. By this time there is little left of the organ,
+and, as a rule, the party is unable to tell where the disease
+originated, whether in the prepuce or glans, to them the swollen prepuce
+seeming to be the whole organ. Of late years, however, it has been
+pretty well established that it generally begins in the prepuce, and the
+great number of amputations of the penis on record for this disease does
+not lead one to believe that it is as rare a disease as was formerly
+believed. In Langenbeck&rsquo;s <i>Archiv</i>, Bd. xii, 1870, Dr. Zielewicz
+reports fifty cases of amputation of the penis by the galvano-cautery
+loop, mostly for carcinoma, one of the fifty being for gangrene and one
+other for a large papillary tumor. That one surgeon was able to report
+forty-eight cases of carcinoma or cancer that were treated by one
+special system of operating tells us plainly enough that the unfortunate
+possessor of a prepuce, no matter how normal or unobjectionable it may
+seem to be in the prime of man&rsquo;s existence, or however
+physiologically necessary it may be deemed, runs too many risks in
+holding on to his possessions.</p>
+
+<p>The views set forth by Hutchinson in the beginning of this chapter are
+precisely those that are held by the writer, who would even go further,
+by advising all such as have, in their youth or since, suffered with
+balano-posthitis in any degree or form, or whose prepuce shows a
+tendency to elongation with age, to have the same removed at once; where
+the prepuce is not redundant, but only tight, a slight operation, such
+as slitting, will at once remove the possibility of any future danger,
+without keeping a man from his business a single day.</p>
+
+<p>It may here be remarked that, although always favorably impressed with
+the great benefits arising out of circumcision, nothing ever resulted in
+such a serious <span class='pagenum'><a name="Page_234" id="Page_234">[234]</a></span>
+consideration of the subject as seeing a professional brother dying
+with a cancerous affection of the penis. The disease had originated in
+the mucous lining of the prepuce, and when seen in consultation with his
+attending physicians the gland had already disappeared and the inguinal
+glands were affected. The man was in the prime of life, and, aside from
+the local trouble, a specimen of perfect health and physique. He
+informed us that while a youth he had suffered from repeated attacks of
+herpes preputialis; that he had suggested circumcision more than once to
+his father, who also was a physician, but who, unfortunately for the
+son, could not see any merit in circumcision. To his eyes there was
+nothing that circumcision could do but what could be accomplished by
+washing and personal attention to cleanliness. When older, the prepuce
+gave him less trouble, and for a long time after his marriage it ceased
+to trouble him altogether. The idea of the necessity of circumcision did
+not occur to him again until the appearance of the cancerous disease;
+even then, not appreciating the danger, and looking upon the trouble as
+a simple transient result of some inflammatory action, he waited until
+the parts would be in a better state or condition of health before
+resorting to an operation,&mdash;that time never came.</p>
+
+<p>Although to Roux, Wadd, and Hey the credit must be given for bringing
+the subject of cancer of this organ so prominently before the
+profession, the knowledge of the existence of the disease has long been
+a matter of record. Patissier, in the fortieth volume of the
+&ldquo;Dict. des Sciences M&eacute;dicales,&rdquo; quotes from the third volume
+of the &ldquo;M&eacute;moires de l&rsquo;Acad&eacute;mie Royale de Chirurgie,&rdquo;
+that in 1724 an officer, aged fifty, was attacked by a cancerous
+affection originating underneath the prepuce; <span class='pagenum'><a name="Page_235" id="Page_235">[235]</a></span>
+at the time he consulted MM. Chicoineau and Sonlier the disease had
+existed for two years, the inguinal glands were implicated, and even the
+suspensory ligament was affected. These surgeons, nevertheless,
+determined upon an operation, and, after a long chapter of
+h&aelig;morrhagic accidents, the patient finally made a recovery.
+Another case, quoted by Patissier, was operated upon by M. Ceyrac de la
+Coste, the patient a man of sixty, the disease originating, like the
+preceding case, underneath the prepuce.</p>
+
+<p>Warren, in his &ldquo;Surgical Observations on Tumors,&rdquo; observes
+that cancer of the penis begins by a warty excrescence on the glans or
+prepuce. Walshe, in his work on the &ldquo;Nature and Treatment of
+Cancer,&rdquo; says: &ldquo;The disease may commence in almost all parts
+of the organ, but the glans and prepuce are by far its most common
+primary seats. It may originate either from a warty excrescence or a
+pimple, or it may infiltrate the glans, or appear as a complication of
+venereal ulceration. Phimosis, either congenital or acquired, is an
+exceedingly common accompaniment, and it appears probable that the
+irritation occasioned by this condition of the parts may act as an
+exciting cause of the disease in persons predisposed to cancer.
+Circumcision is, therefore, an advisable prophylactic measure, where the
+constitutional taint is known to exist.&rdquo;</p>
+
+<hr /><p class='pagenum'><a name="Page_236" id="Page_236">[236]</a></p>
+<h2><a name="CHAPTER_XXI" id="CHAPTER_XXI"></a>CHAPTER XXI.<br />
+<span class='sc sf75'>The Prepuce and Gangrene of the Penis.</span></h2>
+
+<p>Another accompaniment of that preputial appendage is gangrene of the
+penis, which, like carcinoma, starting in at the prepuce, may invade the
+pubes and scrotum. This disease is not so rare as to merit the little
+attention it has received from our text-books. M. Demarquay has
+collected the history of twenty-five cases; from him we learn that the
+prepuce is the most frequent seat of the start of the affection, from
+whence, according to Astruc, it rapidly spreads to the skin of the whole
+organ, and then attacks the corpora cavernosa; it may even extend as
+high as the umbilicus. This disease spares no age; it attacks young and
+old alike.</p>
+
+<p>There is not a case recorded of this disease that particularized any
+other starting-point than the swelling, tension, active or passive
+congestion that takes place in the integument of the penis. By this it
+must not be understood that the initial disease or inflammatory action
+that produces the gangrene must necessarily have its seat in the
+integument, but that it is the integument of the penis (and especially
+that of the prepuce) in which, through the laxity of its tissues,
+passive congestion is favored that the gangrenous action begins. That
+this is the actual case there can be but little doubt about, as, even
+where the gangrene invades the body of the penis itself, even where the
+inflammatory action may have started from a violent urethritis, that
+condition of blood which favors gangrenous results <span class='pagenum'><a name="Page_237" id="Page_237">[237]</a></span>
+will be found to have begun during its state of stasis, where it has
+parted with much of its watery element, as well as considerable of its
+vitality, while in its slow, tedious, and obstructed passage through the
+prepuce. Some of this dark, thickish blood, finding its way from the
+integumentary return circulation to that of the deeper structure,
+becomes there a mechanical as well as a pathological cause for that
+impediment to the free circulation of the parts, through its altered
+physiological condition. The deeper structures of the penis, besides
+their own blood-supply, carry back into the deeper or systemic
+circulation a large supply from the integumentary <ins class='corr'
+title="Transcriber&rsquo;s Note: The original showed
+&lsquo;tisses&rsquo;.">tissues</ins>, when in the latter, owing to the greater
+supply due to any inflammatory action, the blood-current is delayed and
+impeded in its lax and easily-dilatable tissues, and blood-changes occur
+favoring the gangrene in the deeper tissues, so that, whether the
+gangrene first takes place in the body of the penis or in the scrotum,
+it will be in the prepuce or adjoining integument that its real
+originating causes will be found.</p>
+
+<p>Baron Boyer, in speaking of the inflammation of the penis, observes that
+the intensity of the swelling, great pain, and difficulty of urination
+that follow have led many to believe that the inflammation of the deeper
+structures really always formed a part of the disease. In otherwise
+healthy and vigorous subjects it does not, however, extend beyond the
+skin, as has been demonstrated where the resulting gangrene from excess
+of inflammatory action has ended in resolution, the deeper tissues not
+having been found to be injured. It is only where the tone of the
+general system is lowered, through disease, age, or other deteriorating
+conditions, that the whole organ is liable to become affected or to
+break down.</p>
+
+<p><span class='pagenum'><a name="Page_238" id="Page_238">[238]</a></span>
+Boyer, in the tenth volume of his &ldquo;Treatise on Surgical
+Affections,&rdquo; gives several examples of this affection not due to
+age: one case was a person, simultaneously attacked by an adynamic fever
+and a blennorrhagia, who suffered from gangrene of the penis; the local
+and constitutional disturbance was not high, however, and the patient
+escaped with the simple loss of the prepuce.</p>
+
+<p>Another case admitted to the Charit&eacute;, aged thirty-six, was afflicted
+with a blennorrhagia, upon which an attack of low fever supervened. The
+penis inflamed, became engorged and livid, and soon gangrenous symptoms
+presented themselves, making rapid progress; at first the integument
+alone was affected, but later all the structures became implicated and
+the penis was completely destroyed, the sloughs detaching themselves in
+shreds, leaving a conical stump that healed but slowly.</p>
+
+<p>One case, a young man of twenty, also at the Charit&eacute;, was admitted with
+adynamic fever; a few days after admission the prepuce was observed to
+be somewhat inflamed; in spite of all treatment this progressed so
+rapidly that the purple discoloration presaged a gangrene, which was not
+slow in following; the focus seemed to be at the superior and back
+portion of the prepuce; an incision evacuated a quantity of purulent,
+serous fluid; the disease, however, extended up the organ as far as its
+middle before its actions ceased; the sloughs were then cast off, when
+it was found that part of the gland and a portion of the cavernous body
+had followed the integument in the general wreck, subjecting the patient
+to intolerable pain during micturition. After the recovery from the
+fever, the remaining portion of the gland and the mutilated parts of the
+cavernous body were amputated to remedy this condition; the <span class='pagenum'><a name="Page_239" id="Page_239">[239]</a></span>
+patient subsequently admitted to have had a blennorrhagia at the time
+of his admission to the hospital.</p>
+
+<p>The gangrenous action may, in proportion to the low condition of the
+patient, be as proportionately rapid. Another case from Boyer, quoted
+from the works of Forestus, relates how the whole organ underwent such
+speedy disorganization that its liquefied remains were found in a
+poultice, which had been applied with a view of relieving the
+congestion,&mdash;a very dear price to pay for retaining the prepuce, that
+the exquisite sensitiveness of the tactile faculty for enjoyment,
+resident in the corona of the gland, might not be interfered with.</p>
+
+<p>Gross does not mention this affection in his work on surgery, <ins
+class='corr' title="Transcriber&rsquo;s Note: The original showed
+&lsquo;dut&rsquo;.">but</ins> Agnew devotes considerable space to its
+description, dividing the disease into two forms: the inflammatory, such
+as may follow venereal primary sores or operations on the penis, not
+excepting circumcision; and the obstructive variety, such as may follow
+embolism or any mechanical obstruction, either purposely or accidentally
+applied. Of the latter he gives a number of quoted instances; he only
+admits seeing one case, that of an aged man in the Pennsylvania
+Hospital, in whom the disease was caused by embolism of the dorsal
+artery.</p>
+
+<p>J. Royes Bell, in the &ldquo;International Encyclop&aelig;dia of
+Surgery,&rdquo; pays more attention to it than any of our American
+authors; mentioning, among the causes which may give rise to it, the
+exanthemata, especially small-pox, and the poisoning by ergot of rye and
+erysipelas. Among the local causes lie mentions phimosis, paraphimosis,
+and balano-posthitis.</p>
+
+<p>Bell quotes the case reported by Mr. Partridge, in the sixteenth volume
+of the &ldquo;Transactions of the Pathological Society of London,&rdquo;
+wherein a sober man, aged <span class='pagenum'><a name="Page_240" id="Page_240">[240]</a></span>
+forty, lost the whole of his penis up to the root, during the course of
+a typhus fever. Also the case reported by Mr. Gay, in the thirtieth
+volume of the same &ldquo;Transactions,&rdquo; wherein a cabinet-maker,
+aged thirty-one, lost his penis through the probable results of
+rheumatic phlebitis, and due to the presence of a plug in the internal
+iliac vein. In the twelfth volume of the &ldquo;Transactions&rdquo; of
+the same society he finds the record of the case of a soldier who lost
+his penis through gangrene induced by syphilitic phagedena.</p>
+
+<p>In the consideration of the subject of the prepuce as connected with
+penile gangrene, it must not be overlooked that the presence of a
+prepuce may be the inciting cause of some rheumatic affection (the
+writer has repeatedly seen such), just as such cases are often the
+result of stricture; as cases of rheumatism that have resisted all
+remedial means, but that have readily given way to the dilatation of a
+stricture, are by no means uncommon; not a mere muscular reflex
+rheumatic pain, but even when accompanied by a rheumatic blood
+condition. So that even in such a case as above reported as being due to
+rheumatic phlebitis, or the case reported in the fortieth volume of the
+&ldquo;Dictionaire des Sciences M&eacute;dicales&rdquo; by Patissier, wherein a
+man lost penis and scrotum through gangrene, induced by urinous
+infiltration, may all in the origin be due, if not to the immediate, to
+the remote effects of the presence of the prepuce.</p>
+
+<p>In the first volume of the <i>Journal of Venereal and Cutaneous Diseases</i>
+the writer reported a case of the complete loss of penis in a young man
+as a result of phagedena due to syphilis. The man had had a long and
+pendulous prepuce; in his case, had circumcision been performed in early
+childhood, it would have lessened the chances of primary infection, and
+had it been <span class='pagenum'><a name="Page_241" id="Page_241">[241]</a></span>
+performed after his infection, it would have removed one cause&mdash;if
+not the principal cause&mdash;of the ease with which the phagedenic
+action was inaugurated. The case already mentioned as an example of
+spontaneous and natural circumcision belongs to the gangrenous results
+following phimosis, ending with the loss of the prepuce. In
+Maclise&rsquo;s &ldquo;Surgical Anatomy&rdquo; several specimens of
+deformity are figured, showing the results of this mildest of the
+effects of a phagedenic action. The beginning of the interference in the
+return preputial circulation undoubtedly always takes place over the
+superior aspect of the corona, where the pressure of the glans is most
+sharply defined against the inner fold of the prepuce.</p>
+
+<p>There are milder conditions, wherein the circulation of the prepuce is
+materially interfered with, both through the lax tissues of the parts
+and the peculiar anatomical construction and shape of the neighboring
+parts, wherein, without going as far as gangrenous breakdown, the person
+suffers considerably nevertheless, and is placed in danger of losing his
+penis; for, as observed by Patissier, whenever a person affected with a
+gonorrh&oelig;a is attacked by a putrid or any low-grade fever, he runs the
+greatest danger of losing his virile member through gangrene.</p>
+
+<p>Even where phimosis does not exist, but only the long, lax, and
+retractable prepuce, that is considered a perfectly physiological
+condition, the prepuce is liable to cause very distressing and
+complicating annoyances during the progress of other diseases. The
+writer has noticed that cases with a thick, leathery, and redundant
+prepuce, even when perfectly retractable, are more liable to require the
+use of the catheter during the course of a continued fever. Such a
+condition is also a very frequent <span class='pagenum'><a name="Page_242" id="Page_242">[242]</a></span>
+accompaniment of prostatic obstruction. So often has this been noticed
+that its association with prostatic trouble or disease tends to the
+belief that the irritation produced by this condition of prepuce often
+lays the foundation for prostatic disease in not a few cases.<a
+name="FNanchor_100_100" id="FNanchor_100_100"></a><a
+href="#Footnote_100_100" class="fnanchor">[100]</a> In elderly people, with
+the atrophied penis and elongating prepuce, the constant moisture from
+the urine on the <ins class='corr' title="Transcriber&rsquo;s Note: The
+original showed &lsquo;innner&rsquo;.">inner</ins> fold and glans adds greatly
+to the irritation as well as to the discomfort of the patient.</p>
+
+<p>A number of affections are accompanied by &oelig;dema, especially toward
+the latter stages of the disease; such, for instance, as the ending of
+cases of mitral insufficiency. In these, the distension of the prepuce
+and the resulting balano-posthitis is at times a source of great
+distress, and at times the resulting engorgement produces a retention of
+urine. It was after an attendance on one such case that required daily
+and frequent puncturings for its relief, but which, in spite of all
+care, finally became gangrenous, that a fellow practitioner cheerfully
+submitted to circumcision, to avoid the possibility of any such
+complication occurring to embitter his closing illness.<a name="FNanchor_101_101" id="FNanchor_101_101"></a><a href="#Footnote_101_101" class="fnanchor">[101]</a></p>
+
+<p>The prepuce is the starting-point of many of the cases of penitis and
+retention of urine that often accompany attacks of gonorr&oelig;a;
+especially can this result be anticipated where the prepuce is long,
+pendulous, and with its veins in a varicose condition. Why it should be
+so is self-evident. Anything that will add to the interference of the
+return circulation only exaggerates the tendency to penis engorgement;
+this increases the difficulty of urination, which, by the retention that
+results, in turn increases the constriction at the root of the penis,
+and adds to the already difficult return circulation. The bladder by its
+urine, and the <span class='pagenum'><a name="Page_243" id="Page_243">[243]</a></span>
+penis by its blood, actually form, by their mutual pressures, an
+impassable dam at the root of the organ. That this is the true condition
+has been more than once verified from the instant relief given to the
+whole condition by the prompt employment of the supra-pubic puncture or
+aspiration, as catheterization in such cases is altogether out of the
+question, and should never be attempted or employed unless a soft
+catheter can be inserted.</p>
+
+<p>A person laboring under a continued fever has his blood in a condition
+to favor sphacelus; with the slow-moving current of vitiated blood and
+its retention in such lax tissues as those of the prepuce, through the
+medium of the enlarged preputial veins, coupled with the lessened
+sensibilities of the bladder and his perhaps semi-conscious or
+unconscious condition, and an equally unconscious bladder, he is, to say
+the least of it,&mdash;if in possession of a prepuce,&mdash;also the unconscious
+possessor of a certain degree of percentage, no matter how small or
+fractional that may be, of recovering from his fever without his penis.
+Dr. W. W. McKay, of the U. S. Marine Hospital Service of San Diego,
+attended a case of typho-malarial fever in consultation with me, where,
+but for the persistent, intelligent, but delicate use of the catheter
+for nearly three weeks the penis would have become gangrenous. The
+subject was an ur&aelig;mic, irritable, nervous, leathery-prepuced individual;
+the organ was unusually large, the skin of the penis thick, and it was
+only by keeping the bladder empty that prevented a state of engorgement
+that would have effectually interfered with further catheterization. As
+it was, the penis was often dank, livid, and discolored from the passive
+engorgement.</p>
+
+<p>The writer saw a similar case with the late Dr. F. H.<span class='pagenum'><a name="Page_244" id="Page_244">[244]</a></span> Milligan, of
+Minnesota. The congestion in this case was due to a gonorrh&oelig;al
+inflammation involving the skin of the whole penis, retention having
+followed painful micturition, and the swelling of the penis following
+the retention; the prepuce was enormously distended, and the penis
+seemed in a state of erection as far as dimension and rigidity were
+concerned. The man, a steam-boat cook, informed us that it was fully
+twice as large as when rigidly erect in health. All efforts to reduce
+the swelling were unavailing; neither punctures, leeches, nor
+scarifications were of any avail; catheterization was impossible, but,
+after relieving the bladder by the supra-pubic aspiration, the patient
+experienced some relief. He, nevertheless, lost the whole skin of the
+penis, with that of the pubis and on the front of the scrotum. The man
+ran into a low form of fever, with ur&aelig;mic symptoms; the stench was so
+great that it was almost impossible to remain in the same room with him;
+but he finally made a slow and very tedious recovery. In healing there
+was considerable downward curvature of the penis, which, however, did
+not prevent him from following his old, dissolute course of life.<a name="FNanchor_102_102" id="FNanchor_102_102"></a><a href="#Footnote_102_102" class="fnanchor">[102]</a></p>
+
+<p>A calm, unprejudiced consideration of the subject of the liability of
+the uncircumcised races dwelling in the temperate and semi-tropical
+countries to cancer, gangrene, and elephantiasis might well lead one to
+ask: Why are we afflicted with a prepuce? We can understand how a man
+may become gouty, and become a subject in the end for a gangrene of the
+extremities; or how senile gangrene may, through a series of
+pathological processes and blood changes, with the aid of age, finally
+be reached; or how, by a like course of diseased processes, we reach the
+apoplectic stage. These conditions, however, can be put off, or partly,
+if not wholly avoided, by <span class='pagenum'><a name="Page_245" id="Page_245">[245]</a></span>
+a proper course of life, and, at the worst, it is only after the fires
+of our youth and prime have completely burned out, that these conditions
+are liable to claim us as their lawful victim. Not so, however, with
+some of these conditions that may end in penile gangrene; that are
+liable to pounce upon us unawares, like an Apache in an Arizona
+ca&ntilde;on; or as the hired mercenaries of old Canon Fulbert did upon
+poor Abelard in his study, and, without further ado or ceremony
+emasculate man as effectually as the most exacting Turk could demand,
+with a veritable <i>taill&egrave; &agrave; fleur de ventre</i> operation.</p>
+
+<p>Nature has her own ways of protecting what there is of any utility;
+there is a law of the survival of the fittest that we all appreciate.
+If, then, this penile appendage is of any utility, why is it that,
+unlike the rest of the body, it falls such an easy victim to gangrene?
+The procreative function seems to be, in a sense, one of the main cares
+of nature in its relation to the animal as well as the vegetable
+kingdom; but here is a useless bit of skin, adipose tissue, mucous
+membrane, and some connective tissue, that on the least provocation is
+liable to go off into a gangrene and drag one of the main generative, or
+even all the procreative, apparatus into the general wreck. Nature
+certainly never intended anything of the kind. To be generous, and not
+libel nature, we must conclude that the prepuce is a near relative to
+the fast-disappearing climbing-muscle; very useful in our primitive,
+arboreal days, when we needed such a muscle to reach our perch for the
+night, and a prepuce or something of the kind, in default of a
+breech-cloth, to protect the glans penis from being scratched by the
+briars or thorny and rough bark of the trees in our ascent. The prepuce
+was well enough in our primitive and arboreal days,&mdash;ages and ages ahead
+<span class='pagenum'><a name="Page_246" id="Page_246">[246]</a></span>
+of our cave and lake dwellings,&mdash;when the notch in a tree and its
+rough bark formed our couch; but in these days of plush-cushioned pews
+and opera-seats, cosy office-chairs, car-seats, and upholstered
+furniture or polished-oak seats, it serves no intelligent purpose.</p>
+
+<p>Emasculation has never been looked upon with favor by its victim, and it
+would be but natural to suppose that man would take every precaution
+against the accidental occurrence of such an undesired condition. The
+writer well remembers that, in his &ldquo;Tom Sawyer&rdquo; days on the
+banks of the upper Mississippi, in the happy days of the crack rafting
+crews, before the introduction of the towage steamer, when the river
+towns were more or less terrorized by wild gangs of these men, some of
+whom were always fighting and quarreling and drinking when not at work.
+In the lot there was one man with a great reputation at a
+rough-and-tumble fight. His main hold was that he generally tried to
+emasculate his adversary by destroying the physiological condition of
+the testicle. The man was not a large or powerful man, nor was he a
+great boxer or wrestler, but this reputation made him feared by all the
+bullies on the river. The report that not a few who had tackled him had
+subsequently been of no value, either as fornicators or fecundators, or
+had to be castrated on account of the resulting testicular degeneration,
+seemed in no way to encourage any one to wish to meet him in a personal
+encounter. It would seem as if the desire to avoid such an
+accident&mdash;provided persons knew the dangers that lurk in a
+prepuce&mdash;would induce many to submit to circumcision. That many more do
+not do so can only be attributed to the general human wish to escape a
+less present evil for a greater unknown one, being evidently deterred by
+the prospective pain that must be suffered immediately.</p>
+
+<p><span class='pagenum'><a name="Page_247" id="Page_247">[247]</a></span>
+There is a question that should interest man above that of the simple
+loss of penis. It appears that there is a powerful moral effect that
+follows this loss, as might, in the majority, be anticipated. According
+to the experience of Civiale, many who have lost the penis, through
+amputation for disease or through disease itself, end in suicide. He
+mentions particularly a patient at the Charit&eacute; who had lost his penis,
+who, finding no other means to take himself off, saved up sufficient
+opium, from that given him to calm his pains, to take all at one dose
+and commit suicide. In the London <i>Lancet</i> for March 27, 1886, there is
+reported a discussion on this subject, to which the reader is referred,
+as it fully covers the moral and physical effects of castration and
+penis amputation for disease. M. Roux, who amputated the penis of a
+brother of Buffon, in 1810, reported that, in that case, M. Buffon lost
+none of his customary gayety.</p>
+
+<hr /><p class='pagenum'><a name="Page_248" id="Page_248">[248]</a></p>
+<h2><a name="CHAPTER_XXII" id="CHAPTER_XXII"></a>CHAPTER XXII.<br />
+<span class='sc sf75'>The Prepuce, Calculi, and Other Annoyances.</span></h2>
+
+<p>From an article published in the New York <i>Medical Times</i> of March,
+1872, from the pen of Dr. J. G. Kerr, of Canton, China, we learn that
+phimosis is not an uncommon occurrence among the Chinese. As has been
+demonstrated by C. H. Mastin, of Mobile, climate is a great factor of
+calculus. (&ldquo;Transactions International Medical Congress&rdquo; of
+1876, page 609.) That of China seems a most favorable climate in this
+regard; so that, between the prevalence of phimosis among the Chinese
+and the calculus-producing tendency of the climate, China may be said to
+be the classic land of preputial calculi, as England is that of the
+gout, or the United States that of delirium tremens. From Dr. Kerr we
+learn that the occurrence of these concretions were, as a rule,
+multiple, and that in two cases that fell under his observation the
+number of stones from each individual exceeded one hundred. In one case
+there were forty, and in three cases there were between twenty and
+thirty. These were of different sizes and weight, some being an inch and
+five-eighths in diameter, and from that size down to where one hundred
+and sixteen taken from one individual case only weighed one ounce. The
+tendency to calculous disease in that climate may well be imagined, when
+the same observer relates a case of urinary infiltration into the skin
+on the under side of the penis that gave rise to the formation of a
+collection of calculi in that locality, four of which were the size of
+pigeons&rsquo; eggs; and another case in which a urinary fistula
+<span class='pagenum'><a name="Page_249" id="Page_249">[249]</a></span>
+induced the formation of a calculus in the groin, near the scrotum, the
+calculus weighing two and a half drachms and measuring one and a half
+inches by three-quarters of an inch in diameter.</p>
+
+<p>Clapar&egrave;de mentions a case in the practice of M. Dum&egrave;ril, in which the
+stone extracted from the prepuce weighed two hundred and twenty-five
+grammes, or about eight ounces. Civiale speaks of a young man of twenty
+with phimosis, who, after practicing sexual connection for the first
+time, experienced pain and a purulent discharge, from whom, on
+examination, he removed five stones as large as prunes. The patient had
+felt them in their position, but had imagined the condition to be a
+natural one.</p>
+
+<p>E. L. Keyes gives their composition as being of calcified smegma, urate
+of ammonium, triple and earthy phosphates and mucus, and as symptoms and
+results: pain, purulent discharges, interference with urination and the
+sexual act, involuntary emission, ulceration of the preputial cavity,
+and impotence.</p>
+
+<p>Enoch mentions a child of two years in the Charit&eacute;, who, being operated
+upon for phimosis, was found to have a preputial calculus occluding the
+urethral meatus. At the autopsy a calculus as large as an egg was found
+in the bladder.</p>
+
+<p>The presence of these formations, although not necessarily dangerous in
+themselves, may, by their effects and in the irritation they induce, be
+the means of producing serious mischief. The only preventive or remedy
+for this condition is circumcision.</p>
+
+<p>Acquired phimosis has been mentioned as a result of inflammatory lotion,
+such as is connected with balano-posthitis; it sometimes happens that,
+the act of coitus being done forcibly, especially with public women, who
+<span class='pagenum'><a name="Page_250" id="Page_250">[250]</a></span>
+are apt to use very astringent and constricting washes, the prepuce
+becomes injured, with the result of producing a phimosis. One man will
+produce the same results through the means of some vaunted wash or dip
+which is supposed to act as a prophylactic to any venereal infection.
+One patient had developed a chronic herpetic affection by the constant
+use of an iodized ointment which he regarded as an infallible
+prophylactic. Many cases of phimosis result from the attending
+inflammation that follows on the liberal domestic application of nitrate
+of silver to an abrasion after connection, in the mistaken idea that the
+party labors under, that he is destroying some venereal virus.</p>
+
+<p>By the irritation that all these applications and accidents induce,
+warts and vegetations are the but too frequent results. These I have
+never seen in a circumcised individual, and their occurrence and
+frequency, as well as persistency, are directly proportionate with the
+degree of tightness, thickness, or redundancy of the prepuce and the
+irritability of the gland. As remarked by Lallemand, in reference to the
+victim of nocturnal enuresis becoming a future victim of nocturnal
+emissions, so it may be said of the person subject in early life to
+either warts, excoriations or vegetations on the penis, that it is this
+class that furnishes in after life the subjects for cancerous disease as
+well as furnishing the easiest victims for venereal infection. These
+warts, although easily removed, have a tendency to recurrence,
+especially as long as the moist bed that has once grown them there is
+still vegetating.</p>
+
+<p>The prepuce is liable to indurations and hypertrophy. Of the first
+anomaly, the London <i>Lancet</i> of 1846 has a record of two cases in which
+paraphimosis was induced in elderly subjects, and of one in which it
+induced phimosis.<span class='pagenum'><a name="Page_251" id="Page_251">[251]</a></span>
+Since then a number of cases of thickening and induration have been
+reported. Hypertrophy may take place in any degree, varying from the
+mere leathery and overpendulous but unobstructive prepuce to the case
+recorded by Vidal, in the fifth volume of his &ldquo;Pathologie Externe
+et M&eacute;decine Operatoire,&rdquo; which happened in the practice of
+M. Rigal, de Gaillae. The hypertrophied prepuce was something enormous,
+and hung down to below the patient&rsquo;s knees; it was pear-shaped,
+with the base hanging downward; this base was as large as a man&rsquo;s
+head. This prepuce was successfully removed by M. Rigal, who presented
+the specimen before the Paris Surgical Society, who were then discussing
+a somewhat similar but not so extensive a case, presented by M. Lenoire.
+Vidal mentions having operated on a number of cases of this deformity of
+the prepuce in various degrees of growth.</p>
+
+<p>As a rule, simple hypertrophic disease of the penile integument does not
+interfere with the sexual functions of the male organ after its removal;
+it being susceptible of complete removal in exaggerated cases, even
+without touching the body of the organ. There are exceptions to this
+rule, however, when even this otherwise non-malignant disease may entail
+the loss of all the genitals. In the London <i>Lancet</i> of July 11, 1846,
+at page 46, there is a record of a remarkable case of this nature
+reported by F. H. Brett, Esq., F.R.C.S. The case was that of a locksmith
+of forty years of age, who was naturally much phimosed. The penis was
+enormously enlarged, as well as the scrotum, which was more or less
+ulcerated and full of sinuses filled with a serous pus; some six months
+prior to the final operation, a part of the prepuce was removed to
+facilitate urination, but the whole mass had to be subsequently removed,
+<span class='pagenum'><a name="Page_252" id="Page_252">[252]</a></span>
+including the whole of the skin of the penis and the scrotum, the
+testicles having been carefully dissected out and recovered with some
+skin flap.</p>
+
+<p>In this case the disease was believed to have originated from a perineal
+fistula. The pathological investigation in the case, however, by Mr.
+Quekett, who submitted the mass to a microscopical examination,
+confirmed Mr. Brett in his original opinion that the disease had the
+same pathological conditions as the similar disease found in India,
+where it originates from local inflammatory causes. In this case the
+preputial irritation was, in all probability, the precursor of the
+conditions that led to the perineal fistula, the patient having had a
+stricture for some twelve years. Mr. Brett states that the man had been
+abandoned by his wife on account of his previous sexual disability, and
+on account, as well, of his having been incapacitated from following any
+vocation. After the operation all his functions were restored and his
+organs were sound.</p>
+
+<p>Nelaton records a case reported by Wadd, in 1817, of an African negro so
+affected, whose penis measured fourteen inches in length and twelve and
+a half inches in circumference; also the case reported by Gibert, of
+Hospital St. Louis, of a subject &ldquo;with a penis the size of a
+mule&rsquo;s.&rdquo;</p>
+
+<p>Mr. Brett attributes the recovery of his case as being due in a great
+measure to the moral support given to the patient from the knowledge
+that his procreative organs were not interfered with, and on the same
+grounds he attributes the great fatality previously attending the
+operation to the fact that it previously had been the custom in many
+cases to make a clean general <i>taill&egrave; &agrave; fleur de ventre</i>,
+sacrificing all the genital organs. In simple hypertrophy, he considers
+that the body of the <span class='pagenum'><a name="Page_253" id="Page_253">[253]</a></span>
+penis and the testicles will always be found to be in a normal
+condition; a careful dissection of the parts will invariably save not
+only the man&rsquo;s sexual functions, but his moral stamina, which he
+sadly needs in such an emergency. In the discussion on this subject
+heretofore mentioned as taking place in the London Medical Society, Mr.
+Pye, Mr. John A. Morgan, and others insisted on the necessity of
+retaining the testicles, whenever possible, in all these sweeping
+operations upon the genitals, they being actually necessary for the
+moral and physical support of man, Mr. Morgan observing that their
+removal would depress parts controlled by the sympathetic system.</p>
+
+<hr /><p class='pagenum'><a name="Page_254" id="Page_254">[254]</a></p>
+<h2><a name="CHAPTER_XXIII" id="CHAPTER_XXIII"></a>CHAPTER XXIII.<br />
+<span class='sc sf75'>Reflex Neuroses and the Prepuce.</span></h2>
+
+<p>We have seen in the previous chapters what the immediate effects of the
+prepuce may lead to; we have followed its local effects in childhood to
+youth, thence into what it does in our prime, and we have seen how, when
+we are on the down grade, owing to the increase of years, then, like the
+minute-men of Concord, wakened up by Paul Revere&rsquo;s classic ride,
+hanging on to the rear of the retreating and disheartened British, it
+harasses, worries, and downs a man here and there, striking down the man
+as if it had some undying, irremediable spite, which nothing but his
+misery and death could alleviate. Some authorities will argue that all
+that is required is cleanliness; that all men need do is to be like a
+true American, with the old Continental watchword of &ldquo;eternal
+vigilance is the price of liberty&rdquo; in continued active practice. A
+bowlful of some antiseptic wash and a small sponge should always be at
+hand, and he should be as industrious as if haltered in a tread-mill; he
+should make this a part of his toilet, and his daily and hourly care.
+This will, we are told, lessen his chances of becoming a victim to the
+many ills that lie in wait for him, all on account of the glory, honor,
+and comfort of wearing a prepuce, which is a perfectly physiological
+appendage.</p>
+
+<p>From these visible and apparently easily understood conditions and
+results we are now to enter a broad field, wherein the prepuce seems to
+exercise a malign influence in the most distant and apparently
+unconnected manner; <span class='pagenum'><a name="Page_255" id="Page_255">[255]</a></span>
+where, like some of the evil genii or sprites in the Arabian tales, it
+can reach from afar the object of its malignity, striking him down
+unawares in the most unaccountable manner; making him a victim to all
+manner of ills, sufferings, and tribulations; unfitting him for marriage
+or the cares of business; making him miserable and an object of
+continual scolding and punishment in childhood, through its worriments
+and nocturnal enuresis; later on, beginning to affect him with all kinds
+of physical distortions and ailments, nocturnal pollutions, and other
+conditions calculated to weaken him physically, mentally, and morally;
+to land him, perchance, in the jail, or even in a lunatic asylum.
+Man&rsquo;s whole life is subject to the capricious dispensations and
+whims of this Job&rsquo;s-comforts-dispensing enemy of man.</p>
+
+<p>As strange as it may seem, this field of knowledge, this field of misery
+and suffering, disease and distortion, of physical and mental obliquity,
+presided over by this preputial Afrit of malignant disposition, was an
+unknown, undiscovered, and therefore unexplored region for some
+thousands of years, and it remained for an American to discover and
+describe this vast territorial acquisition, and to annex it to the
+domain of medicine, which, through its skill, could modify the influence
+of the evil genius that there presided and spare humanity much of the
+ills to which it had been subjected.</p>
+
+<p>In this regard, Louis A. Sayre was to medicine what Columbus was to
+geography. Neither Strabo nor Herodotus had anything to say regarding
+what existed beyond the pillars of Hercules, and neither Hippocrates nor
+Galen had anything in regard to this preputial Merlin, which in their
+day, even, had its existence. Neither did Tissot nor Bienville, the two
+pioneers in the field of our knowledge regarding onanism and
+nymphomania, <span class='pagenum'><a name="Page_256" id="Page_256">[256]</a></span>
+dream of the existence of this one cause of the diseases to which they
+gave so much time and study. It is only some twenty years since Louis A.
+Sayre read his paper, entitled &ldquo;Partial Paralysis from Reflex
+Irritation Caused by Congenital Phimosis and Adherent Prepuce,&rdquo;
+before the American Medical Association. This was the starting-point
+from whence the profession entered into what had previously been a
+veritable &ldquo;Darkest Africa.&rdquo;</p>
+
+<p>When we read that only some fifty years before the times of Columbus
+Christian Europe had no lunatic asylum,&mdash;not that there was a lack of
+lunatics or that the existence of lunacy was entirely ignored, but that
+the then state of medicine and the general intelligence was not
+emancipated from the idea of demoniacs,&mdash;and we are told that the
+lunatics were in many instances hung, quartered and burned, hooted and
+chased about the streets, or chained in gloomy dungeons; until, as
+related by Lecky, a Spanish monk named Juan Gilaberto Joffe, filled with
+compassion at the sight of the maniacs who were hooted by crowds through
+the streets of Valencia, founded an asylum in that city. His movement in
+this direction called the attention of the Church and people to this
+class in a practical light, and from Spain a more enlightened idea in
+regard to this class swept onward throughout Europe. As observed, it
+seems strange to us of the present day that such ignorance in these
+matters should, or could, have so long existed. It seems impossible for
+us to conceive how these conditions of incoherent action and of mental
+derangements could have existed and their causes have not been fully
+appreciated; and yet we were not above, some twenty years ago only,
+subjecting children to punishment and scoldings for being addicted to
+nocturnal enuresis, or of accusing <span class='pagenum'><a name="Page_257" id="Page_257">[257]</a></span>
+cases of nocturnal and involuntary emissions as being due to
+masturbation. The child was allowed then to grow up paralytic, or with a
+deformed limb, or continually punished to correct what was imagined to
+be a condition of willful carelessness, irritability, or willful moral
+perversion. Perversion, stupidity, and irritability of the mind or
+temper were not known to depend, in many instances, on preputial
+irritation; children were, accordingly, worried and punished for
+something over which they had no earthly control or the least volition.
+Humanity cannot, at present, sufficiently appreciate what Louis A. Sayre
+has done in its behalf. It is here that we realize the hidden wisdom of
+the Mosaic law and the truth of the assertion of the late Dr. Edward
+Clarke, that, &ldquo;The instructors, the houses and schools of our
+country&rsquo;s daughters, would profit by reading the old Levitical
+law. The race has not yet outgrown the physiology of Moses.&rdquo;</p>
+
+<p>These irritations from the preputial irritability are not always so slow
+moving as to span over either months or years in their fell work.
+Instances of their sudden action have been sufficiently recorded as to
+warrant them as being classed as causative agents in acute affections
+that instantly threaten life. In the London <i>Lancet</i> of May 16, 1846,
+there is a record of a very peculiar case reported to the London Medical
+Society by Dr. Golding Bird: &ldquo;The case was that of a child seven
+or eight weeks old only, an out-patient of Guy&rsquo;s Hospital. The
+child had become almost lifeless immediately after nursing, and to all
+appearances looked as if under the influence of some narcotic. It had
+not, however, had anything of the kind given to it, nor had it sustained
+a fall, nor was the head so large as to lead to suspicion of congenital
+hydrocephalus. On inquiring if the child passed water, the answer led to
+an examination of the <span class='pagenum'><a name="Page_258" id="Page_258">[258]</a></span>
+prepuce, which was found to be elongated, and had an aperture only of
+the size of a pin-hole, like a puncture in the intestines. The urine was
+dribbling out; it was evident that the child had never completely
+emptied its bladder. Mr. Hilton slit up the prepuce, and all the
+symptoms were immediately relieved and soon entirely removed.&rdquo; Dr.
+Bird referred to a case which he had related to the Society some years
+before, which was reported in the <i>Lancet</i> at the time, of a child who
+fell a victim to a malformation of this kind, and after death the
+bladder and ureter were found like those of a man who had long suffered
+from stricture. Mr. Hilton has seen many cases similar to the one
+mentioned by Dr. Bird. The greatest benefit resulted from slitting up
+the prepuce. In this case the benefit was very remarkable, a partial
+paralysis of the left side, under which the little patient labored,
+being quite removed in twenty-four hours.</p>
+
+<p>In this case the difficulty was evidently both the result of mechanical
+pressure and reflex irritation. A somewhat similar case as to its
+results is given by Dr. Sayre, to whom the case was reported by Dr. A.
+R. Mott, Jr., of Randall&rsquo;s Island, in January of 1880: &ldquo;John
+English, aged 46, native of England, widower, clerk; admitted to
+workhouse hospital. Patient had been at work for a week as a prisoner;
+on the 23d of December was noticed to be restless and uneasy, and
+finally, in the evening, he fell from his bunk in a fit. During the next
+forty-eight hours he had several convulsions, and during the intervals
+lay in a semi-comatose condition, showing no consciousness except to
+stir a limb when pinched. Pulse, 120; temperature, 101-1/2&deg;;
+respiration, 18. Swallowed nothing, and passed f&aelig;ces in bed. Continued
+in this condition until December 25th<span class='pagenum'><a name="Page_259" id="Page_259">[259]</a></span>
+(temperature having fallen to 100&deg;), when a string was discovered
+passed twice around the penis behind corona and tied, the long prepuce
+serving to conceal it from observation. While not sufficiently tight to
+occlude the urethral canal, still a firm, indurated band remained after
+the string was cut, and did not disappear for four or five days.</p>
+
+<p>&ldquo;Within one hour after the removal of the string the man sat up
+and asked for milk, and from this time remained perfectly well (was
+under observation for three months). He declared that he remembered
+nothing that had taken place during the past three days; had never had
+fits, denied venereal diseases, was moderately addicted to drink, but
+had led a &lsquo;virtuous life since the death of his wife, two years
+before.&rsquo;&rdquo;</p>
+
+<p>The following case in the practice of Dr. F. J. Wirthington, of
+Livermore, Pa., was also reported to Dr. Sayre: &ldquo;When the child
+was born, he was considered the biggest and finest boy that had been
+born in the community for a long time, until, when he was about two and
+a-half years old, and being sick, a doctor was called in, who told them
+that their child was paralyzed, the paralysis being in his lower
+extremities, and who treated him with the usual nerve-tonic and with
+electricity. Notwithstanding all this, the boy went steadily down, and
+the paralysis continued until he was seen by Dr. Wirthington. The child
+was then unable to walk; on examination, the prepuce was found to be
+adherent almost all the way around the glans penis. Behind the corona
+was a solid cake of sebaceous matter. The case was promptly operated
+upon, and, although the previous attendant had not found any cause to
+account for the paralysis, a rapid recovery took place, the boy being
+able to walk even before the complete cicatrization of the wound, and
+was soon the picture of health.&rdquo;</p>
+
+<p><span class='pagenum'><a name="Page_260" id="Page_260">[260]</a></span>
+Dr. T. F. Leech, of Attica, Fountain County, Ind., reports a case of a
+fourteen-month-old child, who had been the terror of all that part of
+the town for over six months, as he cried constantly. Except when asleep
+or nursed by his mother, he would lie perfectly still and squall, not
+showing any disposition to sit up; nor did he like to be raised up. He
+was very nervous, and would have times when his limbs would be rigid.
+This state of things grew worse, until the child was accidentally seen
+by Dr. Leech, who, on examination, found a contracted and adherent
+prepuce, the child being at the time in a high fever and suffering great
+nervous excitement. An operation by slitting and breaking up the
+adhesion afforded immediate relief; the spinal irritation, partial
+paralysis of the lower extremities, spasms during urination, and all
+trouble disappeared as if by magic.</p>
+
+<p>Prof. J. H. Pooley, of Columbus, Ohio, reported the case of a fine,
+healthy boy who, up to three months before being seen professionally,
+had always been well and in perfect health. His condition was found by
+Professor Pooley to be one of localized chorea, manifesting itself in
+constant convulsive movements of the head. They were nodding or
+antero-posterior movements, alternating with lateral or shaking and
+twisting motions; these movements had become almost constant during the
+waking hours of the child. There was no distortion of the features nor
+any choreic movements of the extremities; indeed, the whole affection
+consisted in the nodding and shaking movements of the head referred to.
+These were almost incessant, sometimes slow and almost rhythmical, then
+for a minute or two rapid and irregular, seeming to fatigue the little
+fellow, and accompanied by a fretful, whimpering cry. The child had been
+subjected to a variety of treatment, but without any benefit or <span class='pagenum'><a name="Page_261" id="Page_261">[261]</a></span>
+effect of any kind. Upon the most careful examination of the patient
+and his history, Professor Pooley could not discover anything that
+seemed to throw any light upon the case, except a condition of
+well-marked phimosis. Acting upon this, the Professor immediately
+circumcised the child, and from the very day of the operation the
+spasmodic action began to diminish, and in two weeks he was entirely
+well, without any other treatment of any kind.</p>
+
+<p>Dr. W. R. McMahon, of Huntington, Indiana, has reported three cases of
+epilepsy in children caused by congenital phimosis that were entirely
+relieved by an operation without any subsequent return of the
+difficulty. One of the cases was in a boy ten years old, with very firm
+preputial adhesions and a high grade of inflammation of the parts.</p>
+
+<p>Dr. J. D. Griffith, of Kansas City, Mo., operated on a case of phimosis
+on a child nearly three years of age, who was afflicted with repeated
+attacks of convulsions and paralysis of the hips and lower extremities;
+the little fellow had as many as fifteen convulsions in a day; the
+patient was greatly troubled with painful urination and priapism. On
+examination at the operation, a firmly adherent prepuce and a large roll
+of caseous matter was found just back of the corona. A complete recovery
+followed the removal of these conditions.</p>
+
+<p>The above cases are taken from the paper read before the Section of
+Diseases of Children at the International Medical Congress of 1887, by
+Dr. Sayre. It contains a number of additional cases of an analogous
+character to the above, reported to him by physicians in different parts
+of the country. They show the variety, extent, and far-reaching
+character of the diseases induced by any preputial irritation. Dr. G. L.
+Magruder, <span class='pagenum'><a name="Page_262" id="Page_262">[262]</a></span>
+of Washington, D. C., in the same paper, has a record of twenty-five
+cases of various nervous disturbances which he had entirely relieved by
+circumcision or dilatation, without any medication whatever. Dr.
+Magruder, in concluding his report, in which he quotes the authority of
+Brown-S&eacute;quard, Charcot, and Leyden, as having noticed serious
+nervous disturbances resulting from reflex irritation due to affections
+of the genito-urinary organs, observes as follows:&mdash;</p>
+
+<p>&ldquo;From the foregoing, I think that we are justified in the
+conclusion that phimosis and adherent prepuce give rise to varied
+troubles of more or less gravity, manifesting themselves either in the
+muscular, osseous, or nervous systems; and that the removal of these
+abnormal conditions of the penis frequently affords marked relief, and,
+at times, perfect and permanent cure.&rdquo;</p>
+
+<p>In the discussion that followed the reading of Dr. Sayre&rsquo;s paper,
+Dr. De Forest Willard, of Philadelphia, remarked that he had operated by
+simply stripping back the prepuce and that he did not circumcise, but
+that he looked upon the subsequent cleanliness of the parts as the
+greatest safeguard, not only as against reflex irritation, but also
+against masturbation. Retained filth and smegma are far more likely to
+call a boy&rsquo;s attention to his penis by their unrecognized
+irritative effects than washing can possibly do. His practice is in
+accordance with the belief that young children can be relieved by the
+simpler methods, such as dilatation; but he also observes that when a
+child has reached eight or ten years of age, and has never been able to
+expose the glans, contraction is almost certain to be present, and
+circumcision must be performed. In adults there is rarely any escape
+when the prepuce is tight.</p>
+
+<p>Dr. I. N. Love, of St. Louis, said: &ldquo;It has been my <span class='pagenum'><a name="Page_263" id="Page_263">[263]</a></span>
+judgment and my practice for <ins class='corr'
+title="Transcriber&rsquo;s Note: The original showed
+&lsquo;may&rsquo;.">many</ins> years, in these reflex irritations, to pursue
+the radical course of circumcision. I believe thoroughly in the Mosaic
+law, not only from a moral but also from a sanitary stand-point. All
+genital irritation should be thoroughly removed. It is all very well to
+instruct the mother or the nurse to keep the parts within the prepuce
+clean, but they can not or will not do it. Complete and proper removal
+of the covering to the glans takes away all the cause of disturbance.
+Dr. Sayre takes a more pronounced position on this subject than the
+majority of those who have discussed his paper. An improper performance
+of a surgical procedure is no argument against the operation, but rather
+against the operator. For the reasons I have given, I am in favor of the
+radical application of the Mosaic rite of circumcision.&rdquo;</p>
+
+<p>Dr. J. Lewis Smith, the president of the Section, believed in the evil
+results of the reflex irritation due to abnormality of the prepuce. In
+many instances the causative relation of the preputial disease to the
+symptoms which it produces is not so apparent as it may be in others,
+but after correct treatment of the prepuce they disappear. There was one
+result of phimosis which, he observed, neither Professor Sayre nor those
+who contributed to his paper noticed. The expulsive efforts accompanying
+urination sometimes cause prolapsus of the rectum, and frequently
+produce inguinal hernia. In a lecture before the Harveian Society
+(<i>British Medical Journal</i>, February 28, 1880), Edmund Owen, Surgeon to
+St. Mary&rsquo;s Hospital and to the Hospital for Sick Children, says:
+&ldquo;Perhaps the commonest cause of hernia in childhood is a small
+preputial or urethral orifice, and next to that I would put the
+smegma-hiding or adherent prepuce.&rdquo; Arthur Kemp<span class='pagenum'><a name="Page_264" id="Page_264">[264]</a></span>
+(London <i>Lancet</i>, July 27, 1878), Senior House-Surgeon to the
+Children&rsquo;s Hospital, says: &ldquo;Phimosis is a common occurrence,
+and numerous ill effects can undoubtedly be attributed to it;&rdquo; and
+he alludes to the observation of Mr. Bryant, as published in his book on
+the &ldquo;Surgical Diseases of Children&rdquo;: &ldquo;In fifty
+consecutive cases of congenital phimosis, thirty-one had hernia, five
+had double inguinal hernia, and many had umbilical hernia besides. In no
+one was the hernia congenital, its earliest occurrence being at three
+weeks. Circumcision was performed in these cases, and all were much
+benefited.&rdquo;<a name="FNanchor_103_103" id="FNanchor_103_103"></a><a href="#Footnote_103_103" class="fnanchor">[103]</a></p>
+
+<p>During the session of the Ninth International Congress, where the above
+paper was read and remarks made, which appear in the third volume of its
+&ldquo;Transactions,&rdquo; another paper was also presented by Dr.
+Saint-Germain, of Paris. The Doctor fully recognized the dangers from a
+narrow or adherent prepuce, but did not think that more than one case in
+three hundred really required circumcision; he believed in dilatation,
+as employed by Nelaton, with the exception that, whereas Nelaton employs
+three branches to his dilator, Saint-Germain preferred only a two-branch
+dilator.</p>
+
+<p>Dr. Lewis, the president of the Section, related a number of cases where
+the use of uncleanly instruments had resulted disastrously. But, for
+that matter, the same objection can be offered against dilatation, as a
+filthy instrument is as liable to infect the patient as a knife. There
+is no earthly excuse why a knife that has been used on a case of
+diphtheritic croup should be used some hours afterward to circumcise a
+child. As to the operation of dilatation practiced by Dr. Holgate, it
+can really be said to answer the <i>immediate</i> demands, but how far its
+utility is efficient as to <i>permanent</i> results<span class='pagenum'><a name="Page_265" id="Page_265">[265]</a></span>
+Dr. Holgate has not given the profession any information.<a name="FNanchor_104_104" id="FNanchor_104_104"></a><a href="#Footnote_104_104" class="fnanchor">[104]</a></p>
+
+<p>One of the most interesting and instructive papers that it was ever the
+fortune of the writer to listen to, touching on the subject of reflex
+nervous diseases or neuroses due to preputial adhesions, was one
+prepared by Dr. M. F. Price, of Colton, California, and read at the
+semi-annual meeting of the Southern California Medical Society, at its
+Pasadena meeting in December, 1889. In the course of the paper he gives
+a considerable number of examples, of which some extracts are herewith
+given: One case was a boy aged seven, who for two years had had frequent
+attacks of palpitation of the heart; when seen by Dr. Price the little
+heart was laboring hard, beating at a furious rate (far beyond
+counting), with a loud blowing or splashing sound, and the pulse at the
+wrist a mere flutter. The breath was inspired in a series of jerks, the
+face flushed and somewhat swollen. The chest-wall was visibly moved at
+every thump of the heart. The doctor attended the child for a month
+without the little patient making any appreciable improvement. Some time
+during this period of observation the father happened to mention that
+the boy sometimes complained of his penis hurting him at the time of an
+erection. This led the doctor to examine the parts, when he found a long
+prepuce, with a mucous membrane adherent to the glans, about a line
+beyond the corona, the whole circumference of the organ. With the use of
+cocaine and a blunt instrument the adhesions were removed, with an
+immediate amelioration of all the reflex symptoms. The very next
+paroxysm was lighter and less exhausting; the improvement was
+continuous. The child soon went to school and had no further trouble;
+but, in the doctor&rsquo;s opinion, the two years&rsquo;<span class='pagenum'><a name="Page_266" id="Page_266">[266]</a></span>
+hard struggle have not been without its evil results on the
+constitution and organism of the child.</p>
+
+<p>The next case was born November 2, 1888; a large, healthy boy at birth.
+By June of the following year the child was afflicted with what the
+mother called &ldquo;jerky spells;&rdquo; up to this time the boy seemed
+listless, did not care to sit up, and seemed from some cause to be in
+more or less pain, with his eyes turned to the left. The parents dreaded
+that the child, their only one, would turn out idiotic. The spasmodic
+spells alluded to were of a tetanic nature, the body being thrown
+backward; his head and eyes continued to be turned to the left, and
+nothing could attract the child&rsquo;s attention. The boy cried night
+and day, but he was in good flesh, had all the teeth he should have,
+bowels were regular, and the appetite good. Whatever the doctor did in
+the medical way seemed to be of no avail. One day, however, he thought
+of examining the prepuce, thinking, perhaps, that it might be contracted
+and that the convulsive movements might be reflexes from the parts. On
+examination the prepuce was found elongated and distended, with a very
+minute opening; this was dilated with difficulty, when the inner fold
+was found adhering almost the whole extent of the glans; the dilatation
+and breaking down of these adhesions was slowly persevered in, until
+sufficient dilatation was obtained and the glans was freed. From the
+very first operation the convulsions commenced to diminish, both in
+force and frequency, and a constant and rapid improvement of the child
+took place. Six months afterward the boy was perfectly normal, stood by
+himself, played with play-things, and was an interested member of the
+family circle.</p>
+
+<p>Case No. 3 was a repetition of Case No. 2, except <span class='pagenum'><a name="Page_267" id="Page_267">[267]</a></span>
+that, with the experience of the latter case, the doctor wasted no time
+with medication, but proceeded at once to examine the prepuce, which was
+found to be very long, and with a pin-hole opening. The dilatation of
+this and the breaking up of the adhesions gave immediate relief. During
+the course of the paper he quoted the case related by
+Brown-S&eacute;quard, and recorded in the New York <i>Medical Record</i>,
+vol. xxxiv, p. 314, where he &ldquo;related a very interesting case that
+presented all the rational signs of advanced cerebral disease, a case
+that he considered quite hopeless, that was relieved by an operation for
+phimosis and the treatment of an inflammatory condition of the glans
+penis.&rdquo; To use Brown-S&eacute;quard&rsquo;s own words, &ldquo;So
+rapid was the recovery that within six weeks from the day of the
+operation he presented himself at my office perfectly well in every
+respect.&rdquo;</p>
+
+<p>In the early part of this book, in speaking of female circumcision, it
+was mentioned that when the medical part of the volume should be reached
+some medical reasons for its necessity would be given. Dr. Price, in his
+paper, gives some information on this subject, which is of the greatest
+interest. In the course of the paper he says as follows: &ldquo;Nor do I
+think these reflex neuroses from adherent prepuce wholly confined to the
+male sex. The preputium-clitoridis may be adherent and produce in the
+female similar reflexes. During the session of the American Medical
+Association, held in Chicago in 1874, I think, I attended one afternoon
+a clinical lecture by Dr. Sayre. A little girl, fourteen years of age,
+but about the size of a seven-year-old child, was brought in, who had
+never walked nor spoken, but with quite an intelligent countenance, who
+was in constant motion, and who presented very many nervous <span class='pagenum'><a name="Page_268" id="Page_268">[268]</a></span>
+symptoms. Dr. Sayre examined her, and found the prepuce adherent the
+whole extent of the clitoris. He gave it as his opinion that here was
+the primary and sole cause of the symptoms, and that appropriate
+treatment shortly after birth would have prevented all the serious
+consequences so painfully apparent, and which was then too late to
+remedy.</p>
+
+<p>&ldquo;I once had occasion to pass a catheter into the bladder of a lady
+who presented an innumerable train of nervous symptoms, often bordering
+on insanity, but was unable to do so without exposing the parts.
+Although the meatus could be distinctly felt, the catheter would not
+enter. On exposure to view, an opening was seen in the clitoris, which
+was firmly bound down by preputial adhesions near the extremity of the
+organ. Entering the catheter at this point, it readily passed through
+the clitoris, then down through a passage under the mucous membrane to
+the natural site of the meatus, on into the urethra, and through into
+the bladder. In the light of recent experience, my opinion now is, that
+here was the cause of all the nervous symptoms in this case.&rdquo;</p>
+
+<p>The relative disposition in regard to the irritability of the external
+sexual organs as existing in the female, when contrasted with the male,
+is, for some reason, not sufficiently considered or understood. The idea
+of masturbation or of irritation from the genitals ending in reflex
+neuroses is always, as a rule, associated with the male, and that it has
+not been more associated with the female has deprived her of the same
+benefit that the prosecution of the study in this regard has been to the
+male sex. Masturbation among the feeble-minded, which is so common,
+must, of necessity, have for its determining cause a foundation of
+morbid irritability of the sexual <span class='pagenum'><a name="Page_269" id="Page_269">[269]</a></span>
+organs. This is well known to be so among the males, whose hands seem
+instinctively to be drawn to those parts. Dr. C. F. Taylor, of New York,
+in an article on the &ldquo;Effect of Imperfect Hygiene of the Sexual
+Function,&rdquo; published in the <i>American Journal of Obstetrics</i> for
+January, 1882, gives us an account of his investigations in this regard,
+with the following results: &ldquo;In an asylum for the feeble-minded of
+both sexes, it was found that the habit was about equal in the two
+sexes, there being only this difference: that the females began to
+masturbate one or two years earlier than the males, and that the habit,
+once established, was found to be more persistent than in the males. It
+was, further, ascertained that the habit came naturally, without the aid
+of precept or example to either sex.&rdquo;</p>
+
+<p>It may well be a question as to whether the feeble-mindedness be not a
+reflex condition from this excessive morbid irritability of the sexual
+organs. There is not much doubt but that, if one of the cases reported
+by Dr. Price had not been circumcised, the expressionless, listless
+infant would have grown, in time, into a masturbating, feeble-minded,
+idiotic creature, as many others, so situated, have done before it. Now,
+would it have been logical to have laid the morbid irritability of its
+generative organs to its feeble-mindedness, when its feeble-mindedness
+was fully demonstrated to have been wholly dependent on the sexual
+irritation? From these premises we might take another step forward, and
+ask whether, under a proper hygienic prophylaxis,&mdash;which would involve a
+thorough inspection of the genitals of <i>all</i> children reported to be
+either physically or mentally deficient,&mdash;such a course would not
+greatly diminish the number of paralytics, feeble-minded, and generally
+deficient of both sexes? If the results in <span class='pagenum'><a name="Page_270" id="Page_270">[270]</a></span>
+private practice are any criterion, it is safe to assert that a strict
+adherence to the Mosaic law for the males and to some of the African
+customs for the females would most assuredly relieve all these cases
+that might come under the caption of results of reflex neuroses. Twenty
+years ago this subject was, to the body of the profession, a <i>terra
+incognita</i> in regard to the male, and, as the female is similarly
+subject to the same morbid influence, it is to be hoped that in the
+present decade she will receive the same attention which the profession
+is now beginning to pay to the male sex.<a name="FNanchor_105_105" id="FNanchor_105_105"></a><a href="#Footnote_105_105" class="fnanchor">[105]</a></p>
+
+<p>In the foregoing parts of this chapter, examples of reflex neuroses have
+been given to show the different effects that genital irritation will
+produce. The cases given were chosen for the diversity of variety of
+symptoms, and as cases representing the affection, without any other
+complication. Many more could have been added, but they are unnecessary.
+In the writer&rsquo;s practice there has been a number of cases in the
+adult that have exemplified that this form of ailment is by no means
+restricted to children, as has been shown in the case reported by Dr.
+Mott to Dr. Sayre, in regard to the middle-aged man with a string about
+his penis. One of these cases was that of a young man, six feet in
+stature, broad-shouldered, and well built. He applied for relief for a
+dyspepsia that affected his stomach and also his heart. The man had an
+apparently feeble and irritable heart; cold, clammy skin; disturbed
+digestion, and uneasy sleep; was constipated and flatulent. No treatment
+seemed to make any impression upon his case. At last he began to
+emaciate and look haggard. His mind was also becoming visibly weaker,
+was attacked by dizziness, and on several occasions he fell in a fit.
+With this condition he at last began to have frequent <span class='pagenum'><a name="Page_271" id="Page_271">[271]</a></span>
+nocturnal emissions. On account of the latter his genital organs were
+examined, and the penis was found smaller than the average, with a long
+and narrow prepuce. The glans could easily be uncovered, but the
+tightness of the prepuce and its unyielding qualities made paraphimosis
+a possibility; so that the young man, having once or twice had
+considerable difficulty in returning the prepuce to its place, never
+attempted its retraction again. There were no adhesions, but the inner
+fold of the prepuce had been thickened by balanitis. Seeing the need of
+circumcision <i>for the local benefit</i>, the operation was suggested with a
+view of relieving the pressure on the glans, which was looked upon as
+the probable cause, in his broken-down condition, of the advent of the
+nocturnal emissions. He gladly submitted, and, to the surprise of both
+physician and patient, <i>all</i> his troubles disappeared, and he at once
+became a changed man. So impressed was he with the result, that, on his
+return to his home, he examined his younger brother, and, finding him
+with a like long, narrow prepuce, he immediately brought him in and had
+him circumcised, as a prophylactic against his being subjected to the
+risk of lost health as he himself had suffered.</p>
+
+<p>Another case, a man of forty-five, also a farmer, was afflicted with
+dyspepsia, palpitation of the heart, general debility, constipation,
+constant headache, etc. He could not cut up an armful of wood without
+bringing on palpitations and gaseous eructations, or being upset for the
+day; and after having connection with his wife he generally had a
+terrific headache, lasting for two or three days;<a name="FNanchor_106_106" id="FNanchor_106_106"></a><a href="#Footnote_106_106" class="fnanchor">[106]</a>
+he could stand no protracted mental effort, even such as is required to
+make an addition of a long line of figures, or the least business worry,
+without the supervening <span class='pagenum'><a name="Page_272" id="Page_272">[272]</a></span>
+headache. All treatment against these conditions was useless; the colon
+was kept empty, the diet was changed; pepsin and bismuth, tonics,
+frictions, Turkish baths, and all hygienic observances and moral
+treatment were all of no avail. One day, on consulting the writer, he
+complained of a pruritus at the head of the penis. On examination it was
+found that he had a narrow, long prepuce, a congenitally-contracted
+meatus, and was then suffering with a slight balanitis. He was very
+careful to keep the parts clean, but, he informed me, that in spite of
+all precautions, these attacks would come on. The mucous covering of the
+inner fold of the prepuce and glans was so irritable that connection
+often brought it about. The glans was small and elongated, with the
+meatus red, and with lips &oelig;dematous and congested. To free him
+from this tormenter, circumcision was advised. The party could not,
+however, remain away from home for the time required for the operation;
+so that a compromise operation was performed,&mdash;one that would not
+keep him from business, and, at the same time, relieve the contracting
+pressure on the glans. This was by Clouquet&rsquo;s operation and
+bandaging back the prepuce over the penis, back of the corona,&mdash;an
+operation that, in my hands, has often filled all the desired purpose.
+The meatus was also incised. After the operation <i>all</i> of his troubles
+disappeared, as they had done in the preceding case, and he was soon a
+hearty and well man, able to chop wood, attend to business, and, in case
+of need, do family duty for a Turkish harem without recurrence of his
+old tormenting, dyspeptic palpitation or sick-headache.</p>
+
+<p>The writer has resorted to circumcision in many cases to improve the
+temper and disposition of children, with the best of results, and in one
+case, in association with another physician, performed the operation on
+a <span class='pagenum'><a name="Page_273" id="Page_273">[273]</a></span>
+lunatic, whose lunacy ran to women and girls, with whom he would fall
+desperately in love, without any encouragement or provocation, or even
+acquaintance; finally reaching spells of such incoherence of action and
+speech that confinement would be required. The peculiarity of his
+hallucinations called attention to the genital organs. This man had
+never masturbated, and was, when well, a compactly-built, active, and
+intelligent man. By occupation he was a contractor, and a man of more
+than usual executive ability besides. On examination it was found that
+he was a subject of congenital phimosis, never having been able to
+uncover the glans. He had been in the habit of washing out the preputial
+cavity by the aid of a flat-nozzled syringe. The prepuce was long, but
+not thick; nevertheless, it was inelastic and very firm. The examination
+seemed to have a good mental effect upon the man, as it made him quite
+rational for the moment. He entered into the idea that this condition
+had some connection with his derangement very intelligently, even
+suggesting many symptoms and attacks that he had suffered from childhood
+up as probably gradual-stepping processes through which his present
+condition had been reached. He cheerfully submitted to a thorough
+circumcision, which had the effect of ameliorating his condition. He was
+subsequently sent to an asylum, where, after a short time, he was
+discharged well. Some years afterward, conscious of feeling a return of
+the mental derangement, he voluntarily applied for admission to the same
+institution and remained until better.</p>
+
+<p>This case is very instructive. The patient readily connected his mental
+trouble, by a retrospective view through a series of
+gradually-increasing troubles, that originated in the preputial
+condition, to the phimosed <span class='pagenum'><a name="Page_274" id="Page_274">[274]</a></span>
+condition of that appendage, and he was certain that this prepuce had
+been at the bottom of all the physical and mental trouble he had
+experienced. The reflex nervous train of affections had undoubtedly
+produced some localized lesion in the brain-structure. The natural
+sound, healthy organism of that organ, and the bright, active nature of
+his mind, however, prevented a total wreckage of the mental faculties.
+It is safe to assume that, had he had the ordinary listless, unresisting
+mind, disposed to brood, and easily cast down, he would, from the first
+derangement, have become a hopeless and demented lunatic. The
+circumcision could not undo all the mischief that had been accomplished,
+some of which had certainly left a permanent taint, but the mildness of
+his future attacks and the better exercise of his volition were the
+undoubted results of the operation.</p>
+
+<hr /><p class='pagenum'><a name="Page_275" id="Page_275">[275]</a></p>
+<h2><a name="CHAPTER_XXIV" id="CHAPTER_XXIV"></a>CHAPTER XXIV.<br />
+<span class='sc sf75'>Dysuria, Enuresis, and Retention of Urine.</span></h2>
+
+<p>Any dissertation on circumcision and its many uses, either prophylactic
+or curative, would be incomplete without a reference to enuresis;
+another reason for making a somewhat full reference to the subject would
+be the undecided position that this morbid condition seems to occupy in
+medical literature, as well as the meagre and unsatisfactory treatment
+it has received by the majority of those who have mentioned it. It is
+anomalous, to say the least, to find, in general or special literature,
+enuresis mentioned as a diseased condition peculiar from babyhood to
+puberty; to find it fully described and to have it stated that it is a
+widely-prevalent distemper, affecting both sexes alike; to know that it
+is an annoying, intractable, persistent condition, wearing to the child
+in every sense, subjecting it to a demoralizing mortification as well as
+to unmerited scoldings, humiliations, and punishments, and that its
+habit, in badly-ventilated quarters, will breed other diseases,<a name="FNanchor_107_107" id="FNanchor_107_107"></a><a href="#Footnote_107_107" class="fnanchor">[107]</a>
+as well as that its continued action tends to the development of
+onanism, with its long and widely-ramifying trains of physical and
+social ills; and to find works especially devoted to children&rsquo;s
+diseases silent on the subject. Knowing all these things, and also that
+Ultzmann, Lallemand, and others who have treated this affection, mention
+it as a children&rsquo;s disease, it is unaccountable to reason out why
+most of our text-books and treatises on children&rsquo;s diseases should
+be so remarkably and unreasonably silent. It certainly cannot be laid to
+its lacking in <span class='pagenum'><a name="Page_276" id="Page_276">[276]</a></span>
+study material, as the author of &ldquo;Quain&rsquo;s Dictionary of
+Medicine&rdquo; says: &ldquo;It is one relative to which much might be
+written without exhausting the subject, the pathology of which has wide
+and manifold relations.... There appears to be something analogous
+between this condition and that which determines in after life the
+seminal emissions under similar circumstances.&rdquo; Our American works
+are notably deficient in this regard; although Stewart, of New York, in
+his &ldquo;Diseases of Children,&rdquo; published over fifty years ago,
+devotes a chapter to dysuria and one to retention of urine, treating the
+subject quite fully, even down to the description of preputial calculi;
+he, however, failed to notice that the irritation of preputial
+constriction or adhesions will produce both conditions, and, following
+many of the authors of the time, as has been done since, he adopted the
+urino-digestion theory of acid and irritating urine, due to faulty
+digestion, of Prout and Magendie, who looked to regulating the digestion
+of the child, or the mother who nursed it, as the only method of cure;
+the lithic-acid diathesis being, in their opinion, the main thing to be
+guarded from.</p>
+
+<p>Other works that mention these conditions are equally on the wide sea of
+speculation, as they all, more or less, look upon the treatment that
+they advise as indefinite and unsatisfactory, showing an equal want of
+sound anchorage-grounds for their etiological reasonings. Dillnberger,
+of Vienna, in his hand-book of children&rsquo;s diseases, mentions
+enuresis, but has nothing better to offer for its relief than that
+advised by Bednar, who followed a systematically-timed period of
+awakening, gradually lengthened out, from the time of putting the child
+to bed. In addition, he advises internal medication, and, like Ultzmann,
+he recognizes the possibility <span class='pagenum'><a name="Page_277" id="Page_277">[277]</a></span>
+of a local cause in little girls, in whom he advises the local
+application of nitrate of silver. Edward Ellis mentions dysuria, and a
+long prepuce is noticed among its numerous causes. The works that give
+the subject the most intelligent treatment (the word
+&ldquo;intelligent&rdquo; is here used advisedly, and is in reference to
+the results obtained) are those of West, of London, and Henoch, of
+Berlin. West, in his &ldquo;Diseases of Children,&rdquo; says: &ldquo;In
+the child, however, we sometimes find the symptoms produced by
+difficulty in making water owing to the length of the prepuce and the
+extreme narrowness of its orifice, which may even be scarcely large
+enough to admit the head of a pin. This congenital phimosis is, I may
+add, not an infrequent occasion of incontinence of urine in children,
+and is also an exciting cause of the habit of masturbation, owing to the
+discomfort and irritation which it constantly keeps up. In every case,
+therefore, where any difficulty attends the passing or the retention of
+the urine, or where the practice of masturbation is suspected, the penis
+ought to be examined, and circumcision performed if the preputial
+opening is too small. This little operation, too, ought never to be
+delayed, since, if put off, adhesions are very likely to form between
+the glans and the foreskin, which render the necessary surgical
+proceeding less easy and more severe.&rdquo;</p>
+
+<p>In the &ldquo;Lectures on Diseases of Children,&rdquo; Henoch, of
+Berlin, says: &ldquo;I need scarcely add that an examination of the
+external genitals should never be omitted in any case of dysuria during
+childhood. You will not infrequently discover a phimosis which
+interferes more or less with the discharge of urine and retains portions
+of the latter behind the foreskin, where it may decompose and give rise
+to an inflammatory condition of the <span class='pagenum'><a name="Page_278" id="Page_278">[278]</a></span>
+prepuce, with painful dysuria.... This is also true of the occasional
+adhesion of the labia minora in little girls, like the similar adhesion
+of the foreskin in boys. It is almost constant in the first period of
+life, but sometimes persists to the end of the first year; can usually
+be torn by the handle of the scalpel, and rarely requires an incision.
+In a few cases this adhesion appeared to me to be the cause of the
+dysuria, which disappeared after the separation of the labia from one
+another.&rdquo;</p>
+
+<p>Henoch, however, does not seem to have grasped the full relation that
+the natural phimosis of young children bears to dysuria, as he here
+follows the prevailing opinion, that where by dint, push, hauling, and
+hard work the prepuce can be pushed back phimosis does not exist, as
+well as the general apathy to the fact that a prepuce can exert a very
+injurious influence by its pressure, even when not adherent and very
+retractable; such a prepuce is often attended by balanitis and
+posthitis, with an accompanying difficult, frequent, and painful
+urination. In a case which will be related farther on, in the discussion
+of the systemic effects of a long, contracted prepuce, as it induces
+diseased action by continuity of tissues, there is an account of a death
+of a two-year-old child which we can assume to have had its original
+starting-point in a condition of phimosis. Henoch, however, rather
+attributes the death in that case to what may well be considered the
+result of a cause, leaving the original cause more to appear as a final
+accessory condition.</p>
+
+<p>My reasons for this view of the subject are simply owing to the fact
+that I do not believe that a child can long be afflicted with the
+<i>ischuria phimosica</i> of Sauvages without having the urinary organs
+beyond more or less seriously affected from the mere retention alone,
+irrespective <span class='pagenum'><a name="Page_279" id="Page_279">[279]</a></span>
+of any reflex irritation from the pressure on the glans or of any from
+the irritation of the peripheral nerves; the dilatation of the adjacent
+cavities or channels and the deposit of calcareous matter being
+facilitated by the retention of urine and its naturally altered
+condition owing to that retention. So that dysuria in young children,
+beginning in a slightly phimosed condition, or in the irritability of
+the glans and meatus, due to its preputial covering, it is safe to
+assume, may produce a train of symptoms ending in permanently-injured
+health, or even death. The irritating urine of a slight access of fever
+may, by its passage over the irritable mucous lining of the prepuce, be
+the initial starting-point of a serious or fatally-ending disease. In
+all of these, it must be admitted, the presence of the prepuce is either
+actively or passively the cause of the most serious disease processes
+that may follow.</p>
+
+<p>Ultzmann, of Vienna, in his work on the &ldquo;Neuroses of the
+Genito-Urinary Organs,&rdquo; gives the subject of enuresis considerable
+attention. It is not a work on diseases of children, but it,
+nevertheless, goes into the subject as if it were, and furnishes the
+profession with considerable information. He defines enuresis to be the
+passage of urine of a normal quality in a child who, with the exception
+of this involuntary urination, is healthy. In the first periods of life,
+a slight vesical or intestinal expulsive effort is sufficient to
+overcome the guarding sphincter muscles at their outlet; the child first
+obtains a voluntary control of the rectal sphincter; and, generally,
+with the second year it gains control of the vesical. Those who pass
+their second year without obtaining this control, but in whom the organs
+and urine are normal, may be said to be afflicted with enuresis. He
+divides enuresis into three varieties; that involuntary <span class='pagenum'><a name="Page_280" id="Page_280">[280]</a></span>
+urination which takes place at night during sleep he terms the
+<i>nocturnal</i>; that which takes place while climbing, laughing, coughing,
+or in the course of any violent muscular exercise is the <i>diurnal</i>; and
+that wherein the involuntary evacuation takes place day and night alike
+he terms as the <i>continued</i>. This last is again subdivided into the
+continuous and periodical. As a cause, he cites an&aelig;mia, scrofula,
+rachitis; but adds that physical debility is not necessary for its
+presence, as well-developed, vigorous, puffy children are as liable to
+be affected as thin and scrawny ones; while not all scrofulous or
+rachitic children are so affected, only a small portion being enuretic.
+Sex has no influence on the liability that tends to being attacked, the
+proportion between the sexes being about equal. As to age, he finds the
+greatest proportion to be between three and ten years, but he has often
+treated those of either sex even at the age of fourteen and up to
+seventeen years. It is absolutely necessary to examine the external
+genitals and the urine of those affected by this disease, as
+phlegmasi&aelig; of the vagina, of the vestibule or urethra in girls, or
+the practice of onanism, or lithiasis, cystitis, or pyelitis may be the
+cause of the disease. Girls are apt to be found affected with polypoid
+excrescences at the meatus, which when removed will cause the enuresis
+to disappear.</p>
+
+<p>From the above it will be observed that Ultzmann has paid much attention
+to these neuroses; but it will also be remarked that neither the
+balanitis, collection of infantile smegma, preputial adhesions nor
+irritations are taken into any account as possible factors of either
+dysuria or enuresis; he has followed more or less an electrical form of
+treatment for genito-urinary neuroses, the rectal rheophore being one of
+his favorite modes of <span class='pagenum'><a name="Page_281" id="Page_281">[281]</a></span>
+treating enuresis; in his etiological views of these disturbances he
+has adhered more or less to the views of Trousseau, Bretonneau, and
+Dessault, who looked upon a debilitated or anomalous condition of the
+vesical neck as the cause of the majority of neuroses in that region.</p>
+
+<p>It may be asked why these celebrated and observing physicians have
+neglected the preputial condition, if, as it is claimed, it is, in
+itself, so important and sure a factor of the derangements at the
+vesical neck? To answer this, or to explain any marked discrepancy that
+may occur in medicine between minds equally as acute and observing, it
+is but necessary to observe that there is, in medicine, to a certain
+extent, a like rule of inheritance, education, with fashion or custom of
+habit of thought and practice, as we find in religion. Canon Kingsley
+and Froude are equally as acute and discerning as the late Cardinal
+Newman, but that did not necessitate their following that prelate into
+the foremost ranks of the Catholic Church; and Pere Hyacynthe was
+equally as intelligent as Cardinal Newman, but that did not prevent him
+from leaving the fold into which the Cardinal had entered from out of
+the Reformed Church. Some are born Catholics or Protestants, and are so
+with vehemence; others are born in these religions, but are only
+lukewarm in their doctrinal observance; while others reason and jump the
+traces in either direction. The followers of the destructive theories of
+Bronssais could not see the errors of their ways, and neither could they
+be made to see the merits of a less interfering form of medical
+practice. Trousseau was himself at one time tainted with Bronssaisism,
+but, like Paul of Tarsus, he was made to see the error of his way, as he
+relates, through a case of gout that he nearly laid out in trying to lay
+out the disease antiphlogistically.</p>
+
+<p><span class='pagenum'><a name="Page_282" id="Page_282">[282]</a></span>
+I do not assume that preputial irritation is at the bottom of <i>all</i>
+cases of dysuria or enuresis, any more than it would be rational to deny
+that cases of circumcision performed in some cases of diabetic enuresis
+have proved fatal as a result of the operative interference; but it is
+safe to assume that, in the great number of cases in whom some
+irritating conditions were found and removed, the enuresis or dysuria
+was due to such preputial irritation. It is also logical to assume, with
+West and Henoch, that the organ should in all cases be examined, and its
+condition rendered as harmless as possible. That the condition of
+preputial irritation has not been fully recognized by all parties as a
+cause of enuresis does not do away with the fact that it does exist, any
+more than the refusal of the prelates and doctors of Salamanca to listen
+to Columbus did away with the fact of the existence of the American
+continents.</p>
+
+<p>A. L. Ranney, in his &ldquo;Lectures on Nervous Diseases,&rdquo; pages
+174, 175, speaks of enuresis in children as being a reflex cachexia,
+&ldquo;excessive stimulation of the centripetal nerves connected with
+the so-called &lsquo;vesical centres&rsquo; of the spinal
+cord,&rdquo;&mdash;a condition which may be produced by either worms in the
+intestines or by preputial irritation. Ranney advises a careful
+exploration of the urethra and rectum in these cases, and the
+elimination of all local causes of the conditions.</p>
+
+<p>Probably the most remarkable case of the immediate continuous effects
+resulting from phimosis is the one recorded by Vidal, in the fifth
+volume of the third edition of his &ldquo;Surgery.&rdquo; This was a
+young man with a congenital phimosis, having but a very small aperture;
+on an operation to relieve the phimosis there was a gush of water, but
+this only fell at the feet of the <span class='pagenum'><a name="Page_283" id="Page_283">[283]</a></span>
+patient, without being ejected at any distance; the urethra was found
+to have undergone precisely the same dilatation back of this preputial
+orifice that it usually undergoes back of a stricture; the whole urethra
+from the meatus backward was found to have exceeded the calibre of that
+of the vesical neck; the bladder was greatly dilated.</p>
+
+<hr /><p class='pagenum'><a name="Page_284" id="Page_284">[284]</a></p>
+<h2><a name="CHAPTER_XXV" id="CHAPTER_XXV"></a>CHAPTER XXV.<br />
+<span class='sc sf75'>General Systemic Diseases Induced by the Prepuce.</span></h2>
+
+<p>Aside from all the local affections or reflex neuroses, either mental or
+physical, that a prepuce may induce, there are an innumerable train of
+diseases that may originate in this one cause that at first sight would
+seem to have no connecting-link with any preputial condition.</p>
+
+<p>It has already been suggested that the prepuce does not at all ages bear
+the same analogous relation to man. In childhood, especially during our
+earliest years, it is out of all proportion in size when compared to the
+rest of the organ, or to any use it may have placed to its credit. Man
+does not, then, certainly need that refinement of nervous sensitiveness
+in the corona that is useful in after life in inducing the flow or
+ejaculation of the seminal fluid; neither is there at that age much of a
+corona to protect. In middle life, or what might be called the
+procreative period of man, when the corona would seem to require all its
+excitability or sensitiveness, seems to be the very season in life when
+the glans is most apt to remain uncovered; so that nature and this
+hypothetical idea of the use of the prepuce are evidently at variance.
+So we go through childhood with this long funnel-shaped appendage into
+manhood, when the increasing size of the body of the penis restores a
+sort of equilibrium between the size and bulk of the organ and its
+integumentary covering. At this period, as we have seen, although it
+does not, from the equilibrium restored, and the more or less use to
+which <span class='pagenum'><a name="Page_285" id="Page_285">[285]</a></span>
+it is subjected, induce any great immediate or uncomplicated troubles,
+it nevertheless endangers the existence of the penis through the
+accidental course of some putrid or continued fever, or it subjects man
+to the manifold dangers of venereal or tubercular infections.</p>
+
+<p>In advanced age, owing to the diminution in size of the organ, the
+prepuce resumes the proportionate bulky dimensions of childhood, and as
+the organ recedes and becomes more and more diminutive, the prepuce
+again, like in childhood, begins to tend to phimosis; the urine of the
+aged is also more irritating and prone to decomposition or putrefaction,
+and the constant state of moisture that the preputial canal of the aged
+is necessarily kept in, either by frequent urination or the incomplete
+emptying of the urethra that is peculiar to old age, and which results
+in more or less dribbling, is a powerful factor in inducing the many
+attacks of posthitis and balanitis, as well as those attacks of
+excoriation and eczema which are so annoying to the aged. I have often
+seen such cases happening to men past fifty, who, being widowers, and
+never having had anything of the kind, as well as being in the most
+complete ignorance of the nature of the disease, have, from delicacy and
+fear that the disease might induce some suspicions as to their conduct
+in the minds of those whose good opinions they value above all else,
+gone on suffering untold miseries, especially if the urine were in the
+least diabetic.</p>
+
+<p>One such case that fell under my observation not only produced such
+misery as to entail a loss of rest and of appetite, but even induced
+such a disturbance of assimilation and nutrition that the resulting
+hypochondriacal condition that developed from these enervating causes
+ran the patient into a low condition, ending in complete prostration of
+all vital powers and death, <span class='pagenum'><a name="Page_286" id="Page_286">[286]</a></span>
+without the intervention of any other disease. The subject was a timid,
+retiring man of about fifty-five years, and this was the first and only
+time that the prepuce had ever caused him any annoyance,&mdash;a
+circumstance which greatly preyed upon his mind, as he could not
+disconnect it with the idea that it must be suspected as venereal,
+although he had always led a most continent life since the death of his
+wife. This is, of course, an extreme case; but as it is a result
+beginning in a certain condition, be it an extreme, erratic, or
+infrequent occurrence, it is, nevertheless, an example of what may
+happen in advanced life, even where the prepuce has never before been a
+source of the least disturbance or annoyance. Persons who, with the
+increase of years, are also liable to an increase of adipose tissue, are
+more subject to this dwindling down of the penis and consequent
+elongation of the prepuce, with all the attendant annoyances, than thin
+or spare people.</p>
+
+<p>In this irritation that the prepuce is liable to cause, we have not only
+to encounter the dangers that its thickenings or indurations may bring
+on in their train, in the shape of cancer, gangrene, or hypertrophies,
+but other and no less serious results are liable to follow a herpetic
+attack, or in consequence of an attack of balanitis or posthitis. The
+dysuria attending any of these conditions may be the initial move for
+such a serious complication that life may be brought to a sudden end,
+even in infancy, to say nothing of the ease with which life is taken off
+in after years and in old age; with debilitated and imperfect kidney
+action, it takes very little to hustle us off from life&rsquo;s
+foot-bridge.</p>
+
+<p>A case as occurring in Henoch&rsquo;s clinic, already mentioned or
+referred to in a previous chapter, shows what a simple phimosis is
+capable of inducing. In the history <span class='pagenum'><a name="Page_287" id="Page_287">[287]</a></span>
+of the case the phimosis and the resulting retention in the preputial
+cavity no doubt were the causes of the calculus found there; and the
+succeeding calculi and abnormal condition of the urinary organs, we can
+safely assume, were a subsequent creation to that in the prepuce. The
+case is taken from Henoch&rsquo;s &ldquo;Lectures on Diseases of
+Children,&rdquo; Wood Library edition, page 256, and is as
+follows:&mdash;</p>
+
+<p>&ldquo;A. L., aged two, admitted November 28, 1877. Quite well
+nourished, but pale. Complete retention of urine for two days; slight
+redness and marked &oelig;dema of penis, scrotum, and perineum. The
+foreskin cannot be retracted, on account of phimosis. Abdomen distended,
+hard, and sensitive, the dilated bladder extending a few fingers&rsquo;
+breadth above the symphysis. In order to introduce the catheter, it was
+first necessary to operate upon the phimosis, during which a calculus,
+which completely occluded the meatus, was removed. The catheter, when
+introduced into the bladder, removed a quantity of cloudy urine. The
+&oelig;dema, rapidly disappeared under applications of lead-wash, but on
+November 29th vomiting and diarrh&oelig;a occurred during the night, with
+rapid collapse; December 1st, death. Autopsy: In the bladder, a
+sulphur-yellow stone, as large as a hen&rsquo;s egg, completely filling
+the organ; similar calculi, from the size of a pea to that of a bean, in
+the pelvis of the left kidney; right kidney normal.&rdquo;</p>
+
+<p>In the above case, the &oelig;dema of the penis, scrotum, and perineum was
+as much a result of the distension of the bladder by the retained urine
+interfering with the return circulation from the &oelig;dematous parts as
+the different appearances of diseased conditions were a result of the
+primary phimosis; yet this case, if seen during its early infancy, when
+probably the contraction of the <span class='pagenum'><a name="Page_288" id="Page_288">[288]</a></span>
+preputial orifice was as yet not so well marked, would have been
+pronounced one in which it would be needless and barbarous to perform
+circumcision upon. We would most assuredly have to wander aimlessly and
+unprofitably in the region of speculation to build up the etiology of
+the above-related case and reach the culmination there found, unless we
+accept the one that it was all, from first to last, the result of the
+phimosis.</p>
+
+<p>Jonah, pitched overboard at sea to appease the tempest and swallowed by
+the whale, became convinced finally that he had better return to Nineveh
+to preach reform; while Pharaoh would not let the children of Israel
+depart even after Moses had so frightened him&mdash;as it is related in the
+rabbinical traditions compiled by the Rev. T. Baring-Gould, M.A.&mdash;that
+the royal bowels were completely relaxed at the sight of the snakes
+turned loose about the royal throne,&mdash;a circumstance which nearly lost
+him his claim to divinity, which was based on the fact that his bowels
+moved only once a week, as in this case they not only moved out of time
+and in the most unkingly manner, so that the noble king hid underneath
+the throne, but before even Pharaoh could disengage himself from the
+royal robes, which event could hardly have raised him in the estimation
+of the gentlemen eunuchs of the bed-chamber. Those who unwound the mummy
+of Pharaoh tell us that he had the appearance of a self-willed,
+despotic, but intelligent, old gentleman; but the above rabbinical
+relation, from Baring-Gould&rsquo;s &ldquo;Legends of the Patriarchs and
+Prophets,&rdquo; seems to have had no convincing effect on Pharaoh; so
+we must not be surprised if even a case like the one from Henoch&rsquo;s
+clinic would, with many, carry no conviction.</p>
+
+<p>In the second volume of Otis on &ldquo;Genito-Urinary<span class='pagenum'><a name="Page_289" id="Page_289">[289]</a></span>
+Diseases,&rdquo; of the Birmingham edition, at page 380, there is an
+interesting account of a physician who, in youth, was troubled with an
+annoying prepuce, which, from frequent attacks of balanitis, had finally
+become more or less adherent to the glans penis; up to the age of
+nineteen he had been unable to completely uncover the glans. By six
+months of hard and persistent labor he had finally broken up these
+adhesions. At the age of twenty-two he married, and he then ruptured the
+frenum, which bled profusely and left him sore for some days. Then for
+twenty-seven years he had no further trouble, but at the end of that
+time he began to experience what he believed were attacks of dumb ague,
+and the scrotum began to swell and felt sore on firm pressure. Heavy,
+aching pains then followed. This condition of things lasted for over
+five years, varied by the appearance of carbuncles on the nose and
+elsewhere, to relieve the monotony of the thing. From this time on,
+abscesses began to form in the scrotum and into the integument of the
+penis, burrowing forward into the prepuce, which was much swollen and
+painful. A gangrenous opening effected itself in the dorsal surface,
+which relieved him somewhat. The patient was finally examined by Dr.
+Otis, who found a badly strictured urethra, the strictures beginning at
+the meatus, and at intervals extended down as far as two and
+three-fourths inches. The case had no venereal history, the patient
+never having had any disease or anything of the kind. The strictures
+were plainly the result of the balano-posthitic attacks as much as they
+were the cause of the degeneration of the mucous membrane in the lower
+urethra, that allowed of the infiltration of urine into the tissues,
+which caused all the systemic disturbances, abscesses, misery, and agony
+of the patient, depriving him of comfort, sleep, <span class='pagenum'><a name="Page_290" id="Page_290">[290]</a></span>
+or ability for labor, and which sent him here and there in search of
+health and relief.</p>
+
+<p>It would seem really as if a prepuce was a dangerous appendage at any
+time, and life-insurance companies should class the wearer of a prepuce
+under the head of hazardous risks, for a circumcised laborer in a
+powder-mill or a circumcised <ins class='corr'
+title="Transcriber&rsquo;s Note: The original showed
+&lsquo;brakemen&rsquo;.">brakeman</ins> or locomotive engineer runs actually
+less risk than an uncircumcised tailor or watchmaker. They recognize the
+danger that lurks in a stricture, but what a prepuce can and does do,
+they entirely ignore. I have not had any opportunities for comparison,
+but it would be interesting to know, from the statistics of some of
+these companies, how much more the Hebrew is, as a premium-payer, of
+value to the company than his uncircumcised brother. Were they to offer
+some inducement, in the shape of lower rates, to the circumcised, as
+they should do, they would not only benefit the companies by insuring a
+longer number of years, on which the insured would pay premiums, but
+they would be instrumental in decreasing the death-rate and extending
+longevity.</p>
+
+<p>I have seen so many cases of stricture whose origin could be traced to
+balanitis that it can almost with confidence be assumed that, wherever
+there is a long prepuce with a red and inflamed meatus in a child, that
+unfortunate child will be a victim of fossal strictures when arrived to
+manhood, and that, moreover, he will be a surer victim to the reflex
+neuroses which so often accompany strictures, and which have been so
+ably described by Otis, than the victim of uncomplicated strictures
+acquired in the worship of Venus. There is no end to the misery that
+these poor fellows have to suffer, besides the habitual hypochondriacal
+condition into which the accompanying physical depression, <span class='pagenum'><a name="Page_291" id="Page_291">[291]</a></span>
+throws them; it unfits them for business, any undertaking, or even for
+social enjoyment or entertainment; they keep themselves and their
+families in continued hot water. These subjects are, also, more prone to
+gouty and rheumatic affections, asthma, and other neuroses.</p>
+
+<p>Among the many cases of nervous disorders simulating other diseases that
+I have seen relieved were two Jewish lads with an imperfection of the
+meatus. They were two brothers, and from the history of the cases, and
+that given me by the mother of the lads in regard to the father, the
+malformation must have been hereditary and congenital. It consisted of a
+partial occlusion of the meatus by a false membrane, which divided the
+meatus in two, horizontally, but which was closed at the posterior end
+of the lower passage, which readily admitted a probe from the front as
+far as the occlusion, about a third of an inch to the rear. The
+restoration, or rather the making the anterior urethra and meatus to
+their normal condition, relieved both boys of asthma, under which they
+had labored for years.</p>
+
+<p>The many cases simulating the general disturbances that accompany many
+kidney disorders, that are simply the result, in their primary causes,
+of preputial irritation and the disturbances to the kidney function due
+to the same cause, have long induced me to look upon the prepuce as a
+great and avoidable factor to some of the many forms of kidney diseases,
+prostatic enlargements, vesical diseases, and many other diseases of the
+urinary organs, which we know full well can result from strictures, as
+the latter need not always act in a purely mechanical mode to do its
+full extent of mischief.</p>
+
+<p>One result of these preputial irritations not generally or particularly
+mentioned in any of our text-books&mdash;a <span class='pagenum'><a name="Page_292" id="Page_292">[292]</a></span>
+condition far-reaching as regards its own results, and more annoying
+and serious than it appears at first sight&mdash;usually begins with a
+reflex irritability of the anal sphincter muscle, or a rectal irritation
+of the same order, which in time produces such organic change that an
+hypertrophied and irritable, indurated, unyielding muscle is the result.
+Agnew, of Philadelphia, describes the condition, but does not mention
+this frequent cause under the name of sphincterismus; once this is
+established, the train of resulting pathological or diseased conditions
+that may follow are without end.<a name="FNanchor_108_108" id="FNanchor_108_108"></a><a href="#Footnote_108_108" class="fnanchor">[108]</a>
+This is no fancy sketch, nor will the student of the pedigree and origin
+of diseases feel that the case is exaggerated or imaginative. These are
+some of those cases that are always ailing, never well and really never
+sick, but who are, nevertheless, gradually breaking down and finally die
+of what is termed &ldquo;a complication of diseases,&rdquo; before
+living out half their term of life.</p>
+
+<p>How this happens is simple enough&mdash;the straining required to produce an
+evacuation is out of all proportion with the character of the discharge;
+such patients often complain of being constipated when the evacuations
+are semi-fluid; this straining is followed by a dilatation and
+consequent loss of power of the rectum, which becomes pouched and its
+mucous membrane thickened; the whole intestinal tract sympathizes and
+digestion is interfered with, and the forcible expulsive efforts affect
+all the abdominal and thoracic organs in a more or less degree, laying
+the foundation for serious organic diseases. Now, this condition, which
+may be said to be no more than one of obstinate constipation, is a far
+more reaching condition and a far more injurious state than can be
+imagined at a first glance. Constipation is not, as a rule, always
+accompanied by the indigestion, either <span class='pagenum'><a name="Page_293" id="Page_293">[293]</a></span>
+stomachic or intestinal, that goes with this condition; the contents of
+the intestines in simple constipation may simply lack fluidity without
+undergoing putrefactive fermentation, but in this condition the
+undigested and retained intestinal contents do undergo that change,
+resulting in the generation of material whose re-absorption produces a
+toxic condition of the blood, from whence begins a series of serious
+organic changes in the blood, and from this in the organs.</p>
+
+<p>To the practical physician these changes are evident and their cause
+just as plain, and it is just here where the laity lack the proper
+education, and where they should understand that the intelligent
+physician generalizes the disease and only individualizes the patient;
+and it is this ignorance on the part of the laity that gives to
+empiricism and quackery that advantage over them, as they look upon all
+disease as a distinct individual ailment, that should have an equally
+distinct and individual therapeutic agent to cope singly with. The laity
+know very little of these things, and in their happy ignorance care
+still less for the finer definitions of or of the clinical importance of
+tox&aelig;mia, or the processes of abnormal conditions that lead up to such a
+state, or the results that may follow when that condition is once
+reached. To them, dyspepsia is an indigestion ascribable to the stomach,
+and a sick-headache is ascribed to something wrong about the stomach or
+liver.</p>
+
+<p>The laity have never been called upon to answer the questioning of the
+late Prof. Robley Dunglison: &ldquo;What do you mean, sir, by
+biliousness? Do you mean, sir, that the liver does not secrete or
+manufacture a sufficiency of bile, or not enough? Do you mean that the
+bile-material is left in the blood, or too much poured in?<span class='pagenum'><a name="Page_294" id="Page_294">[294]</a></span>
+Do you mean that there is an excess in the alimentary canal, and a
+deficiency elsewhere? Please, sir, explain what you really mean by the
+term &lsquo;bilious!&rsquo;&rdquo; The Professor had a way about him
+that at least made one stop and seriously inquire, before adopting any
+random notion in regard to medicine. It is to be regretted that, in the
+humdrum tread-mill work of many physicians, they even have to drop into
+the commonplace way of treating dyspepsias and such ailments without any
+further inquiry. A farmer knows better than to drive a dishing wheel, or
+with merely having a nail clinched in the loose shoe of a valuable
+horse; but he is fully satisfied to do so in a metaphorical sense, as
+regards his own constitution, and the mere hint from his physician that
+he had better lay up for repairs, or that there is something wrong about
+him that will require investigation, and that there is an ulterior cause
+to his feeling tired, headachy, or dyspeptic, or an allusion that there
+is something systemic, as a cause, to his momentary attacks of
+disordered vision or amaurosis, will generally make him look on the
+doctor with mistrust.</p>
+
+<p>The merchant, banker, and mechanic are not up to Professor von
+Jaksch&rsquo;s ideas of tox&aelig;mia,&mdash;that tox&aelig;mia may be exogenous or
+endogenous, or that the latter is further subdivided into three more
+varieties,&mdash;and, what is worse, he cares still less. The above three
+classes of humanity, when sick, simply would want to know if Professor
+von Jaksch was good on dyspepsia, the measles, or typhoid fever. They
+care very little that he divides endogenous or auto-tox&aelig;mia into that
+produced by the normal products of tissue-interchange, abnormally
+retained in the body, giving rise to ur&aelig;mia, tox&aelig;mia from acute
+intestinal obstruction, etc., the above being the first division. The
+second depends on the outcome of pathological <span class='pagenum'><a name="Page_295" id="Page_295">[295]</a></span>
+processes, which change the normal course of assimilation of food and
+tissue-interchange; so that, instead of non-toxic, toxic matter is
+formed. The second group he names noso-toxicoses, which he subdivides
+into two principal divisions:&mdash;</p>
+
+<p>(<i>a</i>) The carbohydrates, fats, or albuminous matter, which may be
+decomposed abnormally and give rise to toxic products, <i>e.g.</i>, diabetic
+intoxication, coma carcinomatosum.</p>
+
+<p>(<i>b</i>) A <i>contagium vivum</i> enters the body through the skin, or the
+respiratory or digestive tract, and develops toxic agents in the tissues
+on which it feeds, as in infectious diseases.</p>
+
+<p>In the third group the toxic substance results from pathological
+non-toxic products, which again produce a toxic agent, only under
+certain conditions. This group he calls auto-toxicoses, and includes in
+it poisonous substances, resulting from decomposition of the urine in
+the bladder, under certain pathological conditions, and giving rise to
+the condition called ammoni&aelig;mia. (<i>Medical News</i> of January 7, 1891;
+from <i>Wiener klinische Wochenschrift</i> of December 25, 1890.)</p>
+
+<p>As observed above, unfortunately the patients know nothing, nor can they
+be made to understand these conditions, that are only reached through
+labyrinthic pathological processes, and, what is still worse, this way
+of looking at disease is incompatible with the idea of specific-disease
+treatment, which to them looks more practicable and quick, and which is
+also more to their liking. They cannot see any sense in such reasoning,
+which to them is something eminently impracticable; neither can they see
+a reasonable being in the doctor who practices on such, as they call
+them, <i>theories</i>.</p>
+
+<p>The practical physician, however, sees in Professor <span class='pagenum'><a name="Page_296" id="Page_296">[296]</a></span>
+von Jaksch&rsquo;s summary the turning-point of many a poor
+fellow&rsquo;s career,&mdash;from one of comparative health into one of
+organic disintegration, decay, and dissolution,&mdash;all the required
+processes starting visibly from the very smallest of beginnings; any
+obstruction in the urinary tract or intestinal canal being sufficient to
+start any of the conditions which end in tox&aelig;mia; and, from a
+careful observation running over several years, I do not think that I am
+assuming too much in saying that a balanitis is often the tiny match
+that lights the train that later explodes in an apoplectic attack or
+sudden heart-failure due to tox&aelig;mia; the organic and vascular
+systems being gradually undermined until, unannounced and unawares, the
+ground gives way and the final catastrophe occurs,&mdash;unfortunately,
+an occurrence or ending looked upon as unavoidable by the friends of the
+victim. They cannot see any danger; the idea that diseases have the road
+paved, not only for an easy entrance but an easy conquest, by the action
+of these toxic agents on the tissues, is something that they cannot
+grasp. These blood changes or blood conditions are things too intricate,
+and the physician who understands them is, to them, a visionary and
+unpractical man. These conditions are, however, neither new nor unknown,
+and there is really no excuse for the ignorance exhibited in these
+matters by the general public, as it is through the blood that this
+mischief takes place. They can reason in their impotent way, that they
+should drench themselves with &ldquo;blood tonics&rdquo; and all manner
+of nauseous compounds to &ldquo;purify&rdquo; their blood, but the
+simple, scientific truth is something beyond their understanding, as
+well as something that they steel themselves against.</p>
+
+<p>Sir Lionel Beale, in observing the immense importance <span class='pagenum'><a name="Page_297" id="Page_297">[297]</a></span>
+he attaches to blood composition and blood change in diseases of
+various organs, truly remarks that &ldquo;blood change is the
+starting-point, and may be looked upon as the cause, of what
+follows,&rdquo; the other factor being the &ldquo;&lsquo;tendency&rsquo;
+or inherent weakness or developmental defect of the organ which is the
+subject of attack;&rdquo; to which he adds that he feels convinced that,
+if only the blood could be kept right, thousands of serious cases of
+illness would not occur; while the persistence of a healthy state of the
+blood is the explanation of the fact that many get through a long life
+without a single attack of illness, although they may have several weak
+organs; and that an altered state of the blood, a departure from the
+normal physiological condition, often explains the first step in many
+forms of acute or chronic disease. Sir Lionel has been a pioneer in the
+field of thought that looks for the cause of the disease, which, however
+remote it may be, should not be overlooked as a really primary
+affection. His extensive labor in the microscopic field has fully
+convinced him that many of the pathological changes in the different
+organs are due to what might be called some intercellular substance that
+is deposited from the blood. (Beale: &ldquo;Urinary and Renal
+Disorders.&rdquo;)</p>
+
+<p>Toxic elements in the blood affect the kidneys in a greater or less
+degree, and there produce changes at first unnoticed,&mdash;at least, as long
+as the kidney can perform its function,&mdash;but the day arrives when, as
+described by Fothergill, blood depuration is imperfect, and we get many
+diseases which are distinctly ur&aelig;mic in character, and ending in any of
+the so-called kidney diseases, Bright&rsquo;s disease being one of the
+most common. As observed by Fothergill, however, the kidney is not the
+starting-point, the new departure only taking <span class='pagenum'><a name="Page_298" id="Page_298">[298]</a></span>
+place when the structural change on the kidney has reached that point
+that it is no longer equal to its function&mdash;the &ldquo;renal
+inadequacy&rdquo; of Sir Andrew Clarke. (J. Milner Fothergill, in the
+<i>Satellite</i>, February, 1889.)</p>
+
+<p>During the Bradshawe lecture, Dr. William Carter made the following
+remarks: &ldquo;According to Bonchard, one-fifth of the total toxicity
+of normal urines is due to the poisonous products re-absorbed into the
+blood from the intestines, and resulting from putrefactive changes which
+the residue of the food undergoes there.&rdquo; In the course of the
+lecture, Dr. Carter fully explains that one of the benefits derived from
+milk diet in Bright&rsquo;s disease is the small residuum deficient in
+toxic properties, and lays great stress on the employment of intestinal
+disinfectants or antiseptics that exercise their influence throughout
+the whole tract, suggesting naphthalin as peculiarly efficacious,
+thereby cutting off one source of blood contamination at its source.
+Although these are recent developments in medicine, Bonchard mentions
+that in the practice of M. Tapret cases treated on this principle did
+well. (Braithwaite&rsquo;s <i>Retrospect</i>, January, 1889.)</p>
+
+<p>Persons laboring under this toxic condition of the blood, with a
+consequent deterioration in the texture and the physiological function
+of the vital organs, are of that class that easily succumb to injuries
+or serious sickness, and of that class to whom a surgical operation of
+even medium magnitude is equal to a death-warrant.</p>
+
+<p>The above conditions are an almost constant attendant on that condition
+of the sphincter described by Agnew as sphincterismus, which also is
+productive of h&aelig;morrhoids and fissure, and often of fistula. That
+sphincterismus is caused in many cases by preputial <span class='pagenum'><a name="Page_299" id="Page_299">[299]</a></span>
+irritation is as evident as that the same affection, or
+h&aelig;morrhoids or any other rectal or anal affection, will, in its
+turn, produce vesical and urethral reflex actions, and primarily
+functional and secondarily organic changes in those parts. Besides, the
+great number of cases wherein the gradual and progressive march of each
+pathological event could be traced with accuracy has convinced me of the
+true cause of the difficulty being the result of reflex irritation.</p>
+
+<p>Delafield, in his &ldquo;Studies in Pathological Anatomy,&rdquo; gives,
+as the first form of pneumonia, that from heart disease; in the days of
+Broussais this would have sounded absurd, but, to-day, some forms of
+heart disease are known to be the regular sequences of some particular
+form of kidney disease, just as some form of pneumonia attends an
+affected heart and that some forms of pneumonia degenerate into
+phthisis. When the blood change is an established fact, it is only a
+question as to which is the weak organ, and the organism of the
+individual will decide whether it will be a simple sick-headache or the
+beginning of a pneumonia ending in phthisis.</p>
+
+<p>I have purposely dwelt on this part of this subject, owing to the recent
+origin and publication of many of the views connected with it; also on
+account of the greater ease of making the subject plain by fully
+discussing each step of the process; and if the views of Sir Lionel will
+be recalled, that a toxic element in the blood is the starting-point,
+and that an irritable or weakened organ invites destruction,&mdash;the
+induction of serious and fatal kidney disorder by the transmitted
+irritability and consequent injury to the kidney produced by preputial
+irritation in the first instance, and the supplemental blood-poisoning
+by intestinal absorption of septic <span class='pagenum'><a name="Page_300" id="Page_300">[300]</a></span>
+matter, which soon brings about Sir Andrew Clarke&rsquo;s
+&ldquo;inadequacy of kidney,&rdquo;&mdash;all will be readily
+understood. When this point is reached, a too hearty meal, exposure to
+variable weather, or a little extra care or anxiety, are sufficient, as
+determining causes, to bring life into danger.</p>
+
+<p>As pointed out, many cases of Bright&rsquo;s disease or other renal
+difficulty have their origin in this distant but visible source, and,
+although malarial poisoning and a great number of other causes will
+produce the same particular organic changes and diseases, this condition
+must be admitted as one of the frequent causes. The influence of the
+genito-urinary tract on the rest of the economy, and the importance of
+the sympathy it excites, or how quickly, by its being irritated, some
+apparently dormant pathological condition will be awakened to life and
+activity, is not sufficiently appreciated. As observed by Hutchinson, a
+patient who has once been the subject of intermittent fever is more
+prone, on catheterization, to have a urethral chill and fever than one
+who had never had the fever. (Hutchinson: &ldquo;Pedigree of
+Diseases.&rdquo;)</p>
+
+<p>Ralfe observes, in his &ldquo;Kidney Diseases,&rdquo; that long-standing
+disease of the genito-urinary passages must be reckoned as among the
+chief etiological factors of chronic interstitial nephritis (page 227).
+The condition of the kidneys in cases of strictures of long standing is
+known not to be a reliable one, and any incentive to dysuria or to
+retention, no matter how slight, is apt to lead, eventually&mdash;and that
+even in very young subjects&mdash;to that toxic condition mentioned in a
+former part of this chapter as one of von Jaksch&rsquo;s subdivisions of
+tox&aelig;mia, the ammoni&aelig;mia of Frerichs; this condition being the fatal
+ending of the case of the two-year-old child mentioned by Henoch, who
+died after the relief of a retention due <span class='pagenum'><a name="Page_301" id="Page_301">[301]</a></span>
+to phimosis and calculi resulting from the phimotic occlusion. Having
+seen so many cases wherein the conditions described in this chapter were
+so apparently&mdash;whether from ammoni&aelig;mia due to infection, or
+tox&aelig;mia from the urinary tract, or ur&aelig;mic tox&aelig;mia from
+the intestinal tract&mdash;all due to some preputial interference or
+irritation, I cannot help but feel that in these conditions&mdash;which,
+singularly, are not so prevalent with the Hebrews as with
+Christians&mdash;we have one factor in the cause of the shorter and more
+precarious vitality of the latter.</p>
+
+<p>Morel, in his &ldquo;Trait&eacute; des D&eacute;g&eacute;n&eacute;rescences Phisiques,&rdquo; ably
+discusses the degenerative and morbific influences and results of
+tox&aelig;mia, as well as he clearly defines their sources. The connection
+between tox&aelig;mia and mental affections has already been shown, and Prof.
+Hobart A. Hare, in his instructive and interesting prize essay on
+&ldquo;La Pathog&eacute;nie et la Th&eacute;rapeutique de l&rsquo;&Eacute;pilepsie
+(Bruxelles, 1890)&rdquo;, mentions that convulsive disorders resulting
+from the presence of some toxic substance are of frequent occurrence.
+How much this may enter as a partial factor into many of the cases of
+epilepsy which are classed in the order of &ldquo;reflex&rdquo; may well
+challenge our consideration. Hare lays great stress on the necessity of
+circumcision wherever there is an indication of preputial local
+irritation. &ldquo;If practicable, circumcision should be performed; it
+is an operation with but small risk or danger, and easy of performance.
+In such circumstances it is always permissible to circumcise, were it
+for no other end than an acknowledged attempt to reach a cure.&rdquo;</p>
+
+<hr /><p class='pagenum'><a name="Page_302" id="Page_302">[302]</a></p>
+<h2><a name="CHAPTER_XXVI" id="CHAPTER_XXVI"></a>CHAPTER XXVI.<br />
+<span class='sc sf75'>Surgical Operations Performed on the Prepuce.</span></h2>
+
+<p>In operative interference there is one point which should not be lost
+sight of, this being that the length and bulk of the prepuce in a great
+measure depends on the constriction at its orifice; if the orifice is
+small, the prepuce tight and inelastic, every erection, by putting the
+penis-integument on the stretch, adds to its bulk,&mdash;nature naturally
+trying to make up the deficiency,&mdash;the two points of resistance being
+where the glans pushes it ahead, having the constricting orifice for a
+hold or purchase, and the skin at the pubes, which is called upon to
+furnish the extra tissue for the time being needed during erection,
+which should be supplied by the prepuce&mdash;this being the only office
+which I have been able to assign to this otherwise useless but very
+mischievous appendage. In cases where preputial irritation produces more
+or less priapism, the continued stretching of this integument causes a
+marked increase in its growth, which is mostly added forward. It was on
+this principle or its recognition, that Celsus devised his operations,
+and on which the persecuted Jews undertook to recover their glans by
+manufacturing a prepuce; and, although the trial was not reported as
+being very successful, I do not doubt but that, if the skin could have
+been drawn sufficiently over so as to constrict it anteriorly so as to
+give the glans a purchase, as in the case of phimosis with an inelastic
+prepuce, the operation could be more of a success; all that is required
+is the continued extension and the prepuce might be made <span class='pagenum'><a name="Page_303" id="Page_303">[303]</a></span>
+to rival in length the labia major&aelig; of the females of some
+African tribes, or the pendulous buttocks of the Hottentot Venus.</p>
+
+<p>I have employed the knowledge of this elasticity and source of supply of
+the penis-integument, on more than one occasion, in recovering the
+denuded organ with skin. A number of cases are on record where, owing to
+the want of that artistic and mechanical knowledge without which no
+surgeon is perfect, the operator has drawn forward the skin too tight in
+circumcising, after which, owing to the natural elasticity of the skin,
+the integument has retracted, leaving the penis like a skinned eel or
+sausage. This accident is even liable to occur where the skin has not
+been tightly drawn, but where subsequent erections have torn through the
+sutures, and where the natural retraction of the skin has laid the organ
+bare for some distance. I have seen a number so recorded, but do not
+remember seeing any remedy suggested, it seemingly being accepted that
+the recovery must take place by gradual granulation,&mdash;a necessarily very
+slow process, owing to the constant interference by&mdash;the always present
+in such cases&mdash;unavoidable erections.</p>
+
+<p>Several years ago I advised circumcision to a gentleman owing to a
+contracted condition of the muscles of one hip and thigh, which was
+threatening to render him a deformed cripple; he had a congenital
+phimosis and a very irritable glans penis. The operation was performed
+in a proper manner by a surgical friend, but this friend, unfortunately,
+was a great believer in antiseptic and wet dressings. A few days after
+the operation he called upon me to ask me to go and see the patient, as
+they were both in a pickle, the patient being exceedingly angry, being
+in constant misery, and the penis so <span class='pagenum'><a name="Page_304" id="Page_304">[304]</a></span>
+denuded by the giving way of the sutures&mdash;owing to the
+erections&mdash;that it looked to the patient as if he never could have
+a whole penis again, and the doctor saw no way out of the difficulty;
+the penis was, in reality, a dilapidated and sorrowful-looking
+appendage, and anything else but a thing of beauty or pride; it was raw,
+angry-looking, and bleeding at every move; the first wink of sleep was
+followed by an attempt at erection that raised the patient as
+effectually as an Indian would in scalping him; so that, taken
+altogether, the penis, anxious countenance, and the flexed position of
+the whole body to relieve the tension on the organ, the man looked about
+as battered, cast down, and sorrowful as Don Quixote did in the garret
+of the old Spanish inn, with his plastered ribs and demolished
+lantern-jaw.</p>
+
+<p>Luckily, the patient was seen before the retracted portion of the penile
+integument had had a chance to condense and indurate. The bed was
+slopping wet with the drenchings of carbolized water that the penis had
+undergone, the man&rsquo;s clothing was necessarily damp, and the whole
+bedding and clothes were steamy,&mdash;all of which greatly added to his
+discomfort and tendency to erections. The man was washed, placed in a
+new, clean, and dry bed, and his clothing changed. The organ was then
+forced backward until the preputial frill or edge was approximated to
+the cut end of the penis-skin, where it was made fast by an
+uninterrupted suture around the whole of the circumference. A short
+catheter, about three inches in length,&mdash;the catheter being as full size
+as the urethra would comfortably hold, and of the best and thickest of
+the red, stiff variety,&mdash;was introduced into the urethra. This protruded
+about half an inch beyond the meatus. A stiff, square piece of
+card-board was <span class='pagenum'><a name="Page_305" id="Page_305">[305]</a></span>
+pierced and slipped over this, and then adhesive rubber straps were
+brought from the integument to this little platform, the first being
+from the median line of the scrotum, lifting the sac forward and upward.
+The pubes were shaved and the next four straps started from the root of
+the penis, each strap being split at the glans-end so as to encircle the
+protruding end of the catheter. By these means the skin was brought back
+and firmly supported over the penis, toward the glans; and, in case of
+any erection, the act would only assist in drawing the covering farther
+over the penis as the pasteboard platform and adhesive straps formed the
+distal end of an artificial phimosis. The catheter allowed of free
+urination, and the scrotum was further held up in position by a flat
+suspensory bandage passed underneath the scrotum and fastened over the
+abdomen near each hip. The penis wound was then dressed with a very
+little benzoated oxide-of-zinc ointment passed between the adhesive
+straps; a bridge-support placed over the hips to support the
+bed-clothes, and all was finished, and full doses of bromide of sodium
+and chloral were ordered at bed-time. When the dressings were removed,
+five days afterward, all was healed, the sutures removed, and the
+suspensory alone replaced. The patient had not been troubled with any
+more erections or annoyances of any kind. These are the points which
+often do more or less mischief: wet dressings are uncomfortable and
+favor erections, while the effect of the weight and action of the
+scrotum in drawing backward on the integument should not be overlooked;
+in addition, it should not be overlooked that we have it in our power to
+produce, so to speak, an artificial phimotic action, which has the same
+traction on the penis-integument that the natural phimosis induces.</p>
+
+<p><span class='pagenum'><a name="Page_306" id="Page_306">[306]</a></span>
+The foregoing method, to be used in these cases, has proved very
+serviceable in my hands, and it is here given that it may assist others;
+as there is no need of waiting for granulations or of allowing the
+patient to undergo so much misery, which, besides the local injury,
+cannot help but affect the general health very injuriously. The penis
+can stand any amount of forcing backward; it stands this in cancer or
+hypertrophy of the prepuce, or in the inflammatory thickenings that
+precede gangrene of the prepuce, in any extended degree; becoming, for
+the time being, more or less atrophied. As has been shown by Lisfranc,
+the penis can be made nearly to disappear into the pubes; so that we are
+not as helpless in these cases as our text-books would have us believe.</p>
+
+<p>In infants, and in young children below the age of ten or twelve, the
+Jewish operation, as modified and done in accordance with the dictates
+of modern surgery, will be found the most expedient. By this method we
+avoid the need of any an&aelig;sthetic agents, which are more or less
+dangerous with children, as well as the need of sutures, which are
+painful of adjustment and very annoying to remove in those little
+fellows who dread new harm; there is also much less risk of
+h&aelig;mmorrhages, as the frenal artery is not wounded. In children of a year
+or over, a very good result will be found often to follow
+Cloquet&rsquo;s operation, care being taken to carry the slitting well
+back, as well as care in taking it on one side of the frenum, so as to
+avoid any wound of that artery, the subsequent dressing being a small
+Maltese-cross bandage, pierced so as to admit the glans to pass through;
+the prepuce is retracted and the tails folded over each other and held
+there by a small strip of rubber adhesive plaster; a little vaselin
+prevents the soiling by urine underneath. This last operation is short
+and <span class='pagenum'><a name="Page_307" id="Page_307">[307]</a></span>
+very easy, is not painful, nor does it require much manipulation;
+it is only one quick cut on the grooved director and it is over; by the
+retraction of the prepuce, the longitudinal cut becomes a transverse
+one, making the prepuce wider and shorter at once; the glans soon
+develops and remains uncovered. As there is a very small wound to heal
+over, the repair is very prompt.</p>
+
+<p>In adults with a very narrow, thin, not overlong prepuce, a very good
+result often follows a combination of the dorsal slit with the inferior
+slit alongside of the frenum of Cloquet. The narrower and tighter the
+prepuce, the better the result, as the cuts are at once converted from
+longitudinal into transverse wounds, and the organ at once assumes the
+shape and condition of a circumcised organ, without having suffered any
+loss of substance; three stitches or sutures in each cut (silver or
+catgut) adjust the cut edges; a small roller of lint and adhesive
+plaster, placed so as to shoulder up against the corona, completes the
+dressing. Where this operation is practicable, by the <ins class='corr'
+title="Transcriber&rsquo;s Note: The original showed
+&lsquo;thinnes&rsquo;.">thinness</ins> and narrowness of the prepuce, it has
+many advantages. I have repeatedly performed it on lawyers,
+book-keepers, clerks, and even laboring men, who have gone from the
+office to the courts, counting-rooms, or stores without the least
+resulting inconvenience or loss of time. In laborers it is better to
+perform the operation on a Saturday evening, which gives them a rest of
+thirty-six hours before going to their labor again. The operation is
+comparatively painless and almost bloodless, as there need not be more
+than half a teaspoonful of blood lost during the operation; there is no
+danger of any subsequent h&aelig;morrhage, and, with proper precautions
+against the occurrence of erections, from seventy-two to ninety-six
+hours is sufficient for a complete union; the sutures are <span class='pagenum'><a name="Page_308" id="Page_308">[308]</a></span>
+then removed and a simple lint and adhesive-plaster dressing worn for a
+few days more. In many, no more dressings are required. In many cases,
+with a properly adjusted dressing, that comes forward underneath so as
+to include the frenum, the simple dorsal slit is sufficient; but if any
+of the prepuce depasses the dressing underneath, it will puff and become
+&oelig;dematous and require frequent puncturing. To avoid it, it is
+better to make the Cloquet slit at once. This operation is of no value,
+and perfectly impracticable in a thick, pendulous prepuce. Absorption
+will often remove considerable preputial tissue, but where there is too
+much its very bulk interferes with its removal by any natural means.</p>
+
+<p>Dilatation is recommended by a number of surgeons, but, I must admit, in
+my hands it has always proved a failure; it may be, that if the
+subsequent history of the cases reported as so operated upon had been
+carefully traced, the reports would not have been so good. Nelaton,
+whose dilating instrument is generally recommended, seems, himself, to
+prefer some of the circumcising methods, as in the volume on
+&ldquo;Diseases of the Genito-Urinary Organs,&rdquo; in his
+&ldquo;Surgery,&rdquo; being the sixth volume of the revised edition of
+1884, by Despr&egrave;s, Gillettte, and Horteloup, the subject of dilatation is
+dismissed in two short lines. St. Germain, of Paris, uses, as has been
+before observed, a two-bladed forceps, used after the manner of Nelaton,
+and reports good results. Dr. J. Lewis Smith agrees in his statements
+with Dr. St. Germain. Dr. Holgate, of New York, reports a like
+experience. In my own practice the prepuce has often been made
+<i>temporarily</i> lax and retractable, but with the usual results of the
+return of the contraction, with a possible thickening of the inner fold,
+as a result of the interference; so that only in case of any immediate
+demand, <span class='pagenum'><a name="Page_309" id="Page_309">[309]</a></span>
+where the tight prepuce is producing irritation, either through
+pressure or adhesions, or retained sebaceous matter, do I ever resort to
+dilatation; always, however, even then, not as a final operation, but
+merely as preparatory procedure toward a future operation of a more
+efficient order.</p>
+
+<p>In cases of timid adults, who refuse all kinds of operative
+interference, good results may be obtained by the use of a mild
+lead-wash or cold tea-baths and the introduction of flat layers of dry
+lint interposed between the prepuce and the glans; this has a very good
+effect in keeping the parts apart and dry, and may in time produce a
+certain amount of dilatation; but even when this is done, unless it will
+render the foreskin sufficiently loose to allow of its being kept
+finally back of the corona, it is, after all, but a temporary makeshift.
+The corona should be exposed and kept clear of the preputial covering;
+anything short of this will not give all the good results to be desired.
+I have more than once performed a secondary operation on Jews, who had
+been imperfectly circumcised by not having the prepuce removed
+sufficiently, and in whom the subsequent contraction of the preputial
+orifice had re-covered part of the glans, and only lately visited a
+four-year-old boy, circumcised when eight days old, in whom the prepuce
+covered half of the glans, the corona acting as a tractive point from
+which the penile integument was being drawn forward. In this case the
+simple pierced-lint Maltese cross was used, with an adhesive band to
+hold the tails down behind and around the penis just back of the corona.</p>
+
+<p>These means, although not circumcision either in a surgical or in the
+Hebraic religious sense, are, nevertheless, sufficient in a medical
+sense for all desired purposes; provided, however, that there is no
+resulting constriction, <span class='pagenum'><a name="Page_310" id="Page_310">[310]</a></span>
+or a mild condition of paraphimosis, back of the corona, and that the
+whole of the glans is sufficiently uncovered, and that no abnormal
+dog-ears are left to garnish each side of the penis like an Elizabethan
+frill or collar; although Agnew holds that, in slitting, the practice
+adopted by many of rounding off the corners is mostly superfluous, as
+nature will do so itself in time.</p>
+
+<p>The ordinary way of performing the operation by modern surgeons is by
+what is known as the Bumstead circumcision. It was not an invention of
+Bumstead, but was adopted by him in preference to all others. The
+requisites are a sharp-pointed bistoury, blunt-pointed scissors, and a
+pair of Henry&rsquo;s phimosis forceps, with fine needles and fine
+oculists&rsquo; suture silk. The penis is allowed to hang naturally and
+the position of the corona glandis marked on the outer skin with a pen
+and ink, which is to serve as a guide for the incision. The prepuce is
+now drawn forward until this line is brought in front of the glans and
+grasped between the blades of the forceps. The prepuce is now
+transfixed, and, with a downward cut, that portion is severed; the
+knife&rsquo;s edge is now turned upward and the excision finished. The
+forceps are now removed and the integument allowed to retract; with the
+scissors the inner mucous fold is now split along the dorsum and trimmed
+off so as to leave about half an inch in front of the corona. The parts
+are then brought together with the continuous suture and dressed
+according to the fancy of the surgeon. Care must be taken <i>not to
+bruise</i> the parts with the forceps, as, in such cases, sloughing of the
+sutured edges will be the result instead of union. I have seen this
+accident happen more than once, in one case being followed by a penitis
+that seriously complicated matters.</p>
+
+<p><span class='pagenum'><a name="Page_311" id="Page_311">[311]</a></span>
+It has been my practice to use fine silver-wire and catgut sutures in
+all operations on the prepuce; they excite less suppuration as well as
+less irritation. In case of need, the silver can be left in longer, and
+they are much easier of removal than the silk; besides, they have the
+advantage of not cutting. In the after-treatment the same general plan
+can be followed as with any amputated stump, except that it must not be
+forgotten that at the end of this organ dwells what has been termed the
+<i>sixth</i> sense, and that heat and moisture are very apt to awaken the
+dormant energies of the organ, even after it has undergone cruel
+mutilation, and even has suffered considerable loss of blood; for that
+reason it is best always to avoid wet or sloppy dressing, or too much
+ointment, as they are more apt to cause erection than to do any good.
+Besides, I find water does here, as elsewhere, interfere with the
+deposited plastic matter, properly organizing into cicatricial tissue;
+so that I prefer a snug, dry dressing, which is left on for four or five
+days without being interfered with, and light covering, plain diet,
+quiet, with fifteen grains each of bromide of sodium and chloral hydrate
+at bed-time to insure rest and freedom from annoying erections. Where
+the organ is large in its flaccid state, it is better to support it on a
+small oakum-stuffed pillow, made for the purpose, than to let it hang
+downward. Should the stitches give way and the skin tend to retract, the
+plan proposed on a previous page can be followed to advantage. In
+urinating, care must be taken not to soil the dressings; some patients
+are very careless about this if not warned. The penis should hang nearly
+perpendicular while in the act, and all dribbling should have ceased and
+the meatus and underneath be mopped dry with some soft cotton before
+raising the organ; nothing so irritates the parts, <span class='pagenum'><a name="Page_312" id="Page_312">[312]</a></span>
+retards union, or is more offensive than a urine-saturated dressing.</p>
+
+<p>Dr. Hue, of Rouen, uses an elastic ligature, which he introduces into
+the dorsal aspect of the prepuce by means of a curved needle. This he
+ties in front, and in three or four days it cuts its way through.
+Although Hue reports a large number so operated upon, the tediousness of
+the procedure and the swelling and &oelig;dema, as well as the active pain
+that must necessarily accompany the operation, will hardly recommend the
+ligature in preference to the incision by the knife.</p>
+
+<p>Dr. Bernheim, the surgeon of the Israelitish Consistory of Paris, has
+operated on over eleven hundred circumcisions, besides the cases of
+phimosis occurring in his general practice. His opinion of the procedure
+of M. de Saint-Germain by dilatation is not favorable. He has employed
+it in a number of cases of phimosis, at the time unfit for a more
+radical operation. He has, however, observed that cicatricial
+thickenings and recontractions are very apt to occur, and, as to the
+septic accidents mentioned in connection with circumcision, he has noted
+that they are as liable to occur in hands that are as careless and
+slovenly with what they do with their dilating forceps as they are with
+what they do with their bistouries. Dr. Bernheim prefers the
+circumcision forceps of Ricord, as modified by M. Mathieu. This
+instrument he prefers by reason of its gentler pressure, which, at the
+same time, is all-sufficient to properly fix the prepuce. In applying
+the forceps, he includes as little as possible of the lower part,
+keeping away as much as possible from the frenic artery. The dorsum of
+the inner fold he cuts with the scissors. In children under two years of
+age, he simply turns this back over the free edge of the integument; in
+children over two <span class='pagenum'><a name="Page_313" id="Page_313">[313]</a></span>
+years of age, he uses serres-fines. In children, he uses a piece of
+lint dressing steeped in a watery solution of boracic acid; in adults,
+he uses iodoform-gauze dressings. He finds cases unite in from three to
+ten days. Dr. Bernheim warns us against using antiseptics on infants or
+young children, in connection with the after-dressing of circumcision.
+Neither phenic acid, corrosive sublimate, nor iodoform are well borne by
+these young subjects, and he has seen serious results follow upon as
+light an application as a 1/100 solution of phenic acid. In a number of
+cases he reports operating with the galvano-cautery of Chardin, instead
+of the knife. These operations were bloodless, and cicatrization was as
+rapid as when the knife was used. He has in several cases operated by
+the dorsal incision, owing to disease of the prepuce not allowing any
+other operation.</p>
+
+<p>In France, the Bumstead operation is known under the title of
+Ricord&rsquo;s procedure. Lisfranc, Malapert, M. Coster, and Vidal all
+have operations which are not as useful as Ricord&rsquo;s, and have not,
+therefore, come into general use. M. Sedillot condemns the dorsal
+incision as leaving two unsightly-looking flaps. The reverse, or
+inferior incision of M. Jules Cloquet is likewise not in favor with
+either Malgaigne or Ricord. This inferior incision or section, alongside
+of the frenum was first advised by Celsus. M. Cullerier contented
+himself with slitting the inner preputial fold, longitudinally, from its
+junction with the skin backward to the corona. M. Chauvin, by the aid of
+a complicated instrument with barbed points, drew out the mucous fold as
+far as possible before excising.</p>
+
+<p>There is something unaccountable in the difference in results that
+various operations give in the hands of different surgeons. It must be
+that all methods are <span class='pagenum'><a name="Page_314" id="Page_314">[314]</a></span>
+correct <i>with properly-chosen cases</i> and when properly <i>performed</i>, as
+well as properly looked after subsequently to the operation. It must not
+be expected, however, that, in operations where the kindly assistance of
+nature is a thing contemplated in absorbing superfluous tissue, the case
+will at once give satisfaction to all. These cases must have the
+required time before judgment can be passed upon the merits of the
+operation, just as required time in cases of dilatation or in the method
+of M. Cullerier will often demonstrate that the benefits are but
+transient, and that often even cases that have been so operated upon
+will require a complete circumcision, <i>&agrave; la</i> Ricord or <i>&agrave;
+la</i> Bumstead, owing to the resulting thickening induration and
+overconstriction, when, if left alone, the dorsal slitting or the
+inferior incision of Cloquet would have previously given satisfactory
+results.</p>
+
+<p>The final cosmetic results in the combined Cloquet and dorsal-slit
+operation, for instance, depend on, first, properly choosing the case.
+One on whom the operation is unadaptable it is useless to attempt it on,
+as a future circumcision or tedious and annoying re-operation of
+trimming would be required. The next care is to properly cut through all
+constricting bands, which, like fine, tough strings, will be found to
+encircle the penis. These must be carefully clipped with a fine pair of
+strabismus scissors, as these bands do not give way, either then or
+afterward, of their own accord, but form the nucleus for stronger
+constricting bands for the future. Then you must be sure to cut far
+enough back, either above or below, until you have reached where you
+obtain the normal and largest calibre of circumference of the penis. The
+adaptation of the edges of the parts and the proper application of a
+smooth, equal pressure, <span class='pagenum'><a name="Page_315" id="Page_315">[315]</a></span>
+by means of the lint strap, is of the next importance; and then comes
+the strapping of the whole surface for about an inch and a half back of
+the corona, which should and must include all the tissues of the
+preputial part of the frenum. A neglect or careless performance of any
+of the details, or the carelessness of the patient in not keeping the
+dressing clean, necessitating its change before the fourth day, all tend
+not only to interrupt the union, but to mar the future cosmetic results
+as well. It may be asked why all this care and trouble, and not
+circumcise at once? As already observed, this operation admits of the
+patient following his business; whereas circumcision, on the male, will
+assuredly lay him up for four or five days, and perhaps ten
+days,&mdash;something that many, be they rich or poor, cannot afford,
+and will not submit to.</p>
+
+<p>The cosmetic condition of the penis as a copulating organ is a thing of
+some importance, and this should not be overlooked; for, although the
+particular dimension, shape, or peculiarity of the penile end never
+figures prominently in the complaints of women who apply for
+divorce,&mdash;the charges being everything else under the sun,&mdash;it can
+safely be assumed that this organ and its condition is the original,
+silent and unseen, as well as unconscious power behind the throne that
+is at the bottom of the whole business in more than one case. Like the
+fable of the poor lamb that the wolf wished to devour: the real reason
+of his wishing to kill him was that he might eat him, the pretext set
+forth by the wolf that the lamb had encroached on his pasture, muddied
+his brook, or kept him awake by his bleating having been disproven by
+the lamb. Besides, it is well not to leave any distinctive or
+distinguishing mark, like an individual baronial crest, on the head of
+the organ.</p>
+
+<p><span class='pagenum'><a name="Page_316" id="Page_316">[316]</a></span>
+To return, however, to the operative procedures, we find that Dr. Vanier
+finds that the operation of Cloquet by incision alongside of the frenum
+has the advantage of not leaving any deformity&mdash;contrary to the opinion
+of Ricord and Malgaigne. He, in fact, holds this procedure in such high
+esteem that he considers that Cloquet deserves great credit for reviving
+this old Celsian operation. H. H. Smith, in his &ldquo;Operative
+Surgery,&rdquo; coincides with Vanier in his favorable opinion of this
+method, as he there says: &ldquo;Frequent opportunities of testing the
+advantages of the plan of Cloquet having satisfied me of its value, I do
+not hesitate to recommend it as that best adapted to the adult, because
+it fully exposes the glans and leaves little or no lateral deformity, as
+is frequently the case with the dorsal incision,&rdquo;&mdash;an opinion that
+I can fully agree with, from the results of the same operation in my
+hands, although I have used the method even on infants. Vanier does not
+approve of the dorsal incision unless it is made <span style='font-family:sans-serif; font-size:120%;'>V</span>-shaped, as it
+otherwise leaves the unsightly lateral flaps, but thinks well of the
+modification of Cloquet&rsquo;s practiced by M. Vidal de Cassis, which
+is performed in the following manner: The patient stands before the
+operator, who remains sitting; the operator seizes the prepuce on its
+dorsum and draws it toward him; he then introduces a narrow,
+sharp-pointed bistoury, with its point armed with a small waxen bullet,
+down alongside of the frenum until he reaches the pouched extremity of
+the preputial cavity at this point; the point of the bistoury is now
+made to transfix the waxen bullet and out through the skin, which from
+this point is divided from behind forward. Vanier very sensibly suggests
+that the operation that is effectual, and which can be accomplished in
+the least number of movements or <i>temps</i>, as <span class='pagenum'><a name="Page_317" id="Page_317">[317]</a></span>
+being the least likely to cause extensive pain and agony, should be the
+one preferred, and that the aim of the surgeon should be to simplify the
+operation by reducing the number of necessary movements. For this
+reason, where an excision of considerable amount of tissue is required
+by the nature of the case, he prefers another operation, performed by
+Lallemand,&mdash;that of making a dorsal transfixion and cutting off the
+two lateral flaps, which can all be done in three movements.</p>
+
+<p>It makes but little difference as to which operation is performed on the
+adult, but that the subsequent dressing will exercise a good or evil
+influence, and greatly assist not only in the present comfort or
+discomfort of the patient, but in the ultimate result as well. Bearing
+these points in view, Charles A. Ballance, of St. Thomas&rsquo;s
+Hospital, has adopted the following procedure:&mdash;</p>
+
+<p>&ldquo;When the patient is etherized, the outline of the posterior
+border of the glans is marked on the skin with an aniline pencil. The
+skin of the prepuce is slit and removed up to the aniline line. The
+mucous membrane is next cut away, leaving only a free edge of about
+one-eighth of an inch in width. Any bleeding which occurs should be
+entirely arrested, and asepsis must be insured by frequent sponging with
+carbolic or sublimate solution. Numerous coarse-hair stitches are then
+inserted, so as to bring accurately together the fresh-cut edges of the
+skin and mucous membrane, and subsequently, after a further sponging and
+drying, a piece of gauze two layers of thickness, and wide enough to
+reach from the root of the penis nearly to the meatus, is wrapped
+loosely around the penis and secured by several applications of the
+collodion-brush. The setting of the collodion is hastened by the use of
+a fan, so that the air <span class='pagenum'><a name="Page_318" id="Page_318">[318]</a></span>
+is kept in motion, and the patient should not be allowed to recover
+from the an&aelig;sthetic until the dressing is quite firm and hard.
+This dressing forms a carapace for the penis, protecting it from the
+bedclothes and effectually preventing the annoying and distressing
+erections. Mr. Ballance reports excellent results from this
+dressing.&rdquo; (Braithwaite&rsquo;s <i>Retrospect</i>, July, 1888.)</p>
+
+<p>In applying the above dressing, the shrinking incident to the drying of
+the collodion must not be overlooked, and the gauze layers must be
+loosely applied, as they would otherwise become too tight. The dressing
+is a very ingenious and serviceable one.</p>
+
+<p>Mr. A. G. Miller, at a meeting of the Edinburgh Medico-Chirurgical
+Society, reported a new method of dressing after circumcision. &ldquo;It
+consisted in first closely suturing the skin and mucous membrane by
+numerous catgut sutures, then painting the surface with Friar&rsquo;s
+balsam and covering it over with two or three layers of cotton wadding,
+on which the balsam is poured. The glans penis was left sufficiently
+free to allow of water passing. The band or ring of dressing should be
+at least one inch broad. The dressing was not suitable for young infants
+who were frequently wetting. In the case of older children, they might
+be allowed to go about on the second or third day, when the dressing
+would be quite dry, and would not be required to be changed or
+renewed.&rdquo; (Braithwaite&rsquo;s <i>Retrospect</i>, January, 1888.)</p>
+
+<p>Any constricting or immovable and inelastic dressing is subject to the
+same objections as plaster-of-Paris dressings in thigh-fractures,&mdash;that
+of being dangerous and not expedient, unless the patient is constantly
+under your eye.</p>
+
+<p>Dr. Neil Macleod, in the <i>Edinburgh Medical Journal</i><span class='pagenum'><a name="Page_319" id="Page_319">[319]</a></span>
+for March, 1883, advises a procedure that has always looked favorably
+to me, and which I once put in practice through the means of the
+ordinary ptosis fenestrated forceps, in place of the ordinary
+circumcision forceps, the sutures being introduced through the fenestra
+and the prepuce cut off on the outer side of the forceps, the thickness
+of the steel arm on the outer side of the fenestra allowing of the
+properly-sized border for the hold of the sutures. Dr. Macleod places
+his sutures all in position before making any incisions,&mdash;a
+procedure which will be found to save the patient considerable pain; as
+with many the seizing and holding of the edges of the skin and mucous
+membrane and the forcible pressure exerted by the fingers or forceps
+while the needle is being forced through is the most painful part of the
+operation. In doing this, care must be taken to allow sufficient length
+to each thread to make two sutures, as well as care must be taken to
+properly pull out the thread in the centre between the four folds of
+tissue and to cut it equidistant, after the ablation of the prepuce, a
+blunt hook being used to fish up the threads from the preputial opening.</p>
+
+<p>Erichsen favors the Jewish operation in young children, as being the
+easiest and safest of performance. Slitting, or the inferior or superior
+incision, he thought, left too much of the prepuce, which, wherever
+there is a tendency to phimosis, should be entirely removed, &ldquo;with
+a view of preserving the health and cleanliness of the parts in after
+life.&rdquo; In the phimosis that is acquired by old men, he found
+dilatation with a two-bladed instrument to be sufficient, provided the
+indurated circle was made to yield. For the circumcision of adults he
+has invented an adjustable shield, something like the Jewish spatula,
+with which he protects the glans.</p>
+
+<p><span class='pagenum'><a name="Page_320" id="Page_320">[320]</a></span>
+Gross (the elder) used both slitting on the dorsum and circumcision. He
+found neither objection nor deformity in the flaps left by the dorsal
+incision, as they were only temporary; in some cases, he simply followed
+the practice of Cullerier, of making multiple slits in the constricting
+and inelastic mucous membrane.</p>
+
+<p>Agnew believes in circumcision in the treatment of reflex troubles. He
+relates a case, in the second volume of his &ldquo;Surgery,&rdquo; of
+eczema extending over the abdomen, of over a year&rsquo;s standing,
+cured in a child by circumcision; he operates by incision on the dorsum,
+in which he leaves nature to make away with the flaps, or he circumcises
+by the Bumstead method.</p>
+
+<p>Van Buren and Keyes recommend both the incision on the dorsum and the
+operation of Ricord; where the mucous membrane alone is tight and
+constricted, they follow Cullerier&rsquo;s method of either single or
+multiple incisions of the inner coat. They lay great stress on the
+necessity of keeping the patient quietly in bed to insure rapid and
+complete union.</p>
+
+<p>My friend, Dr. Robert J. Gregg, of San Diego, has lately operated on a
+number of cases, the operation being perfectly painless, the little
+patients submitting to it and feeling no more pain than if it were
+having its toe-nails trimmed, the local an&aelig;sthesia being produced by the
+hypodermatic injection of cocaine. This procedure is now used to a
+considerable extent throughout the country, and it is a far safer and
+more comfortable performance than either etherizing or chloroforming, as
+the sudden and spasmodic filling of the lungs of young children&mdash;who
+will resist and hold their breath for a long time, then suddenly
+inhale&mdash;with an&aelig;sthetic vapor is almost unavoidable, having in two
+instances nearly lost two children from such an accident.</p>
+
+<p><span class='pagenum'><a name="Page_321" id="Page_321">[321]</a></span>
+Dr. G. W. Overall, in a late <i>Medical Record</i>, which is quoted in the
+<i>Journal of the American Medical Association</i> of February 21, 1891,
+gives the description of a very good and painless method of producing
+this local an&aelig;sthesia; for it need hardly be said that with a nervous,
+irritable child the introduction of the hypodermatic needle is as
+formidable an operation as either slitting or the Jewish operation. Dr.
+Overall is in the habit of holding a solution within the preputial
+cavity and then to introduce the needle in the mucous fold, having
+previously applied a light rubber band back of the corona, on the outer
+integument, so as to act like a tourniquet and limit the action of the
+an&aelig;sthetic effect to the prepuce. By this procedure he avoids all pain
+and the operation can be performed while the child is even amusing
+itself, care being taken that it does not see it. Sutures that require
+removal should not be used, according to the Doctor, and the operation
+thereby becomes a perfectly painless and unalarming performance to the
+patient in all its details.</p>
+
+<hr /><p class='pagenum'><a name="Page_323" id="Page_323">[323]</a></p>
+<h2><a name="NOTES_TO_TEXT" id="NOTES_TO_TEXT"></a>NOTES TO TEXT.</h2>
+
+<div class='footnotes'>
+<div class="footnote"><p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> &ldquo;Letters of Certain Jews to Monsieur Voltaire,
+Containing an Apology for their own People.&rdquo; Pages 451-476.
+Translated by Dr. Lefann. Philadelphia, 1848.</p></div>
+
+<div class="footnote"><p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> &ldquo;Circoncision chez les Egyptiens.&rdquo; Brochure by
+F. Chabas. Paris, 1861.</p></div>
+
+<div class="footnote"><p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> &ldquo;Atlantis.&rdquo; By Ignatius Donnelly. Page 472.</p></div>
+
+<div class="footnote"><p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> <i>Ibid.</i>, page 115.</p></div>
+
+<div class="footnote"><p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> <i>Ibid.</i>, page 234.</p></div>
+
+<div class="footnote"><p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> <i>Ibid.</i>, page 178.</p></div>
+
+<div class="footnote"><p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> &ldquo;Circumcision.&rdquo; A. B. Arnold. <i>New York Med.
+Record</i>, Feb. 13, 1886.</p></div>
+
+<div class="footnote"><p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> &ldquo;Atlantis,&rdquo; page 178.</p></div>
+
+<div class="footnote"><p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> This word is, in the Mandan, <i>Maho-peneta</i>; in the Welsh,
+<i>Mawr-pen&aelig;thir</i>. &ldquo;Atlantis,&rdquo; page 115.</p></div>
+
+<div class="footnote"><p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> &ldquo;Cyclopedia of Biblical, Theological, and
+Ecclesiastical Literature,&rdquo; vol. viii, page 58. Article, Phallus.</p></div>
+
+<div class="footnote"><p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> &ldquo;Origine, Signification et Histoire, de la
+Castration, de l&rsquo;eunuchism, et la circoncision.&rdquo; Par. F.
+Bergmann. Published in the &ldquo;Archivio per le Traditione
+Populaire,&rdquo; 1883.</p></div>
+
+<div class="footnote"><p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> &ldquo;Dictionaire des Sciences M&eacute;dicales.&rdquo; Par une
+Soci&eacute;t&eacute; de m&eacute;decins et de Chirurgiens. Paris, 1826, 60-volume edition.</p></div>
+
+<div class="footnote"><p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Dr. Delange mentions a peculiar social habit or custom
+among a tribe of Arabians that in a sociological sense is worth
+mentioning. He observes that for these dances females are preferred, but
+owing to the peculiar habit about to be related it is impossible to have
+any of the village women in Algeria assist at this part of the
+festivities; hence the men have to do the dancing. It appears that the
+females of one tribe&mdash;this being the tribe of Ouleds-Nails, who live on
+the southern borders of Algiers&mdash;are in the habit, when young, of
+emigrating to the oases of the Sahara, which are occupied by the French
+and traveling Arabs, where they give themselves up to a life of
+prostitution. After having exercised this life for some years they
+return to the tribe with a dowry in money, besides an ample supply of
+clothes and jewelry,&mdash;the result of their economy,&mdash;which enables them
+to contract favorable marriages. This practice is so common in this one
+particular tribe, and so much have they monopolized the profession of
+courtesan, that the name of the tribe of Ouleds-Nails is in Arabia
+synonymous with that of courtesan. These young women dance every evening
+in the Arab caf&eacute;s, and are at times employed to do the dancing at Arab
+feasts. For this reason no self-respecting Arab woman ever allows
+herself to dance in public, or why the practice of both sexes dancing
+together is not practiced in Algerian villages, as a man would thereby
+consider himself disgraced.&mdash;Dr. Delange, in <i>Receuil de M&eacute;moires de
+M&eacute;decine de Chirurgie et de Pharmacie Militaire</i>, No. 105, August,
+1868.</p></div>
+
+<div class="footnote"><p><span class='pagenum'><a name="Page_324" id="Page_324">[324]</a></span>
+<a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> &ldquo;Tractatus, Alberti Bobovii, Turcarum Imp.
+Mohammedis IV olim Interpretis primarii, De Turcarum Liturgia,
+peregrinatione Meccana, Circumcisione, &AElig;grotorum Visitatione,&rdquo;
+etc. Oxonii, 1690.</p></div>
+
+<div class="footnote"><p><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> Michel Le Feber. &ldquo;Le Theatre de la Turquie.&rdquo;
+Paris, 1681.</p></div>
+
+<div class="footnote"><p><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> &ldquo;La Circoncision, Sa Signification Social et
+Religieuse.&rdquo; Par M. Paul Lafargue, in the <i>Bulletins de la Soci&eacute;t&eacute;
+d&rsquo;Anthropologie de Paris</i>. Tome x, 3d fascicule, Juin &agrave; Octobre,
+1887.</p></div>
+
+<div class="footnote"><p><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">[17]</span></a> &ldquo;Circumcision.&rdquo; By A. B. Arnold. <i>New York
+Med. Record</i>, Feb. 13, 1886.</p></div>
+
+<div class="footnote"><p><a name="Footnote_18_18" id="Footnote_18_18"></a><a href="#FNanchor_18_18"><span class="label">[18]</span></a> Bancroft&rsquo;s &ldquo;Native Races,&rdquo; vol. ii, page
+278.</p></div>
+
+<div class="footnote"><p><a name="Footnote_19_19" id="Footnote_19_19"></a><a href="#FNanchor_19_19"><span class="label">[19]</span></a> &ldquo;Recherches Philosophiques sur les Americains, ou
+Memoires Interessants pour servir &agrave; l&rsquo;Histoire de l&rsquo;Espece
+Humaine.&rdquo; Par M. de P. Edition par Dom Pernety. Tome ii. Article,
+Circoncision, Berlin, 1774.</p></div>
+
+<div class="footnote"><p><a name="Footnote_20_20" id="Footnote_20_20"></a><a href="#FNanchor_20_20"><span class="label">[20]</span></a> &ldquo;The Family, a Historical and Social Study.&rdquo;
+By Charles Franklin Thwing. Boston, 1887.</p></div>
+
+<div class="footnote"><p><a name="Footnote_21_21" id="Footnote_21_21"></a><a href="#FNanchor_21_21"><span class="label">[21]</span></a> The &ldquo;Recherches Philosophiques sur les
+Americains&rdquo; and Virey, in the 24th volume of the
+&ldquo;Dictionaire des Sciences M&eacute;dicales,&rdquo; are very full on this
+subject, and for fuller information the reader is referred to those
+works.</p></div>
+
+<div class="footnote"><p><a name="Footnote_22_22" id="Footnote_22_22"></a><a href="#FNanchor_22_22"><span class="label">[22]</span></a> &ldquo;Cause Morale de la Circoncision des Israelites,
+Institution Preventive de l&rsquo;Onanisme des Enfants.&rdquo; Par le
+Docteur Vanier, du Havre. Paris, 1847.</p></div>
+
+<div class="footnote"><p><a name="Footnote_23_23" id="Footnote_23_23"></a><a href="#FNanchor_23_23"><span class="label">[23]</span></a> &ldquo;Annual Report of the Bureau of Ethnology.&rdquo; By
+J. W. Powell. Washington, 1881, 1882.</p></div>
+
+<div class="footnote"><p><a name="Footnote_24_24" id="Footnote_24_24"></a><a href="#FNanchor_24_24"><span class="label">[24]</span></a> &ldquo;Among Cannibals, or Four Years&rsquo; Travels in
+Australia.&rdquo; By Carl Lumholtz. Page 46. Charles Scribner &amp; Son,
+1889.</p></div>
+
+<div class="footnote"><p><a name="Footnote_25_25" id="Footnote_25_25"></a><a href="#FNanchor_25_25"><span class="label">[25]</span></a> These interesting historical facts in relation to the holy
+prepuce were published in the <i>Journal l&rsquo;Excommunier</i> in January
+of 1870, when the writer was in France. They were contributed by A. S.
+Morin, of Miron, a learned historiographer and antiquary. Europe has not
+recovered from its love of the supernatural that it had so strongly in
+the middle ages. The blood of St. Gennaro still liquefies once a year,
+and many churches still claim to possess the identical winding sheet
+that served our Lord prior to his resurrection, as well as more than one
+church has the holy cloth that St. Veronica used on the way to Calvary,
+which has an impression of the face of the Saviour.</p></div>
+
+<div class="footnote"><p><a name="Footnote_26_26" id="Footnote_26_26"></a><a href="#FNanchor_26_26"><span class="label">[26]</span></a> This church has a remarkable history connected with its
+foundation. The tradition relates that in the dark ages some
+sacrilegious soldier had robbed a church in the neighborhood of its holy
+vessels of gold and silver. In the vessel in the Tabernacle there
+happened to be a consecrated wafer. The soldier journeyed on to Turin to
+dispose of his plunder, when, on arriving at the spot on which the
+church now stands, the wafer is said to have ascended miraculously to
+some distance above the soldier&rsquo;s head, while at the same time the
+mule he rode, being imbued with more religious piety than his master,
+reverently knelt down on his front legs. The holy wafer was now
+encircled by a halo of shining light; this, with the kneeling donkey and
+the soldier raining blows on the pious animal, while he himself was
+unconscious of the presence of the host above him, attracted the
+attention of the populace, who apprehended the soldier, on whom the
+stolen vessels were found. The bishop in his pontificial robes, in
+solemn procession, received the consecrated wafer, which promptly
+descended into pious hands. The donkey was adopted by <span class='pagenum'><a name="Page_325" id="Page_325">[325]</a></span>
+the bishop and the soldier was promptly hanged, in accordance with the
+general treatment of thieves in those days. The writer has more than
+once seen a flagstone inclosed within a railing that occupies the
+central spot of the floor or pavement of the church, it being the
+identical spot on which the donkey knelt.</p></div>
+
+<div class="footnote"><p><a name="Footnote_27_27" id="Footnote_27_27"></a><a href="#FNanchor_27_27"><span class="label">[27]</span></a> Rush&rsquo;s &ldquo;Medical Inquiries,&rdquo; vol. i, page
+217.</p></div>
+
+<div class="footnote"><p><a name="Footnote_28_28" id="Footnote_28_28"></a><a href="#FNanchor_28_28"><span class="label">[28]</span></a> Fothergill. &ldquo;Gout in its Protean Aspects,&rdquo;
+page 158.</p></div>
+
+<div class="footnote"><p><a name="Footnote_29_29" id="Footnote_29_29"></a><a href="#FNanchor_29_29"><span class="label">[29]</span></a> &ldquo;Philosophy of Magic,&rdquo; from the French of
+Eusebe Salverte, vol. ii, page 143.</p></div>
+
+<div class="footnote"><p><a name="Footnote_30_30" id="Footnote_30_30"></a><a href="#FNanchor_30_30"><span class="label">[30]</span></a> &ldquo;Dictionaire des Sciences M&eacute;dicales.&rdquo;
+Cullerier. Article, Phimosis. Vol. xli.</p></div>
+
+<div class="footnote"><p><a name="Footnote_31_31" id="Footnote_31_31"></a><a href="#FNanchor_31_31"><span class="label">[31]</span></a> Bergmann has gone into this subject at length, and the
+writer has drawn freely from his brochure on &ldquo;Castration and
+Eunuchism,&rdquo; reprinted from the &ldquo;Archivio per le Traditione
+Populaire&rdquo; of 1883.</p></div>
+
+<div class="footnote"><p><a name="Footnote_32_32" id="Footnote_32_32"></a><a href="#FNanchor_32_32"><span class="label">[32]</span></a> &ldquo;The Hermit.&rdquo; By the Rev. Charles Kingsley.
+See Introduction.</p></div>
+
+<div class="footnote"><p><a name="Footnote_33_33" id="Footnote_33_33"></a><a href="#FNanchor_33_33"><span class="label">[33]</span></a> &ldquo;Dictionaire des Sciences M&eacute;dicales,&rdquo; vol.
+liv, page 570.</p></div>
+
+<div class="footnote"><p><a name="Footnote_34_34" id="Footnote_34_34"></a><a href="#FNanchor_34_34"><span class="label">[34]</span></a> <i>Ibid.</i>, page 567.</p></div>
+
+<div class="footnote"><p><a name="Footnote_35_35" id="Footnote_35_35"></a><a href="#FNanchor_35_35"><span class="label">[35]</span></a> <i>Ibid.</i>, page 570.</p></div>
+
+<div class="footnote"><p><a name="Footnote_36_36" id="Footnote_36_36"></a><a href="#FNanchor_36_36"><span class="label">[36]</span></a> &ldquo;Cyclopedia of Biblical, Theological, and
+Ecclesiastical Literature,&rdquo; vol. iii, page 351.</p></div>
+
+<div class="footnote"><p><a name="Footnote_37_37" id="Footnote_37_37"></a><a href="#FNanchor_37_37"><span class="label">[37]</span></a> Smollett gives a good account of the Carthagena expedition
+in his &ldquo;Roderick Random,&rdquo; and for a good satisfactory detail
+of the blundering Walcheren expedition the reader is referred to Harriet
+Martineau&rsquo;s &ldquo;History of England,&rdquo; vol. i, pages 269,
+272, 273, and 354.</p></div>
+
+<div class="footnote"><p><a name="Footnote_38_38" id="Footnote_38_38"></a><a href="#FNanchor_38_38"><span class="label">[38]</span></a> Schoopanism, or p&aelig;derastia, is at times practiced by the
+Omahas, and the man or boy who suffers as the passive agent is called
+<i>min-quga</i>, or hermaphrodite.&mdash;&ldquo;Third Annual Report of the Bureau
+of Ethnology.&rdquo; By J. W. Powell. Washington, 1881, 1882.</p></div>
+
+<div class="footnote"><p><a name="Footnote_39_39" id="Footnote_39_39"></a><a href="#FNanchor_39_39"><span class="label">[39]</span></a> When the missionaries first arrived in this region they
+found men dressed as women and performing women&rsquo;s duties who were
+kept for unnatural purposes. From their youth up they were treated,
+instructed, and used as females, and were even frequently publicly
+married to the chiefs or great men.&mdash;Bancroft&rsquo;s works, vol. i,
+&ldquo;Native Races,&rdquo; page 415.</p></div>
+
+<div class="footnote"><p><a name="Footnote_40_40" id="Footnote_40_40"></a><a href="#FNanchor_40_40"><span class="label">[40]</span></a> &ldquo;Recherches Philosophiques sur les
+Americains,&rdquo; tome ii.</p></div>
+
+<div class="footnote"><p><a name="Footnote_41_41" id="Footnote_41_41"></a><a href="#FNanchor_41_41"><span class="label">[41]</span></a> &ldquo;The History of the Hebrew Commonwealth.&rdquo; From
+the German of John Jahn, D.D. Page 25. Oxford, 1840.</p></div>
+
+<div class="footnote"><p><a name="Footnote_42_42" id="Footnote_42_42"></a><a href="#FNanchor_42_42"><span class="label">[42]</span></a> &ldquo;L&rsquo;Hermaphrodite devant le Code Civil.&rdquo;
+Par le Docteur Charles Debierre. Bailli&eacute;re et Fils. Paris, 1886.</p></div>
+
+<div class="footnote"><p><a name="Footnote_43_43" id="Footnote_43_43"></a><a href="#FNanchor_43_43"><span class="label">[43]</span></a> &ldquo;Recherches Philosophiques sur les
+Americains,&rdquo; tome ii, page 78.</p></div>
+
+<div class="footnote"><p><a name="Footnote_44_44" id="Footnote_44_44"></a><a href="#FNanchor_44_44"><span class="label">[44]</span></a> &ldquo;L&rsquo;Hermaphrodite devant le Code Civil.&rdquo;
+Debierre.</p></div>
+
+<div class="footnote"><p><a name="Footnote_45_45" id="Footnote_45_45"></a><a href="#FNanchor_45_45"><span class="label">[45]</span></a> <i>Occidental Medical Times</i>, Sacramento, Cal., October,
+1890, page 543.</p></div>
+
+<div class="footnote"><p><a name="Footnote_46_46" id="Footnote_46_46"></a><a href="#FNanchor_46_46"><span class="label">[46]</span></a> &ldquo;Dictionaire des Sciences M&eacute;dicales,&rdquo; vol.
+xxxi., page 41.</p></div>
+
+<div class="footnote"><p><a name="Footnote_47_47" id="Footnote_47_47"></a><a href="#FNanchor_47_47"><span class="label">[47]</span></a> <i>British and Foreign Medico-Chirurgical Review</i>, vol.
+xviii, 1856.</p></div>
+
+<div class="footnote"><p><a name="Footnote_48_48" id="Footnote_48_48"></a><a href="#FNanchor_48_48"><span class="label">[48]</span></a> &ldquo;L&rsquo;Hermaphrodite devant le Code Civil.&rdquo;
+Debierre.</p></div>
+
+<div class="footnote"><p><a name="Footnote_49_49" id="Footnote_49_49"></a><a href="#FNanchor_49_49"><span class="label">[49]</span></a> Sir Thomas Brown&rsquo;s works, vol. ii, &ldquo;Religio
+Medici.&rdquo;</p></div>
+
+<div class="footnote"><p><a name="Footnote_50_50" id="Footnote_50_50"></a><a href="#FNanchor_50_50"><span class="label">[50]</span></a> &ldquo;The Bible and other Ancient Literature in the
+Nineteenth Century.&rdquo; L. T. Townsend, D.D. Chautauqua press, 1889.
+See pages 32-45.</p></div>
+
+<div class="footnote"><p><a name="Footnote_51_51" id="Footnote_51_51"></a><a href="#FNanchor_51_51"><span class="label">[51]</span></a> &ldquo;The Religions of the Ancient World.&rdquo; George
+Rawlinson, M.A. Alden edition of 1885. Page 174.</p></div>
+
+<div class="footnote"><p><a name="Footnote_52_52" id="Footnote_52_52"></a><a href="#FNanchor_52_52"><span class="label">[52]</span></a> &ldquo;The Intellectual Development of Europe.&rdquo; John
+W. Draper. Vol. ii, page 113.</p></div>
+
+<div class="footnote"><p><a name="Footnote_53_53" id="Footnote_53_53"></a><a href="#FNanchor_53_53"><span class="label">[53]</span></a> <i>Ibid.</i> vol. ii, page 122.</p></div>
+
+<div class="footnote"><p><span class='pagenum'><a name="Page_326" id="Page_326">[326]</a></span>
+<a name="Footnote_54_54" id="Footnote_54_54"></a><a href="#FNanchor_54_54"><span class="label">[54]</span></a> In &ldquo;Clarke&rsquo;s Commentary,&rdquo; vol. i, page
+113, the reason of choosing the eighth day is given. Circumcision was
+not only a covenant, but an offering to God; and all born, whether human
+or animal, were considered unclean previous to the eighth day. Neither
+calf, lamb, or kid was offered to God until it was eight days
+old.&mdash;Lev., xxii, 27.</p></div>
+
+<div class="footnote"><p><a name="Footnote_55_55" id="Footnote_55_55"></a><a href="#FNanchor_55_55"><span class="label">[55]</span></a> A father circumcised his children and the master his
+slaves. In case of neglect the operation was performed by the
+magistrate. If its neglect was unknown to the magistrate, then it became
+the duty of the Hebrew, upon arriving of age, to either do it himself or
+have it done.&mdash;&ldquo;Clarke&rsquo;s Commentary,&rdquo; vol. i, page
+113.</p></div>
+
+<div class="footnote"><p><a name="Footnote_56_56" id="Footnote_56_56"></a><a href="#FNanchor_56_56"><span class="label">[56]</span></a> Bishop Newton points out the remarkable analogy that marks
+the Hebrew race as descendants of Isaac and the Arab race as the
+descendants of Ishmael, from whom sprung the Saracenic people. These are
+the only two races that have gone on in their purity from their
+beginning. They intermarry only among themselves and have, alike, the
+same customs and habits as their fathers. The sculptured faces of the
+Hebrew on the Babylonian monuments are the same faces that are met in
+the synagogues of Paris or New York. So with the descendants of Ishmael,
+in whom there flows partly the blood of the dominant element of ancient
+Egypt; neither custom, habit, nor physiognomy have changed. In these two
+races, as observed by Bishop Newton, we have an ocular demonstration of
+the Divine origin of our faith, if verification of Scripture history is
+any criterion.&mdash;&ldquo;Clarke&rsquo;s Commentary,&rdquo; vol. i, page
+111; also, Hosmer&rsquo;s &ldquo;Story of the Jews,&rdquo; page 5.</p></div>
+
+<div class="footnote"><p><a name="Footnote_57_57" id="Footnote_57_57"></a><a href="#FNanchor_57_57"><span class="label">[57]</span></a> &ldquo;Cause Morale de la Circoncision.&rdquo; Vanier, du
+Havre. Pages 40-45.</p></div>
+
+<div class="footnote"><p><a name="Footnote_58_58" id="Footnote_58_58"></a><a href="#FNanchor_58_58"><span class="label">[58]</span></a> &ldquo;De la Circoncision.&rdquo; Par le Dr. S. Bernheim.
+Page 7. Paris, 1889.</p></div>
+
+<div class="footnote"><p><a name="Footnote_59_59" id="Footnote_59_59"></a><a href="#FNanchor_59_59"><span class="label">[59]</span></a> &ldquo;Cyclopedia of Biblical, Theological, and
+Ecclesiastical Literature,&rdquo; vol. ii, page 350.</p></div>
+
+<div class="footnote"><p><a name="Footnote_60_60" id="Footnote_60_60"></a><a href="#FNanchor_60_60"><span class="label">[60]</span></a> Among the Semitic race, however, it seems possible to
+bring forward better evidence than this of an early Stone Age. If we
+follow one way of translating we find, in two passages of the Old
+Testament, an account of the use of sharp stones or stone knives for
+circumcision,&mdash;Exodus, iv, 25: &ldquo;And Zipporah took a stone&rdquo;;
+and Joshua, v, 2: &ldquo;At that time Jehovah said to Joshua, Make thee
+knives of stone.&rdquo; ... The Septuagint altogether favors the opinion
+that the knives in question were of stone, by reading, in the first
+place, a stone or pebble, and, in the second, stone knives of sharp-cut
+stone. These are mentioned again in the remarkable passage which follows
+the account of the death and burial of Joshua (Joshua, xxiv, 29,
+30),&mdash;&ldquo;And it came to pass, after these things, that Joshua, the
+son of Nun, the servant of Jehovah, died, being a hundred and ten years
+old, and they buried him in the border of his inheritance in Timnath
+Serah, which is in Mount Ephraim, on the north side of the hill of
+Gaash.&rdquo; Here follows, in the LXX, a passage not in the Hebrew
+text, which has come down to us: &ldquo;And there they laid with him in
+the tomb, wherein they buried him there, the stone knives wherewith he
+circumcised the children of Israel at the Gilgals, when he led them out
+of Egypt, as the Lord commanded. And they are there unto this
+day.&rdquo; The rabbinical law, in connection with this subject, reads
+as follows: &ldquo;We may circumcise with anything, even with a flint,
+with crystal (glass), or with anything that cuts, except with the sharp
+edge of a reed, because enchanters made use of that, or it <span class='pagenum'><a name="Page_327" id="Page_327">[327]</a></span>may bring on
+a disease; and it is a precept of the wise men to circumcise with iron,
+whether in the form of a knife or scissors, but it is customary to use a
+knife.&rdquo; This mention of the objectionable nature of the reed as a
+circumcising medium is attributed to the danger that may arise from
+splinters. The Fiji Islanders use both a rattan knife and a sharp
+splinter of bamboo in performing circumcision and in cutting the
+umbilical cord at child-birth. Herodotus mentions the use of stone
+knives by the Egyptian embalmers. Stone knives were supposed to produce
+less inflammation than those of bronze or iron, and it was for this
+reason that the Cybelian priests operated upon themselves with a sherd
+of Samian ware (Samia testa), as thus avoiding danger. There seems, on
+the whole, to be a fair case for believing that among the Israelites, as
+in Arabia, Ethiopia, and Egypt, a ceremonial use of stone instruments
+long survived the general adoption of metal, and that such observances
+are to be interpreted as relics of an earlier Stone
+Age.&mdash;&ldquo;Researches into the Early History of Mankind.&rdquo; By
+Edward B. Tylor. Pages 217-220. London, 1870.</p></div>
+
+<div class="footnote"><p><a name="Footnote_61_61" id="Footnote_61_61"></a><a href="#FNanchor_61_61"><span class="label">[61]</span></a> The cannibals of Australia do not eat white people, as the
+flesh of these produces a nausea, which the flesh of the vegetable-fed
+blacks does not do. The rice-fed Chinese are considered a treat, and
+these are slaughtered in great number, ten Chinamen having been served
+up at one dinner.&mdash;&ldquo;Among Cannibals.&rdquo; By Carl Lumholtz. Page
+273.</p></div>
+
+<div class="footnote"><p><a name="Footnote_62_62" id="Footnote_62_62"></a><a href="#FNanchor_62_62"><span class="label">[62]</span></a> &ldquo;Cause Moral de la Circoncision.&rdquo; Par le Dr.
+Vanier. Page 266.</p></div>
+
+<div class="footnote"><p><a name="Footnote_63_63" id="Footnote_63_63"></a><a href="#FNanchor_63_63"><span class="label">[63]</span></a> <i>Ibid.</i>, page 288.</p></div>
+
+<div class="footnote"><p><a name="Footnote_64_64" id="Footnote_64_64"></a><a href="#FNanchor_64_64"><span class="label">[64]</span></a> <i>Cincinnati Clinic</i>, vol. ii, page 165.</p></div>
+
+<div class="footnote"><p><a name="Footnote_65_65" id="Footnote_65_65"></a><a href="#FNanchor_65_65"><span class="label">[65]</span></a> &ldquo;The Story of the Jews.&rdquo; Hosmer. Page 263.</p></div>
+
+<div class="footnote"><p><a name="Footnote_66_66" id="Footnote_66_66"></a><a href="#FNanchor_66_66"><span class="label">[66]</span></a> &ldquo;Trait&eacute; d&rsquo;Hygi&egrave;ne, publique et priv&eacute;e.&rdquo;
+Michel Levy. 2d. edition, vol. ii, page 754.</p></div>
+
+<div class="footnote"><p><a name="Footnote_67_67" id="Footnote_67_67"></a><a href="#FNanchor_67_67"><span class="label">[67]</span></a> <i>Ibid.</i></p></div>
+
+<div class="footnote"><p><a name="Footnote_68_68" id="Footnote_68_68"></a><a href="#FNanchor_68_68"><span class="label">[68]</span></a> &ldquo;Diseases of Modern Life.&rdquo; B. W. Richardson.
+Page 19.</p></div>
+
+<div class="footnote"><p><a name="Footnote_69_69" id="Footnote_69_69"></a><a href="#FNanchor_69_69"><span class="label">[69]</span></a> &ldquo;Longevity and other Biostatic Peculiarities of the
+Jewish Race.&rdquo; By John Stockton Hough, M.D. <i>New York Med. Record</i>,
+1873.</p></div>
+
+<div class="footnote"><p><a name="Footnote_70_70" id="Footnote_70_70"></a><a href="#FNanchor_70_70"><span class="label">[70]</span></a> &ldquo;Vital Statistics of the Jews.&rdquo; By Dr. John S.
+Billings. <i>North American Review</i>, No. 1, vol. 152, page 70, January,
+1891.</p></div>
+
+<div class="footnote"><p><a name="Footnote_71_71" id="Footnote_71_71"></a><a href="#FNanchor_71_71"><span class="label">[71]</span></a> &ldquo;On Regimen and Longevity.&rdquo; By John Bell, M.D.
+Page 13.</p></div>
+
+<div class="footnote"><p><a name="Footnote_72_72" id="Footnote_72_72"></a><a href="#FNanchor_72_72"><span class="label">[72]</span></a> <i>British and Foreign Medico-Chirurgical Review</i>, vol.
+xliii, page 539.</p></div>
+
+<div class="footnote"><p><a name="Footnote_73_73" id="Footnote_73_73"></a><a href="#FNanchor_73_73"><span class="label">[73]</span></a> <i>Ibid.</i>, vol. xlii, page 17.</p></div>
+
+<div class="footnote"><p><a name="Footnote_74_74" id="Footnote_74_74"></a><a href="#FNanchor_74_74"><span class="label">[74]</span></a> In &ldquo;Influence of the Trades on Health,&rdquo;
+Thakrah mentions the peculiar exemption enjoyed in this regard by the
+butcher class. He quotes Tweedie in saying that he never saw a butcher
+admitted to the fever hospital.</p></div>
+
+<div class="footnote"><p><a name="Footnote_75_75" id="Footnote_75_75"></a><a href="#FNanchor_75_75"><span class="label">[75]</span></a> Lancereaux. &ldquo;Distribution de la Phthisie
+Pulmonaire.&rdquo;</p></div>
+
+<div class="footnote"><p><a name="Footnote_76_76" id="Footnote_76_76"></a><a href="#FNanchor_76_76"><span class="label">[76]</span></a> Ashhurst. &ldquo;Int. Enc. Surgery.&rdquo;</p></div>
+
+<div class="footnote"><p><a name="Footnote_77_77" id="Footnote_77_77"></a><a href="#FNanchor_77_77"><span class="label">[77]</span></a> Horner. &ldquo;Naval Practice.&rdquo;</p></div>
+
+<div class="footnote"><p><a name="Footnote_78_78" id="Footnote_78_78"></a><a href="#FNanchor_78_78"><span class="label">[78]</span></a> <i>Cincinnati Lancet and Observer.</i>, vol. xvi, 1873.</p></div>
+
+<div class="footnote"><p><a name="Footnote_79_79" id="Footnote_79_79"></a><a href="#FNanchor_79_79"><span class="label">[79]</span></a> It may well be a question of some interest whether the
+atrophy of the testicle in the aged may not at times be partly due to
+the compression exercised by the prepuce on the glans through reflex
+action, and whether at times the virility that is departing cannot be
+restored by circumcision in such cases. I have seen such results, being
+guided to the idea by the Biblical relation in the case of Abraham.</p></div>
+
+<div class="footnote"><p><span class='pagenum'><a name="Page_328" id="Page_328">[328]</a></span>
+<a name="Footnote_80_80" id="Footnote_80_80"></a><a href="#FNanchor_80_80"><span class="label">[80]</span></a> This patient subsequently died of a ur&aelig;mic complication
+following on an attack of fever. The man was in his prime, and had been
+of most exemplary habits. The fever that he had was, I had every reason
+to believe, directly due to the results of imperfect blood depuration
+incident on the irritability of his kidneys, which, retroactively, again
+allowed the ur&aelig;mic condition to assume that dangerous degree that
+suddenly and very unexpectedly to his friends and family ushered the
+patient into eternity. This man had only been merely inconvenienced by
+his prepuce up to the time that it caused his death. It is interesting
+to observe what little trifles bring about the end of some men. The
+unlucky habit of putting the royal countenance on paper brought Louis
+XVI to a sudden halt at Varennes, and his head to the scaffold. The
+lucky meeting of the <i>aides</i> of Bonaparte and Desaix between Novi and
+Marengo gave to France its empire and to Europe the enlightenment that
+was diffused by that event. If such trifles affect individuals and
+nations, we must not be astonished that the little useless prepuce
+should be endowed with the mischief-working power of the historical old
+cow and kerosene lamp that reduced Chicago to ashes.</p></div>
+
+<div class="footnote"><p><a name="Footnote_81_81" id="Footnote_81_81"></a><a href="#FNanchor_81_81"><span class="label">[81]</span></a> In the London <i>Lancet</i> for 1885 there is a very
+interesting communication at page 46 on this subject. There is no doubt
+but that the prepuce offers the best skin-grafting material.</p></div>
+
+<div class="footnote"><p><a name="Footnote_82_82" id="Footnote_82_82"></a><a href="#FNanchor_82_82"><span class="label">[82]</span></a> In the seventeenth volume (third series) of
+&ldquo;Guy&rsquo;s Hospital Reports&rdquo; there is a most interesting
+report at page 243 of a case of skin-grafting that was performed by
+Thomas Bryant. The case was an extensive ulcer resulting from an injury.
+Bryant took some skin-grafts from the man&rsquo;s arm and some from a
+colored man in an adjoining bed. The account gives the daily report as
+taken from the note-book of Mr. Clarke, and is accompanied by a colored
+plate to illustrate the subject; the proliferation of the black skin is
+astonishing. In closing the report Mr. Clarke says: &ldquo;But in the
+figures depicted the amount of increase in the black patches will be
+well seen. In ten weeks the four or five pieces of black skin, which
+together were not larger than a grain of barley, had grown twentyfold,
+and in an another month the black patch was more than one inch long by
+half an inch broad, the black centres of cutification having clearly
+grown very rapidly by the proliferation of their own black
+cells.&rdquo;</p></div>
+
+<div class="footnote"><p><a name="Footnote_83_83" id="Footnote_83_83"></a><a href="#FNanchor_83_83"><span class="label">[83]</span></a> <i>American Journal Med. Sciences</i>, vol. lx.</p></div>
+
+<div class="footnote"><p><a name="Footnote_84_84" id="Footnote_84_84"></a><a href="#FNanchor_84_84"><span class="label">[84]</span></a> &ldquo;Circumcision.&rdquo; By Dr. A. B. Arnold, of
+Baltimore.</p></div>
+
+<div class="footnote"><p><a name="Footnote_85_85" id="Footnote_85_85"></a><a href="#FNanchor_85_85"><span class="label">[85]</span></a> &ldquo;De la Circoncision.&rdquo; By Dr. S. Bernheim.
+Paris.</p></div>
+
+<div class="footnote"><p><a name="Footnote_86_86" id="Footnote_86_86"></a><a href="#FNanchor_86_86"><span class="label">[86]</span></a> The reader is referred to a very interesting paper
+detailing conditions of adhesions in the <i>American Journal Med.
+Sciences</i> for July, 1872. It is taken from the Hungarian of M. Bokai.</p></div>
+
+<div class="footnote"><p><a name="Footnote_87_87" id="Footnote_87_87"></a><a href="#FNanchor_87_87"><span class="label">[87]</span></a> <i>New York Med. Journal</i>, vol. xxvi.</p></div>
+
+<div class="footnote"><p><a name="Footnote_88_88" id="Footnote_88_88"></a><a href="#FNanchor_88_88"><span class="label">[88]</span></a> <i>American Journal Med. Sciences</i>, vol. lx.</p></div>
+
+<div class="footnote"><p><a name="Footnote_89_89" id="Footnote_89_89"></a><a href="#FNanchor_89_89"><span class="label">[89]</span></a> Dr. Vanier describes this operation of Celsus mentioned by
+Vidal in his work on &ldquo;Circumcision,&rdquo; at page 294, which
+consisted in making, by a circular incision immediately back of the
+glans, like in a circular amputation, a complete detachment of the
+integument from back of the corona. The penis was then made to retreat
+into the sheath thus made and a short catheter introduced into the
+urethra, to the end of which the free end of the new preputial fold was
+made fast, a piece of oiled lint being interposed between the raw inner
+surface <span class='pagenum'><a name="Page_329" id="Page_329">[329]</a></span>
+and the glans. Another operation consisted in forcibly drawing the
+integument forward and in making a number of transverse incisions in the
+integument so as to assist its extensibility. By these means it was
+drawn sufficiently forward so as to fasten it to a canula or catheter
+made fast in the urethra. But it can well be imagined that a person must
+possess the most exalted idea of the physiological needs of a prepuce
+and feel the most sensitive need of such an appendage to submit to the
+first of these operations, although it is more than probable that many
+Jews submitted to the operation in the days of Celsus to avoid being
+exiled or plundered of all their possessions. The resulting prepuce
+could not have been a much more unsightly appendage than that which
+ornaments the overburdened virile organ of many Christians, and there is
+no doubt but that in many cases they passed muster.</p></div>
+
+<div class="footnote"><p><a name="Footnote_90_90" id="Footnote_90_90"></a><a href="#FNanchor_90_90"><span class="label">[90]</span></a> &ldquo;Circumcision.&rdquo; Dr. A. B. Arnold.</p></div>
+
+<div class="footnote"><p><a name="Footnote_91_91" id="Footnote_91_91"></a><a href="#FNanchor_91_91"><span class="label">[91]</span></a> Ashhurst. &ldquo;Int. Enc. Surgery,&rdquo; vol. vi.</p></div>
+
+<div class="footnote"><p><a name="Footnote_92_92" id="Footnote_92_92"></a><a href="#FNanchor_92_92"><span class="label">[92]</span></a> &ldquo;Pertes Seminales.&rdquo;</p></div>
+
+<div class="footnote"><p><a name="Footnote_93_93" id="Footnote_93_93"></a><a href="#FNanchor_93_93"><span class="label">[93]</span></a> &ldquo;Circoncision.&rdquo; Dr. Vanier, du Havre.</p></div>
+
+<div class="footnote"><p><a name="Footnote_94_94" id="Footnote_94_94"></a><a href="#FNanchor_94_94"><span class="label">[94]</span></a> &ldquo;Dictionaire des Sciences M&eacute;dicales.&rdquo;</p></div>
+
+<div class="footnote"><p><a name="Footnote_95_95" id="Footnote_95_95"></a><a href="#FNanchor_95_95"><span class="label">[95]</span></a> Erichsen&rsquo;s &ldquo;Surgery,&rdquo; page 1144. Edition
+of 1869.</p></div>
+
+<div class="footnote"><p><a name="Footnote_96_96" id="Footnote_96_96"></a><a href="#FNanchor_96_96"><span class="label">[96]</span></a> <i>Medical News</i> of Philadelphia, page 115. Vol. for 1860.</p></div>
+
+<div class="footnote"><p><a name="Footnote_97_97" id="Footnote_97_97"></a><a href="#FNanchor_97_97"><span class="label">[97]</span></a> &ldquo;Pertes Seminales.&rdquo; In the fourth American
+edition of the English translation of McDougall of Lallemand we find
+that he fully appreciated the dangers that lurk in a prepuce. At page
+216 he says: &ldquo;Such is the condition which the parts present in
+cases of recent balanitis, and these are the inflammations and
+ulcerations that cause more or less extensive adhesions of the prepuce
+to the glans. Such adhesions are generally cellular, but sometimes
+fibrous or even cartilaginous, according to the severity and frequent
+repetition of the inflammation. Various degrees of induration also
+results according to the intensity, the duration, and the frequency of
+the phlogosis. Thus, I have often found a mucous membrane hardened,
+thickened, and covered with numerous papill&aelig;, sometimes fibrous or
+cartilaginous, with three times its natural thickness. I have also met
+with cases in which the prepuce has become cancerous. I have operated in
+several cases of cancer of the penis, too, which certainly arose from no
+other cause. The patients were generally peasants between fifty and
+sixty years of age, who had never known other than their own wives, but
+who had frequently suffered from balanitis attended by abundant
+discharge, swelling of the prepuce, and excoriation of its opening,
+which was so contracted as to prevent the passage of the glans. I have
+seen one case, also, in which balanitis, irritated by a forced march and
+the abuse of alcoholic stimulants, passed into gangrene, by which the
+greater part of the glans was destroyed. Such have been the accidents
+which I have observed on those whose prepuce was too narrow to permit
+the glans being uncovered; accidents which I can only attribute to the
+long retention of the sebaceous matter in a kind of <i>cul-de-sac</i>, into
+which a certain quantity of urine passes every time the patient makes
+water.&rdquo;</p></div>
+
+<div class="footnote"><p><a name="Footnote_98_98" id="Footnote_98_98"></a><a href="#FNanchor_98_98"><span class="label">[98]</span></a> Clapar&egrave;de. &ldquo;La Circoncision.&rdquo;</p></div>
+
+<div class="footnote"><p><a name="Footnote_99_99" id="Footnote_99_99"></a><a href="#FNanchor_99_99"><span class="label">[99]</span></a> Baron Boyer. &ldquo;Trait&eacute; des Maladies
+Chirurgicales,&rdquo; vol. x, page 370.</p></div>
+
+<div class="footnote"><p><a name="Footnote_100_100" id="Footnote_100_100"></a><a href="#FNanchor_100_100"><span class="label">[100]</span></a> I have practiced considerably among the Jewish people,
+but I have never seen their elderly men suffer with prostatic troubles
+like our <span class='pagenum'><a name="Page_330" id="Page_330">[330]</a></span>
+own people who are uncircumcised. From having observed the tendency to
+prostatic complications in young people with troublesome prepuces, and
+that the great number of the elderly people who are affected with
+prostatic disease or enlargement are the unlucky possessors of long or
+large prepuces, I have arrived at the conclusion that the prepuce can be
+entered as a factor in the etiology of enlarged prostate.</p></div>
+
+<div class="footnote"><p><a name="Footnote_101_101" id="Footnote_101_101"></a><a href="#FNanchor_101_101"><span class="label">[101]</span></a> I have now under my care a poor consumptive who has all
+the appearance of having always been as virtuous as Joseph, but who,
+unlike Joseph, has from infancy had as a constant companion a long,
+miserable, smegmanous, and annoying prepuce. The young man has an
+&oelig;dema which first affected his feet, but one day, owing to the
+irritation of a slight balanitis, the prepuce swelled at once; it
+proceeded through the penis integument to the scrotum; the penis itself
+retracted, leaving the integument and scrotum to assume a translucent,
+puffy, cork-screw appearance and attitude; from its labyrinthic passage
+the urine slowly dribbles during urination in a scalding stream. In
+addition to the physical sufferings, he is tormented by the knowledge
+that his friends attribute all his disease and troubles&mdash;since the
+occurence of the penile &oelig;dema&mdash;to the fact that his earlier manhood
+must have been indiscreet, as well as sinful. The laity cannot connect
+any penile, scrotal, or testicular disease with anything except venereal
+disease; and if the physician attempts to explain matters, they simply
+look upon it as the good-natured and well-intentioned efforts of the
+doctor to deceive them and to cover up the shortcomings of some frail
+mortal. Many a poor fellow has to leave this world under a cloud of
+mistrust and a bad odor of past deviltry to which he is not entitled,
+and suffer all this in addition to all his physical ills, owing to his
+having been ornamented through life with an annoying prepuce,&mdash;the
+luckless heritage of having been born a Christian. Columbus in chains
+moralizing on the ingratitude of this world is nothing to the poor
+invalid with a swollen prepuce, innocently acquired, silently
+&ldquo;cussing&rdquo; the ignorance of his relatives and friends.</p></div>
+
+<div class="footnote"><p><a name="Footnote_102_102" id="Footnote_102_102"></a><a href="#FNanchor_102_102"><span class="label">[102]</span></a> This patient, on convalescing, suffered considerable from
+the action of numerous small carbuncles, resulting from the tox&aelig;mic
+condition induced by the partial suppression of urine that he at times
+suffered from, and, when nearly well, brought on a serious relapse by
+the mail-bag appendage at the penis working up the organ into a state of
+erection. While so situated he had intercourse, and from 99&deg; his
+temperature immediately rose to 104&frac12;&deg;, where it remained for several
+days, lengthening out his illness by several weeks, into a
+long-protracted convalescence. The man is not yet circumcised, and, from
+the knowledge that I have of his tendency to ur&aelig;mia, I feel that,
+although in his prime, a fever or an accident may take him off at any
+moment.</p></div>
+
+<div class="footnote"><p><a name="Footnote_103_103" id="Footnote_103_103"></a><a href="#FNanchor_103_103"><span class="label">[103]</span></a> In looking over the literature of reflex neuroses and
+more direct injurious results, I find that George Macilwain, in a work
+on &ldquo;Surgical Observations on the More Important Diseases of the
+Mucous Canals of the Body,&rdquo; published in London in 1830, calls
+special attention to the case of a man aged thirty-eight, admitted to
+the Finsbury Dispensary, and who was in the care of Mr. Hancock. The
+patient was suffering from excruciating pain in different joints, the
+pain <span class='pagenum'><a name="Page_331" id="Page_331">[331]</a></span>
+being so great that he was confined to his bed and unable to stand on
+his feet. He was unable to rest at nights, and neither rheumatic nor any
+other apparently suitable treatment was of any service. Rigors were soon
+added to his other troubles, and during their continuance the pain in
+his joints was greatly aggravated. He was referred to Mr. Macilwain for
+treatment, who promptly relieved him by the removal of a urethral
+stricture, which had quietly been the cause of all the disturbance. It
+is particularly interesting that even at that early day the reflex
+neuroses and complications that may arise from the irritability of the
+genito-urinary organs were so well understood. How well Dr. Macilwain
+appreciated the nicety of these relations can be seen from his remarks
+in connection with the above case, in which he says: &ldquo;It may be
+observed that the severity of the symptoms is not always commensurate
+either with the duration of the disease or the degree of stricture, and
+that, although the progressive development of them varies considerably
+in rapidity, in different individuals, it is, nevertheless, in the
+latter stages, always more rapid.&rdquo; Macilwain also graphically
+describes the insidious approach of these genito-urinary troubles. In
+speaking of stricture he says: &ldquo;Although minute inquiry generally
+informs us that the stricture has been of some standing, and in some
+instances has existed for years, yet it may happen that it is only a few
+months or a year since the patient&rsquo;s attention has been directed
+to the disease. This is very intelligible; for, in conformity with what
+we observe in other parts of the body, the bladder has a power of
+accommodating itself to a change of circumstances. Its strength, for a
+long time, may increase so correctly in proportion to the increase of
+the obstacle which opposes the ejection of its contents that a very
+considerable period elapses before the difficulty in making water
+becomes cognizable to the patient, or it occasions an annoyance so
+trifling as scarcely to excite his attention. This increase of strength
+in the bladder frequently renders the formation of stricture so
+insidious that the urethra at the affected part is very narrow before
+the individual is aware of the existence of any contraction whatever;
+the bladder, however, at length becomes unable to empty itself, and the
+abdominal muscles and diaphragm powerfully act as coadjutors, so that
+each effort to make water is accompanied by a straining which is very
+distressing, and the complete evacuation of the bladder is often not
+accomplished even by these combined forces. The straining which
+accompanies stricture, and which seems necessary to evacuate the
+bladder, although it be occasionally exceedingly annoying to the patient
+at the time, is more important with reference to the results which are
+its consequence. I am firmly of opinion that there are a great number of
+patients laboring under hernia which has been produced by no other
+cause. I must confess that I had seen a great number of instances of
+stricture in ruptured patients before I drew any inference from the
+observation of their co-existence.&rdquo; The foregoing observations of
+Macilwain, made in 1830, are here reproduced for their clearness of
+expression and explanation, as well as to show what injuries can be
+produced on the young child afflicted with phimosis. We are, as
+surgeons, familiar with the anatomical and pathological changes there
+are undergone by the bladder and its lining membrane, as well as in the
+ureters and kidneys, in many <span class='pagenum'><a name="Page_332" id="Page_332">[332]</a></span>
+cases of stricture, as well as of the great amount of prostatic
+irritability and enlargement that is due to the same cause. How
+similarly these results can be and are actually produced by phimosis is
+undeniably expressed by the post-mortem appearances in the poor infant
+described by Golding Bird to the London Medical Society, and mentioned
+in the London <i>Lancet</i> of May 16, 1846. The bladder and ureter were like
+those of a man who had long suffered from stricture. From the remarks of
+Dr. J. Lewis Smith, that phimosis may be productive of inguinal hernia
+and prolapsus of the rectum, and the observations of Edmund Owens and
+Arthur Kemp, both high authorities on children&rsquo;s diseases, being
+both connected with children&rsquo;s hospitals, as well as the remarks
+of Mr. Bryant in his &ldquo;Surgical Diseases of Children,&rdquo; who
+all concur in looking upon phimosis as a great factor in hernia, Bryant
+having observed thirty-one in fifty consecutive cases of phimosis, we
+are certainly warranted in assuming that phimosis is not only a mere
+local timely inconvenience that will disappear with the approach of
+puberty, but a condition which, in the more easily affected organism of
+the child,&mdash;lacking, as it does, that resistance that comes with
+our prime,&mdash;is productive of serious harm; as even the first few
+years of life, even a few months of infant life, with a phimosis, are
+sufficient to so change the structures of parts that the poor child will
+grow into a man with an impaired kidney or sacculated ureter. The strain
+required to induce a prolapsus of the bowel or a rupture into the
+inguinal canal is exerted as much on the bladder, ureter, and kidney as
+on the other localities. Physicians who have taken the pains to observe
+must have noticed, more than once, how the child afflicted with a
+phimosis has not only at times to wait for the stream of urine to
+appear, there seemingly being some obstruction to its starting, but how
+often such a case is afflicted with a stammering, halting urination. A
+child thus started out into life, with a defective kidney or kidneys, is
+sadly handicapped in his usefulness, comfort, or in properly competing
+in the race of life. No parent would for a moment think of starting his
+son in life by giving him a business that is heavily mortgaged at the
+start, but many a parent unconsciously launches the unsuspecting child
+into a life of such ill health&mdash;resulting from a simple narrow
+prepuce&mdash;beside which a heavy mortgage or a heavy yearly tribute
+would be but a mere trifle. I have seen such men, who in after life,
+broken-down and perfectly physical wrecks, would gladly have given all
+their wealth and been willing to have some genii set them down in the
+middle of the Sahara, shirtless and pennyless, provided they had their
+health. To say nothing of the trifling loss of the prepuce, these
+parties would gladly have had a foot or a leg go with the prepuce if
+necessary, and have their health.</p></div>
+
+<div class="footnote"><p><a name="Footnote_104_104" id="Footnote_104_104"></a><a href="#FNanchor_104_104"><span class="label">[104]</span></a> I have often performed dilatation where, for some reason,
+either the timidity of the parents or the health of the child seemed to
+contraindicate any more radical procedure. It is customary to advise
+mothers or the nurses to retract the skin daily, but even after a good
+dilatation I have found as sudden a recontraction, and even in the
+majority of cases, where daily drawing back the skin might have been
+practicable, the cries and struggles of the child are a positive
+prohibition to these instructions being carried out; it is not once in
+<span class='pagenum'><a name="Page_333" id="Page_333">[333]</a></span>
+ten times that it can be carried out. I have seen two very annoying
+cases of paraphimosis resulting from this procedure, the struggles of
+the child having prevented the return of the prepuce to its proper
+place, and the violent crying and sobbing of the child having assisted
+to congest the organ.</p></div>
+
+<div class="footnote"><p><a name="Footnote_105_105" id="Footnote_105_105"></a><a href="#FNanchor_105_105"><span class="label">[105]</span></a> It may well be a question, considering the
+well-established fact that nervous injuries and affections are easily
+transmissible and become hereditary, how much feeble-mindedness is due
+to an heredity originally induced in either parent through reflex
+neuroses from the genital organs. The Jews have a very small percentage
+of feeble-minded; it is true that they have not any inebriates to assist
+in their manufacture, but still the absence of these well-pronounced
+cases of reflex neuroses among the race must be largely ascribed to
+their practice of circumcision, as that operation cures the gentiles so
+afflicted.</p></div>
+
+<div class="footnote"><p><a name="Footnote_106_106" id="Footnote_106_106"></a><a href="#FNanchor_106_106"><span class="label">[106]</span></a> I have seen precisely similar conditions resulting from a
+sphincterismus being relieved by anal dilatation. I had one such case
+who had fallen into the hands of a quack, who made him believe that he
+was being affected with incipient softening of the brain; systematic
+dilatation or a rupture of the sphincter <i>&agrave; la</i> Van Buren is the
+appropriate remedy.</p></div>
+
+<div class="footnote"><p><a name="Footnote_107_107" id="Footnote_107_107"></a><a href="#FNanchor_107_107"><span class="label">[107]</span></a> In the first volume of the &ldquo;American and English
+Encyclopedia of Law&rdquo; there is an interesting account of a young
+child (who had been bound out by the parish officials) who murdered his
+little bed-fellow and, on trial and conviction, was sentenced to be
+hanged, but who was reprieved by royal favor on account of his tender
+years, the sentence being changed to imprisonment for life. The little
+fellow was only eight years of age. On the trial the boy said he was
+driven to commit the crime because the other child soiled the bed. The
+two children being both paupers, it may well be imagined that their
+bedding was none of the cleanest at the best, or that their bed-room had
+the best of ventilation. As at the time the murder was committed English
+paupers were not treated in the most humane manner, it is not surprising
+that a nervous, sensitive child would, under such a combination of
+circumstances, be converted into an insane murderer.</p></div>
+
+<div class="footnote"><p><a name="Footnote_108_108" id="Footnote_108_108"></a><a href="#FNanchor_108_108"><span class="label">[108]</span></a> The study of prematurely acquired impotence in the male
+is a most interesting one. I have frequently seen it result from the
+presence of anal or rectal irritation, from h&aelig;morrhoids. I have seen
+cases who could not have erections, and in whom all sexual desire was
+extinct at a very early age, who have informed me that, although unable
+to have sexual intercourse because of the total absence of sexual
+desire, the flaccidity of the organ, and the want of sound physiological
+organic functional activity to suggest the thought, they had,
+nevertheless, frequently been the victims of nocturnal emissions before
+the <ins class='corr' title="Transcriber&rsquo;s Note: The original
+showed &lsquo;totel&rsquo;.">total</ins> extinction of the function. As a
+rule, much of this premature impotence&mdash;induced by either irritation of
+the genital organs or rectal or anal troubles&mdash;runs its unfortunate
+possessor through such a course of physical incidents as described by
+Hammond, as the wild Indians of the Southwest induce in the <i>mujerado</i>.
+At first the sound organ responds in a natural manner to any stimulus
+that may affect it, but soon a local satyriacal condition is set up,
+which, running a more or less rapid period of intense<span class='pagenum'><a name="Page_334" id="Page_334">[334]</a></span>
+activity, soon leaves its victim completely, permanently, and
+hopelessly impotent, even as much so as if eunuchized in the most
+approved manner. Hammond&rsquo;s description of the manner in which
+these unfortunates are manufactured is an interesting addition to the
+facts contained in the natural history of man, and is as follows:
+&ldquo;A <i>mujerado</i> is an essential person in the saturnalia, or orgies,
+in which these Indians, like the ancient Greeks, Egyptians, and other
+nations, indulge. He is the chief passive agent in the pederastic
+ceremonies which form so important a part in the performances. These
+take place in the spring of every year, and are conducted with the
+utmost secrecy, as regards the non-Indian part of the population. For
+the making of a <i>mujerado</i> one of the most virile men is selected, and
+the act of masturbation is performed upon him many times every day; at
+the same time he is made to ride almost continuously on horseback. The
+genital organs are thus brought, at first, into a state of extreme
+erethism, so that the motion of the horse is sufficient to produce a
+discharge of seminal fluid, while at the same time the pressure of the
+body on the animal&rsquo;s back&mdash;for the riding is done without a
+saddle&mdash;interferes with their proper nutrition. It eventually
+happens that, though an orgasm may be caused, emissions can no longer be
+effected, even upon the most intense degree of excitation. Finally, the
+accomplishment of an orgasm becomes impossible; in the meantime the
+penis and testicles begin to shrink, and in time reach their lowest
+plane of degradation. But the most decided changes are at the same time
+going on, little by little, in the instincts and proclivities of the
+subject. He loses his taste for those sports and occupations in which he
+formerly indulged, his courage disappears, and he becomes timid to such
+an extent that, if he is a man occupying a prominent place in the
+council of the pueblo, he is at once relieved of all power and
+responsibility, and his influence is at an end. If he is married his
+wife and children pass from under his control,&mdash;whether, however,
+through his wish or theirs, or by the orders of the council, I could not
+ascertain. They certainly become no more to him than other women and
+children of the pueblo.&rdquo; Hammond examined one of these men, who
+had, as he himself informed him, formerly possessed a large penis and
+testicles &ldquo;grande como huevos,&rdquo;&mdash;as large as eggs. The
+penis was in its flaccid state and about an inch and a half in length,
+with the glans about the size of a thimble, which it very much resembled
+in shape. The glandular structure of the testicles had disappeared; they
+were atrophied, little besides connective tissue remaining. He examined
+another <i>mujerado</i> in the pueblo of Acoma, who had been so made when at
+about the age of twenty-six. The penis was not more than an inch in
+length and about the diameter of the little finger, and of the testicles
+there was apparently nothing left but a little connective tissue. Both
+of these men had high-pitched voices. The last one examined was then
+thirty-six years of age. (Hammond: &ldquo;Male Impotence.&rdquo;) The
+foregoing detailed description shows an extreme degree of results
+produced by an equally extreme degree of intense and persistent
+irritation applied to the genital organs, purposely employed to obtain
+certain results. In the cases cited the irritation or excitation is
+directly applied, but it is safe to assume that reflex irritability
+<span class='pagenum'><a name="Page_335" id="Page_335">[335]</a></span>
+from the anus or rectum, or from that of a stricture or of a prepuce,
+will in some cases produce a certain degree of excitation in the
+testicles that may result in their functional or organic derangement, in
+a degree proportionate to that of the amount of excitation from which
+they have suffered. That the testicles are very apt to suffer from the
+existence of a stricture is a well-known fact. I have myself worried
+over a case of stricture, in whom the attempted passage of a filiform
+bougie was always immediately followed by a severe attack of
+epididymitis, and who had always been afflicted with a tenderness and a
+tendency to inflammation of the testes. I have also noticed a much
+greater tendency to orchitis in the wearer of an irritating prepuce than
+where it was absent; so that the presence of a satyriacal tendency, no
+matter in what proportion of a degree it may be present, can safely be
+assumed to result in a corresponding degree of apathy, due to an actual
+physical degeneration of the parts. That these conditions, when present
+in any degree of permanency or persistence, will in the end induce early
+impotence, I have no reason to doubt. In this regard we must not
+overlook the fact that persons with phimosis, stricture, or other
+genital irritants and impediments, are more liable to be afflicted with
+h&aelig;morrhoids, prolapsus ani, or other anal and rectal irritation,
+which retroactively assist in bringing about the condition under
+question. How much this may have to do with certain prolific
+peculiarities among the Jews may well be questioned; it is a well-known
+fact that in London the Jewish excess of male births has been as high as
+eighteen per cent., while among the Christian or Gentile population it
+is only six and one-half per cent.,&mdash;a somewhat analogous condition
+of proportion being also observable in the United States. Here, it is
+accounted for, in a measure, by Dr. Billings, in the following words:
+&ldquo;This comparatively large proportion of males among the Jews is
+probably due to the fact that the death-rate of their infants is less
+for males, as compared with females, than it is among the average
+population.&rdquo; Children gotten during the prime of life of the
+parents are naturally more virile and have better stamina than those
+gotten before full maturity is reached. If the father is on the verge of
+impotency just about the time he is expected to beget his best
+offspring, that offspring cannot be expected to present an extra amount
+of vitality, virility, or physical stamina; hence, the prepuce can be
+brought in as directly tending&mdash;in no matter how small the degree
+it may be, but nevertheless a factor&mdash;to the physical degeneracy of
+the race, as well as it demonstrates the existence of some law for the
+production of the sexes which we do not as yet fully comprehend. Aside
+from the above considerations, there are those of the actual bar to the
+increase of population which the prepuce induces, either by primarily
+being the cause of impotence or by direct interference, as already
+mentioned, and the impotence that naturally results from the causes set
+forth in this note. The results of a prepuce are certainly such as must
+act like a moist, warm, and oily poultice to the irritability induced in
+the most confirmed Malthusian when contemplating the&mdash;to
+him&mdash;rapid and unwarranted increase of population.</p></div></div>
+
+<hr /><p class='pagenum'><a name="Page_336" id="Page_336">[336]</a></p>
+<h2><a name="WORKS_AND_AUTHORITIES_QUOTED" id="WORKS_AND_AUTHORITIES_QUOTED"></a>WORKS AND AUTHORITIES QUOTED.</h2>
+
+<p class='hi'>Th&egrave;se pour le doctorat en M&eacute;decine, par J. B. B. Edmond Nogues, sur la
+Anatomie, Physiologie, et Pathologie du Pr&eacute;puce. Paris, 1850.</p>
+
+<p class='hi'>Th&egrave;se &agrave; la facult&eacute; de M&eacute;decine de Strasbourg. Par J. B. A. Chauvin.
+Consideration sur le Phimosis et Operation de la Circoncision par un
+proc&eacute;d&eacute; nouveau. Strasbourg, 1851.</p>
+
+<p class='hi'>De la Circoncision chez les Egyptiens. F. Chabas. Paris, 1861.</p>
+
+<p class='hi'>Cause Morale de la Circoncision des Israelites. Vanier, du Havre. Paris,
+1847.</p>
+
+<p class='hi'>La Circoncision, son importance dans la Famille et dans l&rsquo;Etat.
+Par le Docteur Clapar&eacute;de. Paris, 1861.</p>
+
+<p class='hi'>Dissertation sur la Circoncision, sons les rapports religieux,
+hygieniques, et Pathologiques. Par le Docteur Moyse Cahen. Paris, 1816.</p>
+
+<p class='hi'>Origine, Signification, et Histoire, de la Castration, de
+l&rsquo;Eunuchisme, et de la Circoncision. Par le Docteur F. Bergmann de
+Strasbourg. Archivio per le Tradizioni Populari, vol. ii.</p>
+
+<p class='hi'>Darstellung der Biblichen Krankheiten. Von Dr. J. P. Trusen. Posen,
+1843.</p>
+
+<p class='hi'>Archives Israelites de France, No. 9, 4em ann&eacute;e, Septembre, 1843.</p>
+
+<p class='hi'>Bulletins de la Soci&eacute;t&eacute; d&rsquo;Anthropologie de Paris. Tome x (serie
+iii), 3d fascicule, Juin &agrave; Octobre, 1887.</p>
+
+<p class='hi'>Recueil de M&eacute;moires de M&eacute;decine, de Chirurgie, et de Pharmacie
+Militaires. Tome xxi (serie iii), No. 105, August, 1868.</p>
+
+<p class='hi'>Trait&eacute; d&rsquo;Hygi&egrave;ne, publique et priv&eacute;e. Michel Levy. 2d ed. Paris,
+1850.</p>
+
+<p class='hi'>Neuroses des Organes G&eacute;nito-Urinaires de l&rsquo;homme. Ultzmann. Paris,
+1883.</p>
+
+<p class='hi'>L&rsquo;Hermaphrodisme, sa Nature, son Origine, ses Consequences
+Sociales. Par le Docteur Charles Debierre. Paris, 1886.</p>
+
+<p class='hi'>L&rsquo;Onanisme. Tissot. Lausanne, 1787.</p>
+
+<p class='hi'>Trait&eacute; de la nymphomanie. Dr. Bienville. Amsterdam, 1784.</p>
+
+<p class='hi'>La Folie Erotique. Par Prof. B. Balt. Paris, 1888.</p>
+
+<p class='hi'>Des Pertes Seminales Involontaires. Lallemand. Paris, 1836.</p>
+
+<p class='hi'>Spermatorrh&oelig;a. Lallemand and Wilson. Philadelphia, 1861.</p>
+
+<p class='hi'>The Philosophical Dictionary. Voltaire. London, 1765.</p>
+
+<p class='hi'>&OElig;uvres Compl&eacute;tes, avec notes, etc. Montesquieu. Paris, 1838.</p>
+
+<p class='hi'>Dictionaire d&rsquo;Hygi&egrave;ne, publique et de salubrite. Tardieu. Paris,
+1862.</p>
+
+<p class='hi'>Guide du Posth&eacute;tomiste. Par le Docteur L. Terquem. Paris.</p>
+
+<p class='hi'>La Circoncision et ses suites. Par A.S. Morin. Ext. du Journal
+l&rsquo;Excommuni&eacute;, January, 1870.</p>
+
+<p class='hi'>La Circoncision. Par le Docteur S. Bernheim.</p>
+
+<p class='hi'>Circumcision. By Dr. A. B. Arnold, of Baltimore. Reprint from the New
+York Medical Journal of February 13, 1886.</p>
+
+<p class='hi'>Among the Cannibals. By Carl Lumholtz. New York, 1889. </p>
+
+<p class='hi'><span class='pagenum'><a name="Page_337" id="Page_337">[337]</a></span>
+Recueil de Questions propos&eacute;s par une Soci&eacute;t&eacute; de savants voyageant an
+Arabie, Michealis. Amsterdam, 1774.</p>
+
+<p class='hi'>Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim Interpretis
+primarii, De Turcarum Liturgia, peregrinatione Meccana, Circumcisione,
+&AElig;grotorum Visitatione, etc. Oxonii, 1690.</p>
+
+<p class='hi'>Le Theatre de la Turquie. Michel Le Feber. Paris, 1681.</p>
+
+<p class='hi'>Recherches Philosophiques sur les Americains, ou M&eacute;moires Interessants
+pour servir &agrave; l&rsquo;Histoire de l&rsquo;Espece Humaine. Par M. de P.
+Augument&eacute;e par Dom Pernety. Berlin, 1774. (Also the first edition of the
+same work printed at Cleves in 1772.)</p>
+
+<p class='hi'>History of the Hebrews&rsquo; Second Commonwealth. Wise. Cincinnati,
+1880.</p>
+
+<p class='hi'>History of the Hebrew Commonwealth. Jahn. Oxford, 1840.</p>
+
+<p class='hi'>Jews&rsquo; Letters to Voltaire. Philadelphia, 1848.</p>
+
+<p class='hi'>The Jewish Nation. Revised by Kidder. New York, 1850.</p>
+
+<p class='hi'>The Jews Under Roman Rule. By W. D. Morrison. New York, 1890.</p>
+
+<p class='hi'>The Story of the Jews. By James K. Hosmer. New York, 1887.</p>
+
+<p class='hi'>The History of the Jews. By the Rev. H. H. Milman. New York, 1843.</p>
+
+<p class='hi'>Early Oriental History. By John Eadie, D.D., LL.D. London, 1852.</p>
+
+<p class='hi'>The Bible and the Nineteenth Century. By L. T. Townsend, D.D. New York,
+1889.</p>
+
+<p class='hi'>Legends of the Patriarchs and Prophets. By the Rev. S. Baring-Gould. New
+York, 1884.</p>
+
+<p class='hi'>The Religions of the Ancient World. By George Rawlinson, M.A. New York,
+1885.</p>
+
+<p class='hi'>The Hermits. By the Rev. Charles Kingsley. New York, 1885.</p>
+
+<p class='hi'>Letters on Demonology and Witchcraft. Letters addressed to J. G.
+Lockhart, Esq., by Sir Walter Scott. London, 1831.</p>
+
+<p class='hi'>The Philosophy of Magic, Prodigies, and Apparent Miracles. From the
+French of Eusebe Salvert. New York, 1855.</p>
+
+<p class='hi'>Atlantis, the Antediluvian World. Donnelly. New York, 1882.</p>
+
+<p class='hi'>Sir Thomas Browne&rsquo;s Works. London, 1852.</p>
+
+<p class='hi'>Physical Education, or the Health Laws of Nature. By Felix Oswald, M.D.
+New York, 1882.</p>
+
+<p class='hi'>The Family: an Historical and Social Study. By Thwing. Boston, 1887.</p>
+
+<p class='hi'>The Intellectual Development of Europe. By John W. Draper, M.D. New
+York, 1876.</p>
+
+<p class='hi'>History of European Morals. By W. E. H. Lecky, M.A. New York, 1884.</p>
+
+<p class='hi'>Longevity and other Biostatic Peculiarities of the Jewish Race. By John
+Stockton Hough. Reprinted from New York Medical Record, 1873.</p>
+
+<p class='hi'>Vital Statistics of the Jews. By Dr. John S. Billings, in North American
+Review for January, 1891.</p>
+
+<p class='hi'>On Regimen and Longevity. By John Bell, M.D. New York, 1842.</p>
+
+<p class='hi'>Diseases of Modern Life. By B. W. Richardson, M.D. New York, 1876.</p>
+
+<p class='hi'>Cyclopedia of Biblical, Theological, and Ecclesiastical Literature. By
+McClintock and Strong. New York, 1886.</p>
+
+<p class='hi'>Early History of Mankind. Tylor. London, 1870.</p>
+
+<p class='hi'>Dictionaire des Sciences M&eacute;dicales. 60-vol. edition. Paris, 1816.</p>
+
+<p class='hi'>British and Foreign Medico-Chirurgical Review, vols. for 1846, 1854,
+1856, 1858, 1863, 1868, and 1869. London.</p>
+
+<p class='hi'>Braithwaite&rsquo;s Retrospect of Medicine and Surgery.</p>
+
+<p class='hi'>The Chinese. By John Francis Davis, Esq., F.R.S. London, 1851.</p>
+
+<p class='hi'>Massachusetts State Board of Health Report for 1873.</p>
+
+<p class='hi'><span class='pagenum'><a name="Page_338" id="Page_338">[338]</a></span>
+On Diseases of Children. Stewart. New York, 1844.</p>
+
+<p class='hi'>Diseases of Children. West. Philadelphia.</p>
+
+<p class='hi'>Lectures on Diseases of Children. Henoch. New York, 1882.</p>
+
+<p class='hi'>Women&rsquo;s and Children&rsquo;s Diseases. Dillnberger. Philadelphia,
+1871.</p>
+
+<p class='hi'>Male Impotence. Hammond. New York, 1883.</p>
+
+<p class='hi'>Genito-Urinary Diseases. Otis. New York, 1883.</p>
+
+<p class='hi'>Urinary and Renal Diseases. Roberts. Philadelphia, 1885.</p>
+
+<p class='hi'>Urinary and Renal Disorders. Beale.</p>
+
+<p class='hi'>Renal and Urinary Organs. Black. Philadelphia, 1872.</p>
+
+<p class='hi'>Gout in its Protean Aspects. Fothergill. Detroit, 1883.</p>
+
+<p class='hi'>Venereal Diseases. Bumstead and Taylor. Philadelphia, 1883.</p>
+
+<p class='hi'>Trait&eacute; sur les Maladies des Organes G&eacute;nito-Urinaires. Civiale. Paris,
+1850.</p>
+
+<p class='hi'>Pathologic Chirurgicale, tome vi. Nelaton. Paris, 1884.</p>
+
+<p class='hi'>Pathologie Externe, tome v. Vidal (de Cassis). Paris, 1846.</p>
+
+<p class='hi'>Guy&rsquo;s Hospital Reports, 3d series, vol. xvii. London, 1872.</p>
+
+<p class='hi'>Transactions of the Ninth International Medical Congress, vol iii.
+Washington, 1887.</p>
+
+<p class='hi'>American Journal of Obstetrics for January, 1882.</p>
+
+<p class='hi'>On the Reproductive Organs. Acton. Philadelphia, 1883.</p>
+
+<p class='hi'>Operative Surgery. Smith. Philadelphia, 1852.</p>
+
+<p class='hi'>Operative Surgery. Stephen Smith. Philadelphia, 1887.</p>
+
+<p class='hi'>System of Surgery. Gross. Philadelphia, 1859.</p>
+
+<p class='hi'>Principles and Practice of Surgery. Agnew. Philadelphia, 1881.</p>
+
+<p class='hi'>International Encyclopedia of Surgery. Ashhurst. Philadelphia, 1886.</p>
+
+<p class='hi'>Science and Art of Surgery. Erichsen. Philadelphia, 1869.</p>
+
+<p class='hi'>Diseases of the Kidneys. Ralfe. Philadelphia, 1885.</p>
+
+<p class='hi'>The Clinic. Cincinnati, 1872.</p>
+
+<p class='hi'>American Journal of the Medical Sciences for July, 1872; also vol. lx.</p>
+
+<p class='hi'>New York Medical Journal, vols. xvi, xix, xxvi.</p>
+
+<p class='hi'>Occidental Medical Times. Sacramento, October, 1890.</p>
+
+<p class='hi'>London Lancet, 1875.</p>
+
+<p class='hi'>Distribution Geographique de la Phthisie Pulmonaire. Lancereaux. Paris,
+1877.</p>
+
+<p class='hi'>Annual Report of the Bureau of Ethnology. J. W. Powell. Washington,
+1884.</p>
+
+<p class='hi'>Western Journal of Medicine and Surgery. Louisville, 1846.</p>
+
+<p class='hi'>Native Races of the Pacific Coast. Bancroft. San Francisco, 1875.</p>
+
+<p class='hi'>Encyclopedia Britannica, 9th edition.</p>
+
+<p class='hi'>Classical Dictionary. Lempriere. New York, 1847.</p>
+
+<p class='hi'>Commentary on the Bible. Clark.</p>
+
+<p class='hi'>Satellite for February, 1889, and January, 1891. Philadelphia.</p>
+
+<p class='hi'>Pedigree of Diseases. Hutchinson.</p>
+
+<p class='hi'>Medical Inquiries. Rush. Philadelphia.</p>
+
+<p class='hi'>Half-Yearly Abstract of the Medical Sciences, vols. xii and lx,
+Philadelphia.</p>
+
+<p class='hi'>Cincinnati Lancet and Observer, vol. xvi.</p>
+
+<p class='hi'>Statistics and Climate of Consumption. Millard.</p>
+
+<p class='hi'>Trait&eacute; des Maladies Chirurgicales, vol. x. Baron Boyer. Paris, 1825.</p>
+
+<p class='hi'>Dictionary of Medicine. Quain. New York, 1884.</p>
+
+<hr /><p class='pagenum'><a name="Page_339" id="Page_339">[339]</a></p>
+<h2><a name="INDEX" id="INDEX"></a>INDEX</h2>
+
+<ul class='off'><li>Abolishment
+<ul class='off'><li>of circumcision by Christians, <a href="#Page_18">18</a>;
+<ul class='off'><li>by the Romans, <a href="#Page_66">66</a></li></ul></li>
+<li>of eunuchism in Italy, <a href="#Page_91">91</a>, <a href="#Page_96">96</a></li></ul></li>
+
+<li>Abraham, <a href="#Page_32">32</a></li>
+
+<li>Absence of penis, <a href="#Page_13">13</a>
+<ul class='off'><li>of testicles, <a href="#Page_105">105</a></li></ul></li>
+
+<li>Abyssinians, carry off the male members of slain enemies, <a href="#Page_30">30</a>;
+<ul class='off'><li>circumcised bishop among the, <a href="#Page_64">64</a></li></ul></li>
+
+<li>Acosta, Rev. Father, on Mexican circumcision, <a href="#Page_47">47</a></li>
+
+<li>Adams, Dr. C. Powell, of Hastings, Minn., <a href="#Page_198">198</a></li>
+
+<li>After-treatment of circumcised Hebrews, <a href="#Page_158">158</a></li>
+
+<li>Agnew, D. Hayes, on penile cancer, <a href="#Page_230">230</a>;
+<ul class='off'><li>on eczema as a reflex neurosis from phimosis, <a href="#Page_320">320</a></li></ul></li>
+
+<li>Albutt, T. Clifford, on primary cause of disease, <a href="#Page_13">13</a></li>
+
+<li>American circumcision, <a href="#Page_47">47</a>;
+<ul class='off'><li>infibulation and muzzling, <a href="#Page_48">48</a></li></ul></li>
+
+<li>Amputation of penis, <a href="#Page_230">230</a>, <a href="#Page_233">233</a>, <a href="#Page_247">247</a></li>
+
+<li>Androgynes, <a href="#Page_118">118</a></li>
+
+<li>Augleria, Pierre d&rsquo;, on American circumcision, <a href="#Page_47">47</a></li>
+
+<li>Apis, the white bull, sacred to the Egyptians, <a href="#Page_29">29</a></li>
+
+<li>Apollo Belvidere, as evidence of exactness of ancient sculpture, <a href="#Page_62">62</a></li>
+
+<li>Apure Indians and their circumcision, <a href="#Page_48">48</a></li>
+
+<li>Arabian circumcision, <a href="#Page_38">38</a>;
+<ul class='off'><li>prostitutes, <a href="#Page_323">323</a></li></ul></li>
+
+<li>Arias Montan, on Mexico, <a href="#Page_46">46</a></li>
+
+<li>Arnold, Dr. A. B., of Baltimore, <a href="#Page_25">25</a>, <a href="#Page_219">219</a>, <a href="#Page_220">220</a>, <a href="#Page_223">223</a></li>
+
+<li>Asthma as a reflex neurosis from genital irritation, <a href="#Page_291">291</a></li>
+
+<li>Australian circumcision, <a href="#Page_44">44</a>;
+<ul class='off'><li>operation on the urethra, <a href="#Page_56">56</a></li></ul></li>
+
+<li>Author&rsquo;s modification of circumcision, <a href="#Page_307">307</a></li>
+
+<li>Aztec circumcision, <a href="#Page_46">46</a></li>
+
+<li class='mt1'>Ballance, C. W., dressing after circumcision, '<a href="#Page_317">317</a></li>
+
+<li>Bamboo stick worn in vagina as a chastity protector, <a href="#Page_52">52</a></li>
+
+<li>Baptismal ceremonies of Omaha Indians, <a href="#Page_56">56</a></li>
+
+<li>Barbarous Arabian marriage custom, <a href="#Page_54">54</a>
+<ul class='off'><li>mutilations of Guamo and Othomaco Indians, <a href="#Page_48">48</a></li></ul></li>
+
+<li>Bas-relief representing Egyptian emasculation, <a href="#Page_31">31</a></li>
+
+<li>Bassouto circumcision, <a href="#Page_42">42</a></li>
+
+<li>Battos circumcision, <a href="#Page_45">45</a></li>
+
+<li>Baumgartner&rsquo;s devout and chaste dervish, <a href="#Page_49">49</a></li>
+
+<li>Beale, Sir Lionel, on blood changes, <a href="#Page_296">296</a></li>
+
+<li>Bell, Dr. John, on Jewish hygiene, <a href="#Page_181">181</a>
+<ul class='off'><li>Dr. J. Royes, <a href="#Page_191">191</a>, <a href="#Page_223">223</a>, <a href="#Page_229">229</a>, <a href="#Page_239">239</a></li></ul></li>
+
+<li>Bells, jingling of, under the skirts, denotive of Judean virginity, <a href="#Page_52">52</a></li>
+
+<li>Belt of brass mail to insure female chastity, <a href="#Page_51">51</a></li>
+
+<li>Berbers, mutilations of their prisoners, <a href="#Page_30">30</a></li>
+
+<li>Bergmann, of Strasburg, <a href="#Page_20">20</a>, <a href="#Page_27">27</a></li>
+
+<li>Bergson, Dr., <a href="#Page_160">160</a></li>
+
+<li>Bernbeim, Dr., on freedom of Jews from syphilis, <a href="#Page_195">195</a>;
+<ul class='off'><li>on preputial statistics, <a href="#Page_220">220</a>;</li>
+<li>on circumcisial operation, <a href="#Page_312">312</a></li></ul></li>
+
+<li>Bernoulli, Prof., of Bale, <a href="#Page_168">168</a></li>
+
+<li>&ldquo;Beth Yosef&rdquo; of Joseph Karo, <a href="#Page_153">153</a></li>
+
+<li>Biblical vouching for homoeopathy, <a href="#Page_113">113</a></li>
+
+<li>Billings, Dr. John S., U. S. Army, on Jewish vital statistics, <a href="#Page_174">174</a>;
+<ul class='off'><li>on cancer amongst Jews, <a href="#Page_230">230</a></li></ul></li>
+
+<li>Bird, Dr. Golding, on phimosis, <a href="#Page_257">257</a></li>
+
+<li>Bishop of Abyssinia accused of heresy on account of circumcision, <a href="#Page_64">64</a></li>
+
+<li>Blood of prepuce sprinkled on bride&rsquo;s veil, <a href="#Page_55">55</a>;<span class='pagenum'><a name="Page_340" id="Page_340">[340]</a></span>
+<ul class='off'><li>sprinkled on ears of corn, <a href="#Page_56">56</a></li>
+<li>changes as starting-points of disease, <a href="#Page_293">293</a>, <a href="#Page_298">298</a></li></ul></li>
+
+<li>Bobovii, Alberti, on Mohammedan circumcision, <a href="#Page_39">39</a></li>
+
+<li>Bogera, or African circumcision, <a href="#Page_44">44</a></li>
+
+<li>Bokai, on preputial statistics, <a href="#Page_220">220</a></li>
+
+<li>Bornean circumcision, <a href="#Page_45">45</a></li>
+
+<li>Bowditch, Henry I., on Jewish vital statistics, <a href="#Page_176">176</a></li>
+
+<li>Boyer, Baron, on cancer of the penis, <a href="#Page_232">232</a>;
+<ul class='off'><li>on gangrene of the penis, <a href="#Page_237">237</a></li></ul></li>
+
+<li>Brett, Dr. F. H., case of hypertrophy of prepuce, <a href="#Page_251">251</a></li>
+
+<li>Bryant, Thomas, on skin-grafting, <a href="#Page_328">328</a></li>
+
+<li>Bumstead, on circumcision, <a href="#Page_310">310</a></li>
+
+<li>Burial of Algerine prepuces in the sands of the deserts, <a href="#Page_39">39</a></li>
+
+<li class='mt1'>Cahen, Dr., on diminished sensibility of glans after circumcision, <a href="#Page_224">224</a></li>
+
+<li>Calculus, liability of the Chinese to preputial, <a href="#Page_248">248</a>;
+<ul class='off'><li>Dr. J. G. Kerr, on preputial, <a href="#Page_248">248</a>;</li>
+<li>C. H. Martin, of Mobile, on climatic influence on, <a href="#Page_248">248</a>;</li>
+<li>Prof. Enoch, of Berlin, on preputial and vesical calculi, <a href="#Page_249">249</a>;</li>
+<li>Clapar&egrave;de&rsquo;s case, <a href="#Page_249">249</a>;</li>
+<li>composition of preputial, <a href="#Page_249">249</a>;</li>
+<li>Civiale&rsquo;s case, <a href="#Page_249">249</a>;</li>
+<li>induced by phimosis, <a href="#Page_287">287</a></li></ul></li>
+
+<li>Canary Islands, remains of an antediluvian world, <a href="#Page_25">25</a></li>
+
+<li>Cancer of the penis, <a href="#Page_232">232</a>;
+<ul class='off'><li>views of Jonathan Hutchinson as to its origin, <a href="#Page_226">226</a>;</li>
+<li>pre-cancerous stage of, <a href="#Page_226">226</a>;</li>
+<li>views of Lallemand, <a href="#Page_228">228</a>, <a href="#Page_329">329</a>;</li>
+<li>statistics of, <a href="#Page_231">231</a>;</li>
+<li>Cullerier on, <a href="#Page_231">231</a>;</li>
+<li>fifty cases reported by Dr. Zielewicz, <a href="#Page_233">233</a>;</li>
+<li>early mention of, <a href="#Page_234">234</a>;</li>
+<li>views of Prof. John C. Warren, <a href="#Page_235">235</a>;</li>
+<li>views of Walshe, <a href="#Page_235">235</a></li></ul></li>
+
+<li>Canon of St. John Lateran and his profane doubts, <a href="#Page_74">74</a></li>
+
+<li>Carter, Dr. Wm., on toxic urines, <a href="#Page_298">298</a></li>
+
+<li>Casalis, M., on Bassouto circumcision, <a href="#Page_42">42</a></li>
+
+<li>Cases of spontaneous circumcision, <a href="#Page_58">58</a></li>
+
+<li>Castration, etymology of the term, <a href="#Page_80">80</a>;
+<ul class='off'><li>as a self-sacrifice to deities, <a href="#Page_89">89</a></li></ul></li>
+
+<li>Celsus, on Roman infibulation, <a href="#Page_50">50</a>;
+<ul class='off'><li>on operations on the prepuce, <a href="#Page_302">302</a>, <a href="#Page_313">313</a>, <a href="#Page_328">328</a>;</li>
+<li>originator of Cloquet&rsquo;s operation, <a href="#Page_313">313</a></li></ul></li>
+
+<li>Chabas, M., description of Egyptian <i>bas-relief</i>, <a href="#Page_23">23</a></li>
+
+<li>Charlemagne endows an abbey with a holy prepuce, <a href="#Page_72">72</a></li>
+
+<li>Charles V sacks Rome, and robbery of the holy prepuce, <a href="#Page_73">73</a></li>
+
+<li>Chastity among Egyptian dervishes, <a href="#Page_49">49</a>;
+<ul class='off'><li>belt of brass mail of the Ethiopians, <a href="#Page_51">51</a>;</li>
+<li>plug of bamboo of Soudan, <a href="#Page_51">51</a>;</li>
+<li>rings to insure chastity in the male mentioned by Nelaton, <a href="#Page_54">54</a>;</li>
+<li>enforced among the Hindoo bonzes by infibulation, <a href="#Page_54">54</a>;</li>
+<li>among the Cybelian priesthood, <a href="#Page_89">89</a>;</li>
+<li>Greek monks, ideas of, <a href="#Page_89">89</a>;</li>
+<li>comparative, among the different religious creeds of Prussia, <a href="#Page_195">195</a></li></ul></li>
+
+<li>Chinese, peculiar liability of, to calculous disease, <a href="#Page_248">248</a>;
+<ul class='off'><li>considered a delicate diet by Australian cannibals, <a href="#Page_327">327</a></li></ul></li>
+
+<li>Chippeway Indians and circumcision, <a href="#Page_23">23</a></li>
+
+<li>Chivalry of the male Hottentot, <a href="#Page_60">60</a></li>
+
+<li>Christian abolishment of circumcision, <a href="#Page_18">18</a>;
+<ul class='off'><li>circumcision in Abyssinia, <a href="#Page_63">63</a></li></ul></li>
+
+<li>Circumcised phallus as a religious and civic symbol, <a href="#Page_35">35</a>;
+<ul class='off'><li>races peculiarly exempt from syphilis, <a href="#Page_192">192</a></li></ul></li>
+
+<li>Circumcising knife (see Knife).</li>
+
+<li>Circumcision, abolished by Christians, <a href="#Page_18">18</a>;
+<ul class='off'><li>among Chippeway Indians, <a href="#Page_23">23</a>;</li>
+<li>among the Atlanteans of Plato, <a href="#Page_23">23</a>;</li>
+<li>among the Ph&oelig;nicians, <a href="#Page_34">34</a>;</li>
+<li>among the Egyptians, <a href="#Page_34">34</a>;</li>
+<li>Arabian, <a href="#Page_35">35</a>, <a href="#Page_54">54</a>;</li>
+<li>during the reign of Psamm&eacute;tich, <a href="#Page_34">34</a>;</li>
+<li>civil and religious symbol of ancient Egypt, <a href="#Page_35">35</a>;</li>
+<li>Aztec, <a href="#Page_46">46</a>;</li>
+<li>among the Mijes, <a href="#Page_46">46</a>;</li>
+<li>Mexican, <a href="#Page_46">46</a>;</li>
+<li>Totonac, <a href="#Page_46">46</a>;</li>
+<li>among the Orinoco Indians, <a href="#Page_47">47</a><span class='pagenum'><a name="Page_341" id="Page_341">[341]</a></span></li>
+<li>the climatic limits of, as a general rite, <a href="#Page_47">47</a>;</li>
+<li>in the Island of Cosumel, <a href="#Page_47">47</a>;</li>
+<li>in Yucatan, <a href="#Page_47">47</a>;</li>
+<li>in old Florida, <a href="#Page_47">47</a>;</li>
+<li>Apure Indians, <a href="#Page_48">48</a>;</li>
+<li>among the Amazons, <a href="#Page_56">56</a>;</li>
+<li>accidental case of, mentioned by Cullerier, <a href="#Page_57">57</a>;</li>
+<li>spontaneous, <a href="#Page_58">58</a>;</li>
+<li>abolished by the Romans, <a href="#Page_66">66</a>;</li>
+<li>destroying marks of, <a href="#Page_68">68</a>;</li>
+<li>of Abraham, <a href="#Page_143">143</a>;</li>
+<li>Hebraic, <a href="#Page_143">143</a>;</li>
+<li>not practiced in the wilderness, <a href="#Page_143">143</a>;</li>
+<li>physical conditions that exempt Jewish children from, <a href="#Page_144">144</a>, <a href="#Page_145">145</a>;</li>
+<li>description of Hebraic, by Montaigne, <a href="#Page_146">146</a>;</li>
+<li>as a cure for epilepsy, <a href="#Page_261">261</a>;</li>
+<li>as a preventive of hernia or rupture, <a href="#Page_263">263</a>;</li>
+<li>as a preventive to prolapsus of the bowel, <a href="#Page_263">263</a>;</li>
+<li>as a preventive of idiocy, <a href="#Page_266">266</a>;</li>
+<li>as a cure for dyspepsia, <a href="#Page_270">270</a>, <a href="#Page_271">271</a></li></ul></li>
+
+<li>Civiale, on moral effects of penis amputation, <a href="#Page_247">247</a>;
+<ul class='off'><li>case of phimosis and preputial calculi, <a href="#Page_249">249</a></li></ul></li>
+
+<li>Clapar&egrave;de, on evils resulting from the prepuce, <a href="#Page_229">229</a>;
+<ul class='off'><li>on preputial calculi, <a href="#Page_249">249</a></li></ul></li>
+
+<li>Clarke, Sir Andrew, on renal inadequacy, <a href="#Page_300">300</a></li>
+
+<li>Clavigero, on Mexican circumcision, <a href="#Page_46">46</a></li>
+
+<li>Climatic limits of circumcision, <a href="#Page_65">65</a></li>
+
+<li>Cloquet operation, <a href="#Page_306">306</a>, <a href="#Page_316">316</a></li>
+
+<li>Colchis, colony of, <a href="#Page_33">33</a></li>
+
+<li>Constantine punished circumcisers with death, <a href="#Page_66">66</a></li>
+
+<li>Constipation as a divine attribute, <a href="#Page_288">288</a>;
+<ul class='off'><li>as a result of phimosis and its results, <a href="#Page_292">292</a></li></ul></li>
+
+<li>Consumption, relation of, to Jewish race, <a href="#Page_178">178</a>, <a href="#Page_179">179</a></li>
+
+<li>Controversy about the holy prepuce, <a href="#Page_73">73</a></li>
+
+<li>Convent of St. Corneille and the holy knife, <a href="#Page_78">78</a></li>
+
+<li>Convulsions induced by phimosis, <a href="#Page_260">260</a>, <a href="#Page_261">261</a></li>
+
+<li>Cullerier, accidental circumcision, <a href="#Page_57">57</a>;
+<ul class='off'><li>on penile cancer, <a href="#Page_231">231</a></li></ul></li>
+
+<li>Cybelian priesthood and castration, <a href="#Page_89">89</a></li>
+
+<li class='mt1'>Dakotas, the white bull sacred among the, <a href="#Page_26">26</a></li>
+
+<li>David and the Philistine prepuces, <a href="#Page_31">31</a></li>
+
+<li>Debreyne, trappist, monk, and physician, <a href="#Page_224">224</a></li>
+
+<li>Delange, on Arabian circumcision, <a href="#Page_37">37</a></li>
+
+<li>Delpech, on female circumcision, <a href="#Page_36">36</a></li>
+
+<li>Demarquay, on penile gangrene, <a href="#Page_236">236</a></li>
+
+<li>Dervishes, holy and chaste, <a href="#Page_49">49</a></li>
+
+<li>Difference between Turkish and Buddhist heaven, <a href="#Page_116">116</a></li>
+
+<li>Dilatation of prepuce, <a href="#Page_308">308</a>, <a href="#Page_312">312</a>, <a href="#Page_332">332</a></li>
+
+<li>Donnelly, Hon. Ignatius, on Atlantean circumcision, <a href="#Page_23">23</a></li>
+
+<li>Dressing in cases of retraction of penile skin, <a href="#Page_304">304</a>;
+<ul class='off'><li>C. W. Ballance&rsquo;s, after circumcision, <a href="#Page_317">317</a>;</li>
+<li>A. G. Miller&rsquo;s, <a href="#Page_318">318</a></li></ul></li>
+
+<li>Du Bisson, on Soudanese harems, <a href="#Page_52">52</a></li>
+
+<li>Dyspepsia induced by preputial irritation, <a href="#Page_270">270</a>, <a href="#Page_271">271</a></li>
+
+<li class='mt1'>Ebers, Dr., on Karnac <i>bas-relief</i>, <a href="#Page_23">23</a></li>
+
+<li>Eczema induced by phimosis, <a href="#Page_320">320</a></li>
+
+<li>Effect of the holy prepuce on the hands of a lady, <a href="#Page_74">74</a></li>
+
+<li>Effects of age on the prepuce, <a href="#Page_285">285</a></li>
+
+<li>Egypt, uncircumcised persons not allowed to study in ancient, <a href="#Page_34">34</a></li>
+
+<li>Egyptians emasculated their prisoners, <a href="#Page_30">30</a></li>
+
+<li>Emasculation, its early practices and evolutions, <a href="#Page_29">29</a>;
+<ul class='off'><li>of Uranos, <a href="#Page_83">83</a></li></ul></li>
+
+<li>Emperor Adrian forbids circumcision, <a href="#Page_66">66</a></li>
+
+<li>Endurance and fortitude of Arabs, <a href="#Page_55">55</a></li>
+
+<li>Enforced continence and its effects on the penis, <a href="#Page_61">61</a></li>
+
+<li>Ennery, M., Grand Rabbi of Paris, <a href="#Page_158">158</a></li>
+
+<li>Enoch, Prof., of Berlin, on preputial calculi, <a href="#Page_249">249</a>;
+<ul class='off'><li>on results of phimosis, <a href="#Page_266">266</a>;</li>
+<li>on enuresis, <a href="#Page_277">277</a></li></ul></li>
+
+<li>Enuresis, <a href="#Page_275">275</a></li>
+
+<li>Epilepsy, induced by the prepuce, 258, <a href="#Page_261">261</a>, <a href="#Page_301">301</a></li>
+
+<li>Epstein, Dr., of Cincinnati, <a href="#Page_156">156</a></li>
+
+<li>Erichsen, Prof., on cancer of the penis, <a href="#Page_228">228</a></li>
+
+<li>Ethics at the battle of Fontenoy, <a href="#Page_76">76</a><span class='pagenum'><a name="Page_342" id="Page_342">[342]</a></span></li>
+
+<li>Ethiopian infibulation of infant females, <a href="#Page_51">51</a></li>
+
+<li>Eunuchism, beneficial to guardians of public funds, <a href="#Page_84">84</a>;
+<ul class='off'><li>as excluding from the priesthood, <a href="#Page_90">90</a>;</li>
+<li>in Italy, <a href="#Page_91">91</a>;</li>
+<li>in China, <a href="#Page_91">91</a>, <a href="#Page_93">93</a>;</li>
+<li>in India, <a href="#Page_92">92</a>;</li>
+<li>in the Soudan, <a href="#Page_99">99</a>;</li>
+<li>and music, <a href="#Page_94">94</a>;</li>
+<li>as a punishment, <a href="#Page_97">97</a>;</li>
+<li>mortality attending its manufacture, <a href="#Page_91">91</a>, <a href="#Page_92">92</a>, <a href="#Page_93">93</a>, <a href="#Page_99">99</a>, <a href="#Page_100">100</a>, <a href="#Page_107">107</a>;</li>
+<li>does not prevent copulation at all times, <a href="#Page_92">92</a>, <a href="#Page_100">100</a>, <a href="#Page_101">101</a>, <a href="#Page_102">102</a>, <a href="#Page_103">103</a>;</li>
+<li>manner of procedure among the Pagan priesthood, <a href="#Page_106">106</a>;</li>
+<li>prices of eunuchs, <a href="#Page_99">99</a>;</li>
+<li>numbers annually made, <a href="#Page_91">91</a>, <a href="#Page_98">98</a>;</li>
+<li>fecundating eunuch of Mecca, <a href="#Page_100">100</a>;</li>
+<li>Velutti, the opera-singer, <a href="#Page_102">102</a>;</li>
+<li>eunuchs as possessors of harems, <a href="#Page_90">90</a>;</li>
+<li>eunuch warriors and statesmen, <a href="#Page_90">90</a></li></ul></li>
+
+<li>Evidence of circumcision on Egyptian monuments, <a href="#Page_23">23</a></li>
+
+<li>Extraordinary results of phimosis, <a href="#Page_282">282</a></li>
+
+<li class='mt1'>Female circumcisers in Arabia, <a href="#Page_36">36</a></li>
+
+<li>Females subject to preputial reflex neuroses, <a href="#Page_267">267</a>, <a href="#Page_268">268</a></li>
+
+<li>Flaccourt, M. Martin, account of the Mad&eacute;casses, <a href="#Page_54">54</a></li>
+
+<li>Fothergill and the unlicensed practitioner on renal pathology, <a href="#Page_77">77</a></li>
+
+<li>French war-office records, on Jewish vital statistics, <a href="#Page_175">175</a></li>
+
+<li>Frenum, statistics relating to abnormalities of, <a href="#Page_221">221</a></li>
+
+<li>Frerichs&rsquo; ammoni&aelig;mia, <a href="#Page_300">300</a></li>
+
+<li>Fresnel, M., on marriage circumcision, <a href="#Page_54">54</a></li>
+
+<li>Full-moon rites among the Bassouto maidens, <a href="#Page_44">44</a></li>
+
+<li class='mt1'>Galen, on the flaccid virile member, <a href="#Page_60">60</a>, <a href="#Page_61">61</a></li>
+
+<li>Gangrene of the penis, <a href="#Page_236">236</a></li>
+
+<li>Golden padlocks worn on prepuce for five years, <a href="#Page_54">54</a></li>
+
+<li>Greek and Roman statuary and the penis, <a href="#Page_60">60</a></li>
+
+<li>Greek monks&rsquo; object in infibulations, <a href="#Page_54">54</a>;
+<ul class='off'><li>extreme ideas of chastity, <a href="#Page_89">89</a></li></ul></li>
+
+<li>Gregg, Dr. Robert J., operative procedure, <a href="#Page_320">320</a></li>
+
+<li>Griffith, Dr. J. D., cases of reflex irritation, <a href="#Page_261">261</a></li>
+
+<li>Gross, Prof. S. D., on penile cancer, <a href="#Page_230">230</a>;
+<ul class='off'><li>operations, <a href="#Page_320">320</a></li></ul></li>
+
+<li>Grotius and the origin of the Peruvians, <a href="#Page_46">46</a></li>
+
+<li>Guimara, the, <a href="#Page_153">153</a></li>
+
+<li>Guinzburg, Dr., on Jewish vital statistics, <a href="#Page_176">176</a></li>
+
+<li>Gumilla and his South American voyages, <a href="#Page_47">47</a></li>
+
+<li class='mt1'>H&aelig;mostatic powders, <a href="#Page_160">160</a></li>
+
+<li>Hare, Prof. Hobart A., on circumcision, <a href="#Page_301">301</a></li>
+
+<li>Haskins, Dr. A., on Jewish vital statistics, <a href="#Page_176">176</a></li>
+
+<li>Heaven, Turkish, <a href="#Page_115">115</a>;
+<ul class='off'><li>Buddhist, <a href="#Page_116">116</a></li></ul></li>
+
+<li>Hebraic idea of parental origin of constitution of the child, <a href="#Page_144">144</a></li>
+
+<li>Hebrew Consistory of Paris, <a href="#Page_157">157</a></li>
+
+<li>Hebrew words in Central <ins class='corr' title="Transcriber&rsquo;s Note: The original showed &lsquo;America&rsquo;.">American</ins> languages, <a href="#Page_24">24</a></li>
+
+<li>Hebrews, attempts to efface signs of circumcision, <a href="#Page_69">69</a>;
+<ul class='off'><li>secretly circumcise their dead, <a href="#Page_68">68</a>;</li>
+<li>Hebrew vital statistics, <a href="#Page_169">169</a> to <a href="#Page_179">179</a>;</li>
+<li>as proverbial good livers, <a href="#Page_171">171</a>;</li>
+<li>escape epidemics, <a href="#Page_173">173</a>;</li>
+<li>peculiarly free from syphilitic taint, <a href="#Page_191">191</a>;</li>
+<li>their circumcision suitable to young children, <a href="#Page_306">306</a></li></ul></li>
+
+<li>Heliogabalus, Emperor, was circumcised, <a href="#Page_66">66</a></li>
+
+<li>Henry III of France as a Moslem godfather, <a href="#Page_64">64</a></li>
+
+<li>Henry V of England and the holy prepuce, <a href="#Page_71">71</a></li>
+
+<li>Heraclius, Emperor, persecuted the Jews, <a href="#Page_67">67</a></li>
+
+<li>Hermaphrodites, earliest mention of, <a href="#Page_117">117</a>;
+<ul class='off'><li>pederasty causes belief in their existence, <a href="#Page_118">118</a>, <a href="#Page_119">119</a>, <a href="#Page_120">120</a>;</li>
+<li>Debierre on, <a href="#Page_123">123</a>;</li>
+<li>notable cases of, <a href="#Page_124">124</a>, <a href="#Page_125">125</a>, <a href="#Page_127">127</a>, <a href="#Page_128">128</a></li></ul></li>
+
+<li>Hernia induced by phimosis, <a href="#Page_263">263</a></li>
+
+<li>Herodotus, his views adopted by Voltaire, <a href="#Page_22">22</a>;
+<ul class='off'><li>visits Egypt, <a href="#Page_34">34</a></li></ul></li>
+
+<li>Herrera, on Mexican circumcision, <a href="#Page_47">47</a></li>
+
+<li>Hey, Dr. William, on preputial cancer, <a href="#Page_227">227</a></li>
+
+<li>Hindoo devotee wears a six-inch ring in prepuce, <a href="#Page_54">54</a><span class='pagenum'><a name="Page_343" id="Page_343">[343]</a></span></li>
+
+<li>Hitouch, <a href="#Page_156">156</a></li>
+
+<li>Holgate, Dr., of New York, on preputial adhesions, <a href="#Page_220">220</a>;
+<ul class='off'><li>on preputial dilatation, <a href="#Page_308">308</a></li></ul></li>
+
+<li>Holy circumcision, <a href="#Page_70">70</a>, <a href="#Page_78">78</a>
+<ul class='off'><li>prepuces, <a href="#Page_70">70</a>, <a href="#Page_72">72</a></li>
+<li>vinegar and its miraculous effects, <a href="#Page_79">79</a></li></ul></li>
+
+<li>Homer, Surgeon U. S. Navy, on the worship of Venus Porclna, <a href="#Page_193">193</a></li>
+
+<li>Horrible marriage performance, <a href="#Page_54">54</a></li>
+
+<li>Hottentot restriction on making twins, <a href="#Page_60">60</a></li>
+
+<li>Hough, Dr., on Jewish longevity, <a href="#Page_173">173</a></li>
+
+<li>Humphry, Geo. Murray, on &ldquo;Old Age,&rdquo; <a href="#Page_14">14</a></li>
+
+<li>Hutchinson, Dr. Jonathan, on the pre-cancerous stage of cancer, <a href="#Page_226">226</a>;
+<ul class='off'><li>on urethral child, <a href="#Page_300">300</a></li></ul></li>
+
+<li>Hypospadias, as a heredity, <a href="#Page_129">129</a>;
+<ul class='off'><li>artificially made, <a href="#Page_56">56</a>;</li>
+<li>formerly led to belief in hermaphrodism, <a href="#Page_129">129</a>;</li>
+<li>fecundation in, <a href="#Page_129">129</a>;</li>
+<li>difficulty in determining sex owing to, <a href="#Page_131">131</a></li></ul></li>
+
+<li class='mt1'>Idiocy induced by phimosis and preputial adhesions, <a href="#Page_265">265</a>, <a href="#Page_269">269</a></li>
+
+<li>Impious wretch steals the holy prepuce, <a href="#Page_74">74</a></li>
+
+<li>Impotence, holy vinegar and shrinal observances in, <a href="#Page_71">71</a> to <a href="#Page_81">81</a></li>
+
+<li>Indians and circumcision, <a href="#Page_46">46</a> to <a href="#Page_48">48</a></li>
+
+<li>Induration of prepuce, <a href="#Page_250">250</a></li>
+
+<li>Inflbulation practices, <a href="#Page_48">48</a> to <a href="#Page_52">52</a></li>
+
+<li>Isis inaugurates Osirian rites, <a href="#Page_29">29</a></li>
+
+<li>Isserth, Rabbi Israel, <a href="#Page_153">153</a></li>
+
+<li class='mt1'>Jansen, Surgeon of the Belgian Armies, on frenum deformities, '<a href="#Page_221">221</a></li>
+
+<li>Jews&rsquo; letters to Voltaire, <a href="#Page_22">22</a>;
+<ul class='off'><li>Jews (see Hebrews).</li></ul></li>
+
+<li>Judaism unfavorable to religious insanity, <a href="#Page_166">166</a></li>
+
+<li>Justinia, Emperor, persecuted the Jews, <a href="#Page_67">67</a></li>
+
+<li class='mt1'>Karo, Joseph, and the &ldquo;Beth Yosef,&rdquo; '<a href="#Page_153">153</a></li>
+
+<li>Kemp, Dr. Arthur, on phimosis as a cause of hernia, <a href="#Page_264">264</a></li>
+
+<li>Kerr, Dr. J. G., on Chinese preputial calculi, <a href="#Page_248">248</a></li>
+
+<li>Keyes, Dr. E. L., on composition of preputial calculi, <a href="#Page_249">249</a>, <a href="#Page_264">264</a></li>
+
+<li>King David, the first hom&oelig;opathic patient, <a href="#Page_113">113</a>;
+<ul class='off'><li>secures two hundred Philistine prepuces, <a href="#Page_31">31</a></li></ul></li>
+
+<li>Knife, circumcising, used in ancient Egyptian rite, <a href="#Page_23">23</a>;
+<ul class='off'><li>of shell used by Tonga Islanders, <a href="#Page_45">45</a>;</li>
+<li>of stone used by Australians, <a href="#Page_45">45</a>;</li>
+<li>of the holy circumcision, <a href="#Page_78">78</a>;</li>
+<li>made of rattan among the Fiji Islanders, <a href="#Page_327">327</a></li></ul></li>
+
+<li class='mt1'>Lafargue, on Australian circumcision, <a href="#Page_44">44</a></li>
+
+<li>Lallemand, on masturbation, <a href="#Page_223">223</a>;
+<ul class='off'><li>on tendency to preputial cancer, <a href="#Page_228">228</a>, <a href="#Page_329">329</a>;</li>
+<li>on circumcision, <a href="#Page_317">317</a></li></ul></li>
+
+<li>Las Casas, on Aztec circumcision, <a href="#Page_46">46</a></li>
+
+<li>Leech, Dr. T. F., on preputial irritation, <a href="#Page_260">260</a></li>
+
+<li>Letenneur, Prof., on the knife of the holy circumcision, '<a href="#Page_78">78</a></li>
+
+<li>Life-insurance and the circumcised, <a href="#Page_290">290</a></li>
+
+<li>Lisfrane, rules for operations on the penis, <a href="#Page_232">232</a>;
+<ul class='off'><li>on recession of the body of the penis, <a href="#Page_306">306</a></li></ul></li>
+
+<li>Livingstone, on Bassouto circumcision, <a href="#Page_44">44</a></li>
+
+<li>Longevity of Hebrews, <a href="#Page_162">162</a>, <a href="#Page_169">169</a>, <a href="#Page_179">179</a></li>
+
+<li>Lonyer-Villermay, M., on female circumcision, <a href="#Page_36">36</a></li>
+
+<li>Louis XVI as a candidate for the rite, <a href="#Page_201">201</a></li>
+
+<li>Love, Dr. I. N, on the Mosaic law, <a href="#Page_262">262</a></li>
+
+<li>Lumholtz, on Australian hypospadias, <a href="#Page_56">56</a></li>
+
+<li class='mt1'>Macilwain, on reflex neuroses, <a href="#Page_330">330</a></li>
+
+<li>Magruder, Dr. G. L., on reflex irritation, <a href="#Page_261">261</a></li>
+
+<li>Maids as heat radiators, <a href="#Page_114">114</a></li>
+
+<li>Maimonides, Jewish rabbi and physician, <a href="#Page_32">32</a>, <a href="#Page_144">144</a>, <a href="#Page_153">153</a></li>
+
+<li>Malay circumcision, <a href="#Page_45">45</a></li>
+
+<li>Malgaigne, operative views, <a href="#Page_313">313</a>, <a href="#Page_316">316</a></li>
+
+<li>Mapato, or mystery hut, <a href="#Page_42">42</a></li>
+
+<li>Marriage preceded by circumcision, <a href="#Page_54">54</a></li>
+
+<li>Martius and Spix, on circumcision on the Amazon, <a href="#Page_56">56</a><span class='pagenum'><a name="Page_344" id="Page_344">[344]</a></span></li>
+
+<li>Mastin, Dr. C. H., on calculous disease, <a href="#Page_248">248</a></li>
+
+<li>Masturbation, <a href="#Page_224">224</a></li>
+
+<li>Maury, Dr. Frank, on preputial statistics, <a href="#Page_219">219</a></li>
+
+<li>McLeod, Dr. Neil, circumcision operation, <a href="#Page_318">318</a></li>
+
+<li>McMahon, Dr. W. R., on reflex epilepsy, <a href="#Page_261">261</a></li>
+
+<li>Mendelssohn, Rabbi Moses, <a href="#Page_164">164</a>, <a href="#Page_168">168</a></li>
+
+<li>Mexican circumcision, <a href="#Page_46">46</a></li>
+
+<li>Mezizah, or act of suction, <a href="#Page_150">150</a></li>
+
+<li>Milah, <a href="#Page_156">156</a></li>
+
+<li>Miracles performed by the holy prepuce, <a href="#Page_70">70</a> to <a href="#Page_74">74</a></li>
+
+<li>Mishna, the, <a href="#Page_153">153</a></li>
+
+<li>Mohammed, <a href="#Page_65">65</a></li>
+
+<li>Mohel, <a href="#Page_157">157</a>, <a href="#Page_158">158</a></li>
+
+<li>Moses, Dr., of New York, preputial statistics, <a href="#Page_220">220</a></li>
+
+<li>Moses circumcises his son, <a href="#Page_150">150</a></li>
+
+<li>Mott, Jr., Dr. A. R., cases of reflex irritation, <a href="#Page_258">258</a></li>
+
+<li>Music, first schools of, <a href="#Page_94">94</a></li>
+
+<li>Music at Algerine circumcision, <a href="#Page_39">39</a>;
+<ul class='off'><li>at Mohammedan, in Asia, <a href="#Page_39">39</a>;</li>
+<li>at Turkish feast, <a href="#Page_41">41</a></li></ul></li>
+
+<li class='mt1'>Nelaton, case of infibulation, <a href="#Page_54">54</a>;
+<ul class='off'><li>on penile cancer, <a href="#Page_231">231</a>;</li>
+<li>on penile hypertrophy, <a href="#Page_252">252</a></li></ul></li>
+
+<li>Nelson, Lord, disregard for red tape, <a href="#Page_77">77</a></li>
+
+<li>New Caledonian circumcision, <a href="#Page_45">45</a></li>
+
+<li>Newton, Sir Isaac, and the storm-predicting cow, <a href="#Page_77">77</a></li>
+
+<li>Nicaraguan baptism of blood, <a href="#Page_56">56</a></li>
+
+<li class='mt1'>Oath of mohel, <a href="#Page_158">158</a></li>
+
+<li>Oath, Egyptian manner of making oath, <a href="#Page_35">35</a></li>
+
+<li>Obod, Battle of, <a href="#Page_36">36</a></li>
+
+<li>Operations on the prepuce, <a href="#Page_302">302</a>;
+<ul class='off'><li>Cloquet&rsquo;s, <a href="#Page_306">306</a>;</li>
+<li>Bumstead&rsquo;s, <a href="#Page_310">310</a>;</li>
+<li>Hue&rsquo;s, <a href="#Page_312">312</a>;</li>
+<li>Bernheim&rsquo;s, Sedillat&rsquo;s, <a href="#Page_313">313</a>;</li>
+<li>Chauvin&rsquo;s, <a href="#Page_313">313</a>;</li>
+<li>Cullerier&rsquo;s, <a href="#Page_313">313</a>;</li>
+<li>Vanier&rsquo;s, <a href="#Page_316">316</a>;</li>
+<li>Vidal de Cassis&rsquo;, <a href="#Page_316">316</a>;</li>
+<li>Lallemand&rsquo;s, <a href="#Page_317">317</a>;</li>
+<li>A. G. Miller&rsquo;s, Neil McLeod&rsquo;s, <a href="#Page_318">318</a>;</li>
+<li>Erichsen&rsquo;s, <a href="#Page_319">319</a>;</li>
+<li>Gross&rsquo;s, <a href="#Page_320">320</a>;</li>
+<li>Van Buren and Keyes&rsquo;, <a href="#Page_320">320</a>;</li>
+<li>D. Hayes Agnew&rsquo;s, <a href="#Page_320">320</a>;</li>
+<li>Overall&rsquo;s procedure, <a href="#Page_321">321</a></li></ul></li>
+
+<li>Origin of phallic worship, <a href="#Page_29">29</a>
+<ul class='off'><li>of human slavery, <a href="#Page_29">29</a></li></ul></li>
+
+<li>Orinoco, circumcision on the, <a href="#Page_47">47</a></li>
+
+<li>Orloth, penis or prepuce? <a href="#Page_31">31</a></li>
+
+<li>Osiris vanquished by Typhon, <a href="#Page_28">28</a></li>
+
+<li>Othomacos Indians and their bloody rite, <a href="#Page_48">48</a></li>
+
+<li>Owen, Dr. Edmund, on phimosis, <a href="#Page_263">263</a></li>
+
+<li class='mt1'>Packard, Dr., on preputial statistics, <a href="#Page_219">219</a></li>
+
+<li>Papal indulgences to worshipers of holy prepuce, <a href="#Page_72">72</a></li>
+
+<li>Paralysis induced by phimosis, <a href="#Page_259">259</a></li>
+
+<li>Penis, absence of, <a href="#Page_132">132</a>;
+<ul class='off'><li>diminutive specimens, <a href="#Page_213">213</a>;</li>
+<li>amputation of, <a href="#Page_230">230</a>, <a href="#Page_233">233</a>, <a href="#Page_234">234</a>, <a href="#Page_247">247</a>;</li>
+<li>cancer of, <a href="#Page_232">232</a>;</li>
+<li>gangrene of, <a href="#Page_236">236</a>;</li>
+<li>hypertrophy of, <a href="#Page_248">248</a>, <a href="#Page_251">251</a>, <a href="#Page_252">252</a></li></ul></li>
+
+<li>Periah, <a href="#Page_156">156</a></li>
+
+<li>Persecutions on account of circumcision, <a href="#Page_66">66</a></li>
+
+<li>Ph&oelig;nician origin of circumcision, <a href="#Page_22">22</a></li>
+
+<li>Phimosed penis on ancient statues, <a href="#Page_60">60</a></li>
+
+<li>Phimosis, <a href="#Page_218">218</a>, <a href="#Page_221">221</a>;
+<ul class='off'><li>as a cause of hernia, <a href="#Page_263">263</a></li></ul></li>
+
+<li>Physicians as practical Christians, <a href="#Page_141">141</a></li>
+
+<li>Pooley, Prof. J. H., case of preputial irritation, <a href="#Page_260">260</a></li>
+
+<li>Pop&egrave;, Rabbi Rav, and the <i>Guimara</i>, <a href="#Page_153">153</a></li>
+
+<li>Portuguese sailors as Mohammedan proselytes, <a href="#Page_40">40</a></li>
+
+<li>Potentia generandi, <a href="#Page_103">103</a>
+<ul class='off'><li>coeundi, <a href="#Page_104">104</a></li></ul></li>
+
+<li>Prepuce, infibulated, <a href="#Page_54">54</a>;
+<ul class='off'><li>swallowed by mother, <a href="#Page_54">54</a>;</li>
+<li>fired off in gun, <a href="#Page_54">54</a>;</li>
+<li>holy, <a href="#Page_71">71</a>;</li>
+<li>useful for skin grafts, <a href="#Page_207">207</a>;</li>
+<li>absence of, <a href="#Page_209">209</a>;</li>
+<li>influence on man at different ages, <a href="#Page_225">225</a>;</li>
+<li>induration of, <a href="#Page_250">250</a>;</li>
+<li>warts of, <a href="#Page_250">250</a>;</li>
+<li>reflex neuroses from, <a href="#Page_256">256</a></li></ul></li>
+
+<li>Preputial miracles, <a href="#Page_72">72</a>;
+<ul class='off'><li>statistics, <a href="#Page_219">219</a>;</li>
+<li>adhesions, <a href="#Page_219">219</a>, <a href="#Page_220">220</a>;</li>
+<li>calculi, <a href="#Page_248">248</a></li></ul></li>
+
+<li>Price, Dr. M. F., on reflex neuroses, <a href="#Page_265">265</a>;
+<ul class='off'><li>on female preputial irritation, <a href="#Page_267">267</a>, <a href="#Page_268">268</a></li></ul></li>
+
+<li>Primitive phallic rites, 28<span class='pagenum'><a name="Page_345" id="Page_345">[345]</a></span>
+<ul class='off'><li>hom&oelig;opaths, <a href="#Page_113">113</a></li></ul></li>
+
+<li>Procedure in retraction of skin of penis after circumcision, <a href="#Page_304">304</a></li>
+
+<li>Proselytes, Mohammedan, how circumcised, <a href="#Page_40">40</a>, <a href="#Page_41">41</a></li>
+
+<li>Public women between decks in U. S. Navy, <a href="#Page_193">193</a></li>
+
+<li>Puzey, Dr., of Liverpool, on preputial skin grafts, <a href="#Page_207">207</a></li>
+
+<li>Pythagoras <a href="#Page_32">32</a>;
+<ul class='off'><li>visits Egypt, <a href="#Page_34">34</a></li></ul></li>
+
+<li class='mt1'>Ralfe, on causes of interstitial nephritis, <a href="#Page_300">300</a></li>
+
+<li>Rameses II, circumcision of his sons, <a href="#Page_23">23</a></li>
+
+<li>Ranney, Prof. A. L., on enuresis, <a href="#Page_282">282</a></li>
+
+<li>Reconstruction of a prepuce, <a href="#Page_68">68</a>, <a href="#Page_69">69</a>, <a href="#Page_328">328</a></li>
+
+<li>Rectum, prolapsus of, induced by phimosis, <a href="#Page_263">263</a></li>
+
+<li>Reflex neuroses from preputial irritation, <a href="#Page_254">254</a>, <a href="#Page_330">330</a>, <a href="#Page_331">331</a></li>
+
+<li>Regulations of French Hebrew consistories of 1854, <a href="#Page_157">157</a></li>
+
+<li>Religion, its connection to insanity, <a href="#Page_166">166</a></li>
+
+<li>Resectricis nympharum, profession of, <a href="#Page_36">36</a></li>
+
+<li>Restriction on impregnation, <a href="#Page_57">57</a>;
+<ul class='off'><li>on twins, <a href="#Page_60">60</a></li></ul></li>
+
+<li>Retraction of skin of penis after circumcision, <a href="#Page_303">303</a></li>
+
+<li>Richardson, Dr. B. W., on relation of race to disease, <a href="#Page_169">169</a>, <a href="#Page_170">170</a>, <a href="#Page_171">171</a>, <a href="#Page_177">177</a></li>
+
+<li>Ricord&rsquo;s definition of the prepuce, <a href="#Page_206">206</a>;
+<ul class='off'><li>operations on the prepuce, <a href="#Page_313">313</a></li></ul></li>
+
+<li>Roman infibulation, <a href="#Page_58">58</a></li>
+
+<li>Royal decree of 1845 in France, <a href="#Page_157">157</a></li>
+
+<li>Roux, on cancer of the prepuce, <a href="#Page_227">227</a></li>
+
+<li>Rush, Benjamin, and the cancer quack, <a href="#Page_77">77</a></li>
+
+<li class='mt1'>Saint-Germain, Dr., on preputial abnormalities, <a href="#Page_264">264</a></li>
+
+<li>Saint Foutin and his shrine, <a href="#Page_78">78</a></li>
+
+<li>Saint Guerluchon at Bourg-Dieu, <a href="#Page_79">79</a></li>
+
+<li>Saint Guignole and the miraculous phallus, <a href="#Page_80">80</a></li>
+
+<li>Saint Coulombs and the miraculous prepuce, <a href="#Page_70">70</a></li>
+
+<li>Saturnus the first eunuchiser, <a href="#Page_83">83</a></li>
+
+<li>Sayer, Prof. Lewis A., contributions to medical science, <a href="#Page_255">255</a></li>
+
+<li>Scythians carry off heads of the slain, <a href="#Page_30">30</a></li>
+
+<li>Self-circumcision, attempt at, <a href="#Page_203">203</a></li>
+
+<li>Semiramis first employs eunuchs, <a href="#Page_85">85</a></li>
+
+<li>Severus Sulpicius, on effects of climate, <a href="#Page_50">50</a></li>
+
+<li>Sham battles at circumcision feasts, <a href="#Page_37">37</a>, <a href="#Page_41">41</a>, <a href="#Page_42">42</a>, <a href="#Page_44">44</a></li>
+
+<li>She-circumcisers, <a href="#Page_36">36</a></li>
+
+<li>Shrine for the recovery of impotent males, <a href="#Page_79">79</a></li>
+
+<li>Smith, Dr. J. Lewis, on preputial irritation, <a href="#Page_263">263</a></li>
+
+<li>Solomon, Dr., of Brunswick, on suction, <a href="#Page_158">158</a></li>
+
+<li>Soudanese chastity protector, <a href="#Page_52">52</a></li>
+
+<li>Sphincterismus due to phimosis, <a href="#Page_292">292</a></li>
+
+<li>Spiked chastity belt in Naples museum, <a href="#Page_52">52</a></li>
+
+<li>Stallard, Dr., on Jewish vital statistics, <a href="#Page_173">173</a></li>
+
+<li>Sterility cured at sacred shrines, <a href="#Page_71">71</a> to <a href="#Page_81">81</a></li>
+
+<li>Stricture of urethra and phimosis, <a href="#Page_289">289</a>, <a href="#Page_290">290</a></li>
+
+<li>Styptics used by mohels, 158, <a href="#Page_159">159</a></li>
+
+<li>Syphilis, statistics relating to, <a href="#Page_187">187</a> to <a href="#Page_199">199</a></li>
+
+<li>Syphilis and scrofula, <a href="#Page_190">190</a></li>
+
+<li class='mt1'>Taylor, Dr. C. F., on masturbation, <a href="#Page_269">269</a></li>
+
+<li>Totonac circumcision, <a href="#Page_46">46</a></li>
+
+<li>Tonga Islanders&rsquo; rite, <a href="#Page_45">45</a></li>
+
+<li>Tox&aelig;mia, resulting from phimosis, <a href="#Page_293">293</a>;
+<ul class='off'><li>of von Jaksch, <a href="#Page_294">294</a></li></ul></li>
+
+<li>Tube, penis carried in, <a href="#Page_56">56</a></li>
+
+<li>Tunca Indian circumcision, <a href="#Page_56">56</a></li>
+
+<li>Turkish circumcision, <a href="#Page_39">39</a> to <a href="#Page_41">41</a></li>
+
+<li>Tylor, on the Stone Age and circumcision, <a href="#Page_336">336</a></li>
+
+<li class='mt1'>Van Buren and Keyes, on circumcision, <a href="#Page_320">320</a></li>
+
+<li>Vanier du Havre, Dr., <a href="#Page_54">54</a>, <a href="#Page_224">224</a>;
+<ul class='off'><li>on operations, <a href="#Page_316">316</a></li></ul></li>
+
+<li>Venus, birth of, <a href="#Page_84">84</a></li>
+
+<li>Vidal de Cassis, on preputial operations, <a href="#Page_316">316</a></li>
+
+<li>Virey, account of Hindoo bonze, <a href="#Page_54">54</a></li>
+
+<li>Virgins&rsquo; chain of bells in ancient Judea, <a href="#Page_52">52</a><span class='pagenum'><a name="Page_346" id="Page_346">[346]</a></span></li>
+
+<li>Vital statistics of Jews, <a href="#Page_169">169</a> to <a href="#Page_179">179</a></li>
+
+<li>Voltaire, on origins of circumcision, <a href="#Page_22">22</a></li>
+
+<li>Von Jaksch&rsquo;s definition of Tox&aelig;mia, <a href="#Page_294">294</a></li>
+
+<li class='mt1'>Wadd, Dr., on preputial cancer, <a href="#Page_227">227</a>;
+<ul class='off'><li>on hypertrophy of penis, <a href="#Page_252">252</a></li></ul></li>
+
+<li>Walshe, on preputial cancer, <a href="#Page_235">235</a></li>
+
+<li>Warren, on preputial cancer, <a href="#Page_235">235</a></li>
+
+<li>Warts of penis and prepuce, <a href="#Page_250">250</a></li>
+
+<li>Waterman, Dr., on Jewish vital statistics, <a href="#Page_177">177</a></li>
+
+<li>Wax images of penis deposited on shrines, <a href="#Page_79">79</a></li>
+
+<li>Welsh words in Mandan language, <a href="#Page_24">24</a></li>
+
+<li>Wet dressing objectionable after circumcision, <a href="#Page_304">304</a>, <a href="#Page_311">311</a></li>
+
+<li>White Bull, sacred among Sioux and Egyptians, <a href="#Page_26">26</a>;
+<ul class='off'><li>origin of sacredness, <a href="#Page_29">29</a></li></ul></li>
+
+<li>Willard, Dr. De Forest, observations on the prepuce, <a href="#Page_262">262</a></li>
+
+<li>Wine at circumcision feasts, <a href="#Page_151">151</a></li>
+
+<li>Wirthington, Dr. F. J., on preputial irritation, <a href="#Page_259">259</a></li>
+
+<li>Wise, Dr. I. M., on St. Paul the apostle, <a href="#Page_19">19</a></li>
+
+<li>Warman, Prof., of Brooklyn, on circumcision, <a href="#Page_26">26</a></li>
+</ul>
+
+<hr />
+
+<p class='noin c'>THE THREE FOLLOWING PAGES ARE REDUCED<br />
+FAC-SIMILES OF PAGES FROM<br />
+<br />
+<span style='font-size:120%;'>STANTON&rsquo;S'</span><br />
+<br />
+<span class='b' style='font-size:140%;'>Practical and Scientific Physiognomy;</span><br />
+<br />
+<span class='sf75'>OR,</span><br />
+<br />
+<span style='font-size:140%;'>HOW TO READ FACES.</span><br />
+<br />
+<span class='sf75'>BY</span><br />
+<br />
+MARY OLMSTED STANTON.</p>
+
+<p>The ablest, most entertaining, trustworthy, and exhaustive treatise of
+the kind in the English language. Complete in two Royal Octavo volumes
+of <span class='sc lc'>OVER 600 PAGES EACH</span>; richly illustrated with 380 <span class='sc lc'>CHOICE
+WOOD-ENGRAVINGS</span>, many of them original.</p>
+
+<p>Sold by subscription, or sent direct on receipt of price, shipping
+expenses prepaid.</p>
+
+<p class='hi sf75'>Price, in United States, Cloth, $9.00; Sheep, $11.00; Half-Russia,
+$13.00. Canada (duty paid), Cloth, $10.00; Sheep, $12.10; Half-Russia,
+$14.30. Great Britain, Cloth, 56s.; Sheep, 68s.; Half-Russia, 80s.
+France, Cloth, 30 fr. 30; Sheep, 36 fr. 40; Half-Russia, 43 fr. 30.</p>
+
+<p class='noin c'>EXAMINE THE FOLLOWING PAGES.<br />
+<span style='font-size:140%;'>F. A. DAVIS, Publisher,</span><br />
+<span style='font-size:120%;'>1231 Filbert Street, Phila., Pa.</span><br /><br />
+BRANCH OFFICES:<br />
+<span class='sf75 i'>CHICAGO, ILL.&mdash;24 Lakeside Building, 214-220 S. Clark St.</span><br />
+<span class='sf75 i'>NEW YORK CITY&mdash;117 W. 42d Street.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;ATLANTA, GA.&mdash;26 Old Capitol.</span><br />
+<span class='sf75 i'>LONDON, ENG.&mdash;40 Berners St., Oxford St., W.</span><br /><br />
+<span class='sc lc'>ORDER FROM NEAREST OFFICE.</span></p>
+
+<hr class='minor' />
+
+<div class="figcenter" style="width: 321px;">
+<img src="images/illus-fac1.png" width="297" height="500" alt="" title=""
+style='border:black solid 1px; padding:12px;' /></div>
+
+<p class='sc lc noin c'>HOW TO REDUCE SIZE WITHOUT LOSING STRENGTH. <span class='ralign'>1109</span><br /></p>
+
+<p class='noin'>voice. A thorough-bred person may belong to the artistic, mechanical, or
+scientific classes, either appreciatively or executively; he must
+exhibit both gentleness and spirit, as occasion requires; he must be
+governed by the law of justice; he must make the comfort of his
+associates his concern, and do what is <i>right</i> in order to enhance their
+happiness.</p>
+
+<p>The facial indications of those who are not thorough-bred, speaking
+physiologically, are as follow: A coarse, thick skin; a
+&ldquo;muddy&rdquo; complexion, or one permanently blotched, pimpled, or
+discolored; dull eyes, very small or very large and bulging; coarse
+hair, or that which is very light or colorless,&mdash;that is to say, of
+no <i>decided</i> hue. I regard very light colored, pallid people as morbid
+varieties; also those with irregular teeth, a very small or ill-shapen
+nose, small nostrils, perpendicular jaws, exposed gums, open mouth,
+receding chin, or one that projects greatly forward, ending in a point;
+thin, pallid, dry lips; hollow cheeks, flat upper cheeks. ugly or
+ill-shapen ears, a voice weak, thin, hoarse, shrill or nasal; a long,
+cylindrical neck; a high, narrow forehead.</p>
+
+<p>The undue development of certain organs and systems of the body induces
+abnormal conditions, as, for example, an excessive disposition of fatty
+tissue. When the appetite is voracious, or the nutritive system
+uncommonly active, too much of the carbonaceous elements of the food are
+eliminated, or, as it often occurs, too much carbonaceous food, such as
+white bread, potatoes, etc., is consumed for the needs of the body; the
+consequence is an excess of fat, which, in many subjects, impedes
+respiration, prevents activity, and gives a generally uncomfortable
+feeling. For this condition a spare diet is often prescribed, but as
+this is felt to be a hardship, and as few who attempt it succeed in
+continuing it long enough to produce satisfactory results, it is
+pronounced a failure.</p>
+
+<p>For this class of people there is a very agreeable and sure method of
+reducing the bulk without reducing strength and without compelling too
+great a sacrifice of the appetite.</p>
+
+<p class='sc lc mt1 noin c'>HOW TO REDUCE THE SIZE WITHOUT LOSING STRENGTH.</p>
+
+<p>A diet which will attain this result is easily obtained, and of it the
+subject can use a quantity sufficient to allay the craving for food.</p>
+
+<p>This diet consists of absolutely <i>raw</i> foods, nothing cooked being
+allowed. This diet, of course, must consist mainly of fruits, nuts,
+grains, milk, and, when flesh-meat is desired, a Hamburg beefsteak may
+be partaken of; this steak is raw beef chopped fine and seasoned with
+onion, salt, pepper, or other condiments; to this may be added raw
+oysters and clams. Every kind of fruit</p>
+
+<hr class='minor' />
+
+<div class="figcenter" style="width: 329px;">
+<img src="images/illus-fac2.png" width="305" height="500" alt="" title=""
+style='border:black solid 1px; padding:12px;' /></div>
+
+<p class='sc lc noin c'>SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON. <span class='ralign'>1143</span><br /></p>
+
+<p class='noin'>is a dangerous being); he should develop his friendliness, love of
+children, and of the opposite sex; in short, he should be a <i>lover</i> of
+<i>humanity</i>.</p>
+
+<p class='sc lc mt1 noin c'>THE SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON.</p>
+
+<div class='sf75' style='width:70%; margin-left:auto; margin-right:auto;'>
+<p class='noin c sc'>Fig. 300&mdash;EDWARD JENNER, M.D. (Celebrated English Physician,
+Author, and Discoverer of Vaccination.)</p>
+
+<p>No scientific physiognomist could mistake this face for other than that
+of a physician, and an earnest and attentive one as well, as evidenced
+by the signs of &ldquo;natural physician&rdquo; in the cheek-bones, in
+the attitude of the head and neck, and by the thoughtful, observant
+expression of the eye. The combination of systems in this subject is
+such as is most frequently observed among physicians, viz., the
+supremacy of the osseous and brain systems. The muscular, thoracic, and
+vegetative powers all assist in this combination by their development.
+The signs for Conscience and Firmness are apparent. Love of Home and
+Patriotism rank high. Benevolence, Amativeness, Love of Young, Mirth,
+Approbation, Self-esteem, Modesty, Friendship, Alimentiveness,
+Sanativeness, Pneumativeness, and Color combine to form a lovely
+domestic and social nature. The form, size, and peculiarities of the
+nose claim attention. It is a nose denoting Constructiveness,
+Originality, and logical power. The signs for Hope, Analysis, Mental
+Imitation, Human Nature, Ideality, Sublimity, Construction, and
+Acquisition are strongly delineated. Self-will is normally developed,
+while Size, Form, Observation, Weight, Locality, Calculation, and Memory
+of various sorts are manifest. The signs of Language in the eye and
+mouth denote fluency, while the practical faculties, being dominant,
+would give clearness, perspicacity, and directness to his style of
+expression, either oral or written. Time, Order, Reason, and Intuition
+are well developed. The long-continued observation and experiments of
+this noble physician in his endeavor to protect humanity from the
+ravages of small-pox by his discovery of vaccination, met at last with a
+suitable recognition, for he received by a vote of Parliament the sum of
+&pound;30,000, and special honors were awarded him. It is a singular
+fact that all of the benefactors of the human race&mdash;those who have
+benefited it by discoveries of any kind whatever&mdash;have met with the
+most violent opposition, treachery, and often disgrace, before they
+could make the world see the value of their discoveries. Such was the
+case with Dr. Jenner, but his firmness and truth at last gained the
+victory.</p></div>
+
+<p>The best <i>form</i> for a surgeon who attempts the most severe
+operations is the round build of body and head, and many of them
+are of this shape. The muscular system should be supreme, with
+the brain system a close second, the bony and thoracic systems
+about equal and next in development.</p>
+
+<p>The muscular tissue is <i>comparatively unfeeling</i>&mdash;insensitive;</p>
+
+<hr class='minor' />
+
+<div class="figcenter" style="width: 325px;">
+<img src="images/illus-fac3.png" width="301" height="500" alt="" title=""
+style='border:black solid 1px; padding:12px;' /></div>
+
+<p class='sc lc noin c'>OTHER CLASSES OF SURGEONS <span class='ralign'>1145</span><br /></p>
+
+<p class='noin'>in the body. Form and Size are also requisite to aid the memory of the
+shape and relative position of each part, and to assist Locality. Human
+Nature is essential in order that he may be <i>en rapport</i> with his
+patients, and also to enable him to <i>divine</i> instinctively all bodily
+and mental states. He should be a good physiognomist, and be well versed
+in the <i>pathology</i> of physiognomy. He must have large Observation, in
+order to take cognizance of the most minute changes and appearances.
+Calculation is a useful trait also, as it is required in many ways in
+the medication and treatment of the wounded, as in chemistry and in
+making surgical implements, etc. He should have large Friendship; in
+order to attach his patients to him and to command their esteem; enough
+Benevolence to sympathize, but not enough to weaken the feelings when
+severity is required. The faculty of Amativeness is necessary to
+<i>comprehend</i> the nature of the opposite sex; Love of Young also, that he
+may inspire children with love and confidence.</p>
+
+<p>The sense of Weight should be a strong one, for the muscular sense is
+dependent upon its power in order to <i>gauge</i> the amount of force to be
+used in handling instruments and in bandaging wounds, limbs, etc.
+Executiveness is required to assist authority and give resistance.
+Self-will is another ally most necessary, as well as Analysis, Time,
+Order, and Reason. A fair share of musical ability is required to assist
+the ear in making examinations of the heart and lungs, and in
+auscultation for various other purposes. If to these faculties one adds
+large Intuition, he has a fine bodily and mental equipment for the
+practice of surgery.</p>
+
+<p class='sc lc mt1 noin c'>OTHER CLASSES OF SURGEONS.</p>
+
+<p>Many army surgeons are characterized by a round and broad form, with
+broad, rather low, and round heads; short, round arms, and round and
+tapering fingers. This build is the most suitable for those severe
+operations which require the greatest exhibition of force, endurance,
+and coolness; another class of surgeons&mdash;those who undertake the
+more delicate and less forceful operations&mdash;are characterized by
+about an equal development of the brain and muscular systems. This class
+of surgeons tend naturally to the treatment of those finer, less
+difficult, and more delicate cases of operative surgery, such, for
+example, as treatment of the ear, the eye, etc. This class of surgeons
+require a fine endowment of the brain and nervous system. In short, the
+muscles as well as nerves of this class must be sensitive to a great
+degree, and this combination calls for a fine and high organization.</p>
+
+<p>The surgeon should be something of an actor in order to know when to be
+sympathetic and when to be severe. Yet he</p>
+
+<hr />
+
+<div class='bbox'>
+<h3>Transcriber&rsquo;s Notes &amp; Errata</h3>
+
+<p>The last three pages of the book are facsimile pages from another book.
+I have placed the pages in the text as illustrations followed by their
+transricptions.</p>
+
+<p>Footnotes 25-30 have been renumbered in sequence.</p>
+
+<p>The anchor for footnote 102 was missing. Has been inserted at the
+appropriate place.</p>
+
+<p>&lsquo;oe&rsquo; ligatures have been replaced by separate
+&lsquo;o&rsquo; and &lsquo;e&rsquo; characters.</p>
+
+<p>The following words were found in both hyphenated and unhyphenated forms
+once each.</p>
+
+<div class='center'>
+<table border="1" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>bed-clothes</td><td align='left'>bedclothes</td></tr>
+<tr><td align='left'>co-existence</td><td align='left'>coexistence</td></tr>
+<tr><td align='left'>short-comings</td><td align='left'>shortcomings</td></tr>
+</table></div>
+
+<p>The word &lsquo;pre-cancerous&rsquo; occurred four times in the text,
+while &lsquo;precancerous&rsquo; occurred twice, both in the index.
+These index entries have been hyphenated.</p>
+
+<p>The following typographical errors have been corrected.</p>
+
+<div class='center'>
+<table border="1" cellpadding="4" cellspacing="0" summary="">
+<tr class='b'><td align='left'>Page</td><td align='left'>Error</td><td align='left'>Correction</td></tr>
+<tr><td align='right'>14</td><td align='left'>route</td><td align='left'>rout</td></tr>
+<tr><td align='right'>58</td><td align='left'>prepuse</td><td align='left'>prepuce</td></tr>
+<tr><td align='right'>69</td><td align='left'>a a</td><td align='left'>a</td></tr>
+<tr><td align='right'>99</td><td align='left'>siezes</td><td align='left'>seizes</td></tr>
+<tr><td align='right'>102</td><td align='left'>St&egrave;rilit&egrave;</td><td align='left'>St&eacute;rilit&eacute;</td></tr>
+<tr><td align='right'>114</td><td align='left'>others</td><td align='left'>others&rsquo;</td></tr>
+<tr><td align='right'>170</td><td align='left'>Tranyslvania</td><td align='left'>Transylvania</td></tr>
+<tr><td align='right'>179</td><td align='left'>occasian</td><td align='left'>occasion</td></tr>
+<tr><td align='right'>195</td><td align='left'>suprised</td><td align='left'>surprised</td></tr>
+<tr><td align='right'>205</td><td align='left'>function</td><td align='left'>junction</td></tr>
+<tr><td align='right'>206</td><td align='left'>orginated</td><td align='left'>originated</td></tr>
+<tr><td align='right'>226</td><td align='left'>smoulderd</td><td align='left'>smouldered</td></tr>
+<tr><td align='right'>227</td><td align='left'>wes</td><td align='left'>was</td></tr>
+<tr><td align='right'>237</td><td align='left'>tisses</td><td align='left'>tissues</td></tr>
+<tr><td align='right'>239</td><td align='left'>dut</td><td align='left'>but</td></tr>
+<tr><td align='right'>242</td><td align='left'>innner</td><td align='left'>inner</td></tr>
+<tr><td align='right'>263</td><td align='left'>may</td><td align='left'>many</td></tr>
+<tr><td align='right'>290</td><td align='left'>brakemen</td><td align='left'>brakeman</td></tr>
+<tr><td align='right'>307</td><td align='left'>thinnes</td><td align='left'>thinness</td></tr>
+<tr><td align='right'>333</td><td align='left'>totel</td><td align='left'>total</td></tr>
+<tr><td align='right'>342</td><td align='left'>America</td><td align='left'>American</td></tr>
+</table></div>
+
+</div>
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of History of Circumcision from the
+Earliest Times to the Present, by Peter Charles Remondino
+
+*** END OF THIS PROJECT GUTENBERG EBOOK HISTORY OF CIRCUMCISION ***
+
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@@ -0,0 +1,11743 @@
+The Project Gutenberg EBook of History of Circumcision from the Earliest
+Times to the Present, by Peter Charles Remondino
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: History of Circumcision from the Earliest Times to the Present
+       Moral and Physical Reasons for its Performance
+
+Author: Peter Charles Remondino
+
+Release Date: October 21, 2007 [EBook #23135]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK HISTORY OF CIRCUMCISION ***
+
+
+
+
+Produced by Bryan Ness, LN Yaddanapudi and the Online
+Distributed Proofreading Team at https://www.pgdp.net (This
+file was produced from images generously made available
+by The Internet Archive/Million Book Project)
+
+
+
+
+
+
+
+
+
+No. 11 IN THE PHYSICIANS' AND STUDENTS' READY REFERENCE SERIES
+
+
+HISTORY OF CIRCUMCISION FROM THE EARLIEST TIMES TO THE PRESENT.
+
+MORAL AND PHYSICAL REASONS FOR ITS PERFORMANCE, WITH A HISTORY OF
+EUNUCHISM, HERMAPHRODISM, ETC., AND OF THE DIFFERENT OPERATIONS
+PRACTICED UPON THE PREPUCE.
+
+BY
+
+P. C. REMONDINO, M.D.
+(JEFFERSON),
+
+Member of the American Medical Association, of the American Public
+Health Association, of the San Diego County Medical Society, of the
+State Board of Health of California, and of the Board of Health of the
+City of San Diego; Vice-President of California State Medical Society
+and of Southern California Medical Society, etc.
+
+[Illustration]
+
+PHILADELPHIA AND LONDON:
+F. A. DAVIS, PUBLISHER.
+1891.
+
+Entered according to Act of Congress, in the year 1891, by
+F. A. DAVIS,
+In the Office of the Librarian of Congress, at Washington, D.C., U.S.A.
+
+
+Philadelphia Pa., U. S. A.:
+The Medical Bulletin Printing House,
+1231 Filbert Street.
+
+[Illustration: HEBRAIC CIRCUMCISION]
+
+
+
+
+PREFACE.
+
+
+In ancient Egypt the performance of circumcision was at one time limited
+to the priesthood, who, in addition to the cleanliness that this
+operation imparted to that class, added the shaving of the whole body as
+a means of further purification. The nobility, royalty, and the higher
+warrior class seem to have adopted circumcision as well, either as a
+hygienic precaution or as an aristocratic prerogative and insignia.
+Among the Greeks we find a like practice, and we are told that in the
+times of Pythagoras the Greek philosophers were also circumcised,
+although we find no mention that the operation went beyond the
+intellectual class. In the United States, France, and in England, there
+is a class which also observe circumcision as a hygienic precaution,
+where, from my personal observation, I have found that circumcision is
+thoroughly practiced in every male member of many of the families of the
+class,--this being the physician class. In general conversation with
+physicians on this subject, it has really been surprising to see the
+large number who have had themselves circumcised, either through the
+advice of some college professor while attending lectures or as a result
+of their own subsequent convictions when engaged in actual practice and
+daily coming in contact both with the benefits that are to be derived in
+the way of a better physical, mental, and moral health, as well as with
+the many dangers and disadvantages that follow the uncircumcised,--the
+latter being probably the most frequent incentive and determinator,--as
+in many of these latter examples the operation of circumcision, with its
+pains, annoyances, and possible and probable dangers, sink into the most
+trifling insignificance in comparison to some of the results that are
+daily observed as the tribute that is paid by the unlucky and unhappy
+wearer of a prepuce for the privilege of possessing such an appendage.
+
+There is one thing that must be admitted concerning circumcision: this
+being that, among medical men or men of ordinary intelligence who have
+had the operation performed, instead of being dissatisfied, they have
+extended the advantages they have themselves received, by having those
+in their charge likewise operated upon. The practice is now much more
+prevalent than is supposed, as there are many Christian families where
+males are regularly circumcised soon after birth, who simply do so as a
+hygienic measure.
+
+For the benefit of these, who may congratulate themselves upon the
+dangers and annoyances that they and their families have escaped, and
+for the benefit of those who would run into these dangers but for timely
+warning, this book has been especially written. To my professional
+brothers the book will prove a source of instruction and recreation,
+for, while it contains a lot of pathology regarding the moral and
+physical reasons why circumcision should be performed, which might be as
+undigestible as a mess of Boston brown bread and beans on a French
+stomach, I have endeavored to make that part of the book readable and
+interesting. The operative chapter will be particularly useful and
+interesting to physicians, as I have there given a careful and impartial
+review of all the operative procedures,--from the most simple to the
+most elaborate,--besides paying more than particular attention to the
+subject of after-dressings. The part that relates to the natural history
+of man will interest all manner of people. I regret that the tabular
+statistics are not to be had, but in this regard we must use our best
+judgment from the material we have on hand; at any rate, I have tried to
+furnish a sufficiency of facts, so that, unless the reader is too
+overexacting, he will not find much difficulty in arriving at a
+conclusion on the subject.
+
+P. C. REMONDINO, M.D.
+
+SAN DIEGO, CALIFORNIA, 1891.
+
+
+
+
+CONTENTS.
+
+
+                                                        PAGE
+
+PREFACE,                                                 iii
+
+INTRODUCTION,                                              1
+
+CHAPTER I.
+ANTIQUITY OF CIRCUMCISION,                                21
+
+CHAPTER II.
+THEORIES AS TO THE ORIGIN OF CIRCUMCISION,                28
+
+CHAPTER III.
+SPREAD OF CIRCUMCISION,                                   34
+
+CHAPTER IV.
+CIRCUMCISION AMONG SAVAGE TRIBES,                         42
+
+CHAPTER V.
+INFIBULATION, MUZZLING, AND OTHER CURIOUS PRACTICES,      46
+
+CHAPTER VI.
+ATTEMPTS TO ABOLISH CIRCUMCISION,                         63
+
+CHAPTER VII.
+MIRACLES AND THE HOLY PREPUCE,                            70
+
+CHAPTER VIII.
+HISTORY OF EMASCULATION, CASTRATION, AND EUNUCHISM,       82
+
+CHAPTER IX.
+PHILOSOPHICAL CONSIDERATIONS RELATING TO EUNUCHISM AND
+MEDICINE,                                                105
+
+CHAPTER X.
+HERMAPHRODISM AND HYPOSPADIAS,                           117
+
+CHAPTER XI.
+RELIGIO MEDICI,                                          134
+
+CHAPTER XII.
+HEBRAIC CIRCUMCISION,                                    143
+
+CHAPTER XIII.
+MEZIZAH, THE FOURTH OR OBJECTIONABLE ACT OF SUCTION,     150
+
+CHAPTER XIV.
+WHAT ARE THE BENEFITS OF CIRCUMCISION?                   161
+
+CHAPTER XV.
+PREDISPOSITION TO AND EXEMPTION AND IMMUNITY FROM
+DISEASE,                                                 183
+
+CHAPTER XVI.
+THE PREPUCE, SYPHILIS, AND PHTHISIS,                     187
+
+CHAPTER XVII.
+SOME REASONS FOR BEING CIRCUMCISED,                      200
+
+CHAPTER XVIII.
+THE PREPUCE AS AN OUTLAW, AND ITS EFFECTS ON THE GLANS,  206
+
+CHAPTER XIX.
+IS THE PREPUCE A NATURAL PHYSIOLOGICAL APPENDAGE?        217
+
+CHAPTER XX.
+THE PREPUCE, PHIMOSIS, AND CANCER,                       226
+
+CHAPTER XXI.
+THE PREPUCE AND GANGRENE OF THE PENIS,                   236
+
+CHAPTER XXII.
+THE PREPUCE, CALCULI, AND OTHER ANNOYANCES,              248
+
+CHAPTER XXIII.
+REFLEX NEUROSES AND THE PREPUCE,                         254
+
+CHAPTER XXIV.
+DYSURIA, ENURESIS, AND RETENTION OF URINE,               275
+
+CHAPTER XXV.
+GENERAL SYSTEMIC DISEASES INDUCED BY THE PREPUCE,        284
+
+CHAPTER XXVI.
+SURGICAL OPERATIONS PERFORMED ON THE PREPUCE,            302
+
+NOTES TO TEXT,                                           323
+
+WORKS AND AUTHORITIES QUOTED,                            336
+
+INDEX,                                                   339
+
+
+
+
+INTRODUCTION.
+
+
+This book is the amplification of a paper, the subject of which was, "A
+Plea for Circumcision; or, the Dangers that Arise from the Prepuce,"
+which was read at the meeting of the Southern California Medical
+Society, at Pasadena, in December, 1889. The material gathered for that
+paper was more than could be used in the ordinary limits of a society
+paper; it was gathered and ready for use, and this suggested its
+arrangement into book form. The subject of the paper was itself
+suggested by a long and personal observation of the changes made in man
+by circumcision. From the individual observation of cases, it was but
+natural to wish to enlarge the scope of our observation and comparison;
+this naturally led to a study of the physical characteristics of the
+only race that could practically be used for the purpose. This race is
+the Jewish race. On carefully studying into the subject, I plainly saw
+that much of their longevity could consistently be ascribed to their
+more practical humanitarianism, in caring for their poor, their sick, as
+well as in their generous provision for their unfortunate aged people.
+The social fabric of the Jewish family is also more calculated to
+promote long life, as, strangely as it may seem, family veneration and
+family love and attachment are far more strong and practical among this
+people than among Christians, this sentiment not being even as strong in
+the Christian races as it is in the Chinese or Japanese. It certainly
+forms as much of a part of the teachings of Christianity as it does of
+Judaism, Buddhism, or Confucianism, only Christians, as a mass, have
+practically forgotten it. The occupation followed by the Jews also in a
+certain degree favors longevity, and the influence on heredity induced
+by all these combined conditions goes for something. But it is not alone
+in the matter of simple longevity--although that implies
+considerable--that the Jewish race is found to be better situated.
+Actual observations show them to be exempt from many diseases which
+affect other races; so that it is not only that they recover more
+promptly, but that they are not, as a class, subjected to the loss of
+time by illness, or to the consequent sufferings due to illness or
+disease, in anything like or like ratio with other people.
+
+There is also a less tendency to criminality, debauchery, and
+intemperance in the race; this, again, can in a measure be ascribed to
+their family influence, which even in our day has not lost that
+patriarchal influence which tinges the home or family life in the Old
+Testament. Crimes against the person or property committed by Jews are
+rare. They likewise do not figure in either police courts or
+penitentiary records; they are not inmates of our poor-houses, but, what
+is also singular, they are never accused of many silly crimes, such as
+indecent exposures, assaults on young girls; nor do they figure in any
+such exposures as the one recently made by the _Pall Mall Gazette_.
+
+After allowing all that, which we can, in its fullest limit, to
+religion, family, or social habit, there is still a wide margin to be
+accounted for. This has naturally let the inquiry, followed in the
+course of this book, into a careful review of the Jewish people; into
+their religion and its character, its relation to other creeds, and to
+the world's history; into their many wanderings, and into the
+dispersion, and we have even been obliged to follow them into the midst
+of the people among whom they have become nationed, to try, if possible,
+to find the cause of this racial difference in health, resistance to
+disease, decay, and death. It has been necessary, in following out the
+research, to give a condensed _resume_ of the religious, political, and
+social condition of the Jewish commonwealth, which, although in a state
+of dispersion, still exists. I need offer no apology for the extended
+notice this has received in the course of the book. We read with
+increasing interest either Hallam or May, Buckle or Guizot, through the
+spasmodic, halting, retrograding, advancing, erratic, aimless, and
+accidental phases that England has plowed through, from the days of
+goutless, simple, and chaste, but barbarian England of the Saxons, to
+the present civilized, enlightened, gouty, "Darkest England" of General
+Booth; and, after all is said and done, we are no wiser in any practical
+resulting good. We simply know that the English people, so to speak,
+have, as it were, gone through the figures of some social aspects, as if
+dancing the "Lancers," with its forward and back movements, gallop,
+etc., and have finally sat down, better dressed and better housed, but
+in an acquired state of moral and physical degeneration. The Briton of
+Queen Victoria is not the Briton of Queen Boadicea, either morally or
+physically. On the other hand, the system of sociological tables adopted
+by Herbert Spencer would have but little to record for some six thousand
+years--either in religion, morals, or physique--as making any changes in
+the history of that simple people which, in the mountainous regions of
+Ur, in distant Armenia, started on its pilgrimage of life and racial
+existence; in one branch of the family--that of Ishmael--the changes to
+be recorded are so invisible that its descendants may really be said to
+live to-day as they lived then. So that I do not feel that I need to
+apologize for the space I have given to this subject in the course of
+the book. The causes that make these racial distinctions should be of
+interest alike to the moralist, theologist, sociologist, and to the
+physician.
+
+Ecclesiastical writers and moralists, as well as writers of fiction or
+dramatizers, can write on anything they please, and it is eagerly taken
+up and read by the people generally, either of high or low degree,
+alike; and somehow these people seem never to require an apology on the
+part of the author, for having attempted rapes, seductions, or even
+unavoidable fornication committed through the leaves of the story, or
+having it imaginably take place between acts on the stage. But if the
+physician writes a book touching anything connected with the generative
+functions, and with the best intent and for the good of humanity, he is
+expected to make some prefatory apology. He is supposed to address a
+public who all of a sudden have become intensely moral and extremely
+sensitive in their modesty. Why things are thus I cannot explain. They
+are so, nevertheless. From the time that the celebrated Astruc wrote his
+treatise on female diseases, near the end of the seventeenth
+century,--who felt compelled by the extreme modesty of the people in
+this particular--but who, outside of medicine, were about as virtuous as
+the average Tabby or Tom cats in the midnight hour--to write the chapter
+touching on nymphomania in Latin, so as not to shock the morbidly
+sensitive modesty of the French nobility, who then enjoyed _Le Droit de
+cuissage_,--down through to Bienville, who wrote the first extended work
+on nymphomania, and Tissot, who first broached the subject and the
+danger of Onanism, all have felt that they must stop on the threshold
+and "apologize." Tissot, however, seemed to possess a robust and a plain
+Hippocratic mind, and as he apologized he could not help but see the
+ridiculousness of so doing, as in the preface to his work we find the
+following: "Shall we remain silent on so important a subject? By no
+means. The sacred authors, the Fathers of the Church, who present their
+thoughts in living words, and ecclesiastical authors have not felt that
+silence was best. I have followed their example, and shall exclaim, with
+St. Augustine, 'If what I have written scandalizes any prudish persons,
+let them rather accuse the turpitude of their own thoughts than the
+words I have been obliged to use.'"
+
+For my part, I think that people who can go to the theatre and enjoy "As
+in a Looking-Glass," and witness some of the satyrical or billy-goat
+traits of humanity so graphically exhibited in "La Tosca," with evident
+satisfaction; or attend the more robust plays of "Virginius" or of
+"Galba, the Gladiator," with all its suggestions of the Caesarian
+section, and the lust and the fornications of an intensely animal Roman
+empress, without the destruction of their moral equilibrium or tending
+to induce in them a disposition to commit a rape on the first met,--I
+think such people can be safely intrusted to read this book.
+
+And as to the reading public, there are but few general readers who
+could honestly plead an ignorance of the "Decameron," Balzac, La
+Fontaine, "Heptameron," Crebillon _fils_, or of matter-of-fact Monsieur
+le Docteur Maitre Rabelais,--works which, more or less, carry a moral
+instruction in every tale, which, like the tales of the "Malice of
+Women," in the unexpurged edition of the literal translation of the
+"Arabian Nights," contains much more of practical moral lessons, even if
+in the flowery and warm, spiced language of the Orient, than any
+supposed nastiness, on account of which they are classed among the
+prohibited. To these, and the readers of Amelie Rives's books, or other
+intensely realistic literature, I need not imitate the warning of
+Ansonius, who warned his readers on the threshold of a part of his book
+to "stop and consider well their strength before proceeding with its
+lecture." Metaphorically speaking, the general theatre-going, or modern
+literature-reading public, can be considered pretty callous and morally
+bullet proof. I shall therefore make no apology.
+
+Some fault may, perhaps, be found with some of the occasional style of
+the book, or with some of the subjects used to illustrate a principle.
+To the extremely wise, good, and scientific, these illustrations were
+unnecessary; this need hardly be mentioned; and the passages which to
+some may prove objectionable were not intended for them, either with the
+expectation of delighting them or with the purpose of shocking them.
+These passages, they can easily avoid. This book, however, was written
+that it might be read: not only read by the Solon, Socrates, Plato, or
+Seneca of the laity or the profession, but even by the billy-goated
+dispositioned, vulgar plebeian, who could no more be made to read cold,
+scientific, ungarnished facts than you can make an unwilling horse drink
+at the watering-trough. Human weakness and perversity is silly, but it
+is sillier to ignore that it exists. So, for the sake of boring and
+driving a few solid facts into the otherwise undigesting and unthinking,
+as well as primarily obdurate understanding of the untutored plebeian, I
+ask the indulgence of the intelligent and broad-minded as well as the
+easily inducted reader. Cleopatra was smuggled into Caesar's presence in
+a roll of tapestry; the Greeks introduced their men into Troy by means
+of a wooden horse; and the discoverer of the broad Pacific Ocean made
+his escape from his importunate creditors disguised as a cask of
+merchandise. So, when we wish to accomplish an object, we must adopt
+appropriate means, even if they may apparently seem to have an entirely
+diametrically opposite object. The Athenian, Themistocles, when wishing
+to make the battle of Salamis decisive, was inspired with the idea of
+sending word to the Persian monarch that the Greeks were trying to
+escape, advising him to block the passage; this saved Greece.
+
+There is a weird and ghostly but interesting tale connected with the
+Moslem conquest of Spain, of how Roderick, the last of the Gothic kings,
+when in trouble and worry, repaired to an old castle, in the secret
+recesses of which was a magic table whereon would pass in grim
+procession the different events of the future of Spain; as he gazed on
+the enchanted table he there saw his own ruin and his country's and
+nation's subjugation. Anatomy is generally called a dry study, but, like
+the enchanted brazen table in the ancient Gothic castle, it tells a no
+less weird or interesting tale of the past. Its revelations lighten up a
+long vista, through the thousands of years through which the human
+species has evolved from its earliest appearance on earth, gradually
+working up through the different evolutionary processes to what is
+to-day supposed to be the acme of perfection as seen in the
+Indo-European and Semitic races of man. Anatomy points to the
+rudiment--still lingering, now and then still appearing in some one man
+and without a trace in the next--of that climbing muscle which shows man
+in the past either nervously escaping up the trunk of a tree in his
+flight from many of the carnivorous animals with whom he was
+contemporary, or, as the shades of night were beginning to gather
+around him, we again see him by the aid of these muscles leisurely
+climbing up to some hospitable fork in the tree, where the robust habits
+of the age allowed him to find a comfortable resting-place; protected
+from the dew of the night by the overhanging branches and from the
+prowling hyena by the height of the tree, he passed the night in
+security. The now useless ear-muscles, as well as the equally useless
+series of muscles about the nose, also tell us of a movable, flapping
+ear capable of being turned in any direction to catch the sound of
+approaching danger, as well as of a movable and dilated nostril that
+scented danger from afar,--the olfactory sense at one time having a
+different function and more essential to life than that of merely noting
+the differential aroma emitted by segars or cups of Mocha or Java, and
+the ear being then used for some more useful purpose than having its
+tympanum tortured by Wagnerian discordant sounds. Our ancestors might
+not have been a very handsome set, nor, judging from the Neanderthal
+skull, could they have had a very winning physiognomy, but they were a
+very hardy and self-reliant set of men. Nature--always careful that
+nothing should interfere with the procreative functions--had provided
+him with a sheath or prepuce, wherein he carried his procreative organ
+safely out of harm's way, in wild steeple-chases through thorny briars
+and bramble-brakes, or, when hardly pushed, and not able to climb
+quickly a tree of his own choice, he was by circumstances forced up the
+sides of some rough-barked or thorny tree. This leathery pouch also
+protected him from the many leeches, small aquatic lizards, or other
+animals that infested the marshes or rivers through which he had at
+times to wade or swim; or served as a protection from the bites of ants
+or other vermin when, tired, he rested on his haunches on some mossy
+bank or sand-hill.
+
+Man has now no use for any of these necessaries of a long-past age,--an
+age so remote that the speculations of Ernest Renan regarding the
+differences between the Semitic race of Shem and the idolatrous
+descendants of Ham, away off in the far mountains and valleys of Asia
+lying between the Mediterranean Sea and the Euphrates, seem more as if
+he were discussing an event of yesterday than something which is
+considered contemporary with our earlier history,--and we find them
+disappearing, disuse gradually producing an obliteration of this tissue
+in some cases, and the modifying influence of evolution producing it in
+others; the climbing muscle, probably the oldest remnant and legacy that
+has descended from our long-haired and muscular ancestry, is the best
+example of disappearance caused by disuse, while the effectual
+disappearance of the prepuce in many cases shows that in that regard
+there exists a marked difference in the evolutionary march among
+different individuals.
+
+There is a strange and unaccountable condition of things, however,
+connected with the prepuce that does not exist with the other vestiges
+of our arboreal or sylvan existence. Firstly, the other conditions have
+nothing that interferes with their disappearance; whereas the prepuce,
+by its mechanical construction and the expanding portions which it
+incloses, tends at times rather to its exaggerated development than to
+its disappearance. Again, whereas the other vestiges have no injury that
+they inflict by their presence, or danger that they cause their
+possessors to run, the prepuce is from time of birth a source of
+annoyance, danger, suffering, and death. Then, again, the other
+conditions are not more developed at birth; whereas the prepuce seems,
+in our pre-natal life, to have an unusual and unseen-for-use existence,
+being in bulk out of all proportion to the organ it is intended to
+cover. Speculation as to its existence is as unprolific of results as
+any we may indulge in regarding the nature, object, or uses of that
+other evolutionary appendage, the appendix vermiformis, the recollection
+of whose existence always adds an extra flavor to tomatoes, figs, or any
+other small-seeded fruits.
+
+We may well exclaim, as we behold this appendage to man,--now of no use
+in health and of the most doubtful assistance to the very organ it was
+intended to protect, when that organ, through its iniquitous tastes, has
+got itself into trouble, and, Job-like, is lying repentant and sick in
+its many wrappings of lint, with perhaps its companions in crime
+imprisoned in a suspensory bandage,--what is this prepuce? Whence, why,
+where, and whither? At times, Nature, as if impatient of the slow march
+of gradual evolution, and exasperated at this persistent and useless as
+well as dangerous relic of a far-distant prehistoric age, takes things
+in her own hands and induces a sloughing to take place, which rids it of
+its annoyance. In the far-off land of Ur, among the mountainous regions
+of Kurdistan, something over six thousand years ago, the fathers of the
+Hebrew race, inspired by a wisdom that could be nothing less than of
+divine origin, forestalled the process of evolution by establishing the
+rite of circumcision. Whether this has been beneficial or injurious to
+the race will be, in a measure, the object of the discussion in this
+book.
+
+One object of this book is to furnish my professional brothers with some
+embodied facts that they may use in convincing the laity in many cases
+where they themselves are convinced that circumcision is absolutely
+necessary; but, having nothing in their text-books to back up their
+opinion with, their explanations are too apt to pass for their mere
+unfounded personal view of the matter. If the patient, or the parents of
+the patient, ask the physician for his authority, he is at a loss, as
+there is nothing that deals with the subject in any extended manner; so
+that this book has been written in as plain English as the
+subject-matter could possibly allow, so that non-professionals could
+easily read and understand it. I have often felt the need of such a
+work; people can understand emergency or accident surgery, military
+surgery, or reparative surgery, but such a thing as surgery to remedy a
+seemingly medical disease, or what might be called the preventive
+practice of surgery, is something they cannot understand. First, and not
+the least, among the incentives to skepticism on this subject is the
+unwelcome fact of a surgical operation, which, no matter how trivial it
+may seem to the surgeon, is a matter of considerable magnitude to the
+patient, his parents, or friends; there are risks, pain, worry,
+annoyances, and expenses to be undergone,--considerations which, either
+singly or unitedly, often lead one to reason against the operation, even
+when otherwise convinced of its need or utility.
+
+The hardest to convince are those, however, who insist on having a
+four-and-a-half-foot-gauge fact driven through their two-foot-gated
+understanding, without it ever occurring to them that the gate, and not
+the fact, is the faulty article, Some of these gentry are very
+unconvincible. They at times remind one of that description given by
+Carlyle in regard to one of the Georges, who found himself, when Prince
+of Wales, leading an army in Flanders, and actually engaged in a
+battle. His Royal Highness was on foot, and was seen standing facing the
+enemy, with outstretched legs, like a Colossus of Rhodes, impassive and
+stolid,--the very impersonification of Dutch courage and aggressiveness.
+There he stood, unconscious whether he was at the head of an army or
+single attendant; he might be overridden and annihilated, overturned and
+expunged, but there he would most assuredly stand and fall, if need be;
+overwhelming squadrons, by their impetus and weight, might ride him down
+and crush him; but one thing was most certain, this certain fact being
+that he never could be made to retreat or advance, as no impression from
+front or rear could convince him of the necessity of either.
+
+Then, there is our statistical friend, who cannot discriminate between
+the exception and the rule by any common-sense deductions. He must have
+all the authentic, carefully-compiled statistics before he can allow
+himself to form any opinion. As long as there is the smallest fraction
+of a decimal unaccounted for in a mathematical way, this individual is
+inconvincible. These men pride themselves upon being methodically exact;
+they express their willingness to be convinced if you can present
+acceptable proofs; but, trying to present simple rational proofs to
+these individuals is considerably like presenting a meal of boiled pork
+and cabbage to a confirmed and hypochondriacal dyspeptic,--it only
+increases their mental dyspepsia.
+
+Had Columbus waited to discover America, or had Galileo waited to
+proclaim the motion of the earth, until authorized to a serious
+consideration of the matter by properly-tabled statistics, they would
+have waited a long, long time; and, it may be added, the inconveniences
+that attend the proving of a negative will so interfere with the proper
+arrangement of statistical matter which relates to the prepuce and
+circumcision that, before such tables could be satisfactorily and
+convincingly constructed, time and the evolutionary processes that
+follow it will bid fair to completely remove this debatable appendage
+from man. It may be at a very far-distant period that this evolutionary
+preputial extinction will take place,--probably contemporary with the
+existence of Bulwer's "Coming Race,"--but not at a too remote period for
+the proper and satisfactory tabulation of the statistics.
+
+The ideas of the etiology and pathological processes through which we
+journey,--from a condition of health and good feeling to one of disease,
+miserable feeling, and death,--as described in, or rather as they
+control the sentiment and policy of, this work, are such as have been
+followed by Hutchinson, Fothergill, Beale, Black, Albutt, and
+Richardson, so that if I have totally ignored the old conventional
+systems, with their hide-bound classification of diseases to control the
+etiology, I have not done so without some reliable authority. In
+studying the etiology of diseases we have, as a rule, been content to
+accept the disease when fully formed and properly labeled, being
+apparently satisfied with beginning our investigation not at the initial
+point of departure from health, but at some distant point from this, at
+the point where this departure has elaborated itself, on favorable
+ground, into a tangible general or local disease. As truthfully observed
+by T. Clifford Albutt: "The philosophic inquirer is not satisfied to
+know that a person is suffering, for example, from a cancer. He desires
+to know why he is so suffering,--that is, what are the processes which
+necessarily precede or follow it. He wishes to include this phenomena,
+now isolated, in a series of which it must necessarily be but a member,
+to trace the period of which it must be but a phase. He believes that
+diseased processes have their evolution and the laws of it, as have
+other natural processes, and he believes that these are fixed and
+knowable." To do this, the physician must travel beyond the beaten path
+of etiology as found in our text-books. He must follow Hutchinson in the
+train of reasoning that elucidates the pre-cancerous stage of cancer, or
+tread in the path followed by Sir Lionel Beale, in finding that the
+cause of disease depends on a blood change and the developmental defect,
+or the tendency or inherent weakness of the affected part or organ; to
+fully appreciate the inherent etiological factors that reside in man,
+and which constitute the tendency to disease or premature decay and
+death, we must also be able to follow Canstatt, Day, Rostan, Charcot,
+Rush, Cheyne, Humphry, or Reveille-Parise into the study of the
+different conditions which, though normal, are nevertheless factors of a
+slow or a long life. We must also be able to appreciate fully the value
+of that interdependence of each part of our organism, which often, owing
+to a want of equilibrium of strength and resistance in some part when
+compared to the rest, causes the whole to give way, just as a flaw in a
+levee will cause the whole of the solidly-constructed mass to give way,
+or a demoralized regiment may entail the utter rout of an army. As
+described by George Murray Humphry, in his instructive work on "Old
+Age," at page 11:--
+
+"The first requisite for longevity must clearly be an inherent or inborn
+quality of endurance, of steady, persistent nutritive force, which
+includes reparative force and resistance to disturbing agencies, and a
+good proportion or balance between the several organs. Each organ must
+be sound in itself, and its strength must have a due relation to the
+strength of the other organs. If the heart and the digestive system be
+disproportionately strong, they will overload and oppress the other
+organs, one of which will soon give way; and, as the strength of the
+human body, like that of a chain, is to be measured by its weaker link,
+one disproportionately feeble organ endangers or destroys the whole. The
+second requisite is freedom from exposure to the various casualties,
+indiscretions, and other causes of disease to which illness and early
+death are so much due."
+
+In following out our study of diseases, we have been too closely
+narrowed down by the old symptomatic story of disease; we have too much
+treated surface symptoms, and neglected to study the man and his
+surroundings as a whole; we have overlooked the fact that there exists a
+geographical fatalism in a physical sense as well as the existence of
+the influence of that climatic fatalism so well described by Alfred
+Haviland, and the presence of a fatalism of individual constitution as
+well, which is either inherited or acquired. The idea that Charcot
+elaborates, that, as the year passes successively through the hot and
+the cold, through the dry and the wet season, with advancing age the
+human body undergoes like changes, and diseases assume certain
+characteristics, are also points that are overlooked; and nowhere is
+this latter view seen to be more neglected than in the relations the
+prepuce bears to infancy, prime and old age, as will be more fully
+explained in the chapters in this book which treat of cancer and
+gangrene. Admitting that Haviland has exaggerated the influence of
+climate as an etiological factor in its specific influence in producing
+certain diseases; or that M. Taine claims more than he should for his
+"Theorie des Milieux," or influence of surroundings; or that Hutchinson
+has drawn the hereditary and pedigreeal fatherhood of disease too
+finely; it must also be admitted that the solid, tangible truths upon
+which these authors have founded their premises are plainly visible to
+the most skeptical; the architectural details of the superstructure may
+be defective, but the foundation is permanent.
+
+From the above outline it will be easier for the reader to follow out
+the reasons, or the whys or wherefores, of the views expressed on
+medicine in the course of the book; and, although I do not wish to enter
+the medical field like a Peter the Hermit on a new crusade, to lure
+thousands into the hands of the circumcisers, nor, as a new Mohammed,
+promise the eternal bliss and glory of the seventh heaven to all the
+circumcised, I ask of my professional brothers a calm and unprejudiced
+perusal of the tangible and authentic facts that I have honestly
+gathered and conscientiously commented upon from my field of vision,
+which will be plainly presented in the following pages. I simply have
+given the facts and my impressions: the reader is at liberty to draw his
+own conclusions.
+
+If I have been too tedious in the multiplication of incidents in support
+of certain views, I must remind the reader that the verdict goes to him
+who has the preponderance of testimony, and that many a lawsuit is lost
+from the neglect, on the part of the loser, to secure all the available
+testimony. Having brought the subject of circumcision before the bar of
+public opinion, as well as that of my professional brother, I would but
+illy do justice to the subject at the bar, or to myself, not to properly
+present the case; as it was remarked by Napoleon, "God is on the side of
+the heaviest artillery," and he who loses a battle for want of guns
+should not rail at Providence if, having them on hand, he has neglected
+to bring them into action.
+
+The reasons for the existence of the book will become self-evident as
+the reader labors through the medical part of the work. Our text-books
+are, as a class, even those on diseases of children as a specialty,
+singularly and unpardonably silent and deficient on the subject of
+either the prepuce and the diseases to which it leads, or circumcision;
+and even our surgical works are not sufficiently explicit, as they deal
+more with the developed disease and the operative measures for its
+removal than on any preventive surgery or medicine. Our works on
+medicine are equally silent, and, although from a perusal of the latter
+part of the book the prepuce and circumcision will be seen to have
+considerable bearing on the production and nature of phthisis, this
+subject would, owing to our strabismic way of studying medicine, look
+most singularly out of place in a work devoted to diseases of the lungs
+or throat. Owing to this poverty of literature on the subject, and that
+the library of the average practitioner could therefore not furnish all
+the data relating to it that the profession have in their possession, a
+book of this nature will furnish them the required material whereupon to
+form the basis of an opinion on the subject.
+
+To argue that the prepuce is not such a deadly appendage because so many
+escape alive and well who are uncircumcised, would be as logical as to
+assume that Lee's chief of artillery neglected to properly place his
+guns on the heights back of Fredericksburg. He had asserted, the night
+before the battle, that not a chicken could live on the intervening
+plateau between the heights and the town. On the next day, when these
+guns opened their fire, the Federals were unable to reach the heights,
+while many men were for hours in the iron hail-sweeping discharges of
+that artillery that mowed them down by whole ranks, and yet the majority
+escaped alive. We take the middle ground, and, while admitting that many
+escape alive with a prepuce, claim that more are crippled than are
+visibly seen, as, like Bret Harte's "Heathen Chinee," the ways of the
+prepuce are dark and mysterious as well as peculiar.
+
+A discussion of the relative merits of religious creeds, when considered
+in relation to health, has been, from the nature of the subject of the
+book, unavoidable. Modern Christianity but very imperfectly explains why
+this rite was either neglected or abolished. Frequent reference is made
+to what Saint Paul said and did, but, as Saint Paul was not one of the
+Disciples, it is inexplicable wherefrom he received his authority in
+this matter, seeing that the Disciples themselves had no new views on
+the subject. To the student who prefers to study his subject from all
+its aspects, the question naturally arises, "Where, when, and why came
+the authority that abolished this rite?" There is one probable
+explanation, this being that Paul, who was the real promulgator of
+Gentile Christianity, had to establish his creed among an uncircumcised
+race; although, as we shall see, devotees have not scrupled to sacrifice
+their virility in the hope of being more acceptable to God and to be
+better able to observe His commandments, and others, in their blind
+bigotry, have not objected to sitting naked on sand-hills, with a
+six-inch iron ring passed through the prepuce, it is very evident that
+the Apostle Paul's good sense showed him the uselessness of attempting
+to found the new creed, and at the same time hold on to the truly
+distinctive marking of Judaism among Gentiles, the Hebrew race being
+those among whom he found the least converts, as even the Disciples and
+Apostles in Palestine disagreed with him. In the words of Dr. I. M.
+Wise, it was impossible for the Palestine Apostles, or their flock,
+either to acknowledge Paul as one of their own set or submit to his
+teaching; for they obeyed the Law and he abolished it; they were sent to
+the house of Israel only, and Paul sought the Gentiles with the message
+that the Covenant and the Law were at an end; they had one gospel story
+and he another; they prophesied the speedy return of the Master and a
+restoration of the throne of David in the kingdom of heaven, and he
+prophesied the end of the world and the last day of judgment to be at
+hand; they forbade their converts to eat of unclean food, and especially
+of the sacrificial meats of the Pagans, and he made light of both, as
+well as of the Sabbath and circumcision. In the attempted reconciliation
+that subsequently took place in Jerusalem at the house of James, the
+Jacob of Kaphersamia of the Talmud, Paul was charged by the synod of
+Jewish Christians "with disregarding the Law, forsaking the teachings of
+Moses, and attempting to abolish circumcision." He was bid to recant and
+undergo humiliation with four other Nazarenes, that it might be known
+that he walked orderly and observed the Law; Paul submitted to all that
+was demanded.
+
+This, in short, with the exception of the sayings of Paul on the
+subject, which are all secondary considerations, is really all that
+there is relating to the abolishment of circumcision by the Christians.
+The real Disciples and Apostles believed in Jesus with as much fervor as
+Paul, but it is singular that they who were with the Master should
+always have insisted on the observance of the Law, while Paul as
+energetically insisted on its abolishment.
+
+From these premises, I have seen fit to inquire into the relative merits
+of the three religions practiced by what we call the civilized nations,
+as they affect man morally, physically, and mentally. I have given the
+facts, my impressions, and reasons for being so impressed; from these,
+the reader can easily see that religion has more to do with man's
+temporal existence than is generally believed; its discussion is not,
+therefore, out of place in this book.
+
+Repetitions in the course of the work have been unavoidable. This is not
+a novel nor a work of fiction, and wherever the want of repetition would
+have been an injury, either to the proper representation of a fact or a
+principle, the repetition has not been avoided. In describing the
+operations, I had desired to avoid any too numerous descriptions, as
+that is confusing, but have thought it best to give a number, as the
+reader will thereby obtain the views of the different operators, the
+mode of the operation often being an index to the view of the operator
+in regard to the needs or utility of a prepuce. In the general plan of
+the work, I have adopted the idea and the historical relation carried
+out by Bergmann, of Strasburg, who included all the mutilations
+practiced on the genitals while discussing the subject of circumcision,
+they being, in the originality of performance, somewhat intimately
+connected; this also tends to make the subject more interesting as a
+contribution to the natural history of man,--something in which all
+intelligent persons are more or less interested.
+
+P. C. REMONDINO, M.D.
+SAN DIEGO, CALIFORNIA.
+
+[Illustration: EGYPTIAN CIRCUMCISION.
+
+(From Chabas and Ebers' description of the bas-relief found in the
+temple of Khons, near the great temple of Maut, at Karnac.)]
+
+
+
+
+CHAPTER I.
+
+ANTIQUITY OF CIRCUMCISION.
+
+
+If the ceremonials of the Catholic Church or the High Church
+Episcopalians carry us back into the depths of antiquity, or, as
+remarked by Frothingham, that the ceremonies of St. Peter, at Rome,
+carried him back to the mysteries of Eulesis, to the sacrificial rites
+of ancient Phoenicia, to what misty antiquity does not the contemplation
+of the rite of circumcision take us? The Alexandrian library, with its
+vast collection of precious records, could probably have furnished us
+some information as to its origin and antiquity; but Moslem fanaticism,
+with its belief in the all-sufficiency and infallibility of the Koran,
+was the destruction of that wonderful repository. We must now depend
+wholly on the relation of the Old Testament or on what has since been
+written by the Greek and Italian historians as to its origin and
+practices. The Egyptian monuments and their hyeroglyphics give us no
+information on the subject further back than the reign of Rameses II;
+while the oft-quoted Herodotus wrote some fourteen centuries after the
+Old Testament relation, and Strabo and Diodorus some nineteen centuries
+after the same chronicler. We have, therefore, in their chronological
+order, first, the relation of the Bible; then the Egyptian monuments and
+their revelations; and, thirdly, the information gathered by Pythagoras,
+Herodotus, and other philosophers and historians. To these three
+sources we may add the misty mixture of tradition and mythological
+events, whose beginnings as to period of time are indefinite. These are
+the sources from which we are to determine the origin and antiquity as
+well as the character of the rite.
+
+Voltaire found in the subject of circumcision one that he could not
+satisfactorily make enter into his peculiar system of general
+philosophy. For some reason, he did not wish that the Israelites should
+have the credit of its introduction; were he to have admitted that, he
+would have had to explain away the divine origin of the rite,--something
+that the Hebrew has tenaciously held for over thirty-seven centuries.
+Voltaire thought it would simplify the subject by making it originate
+with the Egyptians, from whom the Hebrews were to borrow it. To do this
+he adopted the relation of Herodotus on the subject. His treatment of
+the Jewish race, however, brought out a strong antagonism from those
+people to his attacks, and in a volume entitled, "Letters of Certain
+Jews to Monsieur Voltaire,"--being a series of criticisms on his
+aspersions on the race and on the writings of the Old Testament (written
+by a number of Portuguese, German, and Polish Jews then residing in
+Holland[1]),--they proved conclusively that the Phoenicians had borrowed
+the rite from the Israelites, as they (the Phoenicians) had practiced
+the rite on the newborn, whereas, had they followed the Egyptian rite,
+they would have only circumcised the child after its having passed its
+thirteenth year,--these being the distinctive differences between the
+Jewish and Egyptian rites.
+
+Luckily, in the small temple of Khons, which formed an annex to the
+greater temple of Maut, at Karnac, there was found a _bas-relief_,
+partly perfect, which goes far toward giving light on the subject of
+Egyptian circumcision. The upper part of the sculpture was so defaced
+that the upper portions of four of the five figures were destroyed, but
+the lower portions were so perfect in every detail as to furnish a full
+history of the age of the candidates for the rite and the manner of its
+performance. It is further interesting from the fact that it establishes
+also the time during which the rite was so performed. M. Chabas and Dr.
+Ebers argue, from the founder of the temple having been Rameses II, that
+the sculpture refers to the circumcision of two of his children. The
+knife appears to be a stone implement, and the operator kneels in front
+of the child, who is standing, while a matron supports him in a kneeling
+posture, and she holds his hands from behind him.[2] In this
+_bas-relief_ we can see the great difference that existed between the
+two forms of the operation, that of the Hebrews being performed, as a
+rule, on the eighth day after birth, while in the _bas-relief_ they are
+ten or twelve years old.
+
+Although tradition and mythology veil past events in more or less
+obscurity, they do, in regard to circumcision, furnish considerable
+explanatory light on matters which would be otherwise hard to reconcile.
+Circumcision has been performed by the Chippeways, on the Upper
+Mississippi, and its modifications were performed among the Mexicans,
+Central Americans, and some South American tribes of Indians, as well as
+among many of the natives dwelling among the islands of the Pacific
+Archipelago. There is a tradition, mentioned by Donnelly in connection
+with the sunken continent of Atlantis, that Ouranos, one of the
+Atlantean kings, ordered his whole army to be circumcised that they
+might escape a fatal scourge then decimating the people to their
+westward.[3] This tradition tells us that the hygienic benefits of
+circumcision were recognized antediluvian facts, as it also points out
+the way by which circumcision traveled westward across to the Western
+World. As Donnelly has pointed out, many of the Americans possessed not
+only traditions, habits, and customs that must have come from the Old
+World, but the similarity of many words and their meaning that exists
+between some of the American languages and those of the indigenous
+inhabitants that have still their remains in spots on the southwestern
+shores of Europe--the ancient Armorica whose colony in Wales still
+retains its ancient words--leaves no room for doubt that at one time a
+landed highway existed between the two worlds. The Mandans, on the Upper
+Missouri, have many words of undoubted Armorican origin in their
+vocabulary,[4] just as the Chiapenec, of Central America, contains its
+principal words denotive of deity, family relations, and many conditions
+of life that are identically the same as in the Hebrew,[5] the name of
+father, son, daughter, God, king, and rich being essentially the same in
+the two languages. It must have been more than a passing coincidence
+that gives the Mandans some of their most expressive words from the
+Welsh, or that gave to Central America many cities bearing analogous
+names with the cities of Armenia.[6] Canadian names of localities, as
+well as those of the Mississippi Valley, denote the French origin of
+their pioneers, as well as the names of Upper California denote the
+nationality and creed of its first settlers. So that there is nothing
+strange in asserting that American civilization and many of the customs
+as found in the fifteenth century by the early Spanish discoverers were
+nothing more than the remains of ancient and modified Phoenician
+civilization, among which figured circumcision.
+
+Dr. A. B. Arnold, of Baltimore, argues that, with the present state of
+our anthropological knowledge and the material that research has been
+able to furnish, we need no longer be surprised to find customs, laws,
+and morals, among nations living in regions of the world widely apart
+from each other, which betray an identity of origin and development, and
+that beliefs and institutions, whether wise or aberrant, grow up under
+apparently dissimilar circumstances, circumcision forming no
+exception.[7] Dr. Arnold leaves too much to chance. It is hardly likely
+that the similarity that existed between the architecture of the
+Phoenicians and the Central Americans, as evinced in their arches; in
+the beginning of the century on the 26th of February; the advancement
+and interest taken in astronomical science; the coexistence of pyramids
+in Egypt and Central America; that five Armenian cities should have
+their namesakes in Central America, should all be a matter of accident.
+The historiographer of the Canary Islands, M. Benshalet, considers that
+those islands once formed a part of the great continent to its west;
+this has been verified by the discovery of many sculptured symbols,
+similar in the Canaries and on the shores of Lake Superior, as well as
+by the discovery of a mummy in the Canaries with sandals whose exact
+counterparts were found in Central America.[8] A compound word used to
+signify the Great Spirit being found identical in the Welsh and Mandan
+languages, each requiring five distinct sounds to pronounce, words as
+intricate as the passwords of secret societies, can hardly be said to be
+the result of chance.[9] There must, at some remote period, have existed
+some communication between the ancestors of these Missouri Mandans and
+the shores of ancient Armorica; the ancestors of these Mandans may have
+then been living farther to the east; they even may have then been a
+tribe of since lost Atlantis; but the analogy, not only in regard to the
+word just mentioned,--_Maho-peneta_, of the Welsh and Mandan,--but in
+the similarity of the pronouns of both languages, and the existence of
+the idea of the counterpart of the sacred white bull of the Egyptians
+being found among the Dakotas, or Sioux, all point to the fact that
+these people, in common with the rest of the Americans, originally came
+from the East; from whence came their languages, manners, customs,
+rites, and what civilization they possessed, among which circumcision
+has, through the mist of centuries, held its own in some shape or other.
+
+That some terrible catastrophe occurred to divide the hemispheres is
+evident; the Western World remaining stationary in its civilization and
+retaining the customs and rites of the times as evidence of their
+origin. With this view of the case, the existence of circumcision as
+found among the inhabitants of the West can easily be traced to its
+origin among the hills of Chaldea. The ancient traditions and
+mythological relations of the Egyptians in regard to the great nation to
+the West are amply verified by the deep-sea soundings of the
+"Challenger," the "Dolphin," and the "Gazelle," which plainly indicate
+the presence of a submarine plateau that once formed the continent of
+Atlantis, whose only visible evidence above the waves of the boisterous
+Atlantic is the Azores and the remains of Phoenician civilization among
+the Americans.
+
+Professor Worman, of Brooklyn, scouts the idea that circumcision was
+ever connected in any way or that it originated in any of the rites
+connected with phallic worship.[10] Bergmann,[11] of Strasburg,
+however, not only claims circumcision to be a direct result of phallic
+worship, but looks upon the rite as something that has been reached by
+what may be termed a gradual evolutionary process of manners, customs,
+and society, from the time of what is termed the hero-warrior period of
+traditional history, when war and the clashing of shields and sword or
+spear were the main delights and occupations of man. It is strange to
+note what difference must have existed between these hero-warriors in
+regard to their ideas of manliness; some were brutal and fiendish,
+whilst others were magnanimous. McPherson, the historiographer of early
+Britain, cannot help but contrast the superior manliness of the heroes
+of Ossian in his graphic description of the ancient Caledonians, when
+compared to the brutality of Homer's Greek heroes. The traditions upon
+which Bergmann undertakes to found the origin of the rite of
+circumcision are all connected with the inhuman and brutish passions
+that animated our barbarous ancestry. The first incident given is the
+Egyptian traditional tragedy, which was, in all probability, the initial
+point of that phallic worship which, with increasing debauchery,
+assisted in the final demoralization of Rome and Greece, after its
+introduction into those countries.
+
+
+
+
+CHAPTER II.
+
+THEORIES AS TO THE ORIGIN OF CIRCUMCISION.
+
+
+We are told that in battle man looked upon the vanquished as unfit to
+bear the name of man, looking upon the weakness or want of skill which
+contributed to their defeat as something effeminate. The victor then
+proceeded by a very summary and effective mode, done in the most
+primitive and expeditious manner, to render his victim as much like a
+female as possible to all outward appearances; this was accomplished by
+a removal at one sweep of _all_ the organs of generation, the phallus
+being generally retained as a trophy,--a practice which was also carried
+into effect with dead enemies, to show that the victor had vanquished
+_men_. It has been the practice from time immemorial for a victor to
+carry off some portion of the body of his victim or defeated enemy, as a
+mark or testimony of his prowess; it was either a hand, head or scalp,
+lower jaw, or finger. The carrying off of the phallus or virile member
+was considered the most conclusive proof of the nature of the
+vanquished, and, as it established the sex, it conferred a greater title
+to bravery and skill than a mere collection of hands or scalps, which
+would not denote the sex. In conformity with this custom, we find that
+Osiris, when he returned to Egypt and found that Typhon had fomented
+dissension in his absence, being vanquished by the latter in the
+conflict that followed, was dismembered and cut into pieces, the
+followers of Typhon each securing a piece and Typhon himself securing
+the phallus or generative member. Isis, the spouse of Osiris, seems in
+turn to have secured the control of government, and, having secured all
+the pieces of the dissected Osiris except the phallus,--Typhon having
+fled with that, and, according to some traditions, having thrown it into
+the sea,--Isis ordered that statues should be constructed, each to
+contain a piece of the unfortunate Osiris, who should thereafter be
+worshiped as a god, and that the priesthood should choose from among the
+animals some one kind which should thereafter be considered sacred. The
+phallus which was missing was ordered special worship, with more marked
+solemnities and mysteries; from this originated the phallic worship and
+the sacredness of the white bull, Apis, among the Egyptians, which was
+chosen to represent Osiris.
+
+By gradual evolution and the progress of society, the cultivation of the
+ground and the need of menials, warriors found some other use for their
+prisoners taken in strife besides merely cutting off the phallus as a
+trophy; these prisoners began to have some intrinsic value. From this a
+change came about; the warrior instinct, however, still claimed that the
+vanquished, even if a slave, should still convey or carry some sign of
+servitude. The original idea of the ablation of the phallus was to
+emasculate the victim; investigation developed the idea that the same
+object could be accomplished by castration, an operation which also
+finally reached a tolerable state of perfection through different stages
+of evolution, it first being performed by a complete removal of the
+whole scrotum and contents. This operation, with the ignorance of the
+times in regard to stopping haemorrhage, was, however, accompanied by a
+large mortality, and it finally evolved into the simple removal of the
+gland, or its obliteration by pressure or violence. Bergmann conveys the
+idea that circumcision was at one time the indestructible marking and
+the distinctive feature of the slave, the mind of the period not being
+able to emancipate itself from the idea that the genitals must in some
+manner be mutilated, not being able to conceive any other degrading mark
+of manhood which barbarians felt they must inflict on slaves.
+
+The generally accepted idea in regard to the physical mutilation of
+captives taken in war, or that some token from the body of the
+vanquished must be carried off by the victor, has not only the support
+of tradition and monumental sculptured evidence, but its practice is
+still in vogue among many races. Among the ancient Scythians, only the
+warriors who returned from the battle or foray with the heads of the
+enemy were entitled to a share in the spoils. Among the modern Berbers
+it is still a practice for a young man, on proposing marriage, to
+exhibit to his prospective father-in-law the virile members of all the
+enemies he has overcome, as evidence of his manhood and right to the
+title of warrior. The Abyssinians and some of the negro tribes on the
+Guinea coast still follow the custom of securing the phallus of a fallen
+foe. However barbarous this practice may seem, its actual performance is
+only secondary, the primary motive being that the warrior wished to
+prove that he had been there, engaged in actual strife, and that his
+enemy had been overcome. The writer remembers that, after one of the
+battles in the West during the late war, many letters arrived in his
+locality with pieces of the garments or locks of the hair of the
+unfortunate Confederate general, Zollikoffer, who had been slain in the
+battle; a disposition in the warrior, seemingly still existing, such as
+animated the old Egyptians. On an old Egyptian monument,--that of
+Osymandyas,--Diodorus noticed a mural sculpture, a _bas-relief_
+representing prisoners of war, either in chains or bound with cords,
+being registered by a royal scribe preparatory to losing either the
+right hand or the phallus, a pile of which is visible in one corner of
+the foreground; from this sculpture we learn that the practice was not
+only an individual performance, but that it was a national usage among
+the Egyptians as well, who subjected, at times, their vanquished foes to
+its ordeal in a wholesale but business-like manner.
+
+Bergmann argues that the Israelites were given to like practices, and
+cites the incident wherein David brought two hundred prepuces--as
+evidence of his having slaughtered that number of Philistines--to Saul,
+as a mark of his being worthy to be his son-in-law. He argues that,
+whereas many have made that Old Testament passage to read "two hundred
+prepuces," it should have read "two hundred virile members" which David
+and his companions had cut off from the Philistines, the word _orloth_
+meaning the virile member, and not the prepuce. That Israelitish
+circumcision could have originated from either phallic worship or any of
+the hero-warrior usages is untenable as a proposition, as regards the
+living prisoners, and is contrary to the monotheistic idea which ruled
+Israel, or to the benign nature of their God. The strict opposition of
+the religion of Judaism to any other mutilation except that of the
+covenant is also antagonistic to the views advanced by Bergmann, as it
+is well known that even emasculated animals were considered imperfect
+and unclean, and therefore unfit to be received or offered as a
+sacrifice to their deity. No emasculated man was allowed to enter the
+priesthood or assist at sacrifices. The whole idea of Judaism being
+opposed to such mutilations, their observance of circumcision and its
+performance can in no way have developed from either phallic or other
+warlike rites or usages; but we must accept its origin as a purely
+religious rite,--a covenant of the most rigid observance, coincident in
+its inception with the formation of the Hebraic creed in the hills of
+Chaldea.
+
+What Herodotus or Pythagoras may have written concerning the practice
+among the Egyptians was written, as already remarked, some nine
+centuries after Moses had recorded his laws; Moses himself having come
+some centuries after Abraham. Herodotus is quoted as representing that
+the Phoenicians borrowed the practice from the Egyptians, in support of
+the theory that Egypt was the central nucleus from whence the practice
+started, and not that it traveled toward Egypt from Phoenicia. The
+difference in the ages, already mentioned, at which the rite was
+practiced--that of Phoenicia and Israel being at one time
+identical--shows that the testimony of Herodotus in this one particular
+was the result of faulty judgment, as we find the people who have
+borrowed the practice from the Egyptians, as well as their descendants,
+closely follow their practice in regard to the age at which the
+operation should be performed. Another evidence of the strictly
+religious nature of the rite, as far as the Hebrews are concerned, lies
+in the fact that, with all their skill in surgery and medical
+sciences,--they being at one time the only intelligent exponents of our
+science,--they never made any alteration or improvement in the manner of
+performing the operation. It is evident that even Maimonides, a
+celebrated Jewish physician of the twelfth century, who furnished some
+rules in regard to the operation, was held under some constraint by the
+religious aspect of the rite. As a summary of this part of the subject,
+it may be stated that the Old Testament furnished the only reliable and
+authentic relation prior to Pythagoras and Herodotus. From its evidence,
+Abraham was the first to perform the operation, which he seems to have
+performed on himself, his son, and servants,--in all, numbering nearly
+four hundred males; he then dwelt in Chaldea. In absence of other as
+reliable evidence we must accept this testimony in regard to its origin,
+causes, and antiquity.
+
+Voltaire, in his article on circumcision in his "Philosophical
+Dictionary," seems more intent on breaking down any testimony that might
+favor belief in any religion than to impart any useful light or
+information. He bases all his arguments on the book "Euterpe," of
+Herodotus, wherein he relates that the Colchis appear to come from
+Egypt, as they remembered the ancient Egyptians and their customs more
+than the Egyptians remembered either the Colchis or their customs; the
+Colchis claimed to be an Egyptian colony settled there by Sesostris and
+resembled the Egyptians. Voltaire claims that, as the Jews were then in
+a small nook of Arabia Petrea, it is hardly likely that, they being then
+an insignificant people, the Egyptians would have borrowed any of their
+customs. To read Voltaire's "Herodotus" is somewhat convincing, but
+Voltaire's "Herodotus" and Herodotus writing himself are two different
+things, and the book "Euterpe" says quite another thing from what M.
+Voltaire makes it say. A perusal of Voltaire and a study of his Jewish
+critics on this subject, as found in the "Jews' Letters to Voltaire,"
+will convince any reader that as to circumcision M. Voltaire is an
+unreliable authority.
+
+
+
+
+CHAPTER III.
+
+SPREAD OF CIRCUMCISION.
+
+
+From Chaldea, then, in the mountains of Armenia and Kurdistan, the
+practice of circumcision was, in all probability, first adopted by the
+Phoenicians, who finally relinquished the Israelitish rite as to age of
+performance and exchanged it for the Egyptian rite. From Phoenicia its
+spread through the maritime enterprises of this race to foreign parts
+was easy. Egypt was the next place to adopt its practice; at first the
+priesthood and nobility, which included royalty, were the only ones who
+availed themselves of the practice. The Egyptians connected circumcision
+with hygiene and cleanliness; this was the view of Herodotus, who looked
+upon the rite as a strictly hygienic measure. History relates of the
+existence of circumcision among the Egyptians as far back as the reign
+of Psammetich, who ruled toward the end of the sixth century B.C. The
+practice must then have been of a very religious and national nature, as
+we are told that Psammetich, having admitted some noted strangers, whom
+he allowed to dwell in Egypt without being circumcised, brought himself
+into great disfavor among his subjects, and especially by the army, who
+looked upon an uncircumcised stranger as one undeserving of favors.
+During the next century Pythagoras visited Egypt, and was compelled to
+submit to be circumcised before being admitted to the privilege of
+studying in the Egyptian temples. In the following century these
+restrictions were removed, for neither Herodotus nor Diodorus, who
+visited the country, were obliged to be circumcised, either to dwell
+among the people or to follow their studies. There is one curious habit
+that is mentioned in connection with the rite of circumcision among
+these people, this being its relation to the taking of an oath or a
+solemn obligation. Among the Egyptians the circumcised phallus, as well
+as the rite of circumcision, seemed to be the symbol of the religious as
+well as of the political community, and the circumcised member was
+emblematical of civil patriotism as well as of the orthodox religion of
+the nation. To the Egyptian, his circumcised phallus was the symbol of
+national and religious honor; and as the Anglo-Saxon holds aloft his
+right hand, with his left resting on the holy Bible, while taking an
+oath, so the ancient Egyptian raised his circumcised phallus in token of
+sincerity,--a practice not altogether forgotten by his descendants of
+to-day. It was partly this custom of swearing, or of affirming, with the
+hand under the thigh, by the early Israelites, that caused many to
+believe that their circumcision was borrowed from the Egyptians,
+especially by M. Voltaire, who insists that it was the phallus that the
+hand was placed on, and that the translation has not the proper meaning,
+as given in the Bible.
+
+Among the Arabs it was the practice to circumcise at the age of thirteen
+years, this being the age of Ishmael at his circumcision by his father,
+Abraham. The Arabs practiced circumcision long before the advent of
+Mohammed, who was himself circumcised. Pococke mentions a tradition
+which ascribes to the prophet the words, "Circumcision is an ordinance
+for men, and honorable in women." Although the rite is not a religious
+imposition, it has spread wherever the crescent has carried the
+Mohammedan faith. Uncircumcision and impurity are to a Mohammedan
+synonymous terms. Like the Abyssinians, the Arabs also practice female
+circumcision,--an operation not without considerable medical import, as
+will be explained in the medical part of the work. This practice is also
+common in Ethopia. Some authorities argue, from this association of
+female circumcision among the Southern Arabs, Ethiopians, and
+Abyssinians, that they did not derive their rite from the Israelites;
+but there is not much room for doubt but that the operation came down to
+the Arabians from Abraham through his son Ishmael. Considering the
+occupancy of Syria, Arabia, and Egypt by the French, and the intercourse
+with these countries by the British, it is surprising that the
+profession in the early part of the present century had not full
+information regarding the nature and objects of female circumcision as
+practiced in these countries. Delpesh observes, in relation to the
+Oriental practice, that his information was too vague to determine
+whether it was the nymphae or the clitoris that were removed, or whether
+it was only practiced in cases of abnormal elongations of these parts.
+M. Murat, however, writes at length on the subject, very intelligently,
+as well as Lonyer-Villermay, who, writing in the same work with Delpesh,
+thinks it is certainly the clitoris that is removed.[12] In Arabia, the
+trade or profession of a _resectricis nympharum_ or she-circumciser is
+as stable an occupation with some matrons as that of cock-castration or
+caponizing is the sole occupation of many a matron in the south of
+Europe. It is related by Abulfeda that, in the battle of Ohod, where
+Mohammedanism came very near to a sudden end by the crushing defeat of
+the prophet and his followers, Hamza, the uncle of the prophet, seeing
+in the opposing ranks a Koreish chief, whom he knew, thus called out:
+"Come on, you son of a she-circumciser!" As Hamza was among the slain,
+it is most likely that he met his death from the hands of the chief,
+whose mother really followed that occupation. So extensive is the
+practice, that these old women sometimes go through a village crying out
+their occupation, like itinerant tinkers or scissors-grinders.
+
+The present ceremonies attending the performance of the rite among the
+Arabians are well described by Dr. Delange, a surgeon of the French
+army, as witnessed by him in the province of Constantine, in Algeria.
+
+With these Arabs, circumcision is performed on a whole class, so to
+speak, at the same time, regardless of the trifling differences in their
+ages. It is preceded by feasting, the total length of the feast being
+for eight days. For the first seven days, all the Arabs of the quarter
+where the candidates for circumcision reside dress in their best. The
+poor have their mantles and clothes carefully washed, and the rich deck
+themselves out in their gold and silver brocaded vests and pantaloons.
+During these seven days there is general rejoicing, and the Arabs spend
+most of this time in the village street, racing, firing guns, or
+engaging in sham battles between the different camps, during which one
+carries the green, or sacred banner, which is supposed to render the
+bearer invulnerable. The battle ends by the standard-bearer being fired
+at by all parties, and falling, but quickly rising again and waving the
+flag in token of its protecting power. The Arabs now adjourn to another
+public place, where the notables and strangers are furnished seats on
+carpets; here a dance to the music of tumtums and the singing of
+invisible females takes place, the dancers being only males.[13] In the
+evening the women sing, to which the men listen in silence, this concert
+being kept up until midnight. On the seventh day, the women, decked out
+in their best, and with all their personal ornaments, accompanied by all
+the young men, armed with their guns and pistols, repair to the
+extremity of the oasis, where they gather plates of fine sand. With this
+sand they return to the village, where it is exposed overnight to the
+glare of the full moon on the terraces of the house. This last day
+closes with a grand banquet, given by the rich whose children are about
+to be circumcised, to which all the people are invited.
+
+The next morning all the relatives of the candidates repair to the house
+where the rite is to be performed; the women going up into the second
+floor, wherefrom they can look down into the court from a porch screened
+with lattice-work, without themselves being seen. The men gather
+together on the ground-floor, together with the operator and his
+assistants and the children about to be circumcised, who are dressed in
+yellow, silken gowns. The child to be operated upon is seated in a pan
+of sand, while an assistant fixes his arms and holds the thighs well
+separated from behind. The circumciser then examines the prepuce, the
+glans, and removes any sebaceous collection. This done, a compress with
+an aperture to admit of the passage of the glans is slipped over the
+organ; a small piece of leather, some six centimetres in diameter, with
+a small hole in the centre, is now used, the free end of the prepuce
+being drawn through the aperture; a ligature of woolen cord is then tied
+on to the prepuce next to the front of the leather shield, and, the
+knife being applied between the thread and the leather, the prepuce is
+removed at one sweep; the mucous inner layer is then lacerated with the
+thumb-nails and turned back over to join the other parts. The surface is
+then sprinkled with _arar_ or _genevriere_ powder and dressed with a
+small cloth bandage, the subsequent dressings consisting of _arar_
+powder and oil. During the operation the women in the gallery keep up an
+unearthly music by means of tumtums, cymbals, and all the kettles and
+saucepans of the neighborhood, which are brought into requisition for
+the occasion. This music is accompanied with songs and chants, each
+woman striking out with an independent song of her own, either
+improvised or suggested by the occasion. This not only serves to drown
+the cries of the children, but it must, in a manner, assist to draw them
+away from the immediate contemplation of their sufferings. The prepuces
+are now gathered together and carried to the end of the oasis, where
+they are buried with ceremony and rejoicings. This circumcision only
+takes place once in three or four years, and the children are from four
+to eight years of age; of fifteen circumcised at the feast witnessed by
+M. Delange, only two had passed their eighth year.
+
+In a very interesting old book,[14] "The Treaties of Alberti Bobovii,"
+who was attached to the court of Mohammed IV, published with annotations
+by Thomas Hyde, of Oxford, in 1690, there is a description of the
+Turkish performance of the rite which leads one to infer that they
+circumcised the children quite young: "Et cum puer prae dolore exclamat,
+imus ex duobus parentibus digitis in melle ad hoc comparato os ei
+obstruit; caeteris spectatoribus acclamantibus. O Deus, O Deus, O Deus.
+Interim quoque Musica perstrepit, tympana et alia crepitacula
+concutiuntur, ne pueri planctus et ploratus audiatur." Bobovii says that
+the age at which circumcision is performed is immaterial provided the
+candidate is old enough to make a profession of faith,--which, however,
+is made for him by the godfather,--in the following words: "There is no
+God but God, and Mohammed is his Prophet," or, as rendered by our
+author, "Non esse Deum nisi ipsum Deum, et Mohammedem esse Legatum
+Dei." To which he adds that the child must not be an infant, but that he
+must be at least eight years of age. Like to the Arabs, the Turks
+celebrated the occasion by feasts, plays, and a general good time; the
+child was kept in bed for fifteen days to allow complete cicatrization
+to take place. The circumcision was performed with the boy standing.
+
+Michel Le Feber, writing in 1681,[15] speaks of the tax levied on the
+Christians by the Turks, that they, the Christians, may enjoy liberty of
+conscience, and observes that, circumcision not being compulsory among
+the Turks, it often led to trouble and annoyances, as many of the Turks
+evaded the operation. The tax-gatherers in Turkey are very industrious,
+and, as being circumcised was, as a rule, sufficient evidence of not
+being a Christian, he often witnessed on the streets scenes wherein
+strangers, arrested by these tax-collectors, were compelled to show
+their circumcision as an indisputable sign of their exemption from the
+tax. He also relates that in their zeal for converts to Mohammedanism
+the Turks often resorted to presents to induce Christians to embrace
+their faith. While in Aleppo, he saw a Portugese sailor, who, through
+presents, had forsaken his religion, but who had repented in the most
+emphatic manner when brought to face circumcision. Finding entreaties in
+vain, the Cadi ordered the immediate administration of a stupefying
+draught, and the sailor was then seized and circumcised without further
+ceremony.
+
+In cases where the new Mohammedan is reasonable and submits like a hero,
+the ceremonies are more elaborate. Le Feber relates that if the
+candidate is a man of note or wealth he is mounted on a horse and
+exhibited all over the city; he is dressed in the richest of Turkish
+robes and in his hand he holds an arrow with the point directed to the
+sky; he is followed by a great concourse of people, some dressed in
+holiday attire and others in fantastic costumes; and general feasting
+and enjoyment is the rule over the course of the march, where all the
+people run to swell the crowd. If the man happens to be a poor man, he
+is simply hurriedly marched about on foot, with a simple arrow in his
+hand pointed skyward, to distinguish him from ordinary mortals; before
+him a crier proclaims in a loud voice that the new religionist has
+ennobled himself by professing the faith of the prophet in this solemn
+manner. A collection for his benefit is taken up among the booths and
+shops, which is mostly appropriated by the conductor, circumciser, and
+his assistants, after which he is circumcised without further ado.
+
+The same author describes the operation as performed on the young Turks
+and the accompanying ceremonies. They differ in some respects from those
+employed in circumcising a convert. The parents of the child give a
+feast in proportion to their means, to which are invited the relatives
+of the family and personal friends; if of the upper ranks, he is
+promenaded about the town to the music of drums and cymbals, dressed in
+rich attire; two warriors lead the procession with drawn swords, and a
+troop of females who sing songs of joy bring up the rear; the procession
+now and then stops, when the two gladiators in the front indulge in a
+fierce set-to, hacking at each other in the most determined and
+murderous manner, but so studiedly shammy that neither is injured; on
+the return to the house, the child, who is usually eight or ten years of
+age, is bound hand and foot to prevent his causing any injury to
+himself, laid on a bed, and circumcised with a razor, the operation
+being performed either by a surgeon or the chief of a mosque.
+
+
+
+
+CHAPTER IV.
+
+CIRCUMCISION AMONG SAVAGE TRIBES.
+
+
+E. Casalis,[16] who, in the capacity of missionary, for a very long time
+resided among the Bassoutos, tells us that among that nation the
+operation is performed at the age of from thirteen to fifteen years. The
+ceremony is gone through once in three or four years. So important an
+event is it considered by the Bassoutos that they date events from one
+of these observances, as the Romans dated events from a certain
+consulship, or the Greeks from an Olympiade. At the time fixed, all the
+candidates go through a sham rebellion and escape to the woods; the
+warriors arm and give chase, and, after a sham battle, capture the
+insurgents, whom they bring back as prisoners, amidst dancing and great
+rejoicings, which are the preludes to the feast. The next day the huts
+of mystery (_mapato_) are erected, where, after the circumcision, the
+young men are to reside for some eight months, under the tutorship of
+experienced teachers, who drill them in the use of the spear, sword, and
+shield, teaching them to endure hunger, thirst, blows, and all manner of
+hardships; prolonged fasts and cruel flagellations being regarded as
+pastimes between the exercises. The severity of the regulations may be
+judged from the fact that the instructors have a right to put to death
+any one who may try to escape from these ordeals. The women are
+rigorously excluded from these camps, but the men are allowed to visit
+them, when they have the privilege of assisting the teachers by adding
+additional blows and precepts to the backs of the unlucky candidates.
+After eight months of such training, the young men are oiled from head
+to foot and dressed in a garment, and are now given the name which they
+are to bear for the rest of their lives. The _mapato_, or mystery hut,
+is now burned to the ground and the young men return to the village. The
+maternal uncle of the youth here presents him with a javelin for his
+defense, and a cow that is to furnish him with nourishment. Until the
+time of his marriage, the newly circumcised dwell together; their duties
+being of a menial character, such as gathering wood and attending to the
+flocks and droves.
+
+M. Paul Lafargue looks upon circumcision among the negro races as being
+a rite commemorating their advent to manhood; Livingstone, who has also
+observed the above, related incidents in relation to the performance of
+_boguera_, or circumcision, among the Bassoutos, believes that with them
+the rite has a purely civil significance, being in no way connected with
+religion.
+
+Among many of the African tribes the young maids have an ordeal
+approaching to circumcision that they must pass when near the age of
+thirteen, this rite bearing precisely the same relation regarding their
+entrance into the state of womanhood that male circumcision denotes the
+entrance into manhood on the part of the males among the Bassoutos. At
+the appointed time the maids are gathered together and conducted to the
+riverbank; they are placed under the care of expert matrons. They here
+reside, after having undergone a kind of baptism; they are maltreated,
+punished, and abused by the old women, with a view of making them hardy
+and insensible to pain; they are also schooled in the science and art of
+African household duties. Among the Gallinas of Sierra Leone, in
+addition to the other observances, the clitoris of the young maid is
+excised at midnight, while the moon is at its full, after which they
+receive their name by which they are to be known through life. The
+initiation of each sex into these mysteries is exclusively for the sex
+engaged, and it would be as fatal for a man to steal into the camp of
+the women during the performance of these ceremonies as it would be
+fatal for a woman to enter a _mapato_ where the young men are undergoing
+their ordeal. After their initiation into womanhood, the maids live by
+themselves, similarly to the young men, until they marry.
+
+Lafargue relates that among the Australians circumcision is held in such
+importance that tribes at war will suspend all hostilities and meet in
+peace during the observance or performance of the rite. Here, again, we
+have a repetition, with a slight variation, of the practices of the
+Bassoutos,--something which gives some countenance to the hero-warrior
+idea of the origin of circumcision advanced by Bergmann. The Australian
+warriors go through a mimic battle, and, after a series of combats,
+finally capture the boys aged about from thirteen to fourteen years,
+whom they bear away amidst the cries and lamentations of the mothers and
+other female relatives, who, in their excess of grief, mutilate
+themselves by cutting gashes into their thighs, so that they bleed
+profusely. The boys are, in the meantime, carried to some out-of-the-way
+place, where an old man, perched on a tree or some rising ground,
+through the means of a musical instrument made of a deal-board and human
+hair, announced that the rite is in process of performance, so that
+neither women nor children might approach. Tufts of moss are placed in
+the axilla and on the pubis, to represent puberty, and among some tribes
+the skin of the penis is divided to the scrotum with a stone knife,
+while others content themselves with simply making a circular incision,
+which removes the prepuce, after the Jewish manner, the excised portion
+being placed as a ring on the median finger of the left hand. The
+circumcised then takes himself to the hills or woods, and there remains
+until healed, carefully guarding himself against the approach of any
+female. After this the third part of the ceremonies takes place: the
+godfather of the youth opens a vein in his own arm, the circumcised
+youth is placed on all-fours, and an incision is made from the neck down
+as far as the lumbar region, and the blood of the godfather is made to
+flow and mingle with that of the godchild; this being in reality a
+bloody baptism, and a near relation to the blood-compacts of the Arabs.
+
+The Malays, as well as the men of Borneo, are circumcised. The Battos
+likewise perform the rite. Among the Islanders they sometimes ligate the
+prepuce so that it drops off. Among the Battos the same object is
+reached by small bamboo sticks, between which the prepuce is fastened.
+In New Caledonia and Tidshi the boys are circumcised in their seventh
+year. The Tonga Islanders split the prepuce on the dorsum with a piece
+of bamboo or of shell. In the Marquesas and Sandwich Islands the
+operation is superintended by the priests.[17]
+
+
+
+
+CHAPTER V.
+
+INFIBULATION, MUZZLING, AND OTHER CURIOUS PRACTICES.
+
+
+It seems a matter of controversy as to whether the Mexicans did or did
+not circumcise their children. That they had a blood-covenant is
+admitted by the historians, as well as the fact that this blood was
+taken from the prepuce; but that the prepuce was actually removed is
+something that is not agreed upon by all authorities. Las Casas and
+Mendieta state that it was practiced by the Aztecs and Totonacs, while
+Brasseur de Bourbourg found traces of its practice among the Mijes. Las
+Casas states that on the twenty-eighth or the twenty-ninth day the child
+was presented to the temple, when the high-priest and his assistants
+placed it upon a stone and cut off the prepuce, the excised part being
+afterward burnt in the ashes. Girls of the same age were deflowered by
+the finger of the high-priest, who ordered the operation to be repeated
+at the sixth year; and once a year, at the fifth month, all the children
+born during the year were scarified on the breast, stomach, or arms, to
+denote their reception as servants of their god. Clavigero, on the other
+hand, denies that circumcision was ever practiced. It was customary in
+Mexico, according to most authorities, to take the children while
+infants to the temple, where the priests made an incision in the ear of
+the females, and an incision in the ear and prepuce of the males.[18]
+
+Grotins and Arias Montan at one time advanced the idea that the western
+coast of South America was peopled by some mutinous sailors from the
+fleets of King Solomon, who, in their endeavor to go away far enough to
+be out of reach, were driven by winds and chance to the Peruvian coast.
+Others have imagined that some of the lost tribes of Israel found their
+way eastward to America, by the way of China, to the Mexican coast. The
+same ideal tradition has made the lost tribes the fathers of the
+Iroquois Nation in the northeastern parts of the United States. An
+author, who will be quoted in another part of this work, scouts the idea
+that the rite, as performed in America, had any connection or common
+origin with the rite performed in Asia and Africa; but, true to his
+theory of the climatic causes of the origin of circumcision, he
+maintains that it originated here as it did elsewhere, being a
+performance born of climatic necessity. He is, however, dissatisfied
+with Father Acosta for not being more explicit in relation to the _modus
+operandi_ of the Mexican circumcision. The want of being explicit, and
+its consequences in this particular regard, may be inferred from a
+"Diatribe on Circumcision," by a Mr. Mallet, in an encyclopaedic
+dictionary of the last century, in which Mr. Mallet informs his readers
+that Mexicans were in the habit of _cutting off the ears and prepuces_
+of the newly born. Herrera and Acosta agree with Clavigero in asserting
+that the Mexicans simply _bled_ the prepuce. Pierre d'Angleria and other
+contemporary writers are as emphatic in asserting that in the island of
+Cosumel, in Yucatan, on the sea-board of the Gulf of Mexico and on the
+Florida coast, they have observed circumcision by the complete removal
+of the prepuce with a stone knife. The Spanish monk, Gumilla, relates
+that the Saliva Indians of the Orinoco circumcised their infants on the
+eighth day. These Indians also included the females in the observance
+of the rite. The same author tells us of the barbarous and bloody
+performances, in relation to the rite, of the nations on the banks of
+the Quilato and the Uru, as well as those dwelling along the streams
+that empty into the Apure. The same is said of the Guamo and of the
+Othomacos Indians; according to Gumilla, many of these Indians, in
+addition to the rite of circumcision, inflicted a number of cuts on the
+arms, legs, and over the body, to a degree that amounted to butchery,
+the child being reserved for this inhuman treatment until the age of ten
+or twelve years, that he might, by his greater powers of resistance and
+of recuperation, stand some chance of escaping alive from the ordeal.
+The friar mentions that in 1721 he found a child dying from this
+treatment, the wounds having become gangrenous and the child dying of
+pyaemia; prior to the operation the children were stupefied with some
+narcotic drink, and were insensible during its performance.[19]
+
+Besides circumcision, the Americans practiced several other operations
+that bore an analogy to the operation of infibulation, a procedure
+common to the Orient and to early Europe, and so ancient that, like
+circumcision, its source is in the misty clouds of antiquity. It
+consisted in introducing a large ring, either of gold, silver, or iron,
+through an opening made into the prepuce, the free ends being then
+welded together. Females were treated likewise, the ring including both
+labia. In some countries an agglutination of the parts induced by some
+irritant or a cutting instrument answered the purpose among females.
+Dunglison mentions that the prepuce was first drawn over the glans, and
+then that the ring transfixed the prepuce in that position; that the
+ancients so muzzled the gladiators to prevent them from being enervated
+by venereal indulgence. The ancient Germans lived a life of chastity
+until their marriage, and to their observance of a chaste life can be
+attributed the superior physical development of the race, as both males
+and females were not only fully developed, but were not enervated by
+either sexual excess or inclinations before having offspring, which were
+necessarily robust and healthy. To obtain the same results in a nation
+given to indolence and luxury, and lax in its morality, some physical
+restraint was required, and we therefore find the practice of
+infibulation coming from the warm countries to the East. The ancients
+not only infibulated their gladiators to restrain them from venery, but
+they also subjected their chanters and singers to the same ordeal, as it
+was found to improve the voice; comedians and public dancers were also
+restrained from ruining their talents by the means of infibulation. In
+an old Amsterdam edition of Locke's "Essay on the Extent of the Human
+Understanding," there is a quotation from the voyages of Baumgarten,
+wherein he states having seen in Egypt a devout dervish seated in a
+perfect state of nature among the sand-hillocks, who was regarded as a
+most holy and chaste man for the reason that he did not associate with
+his own kind, but only with the animals. As this was by no means an
+uncommon case, it led the Greek monks, in Greece and Asia Minor, to
+resort to every expedient to protect their chastity; in some of the
+monasteries not only were the monks muzzled by the process of
+infibulation, but they even had rules that excluded all females, either
+human or animal, from within their convent,--a habit that still prevails
+among many of the convents of the Orient to this day,--that on Mount
+Athos especially, omitting the infibulation of the ancients.
+
+Readers living in the climates of extreme ranges and of seasonal change
+cannot understand the physical temptations that beset mortals in certain
+climates, any more than they can imagine the faultless condition of the
+climate itself. The subject of climatic influences will be more fully
+discussed further on; but climate, as a factor of habits and usages in
+one part of the world, that are incomprehensible to those living in
+others, plays a part that is but little appreciated or understood;
+whether it be the question of diet, dress, or custom, climate exerts its
+influence in no uncertain manner. As Sulpicius Severus remarked to the
+Greek monks, when they accused the Gaulish monks with voracity and
+gluttony, "That which you of Greece consider as superfluous, the climate
+of Gaul renders into a positive necessity." So of all physical needs and
+passions,--they are subject to a similar law. Those who have read Canon
+Kingsley's small work on the "Hermits of Asia, Africa, and Europe" will
+appreciate the above remarks; and it may be incidentally mentioned that
+his description of the climate that is common to the hilly country
+bordering on the eastern half of the Mediterranean Sea gives as vivid
+and as graphic a description of the physical condition of the climate
+and of its effects as can well be written. It occurs in the life of the
+hermit Hilarion, and the description given relates to his last home in
+the ruins of an old temple, situated on a cliff in the island of Cyprus,
+where the air is so invigorating that "man needs there hardly to eat,
+drink, or sleep, for the act of breathing will give life enough." The
+work gives the best insight also into origin and causes that led to
+monachism, as well as it tells the benefit that the condition conferred
+on humanity, showing a phase in the march of civilization that is but
+little understood.
+
+But, to return to the subject of infibulation, which has, in a manner,
+necessitated this digression from the main topic. Thwing[20] informs us
+that in ancient Germany woman was considered the moral equal of man, and
+that woman might traverse the vast stretches of country unprotected and
+unharmed. Woman never held such a position in the Oriental countries;
+neither has man, under the sub-tropics, a like self-command as shown by
+those ancient Gauls. So that, with the advent of Christianity and the
+moral revolution that followed, primitive methods, either inflicted on
+others or self-inflicted, were adopted to insure a chaste life.
+Infibulation was known, as already stated, for centuries, and in those
+rude times it seemed as the most natural and effective mode of
+accomplishing the object. It was not as barbarous an operation as
+emasculation on the male, as it only temporarily interfered with his
+functions.
+
+In the Old World the practice is still performed in various manners. In
+Ethiopia, when a female child is born the vulva is stitched together,
+allowing only the necessary passage for the needs of nature. These parts
+adhere together, and the father is then possessed of a virgin which he
+can sell to the highest bidder, the union being severed with a sharp
+knife just before marriage. In some parts of Africa and Asia, a ring, as
+before stated, transfixed the labia, which, to be removed, required
+either a file or a chisel; this is worn only by virgins. Married women
+wear a sort of muzzle fastened around the body, locked by means of a key
+or a padlock, the key being only in the possession of the husband. The
+wealthy have their seraglios and eunuchs, that take the place of the
+belt and lock. Another method is a mailed belt worn about the hips, made
+of brass wire, with a secret combination of fastenings, known only to
+the husband. In the museum in Naples are to be seen some of these
+belts, studded with sharp-pointed pikes over the abdominal part of the
+instrument, which was calculated to prevent even innocent familiarity,
+such as nest-hiding, to say nothing of greater evils.
+
+In the "Les Femmes, Les Eunuchs, et Les Guerrieres du Soudan," Col. Du
+Bisson mentions a very peculiar custom invented by the careful jealousy
+that is inseparable from harem life. He had noticed that many of the
+harem inmates, contrary to the general Oriental custom, were allowed to
+go about unattended by the usual guard of eunuchs, but that they walked
+in a painful, hesitating, and impeded manner. This walk was not the
+conventional, short, shuffling step that peculiarity of dress and
+shoe-wear imposes on the Japanese beauty, nor the willowy, swaying gait
+produced in the Chinese beauty by the lack of a sufficiency of foot;
+neither could it be ascribed to the presence of the ancient jingling
+chain of bells which induced the mincing steps of the virgins of
+Judea,--an invention which confined the lower limbs within certain
+limits by being worn just below the knees, and calculated to prevent the
+rupture of the hymen by any undue length of step or violent exercise;
+hence a tinkling noise and a mincing step always denoted a virgin. In Du
+Bisson's cases, however, virgins were out of the question; they might be
+the victims of enforced continence, but a Soudanese harem contains no
+virgins. On inquiry he learned that the very peculiar and unmistakably
+painful gait was due to the fact that each woman carried a bamboo stick,
+about eight inches in length, three inches or more being inserted in the
+vagina so as to effectually fill the opening, the balance projecting
+beyond, between the thighs of the person; this bamboo stick, or guardian
+of female virtue, was held in place by a strap with a shield that
+covered the vulva, the whole apparatus being strapped about the hips and
+waist, and the whole being held in an undisplaceable position by a
+padlock. This was affixed to the woman whenever she was allowed outside
+the harem grounds, being placed in position by the eunuch, who carried
+the key at his girdle. In such a harness virtue can be considered
+perfectly safe; even safe from any mental depredation or revolution, as,
+with the plug causing such uncomfortable sensations, it is perfectly
+safe to infer that the imagination could not be seduced by any Don
+Juanic or other Byronic unvirtuous revelry. The physical ills that this
+contrivance must cause are necessarily without number, as the instrument
+is not as lightly constructed as our modern stem pessaries; but to the
+Oriental who can replace a woman at any time and who prizes the
+virginity, continence, and chastity of his slaves, even if enforced,
+more than their health or their lives, these are matters of secondary
+importance. In the Soudan there are no divorce courts, hence the
+probable necessity of the apparatus, and, as the woman is not obliged to
+wear it unless she chooses to go out unattended, it can hardly be
+considered as a compulsory barbarity. In the United States such a
+practice might do away with considerable divorce proceedings.
+
+Celsus gives a detailed description of the manner of infibulating as
+practiced among the Romans. According to this authority, it was employed
+by them on the youth attending the public schools, as well as upon the
+actors, dancers, and choristers, who were sold to the directors of the
+plays and spectacles. In the cabinet of the Roman College there are to
+be seen two small statues representing two infibulated musicians, which
+are remarkable for the excessive size of the ring and the leanness of
+the persons to which they are attached. The mode of applying this ring
+did not differ much from the usual method of preparing the ear for
+pendants.[21]
+
+Among the Greek monks mentioned, the infibulation serves a manifold
+purpose; it not only is a sure badge of chastity, but its weight and
+size is very often increased so as to render it an instrument of
+penitence, and considerable rivalry exists at times in this regard.
+Virey notices that the Hindoo bonze, or fakir, at times submits to
+infibulation at the same time that he takes his vows of eternal
+chastity. This ring is at times enormous, being sometimes six inches in
+diameter; so that it is a burden. These saints are held in great esteem
+and veneration.
+
+Nelaton, in the sixth volume of his "Surgery," mentions the case of a
+man who presented himself at Dupuytren's clinic with a tumefied,
+thickened, and somewhat dilapidated and ulcerated prepuce; this prepuce
+had worn a couple of golden padlocks for five years, a woman having thus
+infibulated his organ.
+
+In an elaborate work on the subject of circumcision,[22] de Vanier du
+Havre relates, on the authority of M. Martin Flaccourt, that with the
+Madecasses the children are circumcised on the eighth day after birth;
+and that in some portions of the country the mother swallows the removed
+portion of the prepuce, while in others the father loads the prepuce in
+some form of fire-arm, which is afterward fired in the air. In the
+neighborhood of Djezan, in Arabia, as reported by M. Fulgence Fresnel in
+the _Revue de Deux Mondes_ of 1838, courtship and matrimony are not so
+great social events as they are with our society beaux. The occasion is
+probably considered social enough by the rest of the invited guests, but
+it can hardly be called an agreeable episode in the life of the groom.
+Those whose bashfulness prevents them from contracting marriage in
+civilized communities can have the consolation of knowing that in
+far-off Arabia, among the fierce followers of the conquerors of Spain
+and of the Eastern Empire, they have sympathizing fellow-sufferers whom
+the conventionalities of the country deter from rushing into matrimony.
+In this region, circumcision is performed on the adult at the time of
+his candidacy for matrimonial bliss. A more inauspicious occasion could
+not possibly have been chosen, unless as in another Mohammedan tribe,
+who circumcise the bridegroom on the day after his marriage and sprinkle
+the blood that falls from the cut onto the veil of the bride. The bride
+is present, and the victim is handed over to what might be called the
+executioner of the holy office, who proceeds to circumcise the victim in
+what might be called its utmost degree of performance and barbarity.
+This attention does not stop at the pendulous and loose prepuce. He
+devotes himself to the skin of the whole organ; beginning at the prepuce
+he gradually works backward, removing the whole skin of the penis--a
+flaying alive, and nothing more. Should the victim betray any sign of
+weakness, or allow as much as a sigh or groan to escape him, or even
+allow the muscles of the face to betray the fact that he is not
+immensely enjoying the occasion, the bride elect at once leaves him for
+good, saying that she does not wish a woman for a husband. A large
+proportion of the male population annually die from this operation. So
+that the Arabs of the Djezin can be likened to those spiders who lose
+their life while in the act of copulation,--the female making a dinner
+from off the male,--only the spider is said to die a happy death, while
+that of the Arab is one of misery.
+
+Margrave and Martyr have recorded a very peculiar practice common among
+some South American tribes: A kind of a tube is fastened onto the
+prepuce by means of threads of the _tacoynhaa_, the latter being the
+bark of a certain kind of a tree. Cabras brought one of the natives, so
+muzzled, to Lisbon, on the return from his first voyage. Some tribes
+were observed to wear an apparatus like the old-fashioned
+candle-extinguisher, the virile member having been forced into this
+receptacle, which was strapped about the loins.
+
+The travelers Spix and Martius found the practice of circumcision of
+both sexes in the region of the upper Amazon River and among the Tuncas.
+Squires mentions a curious custom of the aborigines of Nicaragua. They
+wound the penis of their little sons and let some of the blood flow on
+an ear of corn, which is divided among the assembled guests and eaten by
+them with great ceremony.
+
+On the fifth day after birth it is the custom among the Omaha Indians of
+North America to christen the infant, the child being stripped and
+spotted with a red pigment; considerable ceremony accompanies the
+act.[23]
+
+Among the cannibals of Australia, Lumholtz[24] observed a practice that
+seems to have no analogue in the wide world, either as an operation or
+in regard to its purposes. About ninety-five per cent. of the children
+are subjected to the ordeal. This is no less than the formation of an
+artificial hypospadias; this abnormality is formed through the penis
+into the urethra, near its junction with the scrotum; the wound is about
+an inch in length and is made with a flint knife which serves for no
+other purpose; the edges of the wound are burned with a hot stone, and
+the wound is subsequently kept open by the introduction of a small piece
+of wood, which, on healing, leaves a permanent opening. These cannibals
+undoubtedly are inspired by some Malthusian spirit which impels them
+thus to functionally eunuchize themselves in one sense, as during
+copulation the seminal discharge flies out backward through this
+opening, being thereby a most effectual check on further procreation. By
+some, this practice has been attributed to the unreliability of the
+seasons in regard to food-production; but Lumholtz observes that where
+the practice is most in vogue--among the tribes to the west of the
+Diamantina River and west and north of the Gulf of Carpentaria--the
+food-supply is not deficient, the region being full of rats, fish, and
+vegetables. All the tribes are not subject to the practice of the
+operation at the same time of life; in some, the hypospadias is not
+produced until in adult life and after the person has married and has
+become the father of one or two children, when he must submit to the
+requirements of the law; the operation seems to be invested with some
+civil or religious significance, as a palisade or stockade of trees is
+placed around the place where it is performed. A native, aged about
+twenty years, informed Lumholtz that the operation was performed because
+the blacks did not like to hear the children cry about the camp, and,
+further, that they were not desirous of having many children; this
+native had not yet become a father and had not yet been subjected to the
+operation. The natives were observed to be fat and in good physical
+condition.
+
+There is something mysterious in this operation. It can easily be
+conceived how circumcision might at times have been suggested by its
+spontaneous and natural performance without any assistance from man.
+Cullerier reports one case of partial circumcision through the means of
+an accident happening to a painter. The man was at work on a ladder,
+with a small bucket of paint hooked into one of the rounds above him;
+through some means the bucket lost its hold and in falling struck the
+penis on its dorsum with such force that the prepuce was cut through on
+a parallel with the corona of the glans for fully two-thirds of its
+circumference, the glans slipping through the opening and gathering in a
+fleshy bunch underneath the frenum. This man carried this abnormality
+for some years, when, desiring to marry and seeing that this appendage
+would be as much of an impediment as one of the huge rings worn by the
+Hindoo devotee, he applied to Cullevier for advice, who promptly removed
+it with the knife.[25] The writer has seen three cases, during his
+practice, of spontaneous circumcision, all resulting from phymosis as a
+secondary affection to venereal disease. The first case occurred when he
+first entered into practice; it was in a young, stout, and full-blooded
+man with a violent gonorrhoea. There was much swelling and tumefaction
+of the whole organ, which seemed to be very rebellious to all treatment.
+At one of his morning visits he was horrified to observe a transverse,
+livid mark at what seemed to be the middle of the organ; by noon this
+had gained ground to the right and left and there was no mistaking that
+it meant nothing less than mortification. Never having seen a case, the
+natural uncomfortable conclusion was that, through some cause or other
+or the natural result of excessive congestion, the man was about to lose
+one-half of his organ; and Burnside at Fredericksburg was in no greater
+state of suspense and uncertainty with the fate of the Army of the
+Potomac on his hands than the writer must acknowledge he was with this
+man and his organ apparently liquefying under his treatment. The
+surprise can be better imagined than described when, on the following
+morning, the glans made its appearance safe and sound out of its
+imprisonment, and at right angles with the organ there hung the prepuce,
+thick and as large and as long as the penis itself, inflammatory deposit
+and infiltration having brought it to that shape and consistence; the
+glans became completely uncovered; the parts gathered underneath, where,
+in the course of some weeks, they had shrunk to the size of a walnut,
+which was afterward removed by the knife. In this case, as in the other
+two cases observed, the corona was very prominent and acted as an
+internal tourniquet by its upward pressure, the line of demarkation
+being on the dorsum in the three cases noted.
+
+That such cases would suggest circumcision is not only probable but
+possible, as it would point out the manner of performing the operation;
+but, in the cases of the Australian savages, who performed an artificial
+hypospadias on themselves for a specific purpose, requiring a knowledge
+of the anatomical relation of the parts as well as of their
+physiological functions, it is hard to speculate how the operation was
+first suggested or how it came at first to be performed. As a Malthusian
+agent it is certainly an operation of the highest merit, and it should
+be introduced, by all means, in the United States, where the wealth and
+luxury in which the people dwell is fast drifting them toward the same
+whirlpool that engulfed Rome, which was preceded by a dislike to have
+children. Whenever the writer sees the poor anaemic, broken-down victim
+of many miscarriages, he cannot help but feel that, if the laws of the
+Damiantina River savages were enforced on their husbands, it would be a
+blessing to the poor women without materially injuring the husbands,
+who, in case of need of a re-establishment of the functions of
+procreation, might be fitted with a vulcanite plate for the
+occasion,--something like our cleft-palate patients are supplied with a
+plate that enables them to articulate.
+
+It was the custom among the Hottentots, when first discovered or known
+to the whites, to remove one of their testicles. This was supposed to
+enable them to run more swiftly and to be lighter-footed in the race.
+The real reason, afterward found, was a mixture of pure humanitarianism
+and Malthusianism boiled down to Hottentot ethics. With them a monorchid
+was not supposed to beget twins; when twins are born in the family, the
+mother generally smothers the female, if one happens to be such; if not,
+then the feeblest of the two is sacrificed. In their migratory and
+nomadic life the mother finds it impossible to either carry or care for
+the two children. The male Hottentot, rather than have any avoidable
+infanticide in his family, or that his wife should go through and suffer
+the annoyance and pangs of an unnecessary and unprofitable pregnancy,
+generously has one testicle removed; this is something that the ordinary
+civilized white man would not do, even if his legitimate wife and all
+his outside concubines were to have twins or triplets every nine months;
+so that, even as strange as it may appear, civilization must need go to
+the wild Bushmen in search of that grand old Quixotic chivalry that was
+in ancient times always ready to sacrifice itself for the welfare of
+woman.
+
+The old Greek and Roman statues, representing the gods and athletes of
+ancient Greece and Rome, are a puzzle to many, owing to the diminutive
+and phimosed virile organ that the artists have attached to them. Galen
+represents that the disuse of the organ by the athletes was the cause
+of its undeveloped form, and that as the organ of these did not figure
+in the worship of Venus, or participate in the festivals of Bacchus, but
+was used solely and simply for micturating purposes, impotence was often
+the result, citing the case of a patient who came to consult him for an
+obstinate priapism resulting from venereal excess, who met, in his
+anteroom, an athlete who was being treated for the opposite condition,
+due to the too rigid continence to which he had been for years
+subjected. Acton does not believe that continued continence has that
+effect, quoting Dr. Bergeret, who had long been physician to a number of
+religious societies, as saying that he had never seen serious troubles
+of the organs of generation in these communities, which denotes that if
+they indulged in proper fasting and prayer they were in the same
+condition of flaccid impotence as the athlete in Galen's anteroom. Louis
+VII, of France, tried fasting and prayer in connection with rigid
+continence, and, as a result, his wife, Queen Eleonore, was divorced
+from him and married Henry II, of England, who had not been continent.
+Hence, we see that the old sculptors, whether wishing to represent
+Jupiter or Plato, AEsculapius or Mars, a strongly knit and muscular frame
+was desired, an athlete, gladiator, or soldier being used as a model;
+the small, puerile, funnel-prepuced organ belonged to all these muscular
+or well-trained classes, was a natural appendage, as enforced continence
+and the most absolute chastity was the rule, to enforce which they even
+resorted to infibulation. This enforced continence often resulted in
+impotence, even before the prime of life was passed, accompanied by an
+inevitable atrophy of the male organ, with the resulting prepuce in the
+shape in which it is found in a boy of from eight to twelve years,
+precisely as they are found on the statues. How faithful the sculptors
+and artists were to nature and life in their representations can well be
+imagined by a critical examination of the Apollo Belvidere, where the
+difference of the scrotal position that exists between the right and
+left testicles is carried out to the minutest anatomical detail. In our
+age it is hard to conceive why their most masculine men should be
+deified, and all their gods represented as the most perfect of bodily
+development, while at the same time the finest physical specimens of
+manhood were doomed to a life of the most rigorous continence. It is
+also astonishing that all this should be done not from any principle or
+consideration of morality or virtue, but simply as a means subservient
+in producing at its maximum the highest degree of physical development
+and endurance.
+
+
+
+
+CHAPTER VI.
+
+ATTEMPTS TO ABOLISH CIRCUMCISION.
+
+
+Probably no rite or practice of a custom has been such a long-standing
+bone of contention as circumcision; nor does the Sphynx surpass this
+relic of bygone ages in mystery. From time immemorial its practice has
+been the subject of disputes, and its literature finds oftentimes its
+friends and foes ranged side by side. At one time a noted Israelite and
+Voltaire, the scoffer of Judaism, may be consulted on the question as to
+whether Israelite or Egyptian is entitled to priority as to its original
+practice with a like answer; and, again, Christians are found who, after
+a careful investigation, will accord this to the Israelites. In Rome,
+the persecuted Hebrew was stopped on the street and compelled to show
+the mark of circumcision, that he might be taxed, and in Turkish parts
+the Christian was subjected to the same indignity to enable the
+tax-gatherer to harvest the impost which he paid for his liberty of
+conscience and not being circumcised. When the monkish missionaries of
+the Catholic faith first entered Abyssinia, they were shocked to find
+their converts insisting on their time-honored practice of circumcision;
+and later, when the Propaganda sent its own missionaries, they were
+scandalized to see Christians practicing what they looked upon as an
+infidel rite; and nothing but the most earnest confession of faith, with
+the assurance that the rite of circumcision was only a physical remedy,
+and that in their conscience it in no wise possessed any religious
+significance, and that neither did they, in any sense, hold it in any
+connection with the sacrament of baptism, permitted these Abyssinians to
+save themselves from excommunication. Later still, when an Abyssinian
+bishop was present in Lisbon, the clergy of the city refused him the
+right of celebrating the sacrifice of the holy mass in the Cathedral of
+Lisbon, on the ground that he, having been circumcised, was no better
+than a heretic. The Abyssinian Christians still practice the rite at the
+present day.
+
+The Turks, although very fanatical and greater proselyters than the
+Christians of Rome, seem now and then to relax in favor of general
+utility, as we find Bajazet II writing to the Pope, Alexander VI,
+supplicating his Holiness to confer a cardinal's hat on the Archbishop
+of Arles as a special favor to the Turkish emperor, as he knew that the
+archbishop _had a secret leaning toward Mohammedanism_. As the clergy of
+those days, from the Holy Father down, were more politicians than
+followers of the humble Nazarene, the heaven of Mohammed had probably
+more attractions for their taste than the ideal Christian paradise, and
+it is possible that the good archbishop would have submitted to a
+cardinal's hat and circumcision at the same time to secure the good
+things of this world and of those in the world to come. History also
+relates that his most Christian majesty, Henry III, of France, as a
+relaxation to the interminable squabble between two Christian religious
+factions which were rending France, and which in the end cost him his
+life, actually wrote a letter to the Sultan, asking the favor to be
+allowed to stand as godfather at the circumcision of his son. When it is
+remembered that the godfather at a Turkish circumcision has to make a
+strong profession of Moslem faith and the answers as sponsor for the
+child, and must promise that the child will be faithful to the Koran and
+Mohammed, it will be seen that, however much the lower levels of
+humanity may quarrel over trifles, the heads of the people easily
+accommodated themselves to any existing circumstances. Friar Clemens
+might as well have let such a liberal-minded monarch live, as any of the
+existing churches could easily have got along with him.
+
+On the other hand, we have the remarkable tenacity to custom and habit
+in this regard, as exhibited by the Moslems, who, although having
+neither ordinance nor authority for its performance, either in their
+law, creed, or in any order from their prophet, still no more zealous
+circumciser exists than the son of Islam, who exacts from all proselytes
+the excision of the prepuce. Mohammed was circumcised in his boyhood,
+and, although he did not order its performance to his followers, he did
+not see fit to proscribe a custom so general to the Arabians, where the
+greater development of the prepuce probably renders circumcision a
+necessity. From the same reason it is easy to perceive why the rite has
+found such general observance among the Africans, who are as noted for
+long and leathery prepuces as for their slim shanks. One author, writing
+in 1772, in a work entitled "Philosophical Researches on the Americans,"
+treats the subject in a very intelligent manner. His arguments are both
+ingenious and plausible. This author looks upon circumcision as of
+purely climatic origin in its inceptive causes. From a careful survey of
+the natural history of man in his general distribution over the globe,
+he finds that circumcision may be said to be restricted to within
+certain boundaries of latitude, equidistant on both sides of the line.
+No circumcised people have ever inhabited northern regions, and the bulk
+of the circumcised races are found within certain climates. From this
+reasoning it is easy to see why the rite should lose its standing under
+certain climatic conditions, unless bolstered up by some religious
+significance, as it is equally easy to foresee why it should flourish
+elsewhere, even without any religious backing or ordinance. It is well
+known that in Ethiopia and the neighboring countries, excrescences and
+elongation of either the prepuce or nymphae are as probable as the
+existence of an enlarged thyroid gland or goitre among the inhabitants
+of some of the valleys of Switzerland or of those of the Tyrol.
+According to the author of the treatise just quoted, circumcision would
+be nothing more than a remedy to repair the evils that a faulty
+construction of the human body developed in certain climatic conditions.
+
+With the Israelites it is observed as a religious rite, although they
+are not strangers to the physical benefits that circumcision confers
+upon them; the fact that even where no prepuce exists, as sometimes
+happens, the circumciser nevertheless goes on with the rite, being
+satisfied with drawing a few drops of blood from the skin near the
+glans, stamps the operation essentially as being a religious rite.
+Persecutions have signally failed to suppress its performance by those
+of the Hebrew faith. Beginning with the decree of Antiochus, 167 B.C.,
+which consigned every Hebrew mother to death who dared to circumcise her
+offspring, they have not ceased to suffer in defense of their rite.
+Adrian, among other repressive measures, forbade circumcision; under
+Antonine this edict was still enforced, but he afterward recalled it and
+gave to the Hebrews the right of observing their religious rites. Marcus
+Aurelius, however, revived the edict of Adrian. Heliogabalus, who
+ascended the Roman throne in the year 218 A.D., was himself circumcised.
+During the reign of Constantine all the laws that interfered with
+Hebraic rites were renewed, with the addition that any Hebrew who should
+circumcise a slave should suffer death. Under the sway of Justinian, in
+the sixth century, the persecutions against these people were so
+oppressive that a Hebrew was not allowed to raise or educate his own
+child in the faith of his fathers. In the seventh century, the augurs
+having prophesied the ruin of the Roman Empire by a circumcised race to
+the emperor Heraclius, the persecutions were renewed against these
+unfortunate people. In this century, Hebrews refusing baptism suffered
+banishment and confiscation of all their property; they were obliged to
+renounce the Sabbath, circumcision, and all Hebraic rites if they wished
+to remain. About this period the success of the Saracens induced
+persecutions of the Hebrews in Spain, where their children were taken
+away from them that they might be raised in the Christian religion. In
+the fifteenth century they suffered the greatest persecution and
+martyrdom at the hands of the Spanish Inquisition. The persecutions
+above cited were national and governmental persecutions levelled
+directly at the Jewish nation and creed; the persecutions that they
+momentarily suffered at other times had no signification beyond the
+exhibition of popular spite and fury, but those above cited were moves
+calculated to extirpate the creed, if not the people, from off the face
+of the globe. If repressive measures are of any avail, circumcision as
+an Hebraic rite should now have no existence. Its present existence and
+observance show a vitality that is simply phenomenal; its resistance and
+apparent indestructibility would seem to stamp it as of divine origin.
+No custom, habit, or rite has survived so many ages and so many
+persecutions; other customs have died a natural death with time or want
+of persecution, but circumcision, either in peace or in war, has held
+its own, from the misty epochs of the stone age to the present.
+
+There is something pathetic and soul-appealing in contemplating the
+early Christians forced to worship in the catacombs of Rome, hunted like
+wild animals in their subterranean burrows, and then given the choice of
+making offerings to the heathen gods or being thrown into the arena as
+prey to wild beasts; so are we stirred when we think of the Spanish Jew,
+who had made Spain his home for centuries, being driven into exile in
+such droves that no country could receive them; we see them perishing of
+hunger by the thousands on the African coast, and dying of starvation on
+the quays of the ports of civilized Italy. That many, through all these
+trials, were forced to embrace other religions is not astonishing. In
+Spain apostacy was to no purpose, as the Inquisition could not be
+expected to split hairs in regard to an apostate Jew, when it sent the
+best of Gothic blood, raised in the Catholic faith, to the _auto da fe_
+or the scaffold,--the rack respecting neither faith nor profession that
+fell into its clutches. In milder persecutions, however, he escaped by
+outwardly conforming to the demands of his oppressors and history tells
+us of the circumcisions secretly performed on the dead Jew, that the
+spirit of the law of their fathers might be carried out.
+
+In other cases, threatened exile, confiscation, or exorbitant taxation
+drove them to adopt every possible expedient to eradicate the sign of
+their Israelitism and make attempts to reform a prepuce. The first
+attempts in this line were made during the reign of Antiochus, when a
+number of Hebrews wished to become as the people about them who were not
+persecuted--_fecerunt cibi praeputia_. This is no easy operation, and in
+later times by the aid of appliances, both in Rome and in Spain, they
+undertook to cause the skin to recover the glans. Martial, in speaking
+of the instrument used in Rome, a sort of a long funnel-shaped copper
+tube in which the Hebrew carried his virile organ, terms it _Judaem
+Pondum_, the weight of which, by drawing down the skin, was supposed in
+time to draw it down far enough to answer the purpose. The apostle Paul,
+in his epistle to the Corinthians, refers to these practices when he
+says, "Was any one called being circumcised, let him not be
+uncircumcised." The operation of reforming a prepuce, or of obliterating
+the marks of circumcision, does not appear to have been a success.
+
+The writer had one experience that was interesting. On one occasion he
+advised circumcision for the relief of a reflex nervous disease, in a
+tall, athletic Austrian sailor from the Adriatic; although the nature of
+the operation was explained to the man, he evidently did not appreciate
+its full nature and importance until a sweeping cut with a scalpel left
+the excised prepuce in the operator's hand. Most Adriatic sailors have
+sailed up the Bosphorus and are more or less familiar with both the
+Greek and Turkish nations; the latter they despise with gusto, "_porchi
+di Turci_" being the affectionate appellation they bestow on their
+national neighbors. No sooner did he perceive the real condition of
+affairs than he began to beat his head, saying that he was disgraced
+forever, as he never would dare to associate with his countrymen again,
+as he would be liable to be taken for a _porcho di Turco_; his frenzy
+increased to such a pitch that to spare any unpleasantness it was deemed
+advisable to replace the prepuce, which was done accordingly, the man
+making a tolerable good recovery, as far as the grafted prepuce was
+concerned. It required a secondary operation to overcome some
+cicatricial contraction, and, on the whole, he had a very serviceable
+prepuce; but, what was more to the point, it prevented his ever being
+mistaken for a Turk.
+
+
+
+
+CHAPTER VII.
+
+MIRACLES AND THE HOLY PREPUCE.
+
+
+What strange fancies have circled themselves about the subject of
+generation or its organisms during the different stages of moral
+civilization since the world has existed! The efforts in this regard
+among different creeds have been something peculiar. Neither Mohammedans
+nor Hebrews--both zealous circumcisers--ever went to the lengths reached
+by Christian churches and their followers in some particulars concerning
+this rite; this being especially strange when it is considered that the
+new creed was the one that abolished the rite and through which the Jews
+suffered such cruel and unjust persecutions. The early Christian Church
+celebrated and continues to celebrate the Feast of Circumcision, and
+history relates some strange events in connection with this
+circumcision. Having abolished and repudiated the rite, it would seem
+inconsistent that it should celebrate its performance on any occasion
+and consider such an event sufficiently memorable that its occurrence
+should excite the veneration of the church and be the means of exciting
+the pious zeal of the faithful. The strangest events in this connection
+are still more mysterious and incomprehensible, if not amusing, the only
+excuse for the occurrence being the greedy thirst for relics of any and
+all kinds that in the middle ages pervaded Europe.
+
+At some remote period--in the thirteenth or fourteenth century--the
+abbey church of Coulombs, in the diocese of Chartres, in France, became
+possessed in some miraculous manner of the holy prepuce. This holy
+relic had the power of rendering all the sterile women in the
+neighborhood fruitful,--a virtue, we are told, which filled the
+benevolent monks of the abbey with a pardonable amount of pride. It had
+the additional virtue of inducing a subsequent easy delivery, which also
+added to the reputation and pardonable vanity of the good monks. This
+last virtue, however, we are told, came near causing the loss to the
+abbey of this inestimable prize, for, as a French writer observes, a too
+great reputation is at times an unlucky possession; at any rate, the
+royal spouse of good and valiant King Henry V--he of Agincourt, whom
+England waded up to its knees in the sea at Dover to meet on his return
+from that campaign--had followed the example of all good dames and was
+about to give England an heir. Henry then governed a good part of
+France. Having heard of the wonderful efficacy of the relic of Coulombs,
+he early one morning threw the good monks into consternation by the
+arrival at the convent gate of a duly equipped herald and messenger from
+his kingship, asking for the loan of the relic with about as much
+ceremony as Mrs. Jones would ask for the loan of a flat-iron or saucepan
+from her neighbor, Mrs. Smith. The queen, Catherine of France, was of
+their own country and Henry was too powerful to be put off or refused;
+there was no room for evasion, as the holy prepuce could not be
+duplicated; so the poor monks with the greatest reluctance parted with
+their precious relic, entrusting it into the hands of the royal envoy,
+which wended its way to London, where it in due time, being touched by
+the queen, insured a safe delivery. Honest Henry then returned the relic
+to France; but so great was its reputation that royalty caused a special
+sanctuary to be erected for its reception, and a full period of
+twenty-five years occurred before the monks of Coulombs again regained
+possession of their prize, during which period the population of the
+neighborhood must have suffered from the natural increase of sterility
+and the physicians must have reaped a rich harvest owing to the
+increased difficulty and complications of labor induced by the absence
+of the relic. On its return, the relic was found to have lost none of
+its virtues, and the good people and monks were all correspondingly made
+happy; in 1870, when the writer was in France, it was still working its
+miracles. Balzac found ample facts to found his famous "Droll Stories"
+without straining his imagination.
+
+So great an attraction was not to go without attempted rivalry or
+imitators; hence we find in the "Dictionary of Moreri," edition of 1715,
+in the third volume, at page 108, that several other establishments
+claim the honor of a like relic,--namely, the Cathedral of Puy, in
+Velay; the collegial church of Antwerp; the Abbey of our Saviour, of
+Charroux; and the Church of St. John Lateran, in Rome. All of these have
+had very adventurous histories. The Abbey of Charroux was founded by
+Charlemagne in 788, and among the relics with which that monarch endowed
+the abbey the principal one was a fragment of the holy prepuce. This
+abbey enjoyed great reputation, and indulgences were granted by Papal
+bull to all those who assisted at the adoration of the relics. In the
+internecine wars of the sixteenth century the abbey fell into the hands
+of the godless and heretical Huguenots and the holy relic disappeared.
+In 1856, while some workmen were at work demolishing an ancient wall on
+the abbey site, they discovered some relic cases. The bishop was at once
+notified, who immediately proceeded to investigate, when, lo and
+behold! there, sure enough, was a piece of desiccated flesh, with marks
+of coagulated blood; nothing more or less than the lost prepuce--long
+lost, but now found. It was placed in charge of the Ursuline Sisterhood,
+where it has remained ever since undisturbed, except by a controversy in
+regard to the propriety of the relic, in which the good bishop ambled
+about in the most ambiguous manner, the only clearly defined portion of
+his dissertation being the one wherein he laments "the decadence of that
+truly Christian spirit which animated the laity of the middle ages with
+a radiant zeal. A piety also pervaded those gentle Christians of former
+times, who were possessed of a religious instruction which determined
+for them the tenets of the creed and its practices,--a happy state or
+condition of affairs, which prevented the intelligence of the faithful
+from wandering into the sloughs of unprofitable skepticism." This
+settled the question as to the propriety of the prepuce being converted
+into a miracle-working relic; at least, as far as the good bishop was
+concerned.
+
+It would be an injustice not to mention the other shrines in detail
+after the prominence that has been given to the abbeys of Coulombs and
+Charroux; so the history of another will be given. We are not told just
+how the Church of St. John Lateran in Rome first became possessed of
+_its_ holy prepuce, but it nevertheless had one; also the only authentic
+one in existence, like all the others. It disappeared at one of the
+periodical sackings that Rome has repeatedly suffered at the hands of
+Goth, Vandal, or Christian. This time it was the soldiery of the eldest
+son of the church--- Charles V--who did the sacking; it was in the year
+1527, a soldier--probably some impious, heathenish mercenary--broke into
+the holy sanctuary of the church and stole therefrom the box that
+contained the holy relics, among them the holy prepuce. These impious
+wretches, as a rule, came to grief in short order; hence we are told
+that this mercenary and sacrilegious soldier was compelled to secrete
+his box, when only a short distance from Rome, where the box remains and
+the mercenary wretch disappears, probably carried off bodily by the
+devil, as he deserved. Thirty years afterward the box is discovered by a
+priest, who, ignorant of its contents, carries it to the lady on whose
+domain it was found. On being opened it was found to contain a piece of
+the anatomy of Saint Valentine, the lower jaw of Saint Martha, with one
+tooth still in place, and a small package upon which the name of the
+Saviour was inscribed. The lady picked up the package, when immediately
+the most fragrant odor pervaded the apartment, being exhaled by the
+miraculous packet, while the hand that held it was seen perceptibly to
+swell and stiffen; investigation proved it to be the holy prepuce stolen
+by the miscreant mercenary from St. John Lateran. It is related that in
+1559, a canon of the church of St. John Lateran, impelled by a worldly
+curiosity untempered by piety, undertook to make a critical examination
+of this relic, in the process of which, to better satisfy himself, he
+had the indiscretion to break off a small piece; instantly the most
+dreadful tempest broke over the place, followed by crashing peals of
+thunder and blinding flashes of lightning; then a sudden darkness
+covered the country, and the luckless priest and his assistants fell
+flat on their sacerdotal noses, feeling that their last hour had
+arrived.[26]
+
+Wonderful and miraculous cures are performed at these shrines, and some
+of the cures are of a nature that would baffle the intelligence of the
+most learned mind to ascertain the intricate and devious way that
+nature must at times journey to accomplish some of these changes. The
+writer well remembers seeing, in the Church of Corpus Christi, in
+Turin,[27] a long hall, covered, from marble pavement to ceiling, with
+votive tablets, after the manner inaugurated in the old temples of
+Greece. Modern votaries have the advantage of being able to record their
+cure, safe venture or escape from peril, by means of faithful
+representation of the event in painting or drawing, as the material and
+art is more common now than in the days of ancient Greece, who recorded
+its cures by simple inscription in laconic terms. Modern medicine labors
+under the disadvantage of presuming that the people are endowed with an
+intelligence that was unknown to ancient or mediaeval people, when, in
+fact, the people are as credulous and as subject to imposition as they
+were in the earlier centuries of the present era. With all its supposed
+superior intelligence, there is no fatter pasture for quacks and
+impostors than that presented by the people of the United States.
+Whenever I see the poor, intelligent, broad-minded physician struggling
+along, barely able to procure for himself the necessaries required to
+maintain himself with proper books and appliances, while the itinerant
+quack or dogmatic practitioner rolls in undeserved affluence, I question
+the wisdom of our ethical code. Braddock, at the Monongahela, scorned to
+have his regulars, who had fought under Marlborough and Eugene, break
+ranks before a lot of breech-clouted savages, and take shelter that the
+nature of the ground and the trees could afford, thinking it an unfit
+action for men who had faced the veterans of Louis XIV on many a
+hard-fought European field. I sometimes think that if _our_ regulars
+were, for only a season, to follow the example of the provincial
+militia at that battle, it would be better for the country, the people,
+science, and last, but not the least, for the profession. The theory
+that we should not counsel with quacks is altogether mischievous and
+fallacious, although right and rigidly orthodox in its intent; were we
+to counsel and meet these gentry, we should expose their ignorance and
+assumption, and we should not be exposed to the charge of jealousy and
+of fear to meet them in consultation. I remember on one occasion a
+client went to a lawyer for advice as to how he might dispossess some
+parties who had some adverse claim to some property which he owned,
+after due deliberation and a protracted siege of the house, in the vain
+hope of gaining admittance; the lawyer advised his client to go and nail
+up all exits and fasten them in, which had the effect of driving them
+out. So with our profession--we should not neglect an opportunity of
+meeting a quack in consultation, regardless of the nature of the case;
+it is the only way to nail them up; as it is, we have simply chained up
+the shepherd-dog and given the wolves full play.
+
+The French Guards at Fontenoy, who out of courtesy refused to fire first
+on the English, may have been very ethical and chivalrous, but they were
+very foolish, as the English discharge nearly swept them from the field,
+and but for the Irish Brigade, who knew no ethics, Louis XV would in all
+likelihood have followed the example of King John, who, after Crecy,
+visited England for a season. A disregard of ethics gave Copenhagen to
+Lord Nelson, who insisted on looking at Admiral Parker's signal to
+withdraw from action with his sightless eye, which could not see it. A
+fear of disregarding ethics lost to Grouchy the chance of assisting
+Napoleon at Waterloo. In our strife against ignorance and quackery the
+profession should follow the general plan of action usually adopted by
+Lord Nelson--lie alongside of whom you can and sink or capture your
+enemy; let each man do his duty; never mind any general plan. A reverse
+to this mode of fighting invariably lost the battle to the French and
+Spaniards, who were, as a rule, all tied up in ethical red tape. Our
+profession is broad, intelligent, and fearless; we do not profess any
+exclusive dogma, and should not, therefore, exclude persons; as a large
+ship throws its grappling-irons on to its adversary, we should always
+seek an opportunity to meet these gentry when practicable. As it is, we
+have placed them on the vantage-ground of appearing as being persecuted;
+our ethics need circumcising in this regard, and the prepuce of
+exclusion should be buried in the sands of the desert.
+
+Moreover, we often are apt to learn something from even the most
+ignorant of these men. Rush investigated the nature of a cancer-cure by
+not refusing to meet and talk with one of this kind;[28] Fothergill
+learned from an old, unlicensed practitioner that there was a knowledge
+important to the physician beyond that picked up in the pathological
+laboratory or the study of microscopy; and that the practiced eye of an
+otherwise unlearned man could detect that there were general physical
+signs that negatived the unfavorable prognosis suggested by the presence
+of tube-casts.[29] It is related of Sir Isaac Newton, that while riding
+homeward one day, the weather being clear and cloudless, in passing a
+herder he was warned to ride fast or the shower would wet him. Sir Isaac
+looked upon the man as demented, and rode on, not, however, without
+being caught in a drenching shower. Not being able to account for the
+source of information through which the rustic had gained his
+knowledge, he rode back, wet as he was, to learn something. "My cow,"
+answered the man, "always twists her tail in a certain way just before a
+rain, your Worship, and she so twisted it just before I saw you."[30]
+Although twisting cow-tails do not figure in his "Principia," it is very
+probable that such a lesson was not without its remote effects on a mind
+like Newton's. A spider taught a lesson to one of Scotland's kings; so
+that one man may learn something from another.
+
+Professor Letenneur, of the Medical School of Nantes, in his "Causerie a
+propos de la Circoncision," mentions that the Convent of Saint
+Corneille, in Compiegne, claims to possess the identical instrument with
+which the Holy Circumcision was performed. Such a holy relic must have
+been unusually potential in performing many miracles.
+
+In this connection it will not be amiss to notice the lapping over that
+the old phallic worship and idea has made on the new religions. It is
+also as interesting to observe how the human mind still leans toward
+observances and ideas which are believed to belong to a solely pagan
+people. Hargrave Jennings, in a chapter devoted to phallic worship among
+the ancient Gauls, gives many interesting and curious examples, the
+first example that he notices being that of Saint Foutin (from whom the
+very expressive French word "_foutre_" is taken). Foutin was the first
+Christian bishop of Lyons, and after his death, so intimately was
+priapic worship intermingled with the religion or theology of the Gauls,
+that somehow the memory of St. Foutin and the old, dethroned Priapus
+became commingled, and finally the former was unconsciously made to take
+the place of the latter. St. Foutin was immensely popular. He was
+believed to have a wonderful influence in restoring fertility to barren
+women and vigor and virility to impotent men. It is related that, in the
+church at Varages, in Provence, to such a degree of reputation had the
+shrine of this saint risen, it was customary for the afflicted to make a
+wax image of their impotent and flaccid organ, which was deposited on
+the shrine. On windy days the beadle and sexton were kept busy in
+picking up these imitations of decrepit and penitent male members from
+the floor, whither the wind wafted them, much to the annoyance and
+disturbance of the female portions of the congregation, whose devotions
+are said to have been sadly interfered with. At a church in Embrun there
+was a large phallus, which was said to be a relic of St. Foutin. The
+worshippers were in the habit of offering wine to this deity,--after the
+manner of the early Pagans,--the wine being poured over the head of the
+organ and caught underneath in a sacred vessel. This was then called
+"holy vinegar," and was believed to be an efficacious remedy in cases of
+sterility, impotence, or want of virility.
+
+Near the city of Bourges, at Bourg Dieu, there existed, during the Roman
+occupation of Gaul, an old priapic statue, which was worshipped by the
+surrounding country. The veneration in which it was held and the
+miracles with which it was accredited made it impolitic as well as
+impossible for the early missionaries and monks to remove it; it would
+have created too much opposition. It was therefore allowed to remain,
+but gradually changed into a saint,--St. Guerluchon,--which, however,
+did not detract any from its former merit or reputation. Sterile women
+flocked to the shrine, and pilgrimages and a set number of days of
+devotion to this saint were in order. Scrapings from this statue infused
+in water were said to make a miraculous drink which insured conception.
+Similar shrines to this same saint were erected at other places, and we
+are told that the good monks, who must have had an intense and lively
+interest in seeing that the population was increased, were kept busy
+supplying the statues with new members, as the women scraped away so
+industriously, either to prepare a drink for themselves or for their
+husbands, that a phallus did not last long. At one of these shrines, so
+onerous became the industry of replacing a new phallus to the saint,
+that the good monks placed an apron over the organ, informing the good
+women that thereafter a simple contemplation of the sacred organ would
+be sufficient; and a special monk was detailed to take special charge of
+this apron, which was only to be lifted in special cases of sterility.
+By this innovation the good monks stole a march on their brothers in
+like shrines in other localities, such as those of St. Gilles, in
+Brittany, or St. Rene, in Anjou, where the old-fashioned scraping and
+replacing still was in vogue. Near the seaport town of Brest, in
+Brittany, at the shrine of St. Guignole, the monks adopted a new
+expedient. They bored a hole through the statue, through which a phallus
+was made to project horizontally; as fast as the devotees scraped away
+in front the good monks as industriously pushed forward the wooden peg
+that formed the phallus, so that it gave the member the miraculous
+appearance of growing out as fast as scraped off, which greatly added to
+its reputation and efficacy. The shrine continued in great vigor until
+the middle of the last century. Delaure mentions a similar shrine at
+Puy, also in France, which existed up to the outbreak of the French
+Revolution. The scrapings in this case were immersed in wine, and the
+guardians of the statue saw to it that no amount of paring or scraping
+should remove from the saint any of that appearance of vigor or
+virility which his great reputation demanded, this being done by a
+similar procedure as followed at the church near Brest, one of the
+attendants having been sent to investigate into the marvelous growth of
+the Brest phallus.
+
+
+
+
+CHAPTER VIII.
+
+HISTORY OF EMASCULATION, CASTRATION, AND EUNUCHISM.
+
+
+For the earliest records in regard to emasculation we must go back to
+mythological relations. In the old legendary lore of ancient Scandinavia
+or of Germany, the loves and hatreds of their semi-mythological heroes
+and heroines space over many romantic incidents before reaching a
+culmination. The swiftly flowing Rhine, with its precipitous banks,
+eddies, and rapids; the broad and more majestic Danube or Elb; the broad
+meadows and Druidical groves on its hilly slopes and stretches of dark
+and gloomy forest,--all conspired to people the fancy with elfs, gnomes,
+fairies, and goblins, who were more or less intermingled in all the
+episodes that engaged their semi-mythological heroes. This helped to
+fill in all their deeds with entertaining incidents; their halls and
+castles were made necessary accessories by the rigors of the climate, as
+well as were the beery feasts and carousals with the inspiration of
+monotonous song also rendered necessaries by the same element; hence, we
+have various incidents, either entertaining or exciting, connected with
+their legendary tales, acting like periods of intermission between their
+love scenes, spites, hatreds, murders, and general cremations. From such
+material and such opportunities it was comparatively easy for Wagner to
+construct the thrilling and interesting incidents that compose his opera
+on the legend of the Nibelungenlied.
+
+The Grecian landscape and topography does not permit of such richness of
+romantic incidents or details, any more than the love-making of the
+unfortunate spider who is devoured by his spidery Cleopatra at the end
+of his first sexual embrace could furnish any incidents for one of
+Amelie Rives's spirited novels; so that neither minstrel nor bard have
+recorded the details of the first emasculating tragedy, which from all
+accounts was a kind of an Olympian Donnybrook-fair sort of a
+paricidal-ending tragedy.
+
+Unfortunately, Homer was not there to describe the event, or we might
+have had a Wagnerian opera with its Plutonic music to illustrate all its
+incidents; or even a Virgil could have made it into interesting verses;
+but, as it is, we must content ourselves with the laconic recitals that
+have been handed down by tradition, and, as all the Greek performances
+of those days were marked by an intense decisiveness, with an utter lack
+of circumlocution, it is probable that there was not much to relate
+beyond the bare facts.
+
+In Smith's "Dictionary of Greek and Roman Biographies and Mythology" we
+find it related that Uranos, or Coelus, was the progenitor of all the
+Grecian gods. His first children were the Centimanes; his next progeny
+were the Cyclops, who were imprisoned in Tartarus because of their great
+strength. This so angered their mother, Gaea, that she incited her
+next-born children, the Titans, into a rebellion against their father,
+Uranos. In the general turmoil that followed Uranos was deposed, and, so
+that he would be incapable of begetting any more children, Saturnus, the
+youngest of his sons, with a sickle made from a bright diamond,
+successfully emasculated poor old Uranos. The records are not clear
+whether the operation only included the penis, or the scrotum and
+contents, or whether, like the Turkish or Chinese _taille a fleur de
+ventre_, Saturnus made a clean sweep of all the genitals; it is
+probable that he did, however, as the members fell into the sea, and in
+the foam caused by the commotion from their contact with the element
+Venus was born. Meanwhile, the blood that dripped from the wounded
+surface caused the Giants, the Furies, and the Melian nymphs to spring
+into life. Uranos is also represented as being the first king of
+Atlantis; so that the first eunuch was a god and a king, more
+unfortunate than any of Doran's heroes, in his "Monarchs Retired from
+Business," because he was more effectually retired from business than
+any monarch that Doran records.
+
+After this the practice seems to have been adopted in a general way; and
+the fact that the future proceedings of men and things on earth do not
+much interest these unfortunate members of society in any great degree,
+interest in worldly affairs and testicles seemingly having been as
+intimately connected in those early and remote days as with us of the
+present, it very naturally followed that this disinterestedness, as well
+as the docility and pliability which emasculation engenders, first
+suggested their use as servants or in position of trust, as a eunuch,
+having no incentive either to run away or to embezzle, would naturally
+be a valued and trusted servant. In the days of eunuchism there were no
+defaulting bank, city, or county cashiers,--a circumstance which would
+suggest that such a condition should form one of the qualifications for
+eligibility to such offices, the very opposition to any such proposal
+that the class would make showing in itself the benefits that would
+follow such an innovation, as it would show that the class is not
+possessed with that total spirit of abnegation requisite in the
+guardians of public funds. The requirement might be extended to
+bank-presidents with benefit, if some Cincinnati episodes are any
+criterion. It is safe to assume that the bank that could advertise, in
+connection with its attractive quarterly or semi-annual statement, that
+the president and cashier were properly attested and vouched-for eunuchs
+would find in the public such a recognition of the fitness of things
+that the patronage it would receive would soon compel other banks to
+follow the example. The procedure might, with national benefit, be
+extended as an ordeal to our legislators at the national capitol, as it
+would do away with the particular influential lobby so graphically
+described in Mark Twain's "Gilded Age." These things or ideas are merely
+thrown out as suggestions to be used by those who write those
+interesting articles in the _Forum_, or the _North American_ or
+_Fortnightly Reviews_, on government and social reforms, as a perusal of
+the many articles written in that direction will convince any one that,
+from a practical psychological view of the matter, they are sadly
+deficient. To make those articles effective the reflex impressions made
+by the animal on the psychological and moral nature of man should not be
+neglected.
+
+Semiramis, whose beauty and many accomplishments, assisted by the
+murders of several of her husbands by the hand of the succeeding one,
+had this subject in hand in a far more practical manner than it is
+generally forced on the understanding; hence we see that she was the
+first to introduce the use of eunuchs in the capacity of servants as
+well as in official positions in and about the palace, as well as
+trusting some of the positions of the highest importance to the class.
+From her epoch, eunuchism has become an inseparable attendant on
+Oriental despotism, and has so continued to the present day. Like yellow
+fever, phthisis, and some diseases, as well as many other social
+afflictions and customs, eunuchism does not seem to flourish beyond
+certain degrees of north and south latitudes,--a fact that probably
+assisted Montesquieu to arrive at the conclusion that climate was a
+powerful factor in all things.
+
+Bergmann, of Strasburg, quotes the ancient traditions, wherein it is
+stated that man was taught the art of castration by the brute creation.
+The hyena is cited as having so instructed man by the habit it exhibited
+of castrating its infant males in removing the testicles with its teeth,
+the habit being instigated by a jealousy, for fear of future competition
+in the exercise of the procreative act on the part of the young males.
+Another tradition attributes its origin to the castor. Bergmann here
+traces out the etymological relation existing between the name of the
+operation and that of the animal with that of a Greek verb that forms
+the root of _castrum_, or camp; _casa_, or house; _castigare_, to
+arrange; from whence also is traced _cosmos_, the world; _kastorio_, the
+Greek for wishing to build, and the Latin _kasturio_ having the same
+relative but a more imperative signification; _kastor_, signifying as
+loving to build; _castitiator_, Latin for architect, and _casticheur_,
+old French for constructor. The tale or tradition in regard to the
+self-mutilation inflicted by the castor is traced to the Arabian
+merchants who purchased the castoreum, which was imported from the
+shores of the Persian Gulf and from India. It was called, also, by the
+Arabs, _chuzyalu-l-bahhr_, or testicles from beyond the sea; or, in
+French, _testicules d'outre mer_. These terms and the tradition that the
+castor on being pursued, knowing the reason of the chase, was in the
+habit of tearing out his testicles and throwing them at his pursuers,
+were invented by these merchants to heighten the price and value of the
+article intrinsically, as well as to make it more interesting by this
+peculiar individuality of adventure. The Latins, believing and adopting
+the tradition as a matter of fact, coined the word _castorare_, or doing
+like the castor. Bergmann uses in this connection a number of terms in
+French to denote different forms or degrees of this mutilation which
+have no equivalents in English,--for instance, _chatrure_, as applied to
+animals, making also a distinctive difference between the meaning of the
+French words _castration_ and _chatrement_. Bergmann is a decided
+evolutionist as regards circumcision being evolved from prior forms of
+physical mutilation, as will be more fully explained in the next
+chapter; the shaving of the head of a conquered people by the Hindoos,
+or the shearing the royal locks of the ancient Frankish kings; the
+blinding of one eye of their slaves by the old Scythians, or crippling
+one foot by the division of a tendon in a captive by the Goths, he
+considers as on the same line with the idea that led to castration, the
+different forms of eunuchism, and circumcision.[31]
+
+From a purely materialistic and utilitarian view of the subject, he
+observes that what we call moral progress and civilization owe their
+advancement more to material interest and cold, selfish calculation than
+to any development of the humanitarian sentiments, and that neither
+morality nor justice has much to do with it. The evolution of the slave
+and the marks inflicted upon him by his fellow humans are the most
+emphatic evidences of the justness of the above proposition. The study
+of the subject is equally interesting when considered in connection with
+the evolutions of the Christian Church. In its divergence from Judaism
+and its beneficent laws, both social and moral, the Christian Church was
+but illy fit to cope with its persecutors of Pagan tendencies, or to
+enforce an unwritten law or code of morality or hygiene among an
+idolatrous, barbarous, and ignorant population such as it had to
+encounter. To its professors, the formation of that monachism which has
+been so much misunderstood and abused was but an inevitable
+condition.[32] These men had not the steady compass to guide them in the
+path that was possessed by the Jewish people. The martyrdom of Christ
+and many of his apostles, and the teachings of the early church, pointed
+to physical denials, castigations, humiliations, and sufferings as the
+only way to salvation; all pleasures were sin and all denials and pain
+were looked upon as steps to heaven. The climate pointed to sexual
+indulgence as the sum of all happiness, as can readily be inferred from
+the Mohammedan idea of heaven; so, with the early Christians who were
+born in the same climates, the denials of sexual pleasures were looked
+upon as the most acceptable offering that man could make to the Deity.
+Continence, celibacy, infibulation, and even castration were the
+conditions looked upon by many of these men as the only means of living
+a life on earth that would grant them an eternal life in the next. This
+view of the situation peopled the deserts with a lot of men dwelling in
+caves and in huts, living on such a scarce diet that they barely
+existed. That many went insane, and in their frenzy died while roaming
+in these solitudes, we have ample evidence. The tortures and impositions
+of the Pagan rulers also drove many to this life or death.
+
+Religious mania has caused many cases of self-mutilation, either to
+escape continued promptings and desires, or simply from a resulting
+species of insanity. Of the first, Sernin[33] reported to the Medical
+Society of Paris the case of a young priest who had castrated himself
+with the blade of a pair of scissors, and who nearly lost his life with
+the subsequent haemorrhage. The writer saw an analogous case on board an
+American war-vessel, of which Dr. Lyon was surgeon, in the harbor of
+Havre, in the spring of 1871, the subject being the ship's cobbler, a
+religious fanatic, who was driven insane by self-imposed continence. We
+are not surprised, from the lack of intelligence of the times, the
+extreme but undefined views as to religion that then ruled men, that
+self-imposed castration should have been sanely considered and carried
+into effect by Origines and his monks. The Cybelian priesthood had
+formerly set the example in their Pagan worship, and when we are told
+that the monks of Mount Athos accused the monks of the convent of a
+neighboring island with falling away from grace, because they allowed
+_hens_ to be kept within the convent inclosure, we may well believe that
+Origines and his monks felt that they were gradually ascending in grace
+when they submitted to this sacrifice. As strange as it may sound,
+self-castration is still practiced by the Skoptsy, a religious sect in
+Russia. In justice to the Church, however, it must be said that she
+neither asked for nor did she sanction these performances, although she
+was not quick enough in asserting that she recognized the same law in
+regard to her presbytery that controlled that of the Hebraic priesthood.
+
+Eunuchism presents many contradictory conditions; eunuchs have not
+always been the fat and sleek attendants on Oriental harems as tradition
+and custom places them or would have us believe; neither does the loss
+of virility, in a procreative sense, seem to have always robbed them of
+their virility in other senses, as we find eunuchs holding the highest
+offices in the State under the reigns of Alexander, the Ptolemys,
+Lysimachus, Mithrades, Nero, and Arcadius. The eunuch Aristonikos, under
+one of the Ptolemys, and another, Narces, under Justinian, led the
+armies of their sovereigns. These are, however, exceptional cases; as a
+rule, the result is as we observe in the domestic animals,--loss of
+spirit, vim, and ambition. The Church recognized this result, and, while
+the Hebraic law excluded eunuchs from participating in the priesthood as
+being imperfect and unclean, the Church reproached Origines and his
+monks and excluded eunuchs from its presbytery on the ground that such
+beings lack the moral and physical energy requisite in a calling that is
+supposed to guide or lead men; moreover, there are many reasons for
+doubting that the ministers of state and the generals of the reigns
+above mentioned were actually eunuchs in the full acceptance of the
+word. Among the ancients there were several methods of performing the
+operations that made the eunuchs; some were more effectual than others.
+From the removal of _all_ the genitals, or the penis alone, or the
+scrotum and testicles, or removing only the testicles, down to
+compression or to distorting the spermatic vessels, or, as in the case
+of the Scythians, who often became eunuchs from bareback riding, as
+Hammond describes a eunuchism manufactured by our southwestern Indians
+of New Mexico and Arizona, are performances that left many degrees of
+eunuchism; as we find some eunuchs that not only contracted marriage,
+but engendered children. Voltaire mentions Kislav-aga, of
+Constantinople, a eunuch _a outrance_, with neither penis, scrotum, nor
+anything, who owned a large and select harem. Montesquieu, in his
+"Persian Letters," admits this class of marriages as being practiced,
+but doubts the resulting conjugal felicity, especially on the part of
+the wife. Potiphar's wife was one of these unfortunate wives; no wonder
+that she tore Joseph's cloak in her desire. Juvenal mentions that some
+eunuchs were held in high esteem by the Roman matrons; it possibly could
+have been some of this kind of a eunuch that led armies or ruled in the
+palaces. Among the sultans and Oriental potentates those who had every
+exterior evidence of virility removed, so as to be obliged to micturate
+through the means of a catheter, were considered the safest guards, as
+well as they were the highest-priced eunuchs, for in their manufacture
+fully 75 per cent. of those operated upon died as a result. It is
+related that the Caribs made eunuchs of their prisoners of war on the
+same principle that caponizing is resorted to for our kitchens,--the
+prisoners were easier to fatten and were more tender when cooked. The
+Italians allowed their children to be eunuchized for chorister purposes
+in church services, their soprano voices after this treatment being
+simply perfect. It was considered that, in the year prior to the papal
+ordinance of Pope Clement XVI forbidding the practice or the employment
+of eunuchs in choirs, four thousand boys, mostly in the neighborhood of
+Rome, were castrated for chorister purposes.
+
+In China eunuchs were in use during the reign of the Emperor Yen-Wang,
+in 781 B.C. The Chinese make their eunuchs by a complete ablation of all
+genitals. In India the followers of Brahma never placed their women in
+charge of eunuchs. In Italy it was customary to emasculate boys that
+they might grow up with the faculty of taking the female parts in
+comedies, their voices thereby assimilating to that of the other sex,
+this being on the same principle that the _basso-profundos_ were
+infibulated that they might retain their bass.
+
+Eunuchism resulting from an operation owing to disease has at times
+given queer and unlooked-for results, as, for instance, in the case of
+the old man that Sprengle mentions, in whom castration did not remove an
+inordinate sexual desire. Sir Astley Cooper mentions a case in his
+"Diseases of the Testes" that is somewhat unique. After castration Sir
+Astley's patient showed the following results: "For nearly the first
+twelve months he stated that he had emissions _in coitu_, or that he had
+the sensations of emission; that then he had erections and coitus at
+distant intervals, but without the sensation of emission. After two
+years he had excretions very rarely and very imperfectly, and they
+generally ceased immediately upon the attempt at coitus. Ten years after
+the operation he said he had during the past year been only once
+connected. Twenty-eight years after the operation he stated that for
+years he had seldom any excretion, and then that it was imperfect." In
+regard to the mortality from castration done in a professional manner
+and for disease, Curling, in his work on "Diseases of the Testis,"
+observes that he saw or performed some thirty operations without a
+death, and that in a table of like operations performed at the Hotel
+Dieu, in Paris, it appeared that the mortality was one in four and a
+quarter.
+
+J. Royes Bell, in the sixth volume of the "International Encyclopaedia of
+Surgery," has the following in regard to the practice among the
+Mohammedans in India: "Young boys are brought from their parents, and
+the entire genitals are removed with a sharp razor. The bleeding is
+treated by the application of herbs and hot poultices; haemorrhage kills
+half the victims, and at times brings the perpetrators of the vile
+proceeding within the clutches of the law."
+
+The _taille a fleur de ventre_ of the Chinese is a somewhat primitive
+procedure. According to Dr. Morache, in his account of China in the
+"Dic. Ency. des Sciences Medicales," the operation is as follows: "The
+patient, be he adult or child, is, previous to the operation, well fed
+for some time. He is then put in a hot water bath. Pressure is exercised
+on the penis and testes, in order to dull sensibility. The two organs
+are compressed into one packet, the whole encircled with a silk band,
+regularly applied from the extremity to the base, until the parts have
+the appearance of a long sausage. The operator now takes a sharp knife,
+and with one cut removes the organ from the pubis; an assistant
+immediately applies to the wound a handful of styptic powder, composed
+of odoriferous raisins, alum, and dried puffball powder
+(boletus-powder). The assistant continues the compression till
+haemorrhage ceases, adding fresh supplies of the astringent powders; a
+bandage is added and the patient left to himself. Subsequent haemorrhage
+rarely occurs, but obliteration of the canal of the urethra is to be
+dreaded. If at the end of the third or fourth day the patient does not
+make water, his life is despaired of. In children the operation succeeds
+in two out of three cases; in adults, in one-half less. Poverty is the
+cause which induces adults to allow themselves to be thus mutilated. It
+is said to be difficult to distinguish these last from ordinary Chinese
+men. Adult-made eunuchs are much sought after, as they present all the
+attributes of virility without any of its inconvenience."
+
+The study of the evolutionary moves or processes passed by eunuchism in
+its relation to music and the drama tends to rob these otherwise
+civilizing and enlightened arts of the aureoles of poetry and gentility
+with which they have been surrounded. From Bergmann we learn that the
+practice originated in the Orient, where female voices were held in
+higher esteem in singing, and where the profane songs that accompanied
+the dance were chanted by women. The Hebraic regulations permitted
+neither women nor eunuchs to sing in their temples. With the
+establishment of the early Christian Church in Oriental countries, more
+or less of the ancient Judaic customs were retained, and in addition a
+too literal interpretation of the words of St. Paul was adhered to,
+which said that women should not be _heard_ in the Church. The Oriental
+Church from these reasons long remained in a quandary; according to the
+ceremonials, it was deemed requisite to imitate as near as possible the
+voices of the angelic seraphims, and this could not be done by the
+rasping bass voices of the well-fed monks; women were out of the
+question in the then social stage of church evolution; so that at last a
+compromise was effected by admitting the eunuch, who could chant in a
+most seraphic soprano, as his prototype, the mendicant priests of
+Cybele, had done before him.
+
+Constantinople became the centre of learning for Greek music, and the
+fine soprano solos which now form the attraction of many of our modern
+churches were sung by the eunuchs. Eunuchs were not only the chief
+singers, but they cultivated the art into a science, and Constantinople
+furnished through this class the music-teachers for the world, as we
+learn that in 1137 the eunuch Manuel and two other singers of his order
+established a school of music and singing in Smolensk, Russia. There is
+no doubt but that in a moral sense, considering that women are generally
+the pupils, this was a most meet and an appropriate arrangement; for,
+as St. Alphonsus M. Liquori observed, man was a fool to allow his
+daughters or female wards to be taught letters by a man, even if that
+man were a saint, and, as real saints were not to be found outside of
+heaven, it can well be imagined how much more dangerous it might be to
+have them taught music and singing by a man not a eunuch,--elements
+which have a recognized special aphrodisiac virtue, as was well known to
+the ancient Greeks, who only allowed their wives to listen to a certain
+form of music when they (the husbands) were absent from home.
+
+There is not much room for doubt but that both morality and medicine
+have too much neglected the study and contemplation of the natural
+history of man, and relied altogether too much on the efficacy of church
+regulations and castor-oil and rhubarb. There are other things to be
+done besides simply framing moral codes and pouring down mandrake into
+the stomach; the old conjoined service of priest and doctor should never
+have been discontinued, as, by dividing duties that are inseparable,
+much harm has resulted. Herein dwelt the great benefit of the early
+practice of medicine among the Greeks, and to the physical understanding
+and supervision of human nature by the Hebraic law may be said that the
+creed owes its greatness and stability, and the Hebrew race its sturdy
+stamina. The wisdom of the Mosaic laws is something that always
+challenges admiration, the secret being that it did not separate the
+moral from the physical nature of man. Bain, Maudsley, Spencer, Haeckle,
+Buckle, Draper, and all our leading sociologists base all their
+arguments on the intimate relations that exist between the physical
+surrounding and the physical condition of man and his morality. Churches
+foolishly ignore all this.
+
+From Constantinople the fashion or custom gradually invaded Italy; and
+as Rome was the centre of the new religion, so it also became the centre
+of music, and Rome and Naples were soon the home of the eunuch devoted
+or immolated to the science of music. The eunuchs reached the height of
+their renown in music, as well as what might be termed their golden era,
+with the establishment of the Italian opera, in the seventeenth century.
+At this period all the stages of Italy were the scenes of the lyric
+triumphs of this otherwise unfortunate class, some of whom accumulated
+vast fortunes. In the following century, as has been seen, Clement XVI
+abolished the practice as far as the church was concerned, and in the
+present century the first Napoleon abolished the practice secularly and
+socially. Mankind cannot sufficiently appreciate the benefits it
+received from the results of the French Revolution; we are too apt to
+look at that event simply from the unavoidable means which an uneducated
+class--rendered desperate by long suffering and brutalization under an
+organized system of oppressive misrule--had adopted to remedy existing
+evils. After the dissolution of the Directory France cannot be said to
+have been in a state of anarchy, and the long and bloody wars with which
+Napoleon is usually blamed should rather be charged to that government
+and imbecile ministerial policy that lost to England the American
+colonies. The series of battles from Marengo to Waterloo are as much the
+creation of the cabinet of George III as those from Concord to Yorktown.
+Waterloo involved more than the simple defeat of Napoleon; it meant the
+defeat of moral and intellectual progress, as well as the suppression of
+the rights of man. The suppression of the Inquisition in Spain, and of
+eunuchism in Italy; the Code Napoleon; the Imperial highways of France;
+the construction of its harbors,--notably that of Havre; and the
+political and social emancipation of the Jews in France, Italy, and
+Germany are monuments to this great man that have not their equals to
+crown the acts of any other French monarch. Like the Phrygian monk who
+leaped into the arena in Rome to separate the maddened gladiators, and
+who was stoned to death by the angry and brutal mob of spectators whose
+amusement he stopped, Napoleon's work has had its results, in spite of
+Waterloo and St. Helena. The martyrdom of the poor monk caused an
+abolishment of the brutal sports of the Colosseum, which henceforth
+crumbled to pieces. Little did the people look for this result who
+trampled the monk under foot. Neither did Blucher, debouching on the
+English left with Bulow's battalions on the evening of Waterloo,
+foresee, some fifty years later, Prussia extending its hand to make a
+united Italy, which with Napoleon--who was by blood, nature, instinct,
+and education an Italian--had been the dream and ambition of his life.
+
+Eunuchism as a punishment is an old practice, as the ancient Egyptians
+inflicted it at times upon their prisoners of war; so it formed part of
+their penal code, and we are told that rape was punished by the loss of
+the virile organ; a like punishment for the same offense was in vogue
+with the Spaniards and Britons; with the Romans at different times and
+with the Poles the punishment was castration. The difficulty of proving
+the crime, as well as the ease with which the crime could be charged
+through motives of revenge, spite, or cupidity on innocent persons,
+should never have allowed this form of punishment to be so generally
+used as history relates that it was; rape being one of the most complex
+and intricate of medico-legal subjects, unless we take M. Voltaire's
+summary and Solomonic judgment, who relates that a queen, who did not
+wish to listen to a charge of rape made by one person against another,
+took the scabbard of a sword and, while she kept the open end in motion,
+asked the accuser to sheath the sword.
+
+Count Raoul Du Bisson, _Dedjaz de l'Abyssinie_, gives some very
+interesting information in regard to eunuchism in his work entitled "The
+Women, the Eunuchs, and the Warriors of the Soudan." Count Bisson has
+looked on the question from its moral, physical, and demographic
+stand-points, and, having seen eunuchism in its different aspects, from
+his landing at Alexandria and Cairo, down through his different
+expeditions into Arabia, the Soudan, and Abyssinia, his observations are
+well worth repeating.
+
+From a demographic and statistical view of the subject, its truly
+Malthusian results become at once shockingly and persistently
+prominent,--not alone in the interference that the condition induces in
+arresting any further procreation on the part of the unfortunate victim,
+but in the unparalleled mortality that, in the gross, is made necessary
+by the results of the operative procedures. The Soudan alone furnished,
+according to reliable statistics, some 3800 eunuchs annually, the
+material coming from Abyssinia and the neighboring countries, it being
+gathered by war and kidnapping parties, or by purchase, from among the
+young male population of those regions. These children are brought to
+the Soudan frontier and custom duties are there paid for their passage
+across the border, the duty being about two dollars per head. At
+Karthoum they are purchased by pharmacists, apothecaries, and others
+engaged in the manufacture of eunuchs, who generally perform simple
+castration; the mortality among these amounts to about 33 per cent.
+These simply castrated eunuchs bring about $200 apiece. The great eunuch
+factory of the country, however, is to be found on Mount Ghebel-Eter, at
+Abou-Gerghe; here a large Coptic monastery exists, where the unfortunate
+little African children are gathered. The building is a large, square
+structure, resembling an ancient fortress; on the ground-floor the
+operating-room is situated, with all the appliances required to perform
+these horrible operations. The Coptic monks do a thriving business, and
+furnish Constantinople, Arabia, and Asia Minor with many of their
+complete, much-sought-for, and expensive eunuchs. They here manufacture
+both grades,--those who are simply castrated and those on whom complete
+ablation of all organs has been performed, the latter bringing from $750
+to $1000 per head, as only the most robust are taken for this operation,
+which nevertheless, even at the monastery, has a mortality of 90 per
+cent.
+
+The manner of performing the operation is as barbarous and revolting as
+the nature of the operation itself, and the cruel and ignorant
+after-treatment is as fully in keeping with the whole. The little,
+helpless, and unfortunate prisoner or slave is stretched out on an
+operating-table; his neck is made fast in a collar fastened to the
+table, and his legs spread apart and the ankles made fast to iron rings;
+his arms are each held by an assistant. The operator then seizes the
+little penis and scrotum and with one sweep of a sharp razor removes all
+the appendages. The resulting wound necessarily bares the pubic bones
+and leaves a large, gaping sore that does not heal kindly. A short
+bamboo cannula or catheter is then introduced into the urethra, from
+which it is allowed to project for about two inches, and no attention
+is paid to any arterial haemorrhage; the whole wound is simply plastered
+up with some haemostatic compound and the little victim is then buried in
+the warm sand up to his neck, being exposed to the hot, scorching rays
+of the sun; the sand and soil is tightly packed about his little body so
+as to prevent any possibility of any movement on the part of the child,
+perfect immobility being considered by the monks as the main element
+required to promote a successful result. _It is estimated that 35,000
+little Africans are annually sacrificed to produce the Soudanese average
+quota of its 3800 eunuchs._
+
+When this immense sacrifice of life, the useless barbarity, and the
+really unnecessary needs of such mutilated humanity existing are fully
+considered, it would seem as if Christian nations might, with some
+reason, interfere in this horrible traffic, by the side of which
+ordinary slavery seems but a trifle. When we further consider that, in
+some instances, the child is also made mute by the excision of part of
+the tongue,--as mute or dumb eunuchs are less apt to enter into
+intrigues, and are therefore higher prized,--the barbarity, cruelty, and
+extremes of inhumanity that these poor children have to suffer cannot be
+overestimated. Neither must we be astonished at the stolid indifference
+that is exhibited by the eunuchs in after life to any or all sentiments
+of humanity, or that they should hold the rest of humanity in continual
+execration.
+
+Often-occurring accidents in harems make _complete_ eunuchs a
+desideratum. Bisson mentions that on one occasion he saw the chief
+eunuch of the Grand Cherif of Mecca--a large, finely-proportioned,
+powerful black--on his way to Stamboul for trial and sentence; he was
+heavily chained and well guarded. It appears that the eunuch had only
+been partly castrated, and that the operation had been performed during
+infancy; his testicles had not fully descended, so that in the operation
+the sac was simply obliterated, which gave him the appearance of a
+eunuch. In this condition he seemed to have kept a perfect control of
+himself and passions until made chief eunuch of the Cherif, who
+possessed a well-assorted harem of choice Circassian, Georgian, and
+European beauties. The _neglige_ toilet of the harem bath and the
+seductive influence of this terrestrial Koranic seventh heaven was too
+much for the warm Soudanese blood of the chief; his forays were not
+suspected until a blonde Circassian houri presented her lord and master,
+the Cherif, with a suspiciously mulatto-looking son and heir. A
+consultation of the Koran failed to explain this discrepancy, and
+suspicion pointed to the chief eunuch, who was accordingly watched; it
+was found that he had not only corrupted the fair Circassian, but every
+inmate of the harem as well. The harem was promptly sacked and drowned
+and the false eunuch shipped to the Sultan for sentence, the Cherif
+having the right to sentence and drown the harem, but having no such
+rights over such a high personage as the chief eunuch.
+
+There are physiological facts and pathological conditions brought forth
+for our contemplation, while investigating the subject of eunuchism in
+all its details, that cause us to feel that, after all, the old
+Hippocratic principle of inductive philosophy, upon which our study and
+practice of medicine is founded, with rational experience and
+observation for its corner-stone, is, even if commonplace, the only
+proper avenue of knowledge. To exemplify this proposition we have in
+this particular subject the practical observations and experience of M.
+Mondat, of Montpellier; in his interesting work on "De la Sterilite de
+l'Homme et de la Femme," published in 1840, he details some instructive
+information on the subject of eunuchs, giving some explanation as to why
+many simply castrated eunuchs are, like the much-prized eunuchs of the
+Roman matrons, still able to acquit themselves of the copulative
+function. He mentions that while in Turkey he studied the subject in its
+details, and, having found some of these copulating eunuchs, he secured
+some of the ejaculated fluid and subjected it to a careful examination.
+The discharge was lacking the characteristic seminal odor; it was in
+other respects, to the palpation especially, very much like the seminal
+fluid. He found that these eunuchs were much given to venereal
+enjoyment, but that either legitimate intercourse or masturbation, to
+which many were addicted, was apt to be followed by a marasmus ending in
+galloping consumption. Mondat personally knew the opera-singer Velutti,
+who died in London; Velutti was, when a child, castrated by his parents,
+having both testicles removed, being intended by his father, who had
+himself performed the operation, for the choir of the Papal Chapel at
+Rome. Velutti was as much of a favorite in his day as our present tenors
+and handsome actors. The admiration of the opposite sex was fatal to
+him; he formed a _liaison_ with a young English lady residing in London,
+and the resulting excesses in which he indulged quickly brought him to
+his grave. He was passionately fond of women and was able to acquit
+himself perfectly; at least, as far as the copulative act--barring
+fecundation--was concerned.
+
+In a previous part of this chapter I have alluded to the very
+appropriate arrangement which formerly existed when music-teachers were
+eunuchs, and that our higher circles of society would do well to employ
+eunuchized coachmen, especially if possessed of susceptible and elopable
+daughters; but, from the accounts given by Mondat, it would seem that
+they are not as safe as might at first be imagined. However, they could
+not be as dangerous as the chief eunuch of the Grand Cherif of Mecca and
+increase the population to the same extent; but I should judge that they
+might be a very demoralizing moral element if introduced into modern
+society. If eunuchs must be employed, it can easily be understood why
+the Turk and Chinese prefer the real, clean-cut article. The New York
+"Four Hundred" should make a note of this, as in their present thirst
+for European aristocratic notions, coats of arms and titles, there is no
+telling how soon they may cross over into Oriental customs and run a
+harem, in which case it would be sad to have them make any mistakes in
+the quality and ability of the eunuch.
+
+Dr. Gardner W. Allen has furnished the American profession with a
+faithful translation of the valuable work of Professor Ultzmann on
+"Sterility and Impotence." In this, we have a clear and intelligent
+dissertation that explains the above conditions, and I am only surprised
+that the observations of Mondat have not developed such explanations
+before, as the principle was fully explained in practice fifty years ago
+by the Montpellier physician. According to Ultzmann, there is a form of
+fecundating impotence in persons otherwise well provided with an
+apparent complete apparatus, an impotence which he terms _potentia
+generandi_. He states, however, that this form of impotence was not
+recognized until a few years ago, citing the fact that females have had,
+as a rule, to bear all of the blame for the unfruitfulness of the
+family, and that they have been accordingly subjected to all manner of
+operations, general and local treatment, even to being sent to watering
+places and sanatoria where red-headed male attendants are employed, to
+say nothing of the prayers, intercessions, pilgrimages, and novenas to
+the holy shrines, as mentioned in the chapter on the holy prepuce.
+Ultzmann observes that a man may be perfectly able to go through the
+procreative or, rather, the copulative act, even to the great
+satisfaction of all parties concerned, and yet be perfectly impotent; he
+even goes further, by observing that there are cases in which copulation
+may take place without any fluid whatever being ejaculated. He mentions
+two such cases at pages 87 and 116 of his book. In the first instance
+the ejaculated fluid is precisely as that observed in such cases as
+those of the eunuchs and of Velutti, mentioned by Mondat, and consisted
+of an azooespermic discharge, made up mainly from the secretion of the
+seminal vesicles, the accessory glands of the urethra, the prostate, and
+Cowper's glands, as well as the discharge from the secretory glands
+distributed along the course of the urethral mucous membrane. Some of
+the cases of this form of impotence have exhibited wonderful copulating
+desire and power of endurance, and, even if unfecundating, they must be
+said to be better off than the victims of that other form of male
+impotence, the _potentia coeundi_ of Ultzmann, where, with a normal
+semen, either the power of erection or that of ejaculation may be
+entirely absent.
+
+
+
+
+CHAPTER IX.
+
+PHILOSOPHICAL CONSIDERATIONS RELATING TO EUNUCHISM AND MEDICINE.
+
+
+Eunuchism does not always subdue the animal passions; this is the view
+that the church took in connection with the emasculation of Origenes and
+his monks; the church here held that not only was it possible for them
+to still sin in heart or imagination, but that, even were the complete
+eradication of the sexual idea possible, they had by their act lost the
+main glory of a Christian,--that of successfully striving against
+temptation, and by a force born of triumphant virtue overcome all the
+wiles of the devil. It is related that among the eunuchs at Rome there
+were some who, having been made so late in life, still retained the
+power of copulation, although the final act of the performance was
+absent. Montfalcon relates that Cabral reported dissecting a soldier who
+was hanged for committing a rape, but who on dissection showed not the
+least trace of testicles, either in the scrotum or abdomen, although the
+seminal vesicles were filled with some fluid.[34] Sprengle, in his
+"History of Medicine," relates of the complete removal of both testicles
+from an old man of seventy years of age, on account of inordinate sexual
+desire, the operation having no perceptible effect in subduing the
+disease.[35] These cases are analogous to those exceptionable cases in
+which, after extirpation of the ovaries, both menstruation and
+fecundation have still taken place.
+
+Modern civilization and its unnatural mode of dressing inflict great
+harm on men by keeping these parts too warm and constricted. Much of
+the irritability of these organs, as well as their _decadence_ at an age
+some generation or two before the time when they should still possess
+all their virile attributes, can be directly attributed to this cause. A
+more intelligent way of dressing would result in less moral and physical
+wreckage, and require less galvanic belts and aphrodisiacs in men under
+fifty. If those who habitually swath their scrotums in the heavy folds
+of their flannel shirts, to which are superadded the cotton shirts,
+drawers, and outer clothes in which civilized man incases himself, would
+cast a backward eye into the dim and misty past, and see the priest of
+some of the old Pagan gods soaking the scrotum in hot water, and then
+gradually rubbing the testicles within, by gentle but firm friction, _to
+make the testicles disappear_, a process by which many of the heathen
+priests prepared themselves for the discharge of their sacerdotal duties
+and the strict observance of those rules of chastity and celibacy which
+they were henceforth to live up to, they would find _one_ explanation of
+why civilized man does not possess that vigor and retain that
+procreative power into advanced age that was one of the characteristics
+of our ancient progenitors in the days that breeches were as abbreviated
+as those now worn by the Sioux Indians. These are really but leggins,
+which run only to the perineum and are simply tied by outer points to a
+strap from each hip. Finely and comfortably cushioned chairs may be a
+luxury to sit on, but they will have, on the man who uses them in youth
+and in his prime, a wonderful sedative and moral influence later on,
+about as effectual as the miniature warm baths for the scrotum and
+gentle pressure to the testicles that were used by the heathen priests
+of old, who preferred a gradual disappearance of the glands to the too
+sudden and summary methods of the Cybelian clergy, who used a piece of
+shell and an elaborately-performed castration. According to Paulus
+AEgineta, this was a common practice of making eunuchs out of young boys
+in the Orient, the mortality being hardly any; whereas the _taille a
+fleur de ventre_, the favorite method for making eunuchs for harem
+guards and attendants, and more suited to the jealous disposition of the
+Turk, has a mortality of three out of every four, according to Chardin,
+and of two out of every three, according to Clot Bey, the chief
+physician of the Pasha,[36] and of nine out of ten, according to Bisson.
+So prone to reach high offices were intelligent eunuchs that it is
+related that parents were at times induced to treat their boys in the
+manner above stated, that they might be on the highway to royal favor,
+honor, and rank; such is the ennobling tendency of Oriental despotism,
+polygamy, and harem life. On the same principle Europeans subjected
+their boys to a like operation to fit them for a chorister life or the
+stage, where fame and honor and wealth were to be found.
+
+Medicine has been the butt of wits and philosophers, as well as of the
+men who, from the profession, have gone into the ranks of literature.
+Smollet, himself a physician, gives us an insight into our wandering and
+erratic misapplication of our knowledge on therapeutics in "Peregrine
+Pickle," where the poor painter, Pallet, is believed to be a victim of
+hydrophobia. The learned opinion of the doctor, who explains the many
+and various reasons by which he arrives at his diagnosis, the various
+physical signs exhibited by the patient as being pathognomonic of the
+disease, and his final venture with the contents of the _pot de
+chambre_, as a diagnosis verifier, which he dashes in the patient's face
+in preference to ordinary water on account of the medicinal virtues
+contained in urine, which in the case seemed to him to have a peculiar
+therapeutic value, is something worth reading, however ludicrous it all
+sounds. There are few intelligent physicians but who have seen as
+ridiculous performances, in what might be called medical gymnasts, that
+equal, if not surpass, those of Smollet's doctor. Rabelais was also a
+professional brother, who, equally with Smollet, attempted to waken up
+the profession by his satires. Smollet was not only a physician, but in
+his early life had seen some very active and practical work, having
+participated in and been a witness to the ills and misfortunes that
+follow any attempts to "lock horns" with nature through ignorance of
+physical laws and preventive medicine,--having been a surgeon's mate in
+the fleet which assisted the land forces in the murderous and ill-fated
+Carthagena expedition which cost England so many lives, ignorantly and
+needlessly sacrificed to ministerial disregard of physical laws and its
+consequences,--lessons which, unfortunately, seem to have but little
+effect on cabinets, owing to their shifting _personelle_, England
+following up the disasters of Carthagena with the still greater blunder
+of the Walcheren expedition, where, out of England's small available
+physical war material, nearly forty thousand men were either left to
+fatten the swamps of Walcheren, or to wander through England in after
+years on the pension-list, physical wrecks and in bodily and financial
+misery.[37] Again, the same disregard, born of ignorance and red tape,
+crippled the British army in the Crimea, causing in its ranks the
+greatest mortality. It has seemed as if it would be of advantage if all
+the blunders, either philosophical or of statesmanship, committed by a
+cabinet, should be written in large letters of gold, to be hung in the
+council-halls of the nations, that similar blunders at least might not
+occur again.
+
+Dumas, in his "History of the Two Centuries" and his "History of the
+Century of Louis the XIV," gives some very interesting medical touches.
+Le Sage, in his "Adventures of Gil Blas," gives us food for speculating
+on medical philosophy in connection with the interesting subject of how
+to make the profession remunerative. Dickens's ideas of the doctor, as
+given in his works, are life touches. Witness his description of the
+little doctor who superintended little David Copperfield's advent into
+the world, or of Dr. Slammer of the army; they represent his view of the
+professional character. Fontenelle, probably, was right in ascribing the
+fact of his becoming a centenarian, and maintaining a stomach with the
+force and resistance that are the peculiar characteristics and
+attributes of a chemical retort, to the fact that when sick it was his
+practice to throw the doctor's physic out of the window as the doctor
+went out of the door, as in his day a man required the constitution of a
+rhinoceros and the stomach of an ostrich, with the external
+insensibility of a crocodile, to withstand the ordinary doctor of the
+period and his medications. Napoleon believed that Baron Larrey was the
+most virtuous, intelligent, useful, and unselfish man in existence; in
+fact, it is doubtful if any man of his time commanded from this truly
+great man so much admiration or respect, either for bravery, courage,
+intelligence, or activity, as the great and simple-minded Larrey. As
+observed by Napoleon of his bravest general,--poor Marshal Ney, the
+bravest of the brave, the rear guard of the grand army, the last man to
+leave Russian soil,--Ney was a lion in action, but a fool in the closet.
+All his generals had some great distinguishing characteristic, beyond
+which was a barren waste, a vacuity, but too apparent to a man of
+Napoleon's discernment. But the cool, unflinching bravery of Larrey,
+that did not require the stimulus of the fight or the phrenzy of strife
+to bring it to the surface and keep it alive; bravery and intelligence
+alike active under showers of shot and shell or in the thunders of
+charging squadrons; in the face of infective epidemics or
+contagiousness, walking about in these scenes in which his own life was
+as much at stake as that of the meanest soldier, with the same cool
+exercise of his intelligence that he exhibited in the organization and
+superintendence of his hospitals in the time of peace; always the same,
+untiring, unmurmuring, brave, studious, observing, unflinching in his
+duties, unselfish; whether in the burning sands of Egypt or in the snowy
+steppes of Russia, in the marshy plains of Italy or in the highlands of
+Spain, he always found him the same, and his notes and observations,
+from his first government service on the Newfoundland coast to his last,
+always showed him the same laborer and student in the field of medicine.
+And yet at St. Helena we find Napoleon refusing to take remedies for
+internal disease whose real nature was unknown, and only toward the end
+did he consent to take anything, and then only when seeing that the end
+was approaching, and more from a kindly desire to express his
+appreciation of the services of his attendants, and not to wound their
+feelings, than from any hope of assistance. Napoleon had not neglected
+the study of medicine any more than he had the study of every other
+science. This is evident from the instance related as taking place
+during the march of the grand army from the confines of Poland into
+Russia, in 1812, when dysentery became very prevalent, of his inviting
+several of his favorite guard to his own table, where he experimented
+on each particular grenadier with a specific form of diet, so as to
+determine its cause and possible remedy. He did not look upon our
+knowledge of pathology and our skill in diagnosis as being sufficiently
+advanced or perfect to make him feel but that a treatment for an obscure
+disease like his own would be pretty much a matter of guess-work.
+Charles Reade, in his "Man and Wife," shows an intimate knowledge of
+medical science where he philosophizes on the effects of an irregular
+life and of over-physical training. His logic is sound science. Defoe
+and Cervantes show a like intelligent insight as to medicine; and it was
+not without reason that Sydenham, the English Hippocrates, advised a
+student of medicine who entered his office as a student to begin the
+study of medicine by the careful study of "Don Quixote," remarking that
+he found it a work of great value, which he still often read. The works
+of Bacon and of Adam Smith on "Moral Sentiments;" the famous treatise on
+the "Natural History of Man," by the Rev. John Adams; the later works of
+Buckle, Spencer, Darwin, Draper, Lecky, and other robust wielders of the
+Anglo-Saxon pen, as well as the works of Montaigne, Montesquieu, La
+Fontaine, and Voltaire, are all works that the medical man could
+probably read with more profit than loss of time. In fact, either Hume,
+Macaulay, or any philosophical work on history will furnish to the
+physician additional knowledge of use in his profession. No physician
+can afford to neglect any study that in any manner adds to his knowledge
+of the natural history of man, as therein is to be found the foundation
+of our knowledge as to what constitutes health, and as to what are the
+causes that lead humanity to diverge from the paths of health into those
+of physical degeneracy and mental and bodily disease.
+
+We have in medicine many sayings which pass for truisms, which are,
+after all, misleading. We say, for instance, keep the feet warm and the
+head cool; this will not always either keep you comfortable or well, as
+we know that in neuralgias it is absolutely necessary, either for
+comfort or to get well, to keep the head warm. While so much stress is
+laid on the necessity of keeping the head cool, a thing a person is sure
+to look after whenever the head becomes uncomfortably warm, and to which
+can be ascribed but few ailments or deaths, we hear comparatively
+nothing about the thermometric condition of the perineum, which, from
+the varying temperatures in which it is at times plunged, produces more
+beginnings for diseases in the future, during youth and our prime, as
+well as it quite often causes the sudden ending of life in more advanced
+periods. People who carefully observe the rule of keeping their heads
+cool and their feet warm will stand with outspread legs and uplifted
+coat-tails with their backs to a blazing grate, and then, going outside,
+incontinently sit down on a stone or iron door-step, or, stepping into a
+carriage or other vehicle, they sit down on a cold oil-cloth or leather
+cushion, without the least knowledge of the harm or danger that they are
+liable to incur. They little dream of the prostatic troubles that lie in
+wait for the unwary sitter on cold places, ready to pounce upon him like
+the treacherous Indian lying in ambush,--troubles that carry in their
+train all the battalions of urethral, bladder, kidney disease and
+derangments, and subsequent blood disorganization, which often begin in
+a chilled perineum, and, in conjunction with the local disease that may
+result, end in handing us over to Father Charon for ferriage across the
+gloomy Styx long before our life's journey is half over. It is true,
+neither the savage of Africa or America nor the nomads of Asia are
+subject to any of these troubles; but with us, hampered with all the
+benefits of the dress, diet, habits, and luxuries of civilization, and
+with a civilized prostatic gland, it is quite otherwise. Herein, again,
+comes that connection between religion, morality, and medicine, that
+existed with so much benefit to mankind, but from which we of later days
+have, in our greater wisdom, seen fit to separate; although,
+inconsistently as it may seem, the present age has done more than any
+previous epoch in practically demonstrating the intimate and inseparable
+relation existing between the physical and moral nature of man. The
+persistent priapism which oftentimes results from riding with a wet seat
+and the inordinate morbid sensibility of the sexual organs that may
+result from the same cause or from spinal irritation are not to be
+allayed by any homily on morality or on the sanctifying attempts at
+keeping the animal passions under subjection, any more than will prayers
+or offerings to all the gods of Olympus restore the eunuchized, either
+through foolish civilized dress and customs or through excessive
+indulgence. We must mix medicine with our religion and make the clergy
+into physicians, or ordain our physicians into full-fledged clergymen.
+
+The science of medicine, or what might be called the natural ways of
+nature through its physical laws, is true to itself; the fault lies in
+our interpretation of its phenomena, which we fail to study with
+sufficient discriminative precision and nicety. We have repeatedly
+mistaken causes and results from this want of close observance and of
+precision, attributing results to causes which did not exist. As an
+example, when the early disciples of homoeopathy in ancient Palestine
+undertook to revive poor, old, withered King David, by putting him to
+bed with a young and caloric-generating Sunamite maid, when it was by
+like incontinent practices that he had brought himself to that state of
+decrepitude, it is plain that they misunderstood the principle.
+Boerhaave--who, as a true eclectic practitioner, followed these ancient
+and Biblical homoeopaths in their practice in a similar case, the
+subject being an old Dutch burgomaster, whom he sandwiched between a
+couple of rosy Netherland maids--also failed to grasp the true condition
+of the nature of things, or the true philosophical explanation. The
+exhalations from the aged are by no means an elixir of health or life to
+the young, and the fact that the young were apt to lose health by
+sleeping with the aged was wrongly attributed to their loss being the
+others' gain, and the result of its passing into the bodies of their
+aged companions, and not to its true cause,--the deteriorating influence
+to which they were subjected; and, further, when we analyze the subject
+still more, we can understand how a full-blooded and active,
+lithe-bodied, thin, and active-skinned Sunamite maid might and would
+impart caloric to King David; but, from our knowledge (not altogether
+practical) of the difference that exists between differently
+constitutioned and differently built maids in imparting caloric, and
+from our knowledge of the physique of the Netherland maids, who are cold
+and impassive, with a layer of adipose tissue that answers the same
+purpose as that of the blubber in the whale,--that of retaining heat and
+resisting cold,--we can well believe that the poor, shriveled
+burgomaster could receive but little heat, even when sandwiched between
+the two; but, on the contrary, he was, in fact, more liable to lose the
+little he had, unless we look at the subject in another light, and
+consider that sentiment that is common to both animals and men of
+spirit, a sentiment that has furnished the subject for more than one
+canvas in the hands of the true and sympathetic artist, as seen on the
+awakening and alert attitude of the worn-out and old decrepit war-horse,
+browsing in an inclosed pasture, as he hears from afar the familiar
+bugle-notes of his early youth, or some cavalry regiment with prancing
+steeds and jingling accoutrements, with bright colors and shining arms,
+going past the pasture, restoring for a time to the stiffening joints
+and dim eyes the suppleness and fire of bygone times, with visions of
+gallant charges and prancing reviews; or, how the same sentiment erects
+once more the bowed and withering frame of the old veteran, and once
+again fires his soul with the martial zeal of his prime as he sees the
+passing colors and active-stepping regiment which he followed in the
+bright sunshine and flush of his youth. Aside from these sentiments,
+which might possibly have inspired David and the Dutch burgomaster with
+an infusion of a new and transient good feeling, it is unquestionable
+but that some heated brickbats or stove-lids, curocoa jugs or old stone
+Burton ale-bottles filled with hot-water, would have been more effectual
+in imparting warmth than either Sunamite or Netherland maids.
+
+It is hard to reconcile the beliefs of some people or nations with their
+manners and customs. For instance, there is the Turk; when a Jew becomes
+a Mohammedan he is made to acknowledge that Jesus Christ, the son of
+Mary, is the expected Messiah, and that none other is to be expected;
+they know of Christ's speech on the cross, made to the repentant thief;
+they believe in a heaven full of houris, with large black eyes and faces
+like the moon at its full, in which all good Moslems are to have
+continual rejoicings, and yet they go on performing the most barbarous
+and inhuman forms of castration imaginable, which not only deprives its
+victims of their virility, but subject more than three-fourths of those
+operated upon to a painful death, and the remaining to a life of
+continual misery. Have these poor subjects no right to future bliss, or
+in what shape will they reach there? If the heavens of these eunuchisers
+were like the heaven of Buddhism, or, as the Chinese call it, the
+Paradise of the West, where, although all forms of sensual
+gratifications are to be enjoyed, no houris are to be supplied to the
+saints of Buddhism,--as even the women who enter this paradise must
+first change their sex,--we might understand that, the genitals not
+being needed in the eternal world, it might be considered a matter of
+small moment to compel a man to go through this short and transient life
+without them; but where a robust condition of the sexual organs is
+suggested as one of the heavenly requisites, it would seem as if the
+Turk would look upon the suffering, misery, and death that they cause,
+in connection with the inhuman mutilation they inflict, with horror.
+Doctrinal theology, whether in the East or West, is something
+incomprehensible.
+
+
+
+
+CHAPTER X.
+
+HERMAPHRODISM AND HYPOSPADIAS.
+
+
+There exists a class of human beings whose description is connected with
+the subject of this work. They date back to mythological times, and the
+confusion incident to the misapplication of names and the want of proper
+observation on the part of the narrators has tended to carry the
+uncertainty of their real existence to the present day. One reason that
+this part of the subject would be incomplete without their description
+is on account of the origin of their existence being intimately
+connected with eunuchism, being, in fact, an outgrowth of this
+condition; and any history of eunuchism would be but half told, without
+the additional information concerning these persons.
+
+Hermaphrodites, as stated, date back to mythology. Tradition tells us
+that Hermaphroditus, a son of Venus and Mercury, was educated by the
+Naiades dwelling on Mount Ida. At the age of fifteen years, he began his
+travels; while resting in the cool shades on the woody banks of a
+fountain and spring near Caira, he was approached by the presiding nymph
+of the fountain, Talmacis, who, becoming enamored of him, attempted to
+seduce him. Hermaphroditus, like Joseph, was the pattern and mirror of
+continence, and would not be seduced. Talmacis then, like Potiphar's
+wife, seized on the unlucky pattern of virtue, and prayed to the gods
+that they should so amalgamate poor Hermaphroditus to her body as to
+make them one. The prayer was heard on Olympus, and forthwith the two
+became one, but with the distinctive characteristics of each sex
+unchanged. Thus began that fabled race of the _androgynes_ of the
+ancients. Another tradition, which is probably correct, affirms that
+ancient Carnia, or Halicarnassus, was in those days the Baden-Baden of
+Asia Minor; that thither repaired all the victims of gluttony,
+debauchery, and general physical bankruptcy. Its name in ancient Caria
+denotes its seaside-resort location, Hali-Karnas-Sos meaning literally
+"Karnassus-by-the-sea," like Boulogne-sur-mer. The city was under the
+protection of Hermes and Aphrodite, whose temples were near each other.
+Human nature in the days of Halicarnassus did not much differ from human
+nature at Monte Carlo or Baden-Baden. The baths had a number of young
+and handsome eunuchs who waited on the old, debauched, and nervous
+wrecks, and the nymph who presided over the whole was Talmakis, a name
+derived from the salty nature of the springs which fed the baths; this
+nymph was worshiped as Aphrodite. Pederasty was one of the practices at
+these baths. From these conjoined conditions the place was said to be
+peopled with hermaphrodites,--meaning, at first, simply that they were
+under the protection of Hermes and Aphrodite; and latterly the name was
+attached to the passive agent in the pederastic art,--a name that has
+followed the class and crossed the ocean into the interior wilds of
+America, as in Powell's history of the manners and customs of the
+Omahas, an Indian tribe of the Missouri, we find that they at times
+practiced pederasty, the passive agent being called by the Indians an
+hermaphrodite, or double sexed.[38]
+
+The relations that from eunuchism led to pederasty are very easy of
+explanation. Eunuchism induces an effeminate form, softer body, and
+prevents the growth of the beard; the voice is softer and more
+melodious; and their timidity renders them also more effeminate,
+obedient, and dependent. The peculiar commingling of the female form
+with that of the male furnished to the sculptors the models for those
+wonderfully well-made forms which are yet to be seen, representing in
+statuary the forms of Androgynes and Hermaphrodites; that of the
+favorite eunuch of the emperor Adrian being remarkable for the symmetry
+of its form and grace of pose.
+
+Europe must have been astonished at the tales that were carried back by
+the early explorers and voyagers, in relation to the New World. The
+story of the immensity of the quantity of gold and silver, of great
+stores of hidden treasures, of the quantities of precious gems and
+priceless crystals was fully discounted when, from the Florida coast and
+the explorers of the Lower Mississippi, men returned with the tale that
+in the everglades and in the trackless forests, intersected by navigable
+sloughs, there dwelt a people half of whom were hermaphrodites. Neither
+the explorers nor their European historiographers seem able to have
+grasped the true state of affairs. Many believed in the actual existence
+of such numbers of these monstrosities, while others, arguing from what
+was then known regarding the extraordinary development of the nymphae and
+clitoris, as well as of the great labia, of the women in the African
+regions, concluded that these supposed _androgynes_, or hermaphrodites,
+must be women, the dress assumed by these and the menial labors to which
+they were consigned assisting to favor this opinion. The early
+Franciscan missionaries to California found the men who were used for
+pederasty dressed as women.[39] Hammond mentions the practice as in
+vogue among the Indians of the southwest, which in a measure greatly
+resembled that of the ancient Scythians in its operation, the men being
+dressed as women, associating with women, and used for pederastic
+purposes during the orgies of their festivals. These men had previously
+been eunuchised by a process of continued and persistent onanism, which
+caused at the end a complete atrophization of the testicle.
+
+In regard to the great number of hermaphrodites observed in Florida and
+on the Mississippi, the accounts are only reliable as far as they were
+present in female garb and in an apparent state of slavery, being
+compelled to do all the menial labor of the villages and camps, besides
+being used for pederasty, no examination having been made by any
+traveler. Their lot was different from those described by Hammond in his
+work on "Male Impotence," where the whole transaction seems to have some
+sort of religious and civil significance. In Florida, however, they
+tilled the ground, extricated and carried off the dead during a battle,
+and did all the work generally, being used for beasts of burden and not
+allowed to cut their hair; but all authorities are silent or in complete
+ignorance as to whether they had suffered castration. Pere Lafiteau,
+however, gives an explanation which was in the last century considered
+ridiculous, but which, in the light that has been thrown on the
+existence of a former continent, and of the undisputable relation that
+must, some ages in the past, have existed between Phoenicia and Central
+America, seems a strongly probable solution of these customs. The Father
+accounts for the presence of these American _androgynes_ in the
+following manner: The Carribeans, or Caribs, were originally a colony
+from Carnia; with these colonists was brought over the worship of their
+Pagan gods of Caria and Phrygia; these two localities were the homes of
+the Cybelian priesthood, who dressed in female garb, as did the
+sacrificial priests of the Temple of Venus Urania. It is true that the
+Java or Floridian priest had nothing in common with the priests of
+Cybele or of Venus Urania; but, still, Lafiteau gave as lucid an
+explanation for the existence of these conditions as any of his
+contemporaries. Charlevoix observed the same practices among the
+Illinois, which he attributed as being due to some principle of
+religion. The Baron de la Hontan insists that the missionary,
+Charlevoix, was mistaken; that the persons whom he saw in female attire,
+whom he took to be men, were not men. Hontan asserts that they were
+veritable hermaphrodites. The missionaries were, however, correct, as
+what has since been observed confirms their opinion. M. du Mont, who
+ascended the Mississippi for a distance of nine hundred leagues, also
+reported meeting Indians at different places attended by these
+petticoated androgynes.[40]
+
+As strange as it may seem, many intelligent men were loth to part with
+their belief in the existence of these double-sexed individuals; the
+logic used by many of these insisters of hermaphrodism, although now
+very ridiculous, was no doubt sensible logic one hundred and fifty years
+ago. As a matter of curiosity, some of this reasoning will bear
+repeating. It is taken from a Latin edition of an ancient description of
+Florida, originally in the English, but translated into the Latin by the
+geographer, Mercator. In this book we find the roots of some of the
+myths that led Ponce de Leon and his steel-clad warriors to wander
+through Florida in a vain search of that spring or fountain of the
+waters of perpetual youth and of everlasting life which they were never
+to find. We there learn that, in the days of the good old Spanish
+knight, the inhabitants of Florida lived to a very old age, and that
+they did not marry until very late in life, as before that period it was
+very difficult to determine the sex of the individual.
+
+From what has since been seen among the Indians, the probability is that
+these were really eunuchs, and probably in slavery, as the result of the
+fortunes of war, as their great number and servile condition will hardly
+admit of the belief that they belonged to the same tribe as their
+masters and oppressors. Pederasty was an old, very old practice, being
+mentioned before circumcision; it prevailed among many of the Orientals,
+and among the many peoples by whom the early Jews were surrounded, who
+were, according to the Old Testament, about as an immoral, dissolute,
+and bestial a set as one could well imagine. Their religions were
+nothing but a gross mixture of stupid superstition and blind idolatry,
+pederasty, fornication, and general cussedness. In the then state of the
+Jewish nation, to have allowed them to mingle freely with these people
+would have ended in having the Jews adopt all their customs and habits.
+The aim of the Jewish leaders was to prevent any too free intercourse of
+their people with these nations, that they might remain uncontaminated
+even while dwelling near them. To accomplish this it was necessary to
+raise a barrier that would be the distinguishing mark of the Jewish
+nation. Jahns, in his learned work on the "History of the Hebrew
+Commonwealths,"[41] lays down the idea that circumcision, as well as
+many articles in their laws,--which to us appear trivial,--were in
+reality intended to separate the Jews farther and farther from their
+idolatrous, bestial, and heathenish neighbors, while at the same time
+these same ordinances were intended to preserve a constant knowledge of
+the true and only God, and maintain their moral and physical health.
+
+Although hermaphrodism on a large scale, as an existing condition, was a
+matter of serious belief at the end of the eighteenth century, it has
+occupied no little attention in this. Courts have been called to decide
+on cases to invalidate marriages, or to decide the sex, more than once;
+and physicians are often asked the question, Do hermaphrodites really
+exist? Dr. Debierre, of Lyons, published in 1886 a valuable paper,
+entitled "Hermaphrodism Before the Civil Code: its Nature, Origin, and
+Social Consequences," which was published in the _Archives of Criminal
+Anthropology_ of Lyons, France. In this short but very concise treatise,
+Debierre gives us a complete review of the subject from mythological
+times to 1886. It must be quite evident to all that there exists no
+logical reasons why the sexual or generative organs should be exempt
+from, at times, being subject to variations from the normal, either
+through the commingling of two conceptions or of faulty development
+affecting other parts of the body,--conditions that go to form
+monstrosities. Debierre gives one peculiar case of a duplication of
+vagina and uterus in a girl of nineteen, the appearance of the parts and
+the septum between the vaginae giving to the whole an appearance
+precisely similar to that of a double-barreled shot-gun. These
+monstrosities are as likely to happen as the different forms that
+affect--either by arrested development or some abnormality of excessive
+development--the head, which is a very prolific subject of anomalies.
+
+Hermaphrodism is a common attribute in the vegetable kingdom, where
+fixed habitation or position makes such a condition necessary; it is
+also common to many of our lower forms of animal life, and even in the
+human foetus the presence of the Wolfian bodies and the canal of Mueller
+in the same individual attest a primitive case or condition of
+hermaphrodism. In other words, humanity begins its existence in a state
+of hermaphrodism. This condition is found up to the end of the second
+month of foetal life in the human being, in common with all mammals, as
+well as all the vertebrates, where, however, it is subject to variations
+as to time of development and limit of existence in the normal
+condition. In the chick, it is only after the fourth day that the
+genital gland begins to determine whether it will turn into an ovary or
+a testicle; in the rabbit it is on the fifteenth day, and in the human
+embryo on the thirtieth day. Hermaphrodism does not occur, however, from
+this at first uncertain state of affairs, but rather from subsequent
+developments of the external organs that by their abnormality of
+formation simulate one or the other sex, while the internal organs may
+belong without any equivocation of structure to its definite sex; as it
+has often happened that some of these cases, having been the subject of
+differences of opinion among experts during life, were, after death,
+unanimously assigned to one sex by all of the same experts, the organs
+readily defining the sex being completely of the one sex. As observed by
+Debierre, where the subject is really a female, even where the vagina or
+uterus is unperceived, the presence of the menstrual function or some
+physical disturbance at its stated periods are sufficient evidences, as
+a rule, by which to determine the sex. The case of Marzo Joseph, or
+Josephine, reported by Crecchio in 1865, had rudiments of an hypospadic
+penis ten centimetres in length and a prostate of the male sex, with a
+vagina 6 centimetres in length and 4 in circumference, ovaries,
+oviducts, and uterus of the female; it was not until her death, at the
+age of fifty-six, that her sex was fully determined. The case reported
+by Sippel in 1880, supposed to be a male from external evidences, was at
+death found to be a female. Guttmann reported a like case in 1882. The
+celebrated case of Michel-Ann Dronart is remarkable; this case was
+declared a male by Morand Pere and a female by Burghart, as well as by
+Ferrein; declared asexual or neutral by the Danish surgeon, Kruger; of
+doubtful sex by Mertrud. The case of Marie-Madeleine Lefort, to which
+Debierre devotes four figures, is full of interest. One of the figures
+is her portrait at the age of sixteen, and another is from her
+photograph at the age of sixty-five. She has a man's head in every
+particular of physiognomy and expression, having in the latter figure a
+full beard and the peculiar intellectual development of a male sage; she
+has the hairy breast of the man, with the mammary development of the
+female, and an abnormally-enlarged clitoris, which was often mistaken
+for the male organ. The vagina at its lower end was narrow, and the
+urethral aperture opened into it some distance from its outer opening;
+otherwise she was sexually a perfect woman, and menstruated regularly.
+Debierre quotes the case which Duval gives in his work on
+hermaphrodites, wherein a man asked for a dissolution of marriage,
+claiming that his wife had a male organ, which, although she was a woman
+in every other sense, prevented by its interference the consummation of
+the marriage act. The court had the case examined, when it was found
+that the erection of the clitoris, which was large, was enough to
+interfere as the husband had stated. It decreed that the young woman
+should have the objectionable and interfering member amputated, and on
+the refusal to have this done the marriage should be dissolved. She
+refused, and the divorce was consequently granted to the man.
+
+From the history of Marie Lefort, it can well be conceived how the
+popular mind, in ignorant times, could easily be imposed upon. Montaigne
+relates the history of a Hungarian soldier who was confined of a
+well-developed infant while in camp, and of a monk brought to a
+successful accouchement in the cell of a convent; while Duval reports
+the case of a priest in Paris who was found to be pregnant with child,
+who was in consequence imprisoned in the prison of the ecclesiastical
+court. These cases were strongly females in every sense, but with some
+male characteristic sufficiently developed, like in the case of Marie
+Lefort, to allow them to believe themselves men and to pass for such.
+
+On the other hand, males have had some female characteristics so well
+pronounced that they have passed for females. Debierre mentions a number
+of cases, to wit: Ambroise Pare reported such a case in his time;
+Ladowsky, of Reims, reports the case of Marie Goulich, who, up to the
+age of thirty-three, was believed to be a female, at which time the
+descent of the testicles removed all doubts as to sex. Sheghelner and
+Cheselden have reported analogous cases, and Girand's case--who was
+happily married to a man with whom he lived until the death of the
+husband, in which the only female attribute was a blind vagina, which,
+in his case, seems to have answered all purposes--was a most remarkable
+case. As a rule, the cases of males who have been mistaken for
+hermaphrodites have been cases of hypospadic urethrae in a greater or
+lesser sense of deformity.
+
+Debierre, however, mentions some cases of true hermaphrodism. He quotes
+a number of cases, the earliest being from the writings of Coelius
+Rhodigin, who claimed to have seen in Lombardy a case in which the
+organs of the two sexes were side by side; Ambroise Pare records that in
+1426 a pair of twins were born, joined back to back, wherein both were
+hermaphrodites. Among the many reporters that he quotes, he mentions
+Rokitansky, who reported a case in 1869, at Vienna, this being the
+autopsy of Hohmann, who had two ovaries and oviducts, a rudimentary
+uterus, and a testicle, with a sperm-duct containing spermatozoa. This
+individual menstruated regularly, and it is an interesting question as
+to what the result would have been had some of the spermatic fluid come
+in contact with some of the ovules that were periodically discharged.
+Hohmann had an imperforate penis and a bifide scrotum. Ceccherelli, who
+gives a more minute description of this interesting case, relates that
+Hohmann, who died at the age of forty, had menstruated regularly to the
+age of thirty-eight. The penis was imperforate but hypospadic, from
+whence came the urinary and spermatic discharges, and Hohmann could in
+turn copulate as either male or female. Odin is also quoted in relation
+to the case seen at the Hotel-Dieu-de-Lyon, during the service of M.
+Bondet. The subject was aged sixty-three, and named Mathieu Perret. The
+case greatly resembled that of Hohmann, at the autopsy being found to be
+double sexed. So that, while most of the cases mentioned are fictitious
+and only apparent, the fact remains that the existence of true
+hermaphrodites is indisputable.[42]
+
+If the subject of either apparently or true hermaphrodism is one of
+unhappiness, and oftentimes of discomfort and misery, history relates
+that this unfortunate class has suffered additionally, from the laws and
+action of ignorant and barbarian times, as such freaks of nature must
+of necessity have occurred at all times; only in the then ignorant state
+of medicine and anatomy they must have been considered as occurring much
+oftener--every deviation from the normal being considered as
+hermaphroditic. Opmeyer relates that in excavating in the neighborhood
+of the capitol in Rome, the laborers discovered the bronze tables on
+which were inscribed the twenty-two laws of Romulus, termed by many
+historians "The Double Decalogue of Romulus." Article XV of this law, as
+well as Articles IX and X, seem to be directed against the life of these
+androgynes. In Roman history, however, we have an event which would seem
+to contradict that there existed any laws in actual force against this
+unfortunate class. It happened during the existence of the Punic wars,
+when the people were more or less laboring under fear and excitement,
+which would readily prepare them to accept any superstitious notion. It
+was during these times that three of these androgynes were known to
+exist in Italy. Titus Livius mentions that the existence of one of these
+was denounced during the consulships of C. Claudius Nero and of Marcus
+Livius. Etruscan soothsayers and seers were summoned to Rome, that they
+might consult the signs and the conditions of the constellations that
+accompanied the nativity of this hermaphrodite, or androgyne. These
+impostors, after a careful consultation of all attending circumstances,
+gave it as their opinion that the occurrence was an unfortunate
+impurity, and that it could only result to the disadvantage of Rome,
+unless she at once took steps to purify herself of such a monstrosity,
+with the conclusion that the androgyne should be first exiled from Roman
+soil, and then drowned in the depths of the sea. The unfortunate being
+was accordingly inclosed in a chest and put on board a galley, which
+put immediately to sea; when the vessel was out of sight of land the
+chest was thrown into the Mediterranean.[43]
+
+A hermaphrodite born in Umbria during the consulship of Messalus and C.
+Lucinius was condemned to death, as well as was the one born at Luna
+during the consulship of L. Matellus and Q. Fabius Maximus. Debierre
+states that in the reign of Nero this barbarous custom was discontinued,
+as this emperor admired these freaks of nature from their novelty, as it
+is related that his chariot was drawn by four hermaphroditic horses.[44]
+
+In connection with hermaphrodism it has been shown that the males who
+have been supposed to be so malformed were really, in most instances,
+but cases of hypospadias. It may not be uninteresting to observe that,
+while during nearly four thousand years circumcision has been practiced
+without the habit or condition ever having become transmissible or
+hereditary, hypospadias has shown a decided tendency to being
+transmitted. In Virchow's _Archives_, Lesser reports having treated
+eight subjects during one generation in a family.[45] Fodere records the
+case of hypospadias reported by Schweikard, in a person of forty-nine
+years of age, whose urethral orifice was near the junction of the penis
+and scrotum, but who, nevertheless, had three fine children. The same
+author records the remarkable case reported by Hunter to the Royal
+Society of London, also so deformed, who successfully impregnated his
+wife by receiving the spermatic fluid in a warm spoon and immediately
+injecting it into the vagina.[46] Another interesting case is taken from
+_L'Union Medicale_ of August 26, 1856. It instances both the heredity
+connected with hypospadias and the peculiar circumstances under which
+impregnation at times takes place; it is reported by Dr. Trexel, of
+Kremsier, and is as follows: "On April 1, 1856, a newborn infant was
+brought to Dr. Trexel, that he might determine its sex. The father and
+mother were servants of a peasant. On an examination of the alleged
+father, he was found to have all the external characters of a male; the
+urethra, which was rather shorter than ordinary, but of large size, was
+imperforate; the scrotum was divided into two pouches, each containing a
+testicle. The apposed surfaces of the scrotal pouches were covered with
+a red skin, and the division extended through their entire length. At
+the root of the penis, in the anterior angle of these pouches, was an
+opening of the size of a lentil; this was the orifice of the urethra.
+The lower surface of the penis was grooved from the above-mentioned
+orifice to the end of the glans. There was no prepuce. Almost in a line
+behind the corona of the glans, and in the groove, were two elliptical
+openings, which readily admitted a large hog-bristle; there was a third
+smaller opening two lines from the orifice of the urethra. This man had
+always passed for a woman. He lay in the same room with the mother of
+the child; and they acknowledged having had frequent connection. The
+woman declared that she had had no commerce with any other man for three
+years, and the man did not deny this assertion. The idea of cohabitation
+with another man was further negatived by the circumstance that the
+infant had the same conformation of the genital organs as the father.
+How did fecundation take place? The three openings in the penis were
+probably the orifices of the excretory ducts of Cowper's glands. But
+might not these have been the openings of the ejaculatory ducts? It is
+to be regretted that Dr. Trexel did not examine these canals; their
+length and direction would have thrown light on the subject. The fact
+of fecundation may also be explained by supposing that during coition
+the posterior wall of the vagina supplied the place of the absent floor
+of the urethra, thus forming a complete canal. This is the most probable
+explanation."[47]
+
+The above case, as stated, had passed for a woman; these cases are by no
+means such rarities. The case of Marie Dorothee, mentioned by Debierre
+in his work, was as peculiar. Hufeland and Marsina had pronounced Marie
+a woman, while Stark and Martens pronounced her a man, and Metzger could
+not determine on the sex. The case of Valmont, noticed by Bouillaud and
+Manee, is on a par with that of Giraud, in which the party was married
+as belonging to one sex and where it was not until after death
+ascertained that the person belonged to the other sex. Valmont had a
+hypospadic urethra and penis; a scrotum without testicles; ovaries with
+the Fallopian tubes; a uterus opened into a vagina of two inches in
+length, which, gradually narrowing, ended in the male urethra, to which
+was attached a prostate gland. Valmont contracted marriage as a man and
+was not discovered to have been a female until the autopsy revealed her
+to be a woman. The relation does not state anything in regard to
+menstruation; so that her condition in that regard is unknown.[48]
+
+There has also been reported a number of cases in the male analogous to
+the double organed female mentioned by Debierre. Geoffrey St. Hilare
+reports a case where the penis was double, one being above the other,
+urine and semen flowing through both urethras. Gore mentioned a like
+case to the Academy in 1844. Dr. Vanier (Du Havre) records the case
+reported by Huguier to the Academy, where the organs in the anatomical
+preparation which he exhibited were so anomalous that it was impossible
+to decide the sex. Aside from the medico-legal aspects that these cases
+present, there is an interesting Jewish theological question connected
+with them. The law is explicit as to circumcision; the cases presenting,
+if males, should be circumcised, but how to determine the sex where an
+autopsy alone will decide the question is not defined. It has been
+decided, in such cases where the presumption is that the child is of the
+male sex, that, like in cases of absence of prepuce, a suppositious
+circumcision should be performed, so that the covenant should be
+observed; this being in keeping with the sentiment shown by the Jews
+when persecuted by the Romans, or, later, by the Spaniards, who often
+were not able to circumcise until after death; but they never fail to
+comply with the covenant as far as it is possible.
+
+Cases are liable to occur, however, which, without leaving the question
+as to sex in doubt, if reasoned by exclusion, would not furnish any
+possible opportunity for circumcision. Such a case is reported in
+Virchow's _Archives_, vol. cxxi, No. 3; also in the _British Medical
+Journal_ of December 6, 1890, and in the _Satellite_ for January, 1891.
+It is one of congenital absence of penis. "Dr. Rauber records very
+briefly the case of a shoe-maker, aged 38, who complained of pain and
+trouble in the anus. On examining him, Rauber found a well-formed
+scrotum containing two testicles, each with a vas deferens and spermatic
+cord, but no trace of a penis. The urethra opened apparently into the
+anterior wall of the rectum. The man occasionally experienced sexual
+excitement, followed by an emission into the rectum. The burning pain
+complained of in the rectum and about the anus was due to the irritation
+caused by the urine. The man would not allow an ocular inspection of
+the interior of the rectum. Unfortunately, the details of this very rare
+condition are incomplete."
+
+It would be interesting to know where the seat of his sexual desire is
+situated, unless an aching testicle is such. I once knew a Spiritualist
+who claimed to feel the pains suffered by any friends with whom he was
+in sympathy; he once tried to argue with me that a certain lady
+patient--a warm personal friend of my questioner and a Spiritualist--had
+ovaritis, because he felt an intense burning pain in his _right ovarian
+region_ whenever he went near to her. I tried to reason with him that
+that pain should be in his right testicle, but he would insist on having
+the sympathetic pain in _his_ ovarian region.
+
+
+
+
+CHAPTER XI.
+
+RELIGIO MEDICI.
+
+
+Sir Thomas Browne, in his "Religio Medici,"[49] alludes to the scandal
+that is generally attached to our profession, we being accused of
+professing no religion. That this opinion is still prevalent at the
+present day is undeniable,--philosophers and physicians are believed to
+be atheists and non-religionists,--while, at the same time, by that
+strange contradiction that is so common, philosophers and physicians are
+the known and recognized sources of religions, such is the intimate
+relation existing between physical and moral hygiene. Confucius, the
+contemporary of Pythagoras, whose religion was said to be nothing more
+than the observance of a certain moral and political ethical code, and
+he who first formulated the text "that one should do unto others as one
+wishes others to do unto him," the founder of the Confucian religion,
+the orthodox religion of China, was a philosopher. Buddha, the founder
+of the second creed recognized in China, and which forms the religion of
+a great part of eastern Asia, was also a philosopher who was endeavoring
+to reduce the Brahminical religion to the simple principles of
+philosophical religion, based on morality. Moses not only was the
+greatest philosopher of his time, but also had an insight into medicine
+that to us of the present day is simply incomprehensible. The Great
+Master was both a philosopher and a physician, his disputes with the
+learned and his attention to the sick having given him the titles of
+Great Master and Divine Healer.
+
+To use the words of the "Religio Medici," the great body of the medical
+profession can, without usurpation, assume the name of Christians; for
+no monk of the desert convents of Asia Minor or religious knight of the
+middle ages, either in their care of the sick, or giving food and
+shelter to the weary, or protection of sword and shield to the oppressed
+pilgrim plodding his way to the Holy Land, were more deserving of the
+name of Christian than the medical man unwearily and unselfishly
+practicing his profession. To the true student of his art there is that
+in medicine which makes of the physician a practical Christian. Nor is
+there aught in medicine, either in its traditions, history, study, or
+practice, that in the lover of his art should ever make him anything but
+a philosophical and practical religionist. The physician, such as is
+actively engaged in the daily practice of his profession, instead of
+having no religion, is really a practical religionist, and, although he
+may subscribe to no outer ceremonial form or dogma, his life is such
+that a Confucian, a Buddhist, a Christian, or a Hebrew can behold in him
+the practitioner of the essence of either of their religions,--a
+conception carried out by Lessing, in his play of "Nathan the Wise,"
+where the Jew, the Saracen, and Crusader teach the impressive lesson
+that nobleness is bound by no confession of faith or religion; showing
+the principle that should guide true religion.
+
+The Rev. Dr. Townsend, of Boston University, has given a very
+interesting and intelligent relation of the connections that exist
+between medicine and the Old Testament, in the light of
+nineteenth-century science.[50] The article in question is interesting
+in its logical reasons as to why the Bible was inspired by a superior
+power, as well as in the comparisons it lays before us of the medicine
+of the Pagans and that of the Bible, during the early history of the
+world. After reviewing the false, crude, and senseless vagaries and
+superstitious notions that passed for medicine from the period of the
+Trojan war, in 1184 B.C., to the dissolution of the Pythagorean Society,
+500 B.C.--periods which existed after the writing of the books of
+Moses,--and the period between 500 B.C. and 320 B.C., or the philosophic
+era of medicine, during which flourished the father of our present
+system of medicine, an era of advancement, but which in our eyes is
+still full of errors and unscientific conclusions. From these two
+periods we span over centuries of darkness for science and medicine to
+the ages of Ambroise Pare and the more modern fathers of our art, who by
+perseverance finally extricated medicine from the mass of magical and
+superstitious rubbish which, like barnacles, had clung to it during its
+passage through the dark and ignorant ages. After this review our author
+turns to the Bible and discourses in this wise:--
+
+"Turning our attention to the Bible, we take the position that, though
+it was not designed to teach the science of medicine, still, whenever by
+hint, explicit statement, or commandment there is found in it anything
+relating to medicine, disease, or sanitary regulation, there must be no
+error; that is, provided the Bible, in an exceptional sense, is God's
+book. Now, what are the facts in this case? They are these: though the
+Bible often speaks of disease and remedy, yet the illusions, deceptions,
+and gross errors of anatomy, physiology, and pathology, as formerly
+taught, nowhere appear upon its pages. This, it must be acknowledged, is
+at least singular. But more than this: the various hints and directions
+of the Bible, its sanitary regulations, the isolation of the sick, the
+washing, the sprinkling, the external applications, and the various
+moral and religious injunctions in their bearing upon health are
+confessed to be in harmony with what is most recent and approved. To be
+sure, the average old-school physician of a century ago would have
+blandly smiled at our simplicity, had it been suggested to him that his
+methods would be improved by following Bible hints. 'What did Moses know
+about medical science?' would have been his reply. But Moses, judged by
+recent standards, seems to have known much, or, at least, to have
+written well."
+
+The above statement is a truthful relation of facts, from which it can
+well be conceived that even in the Bible the physician finds something
+to inspire him with the idea of its divine inspiration, as the very
+history of medicine, with which it is connected, and with which he is
+familiar, only lends him further support in that direction. Most
+intelligent physicians are also lovers of philosophical history. None is
+more entertaining than Rawlinson, either in his "Seven Great Monarchies"
+or his "Ancient Egypt." In his "Ancient Religions," in his concluding
+remarks, he observes as follows, in regard to the Hebraic religion: "It
+seems impossible to trace back to any one fundamental conception, to any
+innate idea, or to any common experience or observation, the various
+religions which we have been considering. The veiled monotheism of
+Egypt, the dualism of Persia, the shamanism of Etruria, the pronounced
+polytheism of India are too contrariant to admit of any one explanation,
+or to be derivative of one single source.... It is clear that from none
+of the religions here treated of could the religion of the ancient
+Hebrews have originated. The Israelite people, at different periods of
+its history, came and remained for a considerable time under Egyptian,
+Babylonian, and Persian influence, and there have not been wanting
+persons of ability who have regarded Judaism as a mere offshoot of the
+religion of one or the other of these three peoples. But, with the
+knowledge that we have now obtained of the religions in question, such
+views have been regarded as untenable, if not henceforth impossible.
+Judaism stands out from all other ancient religions as a thing _sui
+generis_, offering the sharpest contrast to the systems prevalent in the
+rest of the East, and so entirely different from them in its essence
+that its origin could not but have been distinct and separate.... The
+sacred books of the Hebrews cannot possibly have been derived from the
+sacred writings of any of these nations. No contrast can be greater than
+that between the Pentateuch and the 'Ritual of the Dead,' unless it be
+that between the Pentateuch and the Zendavesta, or between the same work
+and the Vedas.... In most religions the monotheistic idea is most
+prominent _at the first_, and gradually becomes obscured, and gives way
+before a polytheistic corruption.... Altogether, the theory to which the
+facts appear on the whole to point is the existence of a primitive
+religion, communicated to man from without, whereof monotheism and
+expiatory sacrifice were parts, and the gradual clouding over of this
+principle everywhere, unless it were among the Hebrews."[51]
+
+Medicine is indebted for its advancement to the Hebraic religion to a
+greater extent than is generally believed. In the early Christian
+centuries there existed three great creeds: the Christian, Hebraic, and
+Mohammedan. The Christian Church was in a perplexing condition. As
+observed by Draper,[52] it was impossible to disentangle her from the
+principles which had, at the beginning, entered into her political
+organization. For good or evil, right or wrong, her necessity required
+that she should put herself forth as the possessor of all knowledge
+within the reach of the human intellect. But the monk and priest were
+prohibited from studying medicine,[53] as by so doing the church saw
+that she would have to relinquish the spiritual control of disease were
+medicine a matter of scientific research; she preferred to hold on to
+her spiritual dominion, and let science slumber in darkness. On the
+other hand, the Mohammedans, recognizing the principle of fatalism in
+their religion, it was not to be expected that they should cultivate an
+art entirely opposed to that principle. In this state of affairs the
+Jewish physician, led by the teachings of his religion, alone presented
+the study of medicine in a scientific manner, and its practice and its
+result taught the Moslems that medical science placed it within the
+power of man to keep himself out of the grave, when either assailed by
+disease or laid low by the wounds of war. The Arabs were not slow to
+avail themselves of this discovery; and to the learning and skill of the
+Jewish physician, guided by the light of an intelligent Deity and a
+liberal religion, does medicine owe the existence of those able and
+learned Arabian physicians that flourished during the eleventh and
+twelfth centuries.
+
+There has been more or less of fault-finding in regard to certain rules
+and ordinances being sacramental, which, from the nature of things,
+should have been merely advisory or suggestive, as they pertained
+more to the hygienic welfare of the people than to the spiritual. Thus
+to reason, is neither philosophical nor in concert with our knowledge
+of the structure of man, and of the intimate relations that exist
+between mind and body, or of good health and good morals. The writer
+has seen violent catharsis produced by bread pills, after podophyllin,
+castor-oil, and phosphate of soda in the most generousdoses--administered
+as one would drop a letter in a mail-box--had completely failed; it is
+all in the manner and way we give a medicine or treat a disease. Certain
+narcotic and irritant poisons or powerful sedative agents have a
+physical action uninfluenced by the mind, but an intelligent physician
+is hardly supposed to drive at the small tack of disease with such
+powerful sledge-hammers. Charcot, recognizing the power of and availing
+himself of such a remedial agent as the pilgrimages to the Notre Dame de
+Lourdes, is an evidence of the intelligent and enlightened practitioner,
+who has learned, what the Bible taught, long, long ago, that human
+nature must be taken as it is found, and that, like the homely saying of
+Mohammed, as the mountain would not come to him, he must go to the
+mountain. Moses and all the Scriptural writers were well aware of this
+state of affairs, and their manner of using their knowledge was adapted
+and timed to the general intellectual development of the times.
+
+There is one point in connection with the above that should not escape
+our attention, this being that, while the Hebraic creed and the people
+still subscribed to the theological doctrine of the origin of disease,
+in common with the religions then in vogue, here the connection stopped.
+All other creeds--not excepting Christianity--looked forward to a
+theological doctrine of the cure of disease. With the Hebrew, disease
+was looked upon as the result of some infraction on his part of some of
+the laws, and the consequent expression of displeasure on the part of
+the Deity. He was taught, however, that the observance of certain
+ordinances were both conducive to health and to the prevention of
+disease, and acceptable to God, as well as to rely upon his study and
+skill to cure disease. This was equivalent to teaching them that
+diseases arose from physical causes, and that physical means were to be
+used to combat them. From this arose the practice of exposing the sick
+in public places, that they might receive the benefit of the advice of
+such who might have had experience in a like case. It is from their
+religion that Hebraic medicine has received its foundation of
+intelligent philosophy that carried it in its purity through all ages,
+free from magic, superstition, and imposture. With other creeds and
+religions, medicine, disease, as well as the physical phenomena
+affecting nature, were believed to be the arbitrary expression of anger
+of their gods, and that the cure of disease, or alterations in physical
+phenomena, were to be as arbitrarily effected, regardless of the
+existence or action of physical laws. It is to be regretted that one of
+the sects which has sprung from the Hebraic creed, and which worships
+the same God, has been unable to emancipate itself or its people from
+the idea of an arbitrary theological doctrine of the origin and control
+of disease. It is this creation of a narrow-minded theology of a
+vaccilating, unintelligent, unphilosophical, and arbitrary God, who
+would neither respect nor regard the laws of his own creation, that has
+led the great body of physicians out of the modern churches. They do not
+deny the existence of the Deity, but the god of their conception is a
+higher and nobler god,--the Deity of Religio Medici.
+
+When the prize for the best essay on "_the power, wisdom, and goodness
+of God, as manifested in creation_"--a series of publications known as
+the Bridgewater Treatises--has been nearly every other time won by
+physicians, among whom we may mention Sir Charles Bell, Dr. John Kidd,
+Dr. Peter M. Roget, and Dr. William Prout,--not only won on their own
+merit, but in competition with learned theologians and noted
+divines,--we may truly say that physicians are by no means atheists or
+agnostics, but that, on the contrary, they are the real exponents of a
+practical and intelligent religion, which they not only practice, but
+fully and intelligently comprehend.
+
+
+
+
+CHAPTER XII.
+
+HEBRAIC CIRCUMCISION.
+
+
+The first mention that we meet concerning circumcision is in Genesis. It
+is the command of God to Abraham; in establishing the covenant with him,
+He said to him: "This is my covenant, which ye shall keep between me and
+you, and thy seed after thee: every man-child among you shall be
+circumcised. And ye shall circumcise the flesh of your foreskin; and it
+shall be a token of the covenant betwixt me and you" (Gen. xvii, 10,
+11). It was also ordained that this should be extended to servants
+belonging to Abraham and his seed, as well as to their own children; and
+that in case of children it should be done on the eighth day after
+birth.[54] This was appointed as an ordinance of perpetual obligation on
+the Hebraic family, and its neglect or omission entailed being cut off
+from the people (12, 14). In compliance with this ordinance, Abraham,
+although in his ninety-ninth year, circumcised himself and all his
+slaves, as well as his son Ishmael. Slaves by purchase were
+circumcised,[55] as were any strangers, who were also circumcised before
+being allowed to partake of the passover or to become Jewish citizens.
+It was to be observed by all heathens who became converted to the Jewish
+faith. During the wanderings in the wilderness circumcision was not
+practiced, but Joshua caused all to be circumcised before they entered
+the promised land.[56]
+
+The old Hebrews strictly followed the injunction to circumcise on the
+eighth day, and of such importance in a religious sense was this rite
+in their estimation that even when the eighth day fell on the Sabbath
+the eighth day ordinance was observed. The ordinance, however, was not
+blindly arbitrary, as rules were laid down for exception. For instance,
+whenever a family had lost two children through circumcision it did not
+become obligatory on that family to circumcise the third child, who was
+however considered as entitled to all the benefits of the congregation
+or of the Hebraic religion, just the same as if he had been circumcised.
+Again, Maimonides, or Moussa Ben Maimon, a celebrated physician and
+rabbi, born in Cordova in the year 1135 A.D., among his works on
+medicine, has left directions in regard to circumcision which have been
+the guides of the _mohels_. Among the Hebraic physicians it was
+considered that the child partook of the constitutional strength or
+feebleness of the mother; hence the rule above mentioned, in regard to
+exemption to circumcision, only was in operation when the two who had
+formerly died belonged to the same mother as the third one, who would
+thereby be exempt; but if the two children had belonged to another
+woman, and this third child of the father was not from the same mother,
+the rule did not exempt. The third child of the mother who had
+previously lost two infants at the rite was, however, to be circumcised
+when arrived at adult age, provided no further counter-indication
+occurred. The opinion that the mother gave the constitution to the child
+was promulgated by Maimonides and became general.
+
+The eighth day is believed to refer to the eighth day after full term;
+thus, a child born prematurely is not supposed to be circumcised until
+eight days after it would have reached its full term, and only then if
+its general good condition is settled. Maimonides looked upon infantile
+jaundice, general debility, and marasmus as contra-indications to the
+performance of the rite; any erysipelatous inflammation, ophthalmia,
+anaemia, eruption of any kind, fever, tendency to convulsive
+movements--in fact, any observable departure from normal health should
+be allowed to pass before performing the rite. Aside from these general
+conditions that denoted that the operation was contra-indicated, the
+local condition of the organ itself also was to be examined, and if
+certain conditions existed the operation was to be put off. These
+conditions consisted in any irritation or red appearance of the prepuce,
+due to either inflammation or to the irritative action of the sebaceous
+matter underneath the prepuce, the acrid nature of these secretions
+being at times sufficiently virulent to produce an ulceration, even in
+the newborn.[57]
+
+Among the Hebrews themselves there are those who do not look upon
+circumcision in a favorable light, but on something that has served its
+time in its own day, and within the past year a proselyte has been
+accepted into one of the New York synagogues without previous or
+subsequent circumcision, these reformed Jews looking upon adult
+circumcision as too painful an operation to be gone through, as they
+claim, unnecessarily. It must be said, however, that these persons look
+upon circumcision purely in a sacramental light, and simply as an
+arbitrary ordinance of God in the remote ages of antiquity, but which in
+the present century has not enough practical significance to warrant its
+performance on the occasion of an adult joining the congregation. These
+persons look upon it, as has been said, in a purely theological light,
+and ignore any and all considerations of hygiene in connection with it,
+claiming that if it is a simple matter of hygiene, then it is not a
+sacrament, and that, if it is sacramental, then the subject of hygiene
+has nothing whatever to do with it. The force of their reasoning and
+logic is very obscure and clouded, to say the least. The covenant either
+exists or it does not; to do away with one ordinance in any arbitrary
+manner is to gradually begin to crumble down the whole fabric of
+Judaism; for when exceptions are begun, one tenet as well as another is
+liable to topple over. If the rite is a sacrament, then it should be
+performed on all, and a proselyte should not be admitted without being
+circumcised, and, if a hygienic measure only, the same rule holds. These
+Jews evidently ignore the rationalism that governed the promulgation of
+the Mosaic law, and its recognition of the inseparability of the moral
+from the physical nature of man.
+
+Montaigne has left us a description of the performance of the rite, as
+witnessed by him in the city of Rome in the sixteenth century. He
+relates it as follows: "On the thirtieth of January was witnessed one of
+the most ancient ceremonies of religion practiced by mankind, this being
+the circumcision of the Jews. This is performed at the dwelling, the
+most commodious chamber being chosen for the occasion. At this
+particular time, by reason of the incommodity of the house, the rite was
+performed at the door of the domicile. The godfather sat himself on a
+table, with a pillow on his lap. The godmother then brought the child,
+after which she retired. The godfather then undressed the child's lower
+part so as to expose his person, while the operator and his assistant
+began to chant hymns. This operation lasts at least a quarter of an
+hour. The operator may or may not be a rabbi, as it is considered a
+great blessing to perform this operation; so that it follows that many
+are found who are anxious to exercise their faculty in this regard,
+there being a tradition that those who have circumcised a certain number
+do not suffer putrefaction in their mouth, nor does their mouth become
+food for worms after death; so that it often happens that they make
+presents of value to the child for the privilege of operating upon it.
+On the same table on which the godfather is seated all the required
+instruments and apparatus are placed, while an assistant stands by with
+a flask of wine and a glass. A warming-pan full of coals is on the
+floor, at which the operator warms his hands. The child being now ready,
+with its head toward the godfather, the operator, seizing the member,
+draws the foreskin toward him with one hand, while with the fingers of
+the other he pushes back the glans; he then places a silver instrument,
+which fixes the skin, and which at the same time holds back the glans so
+that the knife may not cut it. The foreskin is then cut off and buried
+in the little basin of soil that forms one of the appurtenances to the
+operation. The operator then tears with his nails the skin which lies on
+the glans, which he turns back over the body of the member. This seems
+the hardest and most painful part of the operation, which, however, does
+not seem dangerous, as in four or five days the wound has healed. The
+crying of the child resembles that of an infant undergoing baptism. No
+sooner is the glans uncovered than the operator takes a mouthful of
+wine; he then places the glans in his mouth and sucks the blood out of
+it; this he repeats three times. This done, he applies a powder of
+dragons' blood, with which he covers up all the wound, the parts being
+then done up in expressly-cut bandages. He is then given a glass of
+wine, over which he says some prayers; of this he takes a mouthful, and,
+after moistening his fingers in the same, he applies the wine three
+times to the child's mouth. The wine is then sent to the mother and the
+women, who are in some other apartment, who all take a sip. An assistant
+then takes a silver instrument, pierced with little holes like a small
+strainer, which he first applies to the nose of the officiating
+minister, then to that of the child, and afterward to the nose of the
+godfather."[58] The above description of the performance of the rite in
+the sixteenth century answers to the method of its performance as was
+witnessed some years ago in France.
+
+In the "Biblical, Theological, and Ecclesiastical Cyclopaedia" of Drs.
+McClintock and Strong the following description of the rite, as taking
+place in our modern synagogues, is given:--
+
+"The ceremony of circumcision, as practiced by the Jews in our own
+times, is thus: If the eighth day happens to be on the Sabbath, the
+ceremony must be performed on that day, notwithstanding its sanctity.
+When a male child is born the godfather is chosen from amongst his
+relatives or near friends; and if the party is not in circumstances to
+bear the expenses, which are considerable (for after the ceremony is
+performed a breakfast is provided, even amongst the poor, in a luxurious
+manner), it is usual for the poor to get one amongst the richer, who
+accepts the office, and becomes a godfather. There are also societies
+formed amongst them for the purpose of defraying the expenses, and every
+Jew receives the benefit if his child is born in wedlock.
+
+"The ceremony is performed in the following manner, in general: The
+circumciser being provided with a very sharp instrument called the
+circumcising-knife, plasters, cummin-seeds to dress the wound, proper
+bandages, etc., the child is brought to the door of the synagogue by the
+godmother, when the godfather receives it from her and carries it into
+the synagogue, where a large chair with two seats is placed; the one is
+for the godfather to sit upon, the other is called the seat of Elijah
+the Prophet, who is called the angel or messenger of the covenant. As
+soon as the godfather enters with the child, the congregation say,
+'Blessed is he that cometh to be circumcised, and enter into the
+covenant on the eighth day.' The godfather being seated, and the child
+placed on a cushion in his lap, the circumciser performs the operation,
+and, holding the child in his arms, takes a glass of wine into his right
+hand, and says as follows: 'Blessed be Thou, O Lord our God, King of the
+Universe, Creator of the fruit of the vine! Blessed art Thou, O Lord our
+God! who hath sanctified His beloved from the womb, and ordained an
+ordinance for His kindred, and sealed His descendants with the mark of
+His holy covenant; therefore, for the merits of this, O living God! our
+rock and inheritance, command the deliverance of the beloved of our
+kindred from the pit, for the sake of the covenant which He hath put in
+our flesh. Blessed art Thou, O Lord, the Maker of the Covenant! our God,
+and the God of our fathers! Preserve this child to his father and
+mother, and his name shall be called in Israel, A, the son of B. Let the
+father rejoice in those that go forth from his loins, and let his mother
+be glad in the fruit of her womb, as it is written: "Thy father and
+mother shall rejoice, and they that begat thee shall be glad."' The
+father of the child then says the following grace: 'Blessed art Thou, O
+Lord our God, King of the Universe! who hath sanctified us with His
+commandments, and commanded us to enter into the covenant of our holy
+father, Abraham.' The congregation answer: 'As he hath entered into the
+law, the canopy, and the good and virtuous deeds.'"[59]
+
+
+
+
+CHAPTER XIII.
+
+MEZIZAH, THE FOURTH OR OBJECTIONABLE ACT OF SUCTION.
+
+
+Biblical and rabbinical traditions throw no light on the origin of the
+details of the operation as now performed. That it was anciently
+performed with a knife of stone is certain; an event common in its
+general observance, and which seems to have pervaded all nations or
+races, howsoever remote or scattered, that it has induced Tylor[60] to
+ascribe the origin of the rite to the stone age. We are told that when
+Moses was returning to the land of Egypt he had neglected circumcising
+his son, and that because of that neglect he nearly lost his son's life;
+his wife, Zipporah, the daughter of the Midian king and priest, Jethro,
+seeing the danger and knowing its cause, took her little son Gershom and
+circumcised him with a stone knife, and offered the foreskin to God as a
+peace-offering. Just where the wine was first used we are not told.
+Wine, however, was an emblem of thanksgiving, and, being one of the
+fruits of the earth, was considered an acceptable offering to God. It
+has since, in some form or other, either as wine or as the
+representative of either divine or human blood, been used in both the
+Catholic and Protestant Churches in their ceremonials or vicarious
+sacrifices, or imitations of old customs. Circumcision was by many
+connected with a blood sacrifice; it was so suggested by the words of
+Zipporah at the circumcision of Gershom: "And Zipporah, his Midianitish
+wife, took up a sharp stone and cut off the foreskin of her son, and
+cast it at his feet and said, 'Surely a _Khathan_ of blood art thou to
+me.'" Much speculation has followed the use of this word _Khathan_,
+which, in the ordinary Arabian, may mean either husband or son-in-law;
+it also means a newly-admitted member of a family; a similar word means
+"to provide a wedding feast," and one other word from the same root and
+branch means "to give or receive a daughter in marriage." In our own
+day, the _mohel_, or ministerial circumciser, makes it a practice to
+draw a little blood from the skin of such as are presented for the rite,
+but whom nature has not furnished with sufficient foreskin for the
+operation. The application, thrice repeated, of the blood and wine to
+the lips of the child, is probably used as a sign of the sealing of the
+compact. Wine is mentioned in connection with the High-Priest
+Melchisedeck as the wine of thanksgiving at his meeting with Abraham;
+wine was presented to Aaron by the angel, who, giving him a crystal
+glassful of good wine, said to him: "Aaron, drink of this wine which the
+Lord sends you as a pledge of good news." Originally, circumcision must
+have consisted of the simple removal of the foreskin, and the
+elaboration of the ceremonial details must have been a subsequent
+occurrence; persons wounding their fingers will instinctively carry them
+to their mouth, and it may be that the suction practiced by the Hebrews
+had its origin in this natural haemostatic suggestion. Wine as a
+haemostatic and as an emblem of thanksgiving and an acceptable offering
+naturally came in as an accessory.
+
+This practice--which, in the old, patriarchal days of the simple
+shepherds, when men only lived on the flesh of their own flocks, their
+diet, however, consisting mostly of cakes of flour, milk, honey, a few
+herbs, or the flesh of the goat or sheep--could not have been as
+objectionable as it is at the present day, with blood and secretions in
+a continued ferment through diet and habits. Man, living in the open air
+of Armenia, Palestine, or Arabia, sleeping in the open tents of our
+Biblical forefathers, living on the simple diet of a shepherd's camp,
+with the abstemiousness that those climates naturally induce in man,
+could not help but be healthy. In those early days, when neither
+passion, anxiety, nor worry disturbed either digestion or sleep, man had
+no vitiated secretions, wine was then a rarity, and water was the drink.
+One of the early patriarchs on such diet would have furnished a dainty
+and savory dish to the most fastidious cannibal, who is now tormented by
+the _komerborg kawan_, this being a term used by the Australian
+cannibals to designate the peculiar nausea that is induced in them when
+they recklessly eat of white man,[61]--something which they do not
+experience from feasting on the savages who live on the simple diet of a
+pastoral tribe. This primitive gastronomic science in regard to
+cannibalism even reached such a pitch of refinement that, as has been
+previously mentioned, some tribes even resorted to emasculation to
+improve the flavor of the animal juices, which by this procedure became
+less acrid. The Arabian and Oriental traditions bring us down tales of
+how, on the same principles, human beings intended to grace the festive
+platter were fed exclusively on rice. The salivary and buccal
+secretions, under such a simple diet as that indulged in by our Biblical
+forefathers, become bland and harmless; not only harmless, but even
+antiseptic and positively beneficial, acting on the same principle as
+local applications of pepsin. So that the practice, at the time of the
+patriarchs and in their own family, of this part of the rite could not
+have offered the same objection that it does at the present day. The
+modern house-dweller, living on a mixed diet and in a climate that
+induces him to eat grossly, both as to quality and quantity, partaking
+more or less of vinous, spirituous, or fermented liquors, as well as
+indulging in tobacco, is quite another being from the Arabian or
+Armenian shepherd of former days. Business anxieties and worry also have
+a very pronounced effect; so that, with the change in the conditions of
+man and the inception and multiplication of diseased conditions, as well
+as the creation of constitutional and transmissible diseases, this
+practice of suction should have been stopped.
+
+Intelligent rabbis, devoted to their religion, are necessarily prone to
+defend any of the details in its ceremonials that age and practice have
+sanctioned, and even some of the later writings of Israelism seem to
+make the mezizah, or suction, a necessary and ceremonial detail. In the
+"Guimara," composed in the fifth century, Rabbi Rav Pope uses these
+words: "All operators who fail to use suction, and thereby cause the
+infant to run any risk, should be destituted of the right to perform the
+ceremony." In the "Mishna" it says, "It is permitted on the Sabbath to
+do all that is necessary to perform circumcision, excision, denudation,
+and suction." The "Mishna" was composed during the second century. The
+celebrated Maimonides lent it his sanction, as in his work on
+circumcision he advises suction, to avoid any subsequent danger. Our
+modern Israelites are supposed, as a rule, to have taken their
+authority, aside from previous usage and custom, from the "Beth Yosef,"
+which was written by Joseph Karo, and subsequently annotated by the
+Rabbi Israel Isserth. In all of these sanctions, however, there is no
+reason expressed why it should be performed.[62] Maimonides undoubtedly
+looked upon this act as having a decided tendency or action in depleting
+the immediate vessels in the vicinity of the cut surface, and that the
+consequent constriction in their calibre would prevent any future
+haemorrhage. That this is the natural result of suction is a fact readily
+understood by any modern physician. The depletion of the vessel for some
+distance in its length, with the contraction in the coat that follows,
+is certainly a better preventive to consequent haemorrhage than the
+simple application of any styptic preparation that can only be placed at
+the mouth of the vessel, but which leaves its calibre intact. Hot water,
+or an extreme degree of cold, will answer to produce this contraction
+and depletion, but there is here a local physical reaction that is more
+liable to occur than when the contraction has taken place naturally, as
+when induced by depletion, instead of by the stimulus of either heat or
+cold. So that if, in the light of modern civilization and changed
+conditions of mankind, and the existence of diseases which formerly did
+not exist, we are now convinced that suction is dangerous, we should not
+judge the ancients too hastily or rashly for having adopted the custom,
+as it is certainly not without some scientific merit; although,
+authorities are not wanting who hold that suction or depletion increases
+the danger of haemorrhage.
+
+It can be understood that the results of suction would be in some
+measure analogous to those left by the application of an Esmarch bandage
+on a limb. The ancients, performing the operation with rude implements
+and having no haemostatic remedies or appliances, naturally followed the
+best means at their command; they evidently feared haemorrhage, and their
+rule in regard to exemption shows us that they recognized the existence
+of haemorrhagic diathesis or other transmissible peculiarities of
+constitution. This same fear of haemorrhage probably suggested the second
+step of the operation being performed, as it is by laceration instead of
+by cutting instruments, showing in this an evident desire to limit the
+cutting part of the operation to as small a limit as possible. Against
+an infant who has decided haemorrhagic tendency, we are about as helpless
+as were the ancient Hebrews, and, while the Turkish or some of the
+Arabian methods of performing the operation may be said in ordinary
+cases--by the application of cord and the consequent constriction--to
+limit the danger from subsequent haemorrhage, still, in the haemorrhagic
+diathesis this would not be of any avail; so, as already observed, we
+must not too rashly judge those old shepherds of the Armenian plains for
+adopting a practice which to them was calculated to avert subsequent
+dangers, or their descendants following in their footsteps, until having
+learned better, even if that practice is to us disgusting, primitive,
+and useless.
+
+Cases occur,--happily not frequently,--of alarming and uncontrollable
+haemorrhage. The following case is suggestive of the alarming extent and
+persistence that may attend one of those haemorrhagic cases, even when
+recovery eventually takes place. It is reported by Dr. Sannanel in the
+_Gazetta Toscana delle science medicale e fisiche_ of 1844. The case was
+that of a Jewish infant circumcised on the eighth day. Some hours after
+the operation the child was observed to be bleeding; the haemmorrhage
+would only cease for a few moments, and then come on with increased
+force, and which proved rebellious to ordinary remedies. Dr. Sannanel
+was called during the night of the third day after the operation. A
+number of physicians had been in attendance, and neither ice,
+astringents, pressure, nor any usual haemostatic means had had the least
+effect; cautery with nitrate of silver, sulphuric acid, and the actual
+cautery by means of heated iron were tried in succession, without any
+good results. Ten days passed in this manner, the haemmorrhage only
+ceasing for a few moments at a time, and the child was nearly
+exsanguinated from the continued serous seepage and the paroxysmal
+haemorrhages, when a lucky application of caustic potassa almost
+immediately stopped the haemorrhage. This case was seen by nearly all the
+leading medical men of Leghorn, who lent their aid and counsel to save
+the little life. The case is interesting from the length of time it
+persisted, and that even after all the loss of blood and suffering that
+the little fellow endured he survived.[63]
+
+Dr. Epstein, of Cincinnati, in a letter of March 29, 1872, to the
+_Israelite_ of that city, mentions a nearly fatal case from haemorrage
+after the rite of "_Milah_," and gives the result of his experience in
+such cases. He argues that _Hitouch_ or _Hitooch_ alone, or the first
+step or cutting off of the prepuce, performed with ordinary care, could
+hardly be followed up with any more serious results than can be
+controlled with the application of a little acidulated water. The second
+act, or _Periah_, the act of laceration, he looks upon as one that calls
+for coolness, judgment, and skill, as the membrane should only be torn
+so far and no farther, the thin, inner fold of the prepuce being
+vascular only in the sulcus back of the corona and at its lower
+attachment, where it forms the frenum, or bridle; any carelessness or
+over-anxiety on the part of the operator in tearing this membrane too
+far back results in danger of haemorrhage; especially is this part of the
+operation liable to be badly done if the inner preputial fold is thick
+and resisting, as in that case undue force may carry the laceration back
+into the vascular tissue. The means suggested by Dr. Epstein to arrest
+haemorrhage are those ordinarily used in haemorrhagic cases, such as will
+be given presently. The doctor regrets that the operators are not as
+they should be, physicians, and that, when _mohels_ are employed,
+persons are not sufficiently exacting as to their qualifications.[64]
+
+In France the government has managed to secure more safety in the
+operation. By a royal decree of date of May 25, 1845, in compliance with
+a desire expressed by the Hebrew Consistory, it was ordered that no one
+should exercise the functions of a _mohel_ or of _schohet_, without
+being duly authorized to perform said functions by the Consistory of the
+Circonscription; and that all _mohels_ and _schohets_ shall be governed
+in the exercise of their functions by the Departmental Consistory and
+the General Consistory. By virtue of this decree a regulation was passed
+by the Consistories on the 12th of July, 1854, ordering that thereafter
+circumcision should only be performed in a rational manner, and by a
+properly qualified person. Suction was likewise abolished, and the wound
+directed to be sponged with wine and water. This decree and the
+resulting regulations have been of the greatest benefit to the French
+Israelites, and some attention to the matter would not be amiss in the
+United States.
+
+This reformation has met with the approval of the leading French Jews,
+whose General Consistory decided that suction was not necessarily a part
+of the religious rite, and that, as it was undoubtedly introduced into
+the rite on the days of primitive surgery, it was perfectly rational to
+suppress this operative accessory, now that that same science, in its
+enlightenment, pronounced it unsafe. The whole body of the Congregation
+did not tamely submit to what they considered an innovation, and from
+some of the mohels all possible resistance was opposed to prevent the
+abolishment of this part of the operation from becoming a law. So
+determined was this opposition in some instances that the Consistory of
+Paris found it necessary to impose on all the mohels an obligation,
+bound by an oath, that they would respect the law. Those who refused to
+take the obligation gave up their vocation.
+
+The Grand Rabbi of Paris, at the time of this reformation, M. Ennery,
+was one of the most zealous supporters of the new departure. The
+influence of the French pervaded northward, and the _mezizah_ was
+abolished in Brunswick, Dr. Solomon, a learned Hebrew of that State,
+being instrumental in having it done legally. The discussion of this
+subject, in 1845, had one very happy effect,--the supporters of the
+reformed idea of the rite issued a circular letter to all the leading
+continental surgeons and medical men asking for their opinion on several
+points in relation thereto, especially, however, on this part of the
+rite. The opinions of many of these will be referred to in the medical
+part of this work.
+
+The after-treatment of the circumcised infant is governed more or less
+by local habits and the individual intelligence of the mohel and his
+experience. After turning back the inner fold of the prepuce, the parts
+are covered with a small, square bandage, with an aperture to admit the
+passage of the glans. This, and the subsequent small bandage of old
+linen, which is calculated to hold it in place, are slightly coated with
+a powder composed of lycopodium, with the slight addition, at times, of
+Monsel's salts, alum-powder, or some vegetable astringent. Over these
+another compress is placed, to prevent the friction of the clothes of
+the infant or of the bedding. The infant then receives a final
+benediction, and the godmother then receives the child in her arms and
+carries it to its cot or crib. The operator generally visits the infant
+in the afternoon of the operation, and carefully inspects the dressings,
+to see that no haemorrhage has supervened.
+
+It is customary to place the child in a bath, either the same evening or
+on the following morning, the object of this being to remove and to
+facilitate the removal of the dressings, which are more or less
+saturated and clotted with blood. After the removal of these, the wound
+is redressed, as previously, except that some cerate--ointment of roses
+or some other mild ointment--is used. Some prefer the simple water
+dressing from beginning to end. Since the introduction of creasote, acid
+phenique, and carbolic acid, many mohels are in the practice of washing
+the parts with water impregnated with one of these before performing the
+operation, and using subsequently the same form of lotion at every
+dressing. In case of haemorrhage there is an haemostatic water or lotion,
+which has been long used by the German and Polish mohels with
+considerable success, and which, in ordinary cases, has been found to be
+all that was required. This water, called by the French "Mixture
+d'arguesbusade," "Eau vulneraire spiriteuse de Theden," and by the
+Germans as "Spritzwasser" and "Schusswasser," is composed as follows:--
+
+  Acetic acid,                  10     grammes.
+  Rectified spirits of wine,     5        "
+  Diluted sulphuric acid,        21/2       "
+  Clarified honey,               8        "
+
+This mixture is well mixed and filtered, and is then kept in a
+tightly-stoppered vial.
+
+Dr. Bergson uses a mixture composed of diluted sulphuric acid, 1 part;
+alcohol, 3 parts; honey, 2 parts; and 6 parts of wine vinegar.
+
+Haemostatic powders are also used by the Hebrews, being more conveniently
+kept or carried than the haemostatic waters. In Russia and in Poland they
+are composed of decomposed or decayed hawthorn-wood powder and
+lycopodium. That of Berlin is composed of Armenian bole, red clay,
+dragons' blood, powdered rose-leaves, powdered galls, and powdered
+subcarbonate of lead. In France a haemostatic fluid, composed of dragons'
+blood digested in turpentine, is in vogue. The Eau de Pagliari is also
+used; it is composed of a mixture of tincture of benzoin, 8 ounces;
+powdered alum, 1 pound; and 10 pounds of water, boiled together for six
+hours, and is considered a powerful styptic. In addition to these, burnt
+linen, spiders' webs, starch-powder, powdered alum, and plaster-of-Paris
+powder are used by different mohels. Touching the bleeding points with a
+pointed pencil of nitrate of silver is also a practice understood by the
+Jewish circumcisers.
+
+
+
+
+CHAPTER XIV.
+
+WHAT ARE THE BENEFITS OF CIRCUMCISION?
+
+
+There are those, even among the Hebrews, who are so imbued with the
+purely theological idea of the origin, performance, and causes of
+circumcision, that they cannot see any moral nor hygienic value in the
+operation. Among many Christians the idea still prevails that
+circumcision is the relic of some barbarous rite, practiced in some
+epoch away in the remote ages of the world, grafted on to the Jewish
+religion by some accident or other; but that beyond the clinging of the
+Jews to this custom, as being a remnant of their old religion, they
+neither see in the rite any other significance, moral results, nor
+hygienic precaution; and the fact of a Jew being circumcised is too
+often made a subject of merriment among the unthinking portion of the
+Christian world. Neither are physicians all of one accord on the subject
+as to whether circumcision is a benefit, or, being useless, a dangerous
+and an unnecessary operation. The writer is most emphatically in favor
+of circumcision, and has the fullest faith in the positive moral and
+physical benefits that mankind gains from the operation.
+
+It may well be asked: What does the Jew receive in return for all the
+suffering that he inflicts through circumcision on himself and his
+little children? What is there to repay him or his for all the risks and
+annoyances, besides branding himself and his with an indestructible
+mark, which has been more than once the sign by which they have suffered
+persecution, spoliation, expatriation, and death? Are there any
+benefits enjoyed by the Jew that the uncircumcised does not enjoy in
+equal proportion?
+
+The relative longevity between the Hebrew race and the Christian nations
+that dwell together under like climatic and political conditions
+indicates a stronger tenacity on the part of the Jewish part of the
+nations to life, a greatly less liability to disease, and a stronger
+resistance to epidemic, endemic, and accidental diseases. By some
+authorities it has been held that the occupations followed by the Jew
+are such as do not compel him to risk his life, as he neither follows
+any labor requiring any great and continued exertion, nor any that
+subjects him to any great exposure; that, as a rule, when in business,
+by some intuition he follows some branch that has neither anxiety, care,
+nor great chance of loss connected with it; that he does not follow any
+occupation that is attended with any risk of accident for either life or
+limb. Besides all these, it is also urged that in cities the careful
+inspection of their meat, and the peculiar social fabric of the family,
+the love and veneration for their aged, as well as their proverbial
+charity to their own poor and sick, and their provident habits and
+hygienic regulations imposed upon them by the Mosaic law, are all
+conditions that conspire to induce longevity.
+
+That the Hebrew is generally found in such conditions as above described
+is undisputed; but it is questionable if all these conditions are
+necessarily such as are favorable to health and long life, and that,
+therefore, the longevity of the Jewish race cannot altogether be
+ascribed to the above conditions. Looking at the subject of occupation,
+if we consult Lombard, Thackrah, and the later works on the effects of
+occupation on life, we must admit that the Jew has no visible advantage
+in that regard, as he follows hardly any out-of-door occupation, being
+often in-doors in a confined and foul atmosphere. To those who have
+closely observed the race in this country,--coming as they do from the
+cold-wintered climates of Germany, Austria, or Poland, bringing with
+them the habit of living in small, close rooms, for the sake of economy
+and comfort,--it must be admitted that among the lower classes and the
+poorer of the race, their shops being connected, as they usually are,
+with their living-rooms, the _toute ensemble_ is anything but conducive
+to a long life. Their anaemic and undeveloped physical condition and weak
+muscular organization are sufficient evidence that their surroundings
+are not calculated to improve health. In England, statistics
+sufficiently prove that the fisherman on the coast, exposed to all kinds
+of weather, is not as prone to disease as is his brother Englishman who
+deals out the groceries in his snug shop. Exercise has been held an
+important element in the factory of the long-lived. From the time of
+Hippocrates down to Cheyne, Rush, Hufeland, Tissot, Charcot, Humphry,
+and all authorities on the factors of old age, exercise has been looked
+upon as favoring long life. Exercise cannot be said to enter in any way
+as a factor in the longevity of the Jew; but, on the contrary, his
+in-door life is known to be very productive of phthisis in other races.
+His recreations are, as a rule, of the home social order. They visit and
+spend the time allotted to recreation in social intercourse, which their
+hospitality always insists on accompanying with a generous lunch, which,
+to say the least, is not an element that is conducive to either health
+or long life; for no people excel the Jew in home hospitality, and even
+among the poorer classes a stranger is never allowed to depart without
+some refreshment being offered him. Among the class better able to
+extend hospitality, social reunions and card parties, with lunches of
+fruits, cakes, cold meats and coffee, or wines, are among their regular
+occurrences. Their great affection for the family and for their youth
+and aged suggests these means of recreation, as then they are enjoyed by
+all alike; but, as observed, the hygiene of all this is very doubtful;
+it produces too much irregularity.
+
+It is related that after the Roman conquest of Palestine many of the
+Jews, becoming more or less accustomed to Roman manners and customs,
+often joined in the games which the Romans held in imitation of the old
+Olympic games of the Grecians. Not to be ridiculed, many resorted to the
+practices described in a previous chapter, to efface all the marks of
+their circumcision, that they might enter the games with as much freedom
+as the Romans or other uncircumcised nations; so that the present
+aversion to out-of-door sports evinced by the Jew is not necessarily a
+racial trait; the persecutions and political inequality that until
+lately he has been made to suffer have driven him into retirement and
+seclusion. Although seeking neither converts nor political power and
+influence, he has been hunted down, massacred, and chased about as a
+dangerous beast. As the children of the great Rabbi Moses Mendelssohn
+asked of their father: "Is it a disgrace to be a Jew? Why do people
+throw stones at us and call us names?" It may well be asked, why? These
+actions have forced them into the social and retired habits for which
+they are noted; although it cannot be said that it is from a lack of
+spirit, as one of the Rothschilds is well known to have been present at
+the battle of Waterloo, where from a spot in the vicinity of the
+British right-centre he observed the events of the battle; and when,
+with the failure of Ney's last desperate charge with the formidable
+battalions of the Old Guard, he saw the advance of the Prussians closing
+in on the French right, he galloped to the sea-shore, and, crossing the
+Channel in a frail boat, reached London twenty-four hours in advance of
+the news of the battle,[65] but long enough for him to clear several
+millions from off the panicky state of the money market. Marshal
+Massena, one of Napoleon's bravest generals, the defender of Genoa and
+the hero of Wagram, was of Jewish origin.
+
+Athletic sports are not of necessity conducive to long life, even if
+they are to temporary robust health; but there is no mistaking the fact
+that the sedentary and in-door life of the average Jew is a deteriorator
+to health and life, and especially among that class of families who are
+poor and keep no servant; from heredity and home education having
+adopted unhygienic customs, in which they have grown up,--in these a
+total disregard for all ventilation forms a part. Were an uncircumcised
+race so to live, scrofula and phthisis would be the inevitable result.
+This difference of results I have witnessed more than once as existing
+among the two races coming from the same European nationality, where
+their disregard to ordinary rules of hygiene, induced by climatic
+causes, especially ventilation, were alike in both the Semitic and
+European descendants of the one nation, the purely European being more
+prone to consumption and scrofula. It is interesting to note the
+difference in the moral, mental, and physical conditions induced by
+creeds; it would seem as if it should not make any difference. The
+generally accepted idea of religion is that it should raise the moral
+standard of all those nations who practice religion; but the results
+are very peculiar, as we are forced to admit that reformation in
+religion has not always been a reformation in morals. Take Great Britain
+for example; if illegitimacy is any criterion of the moral state of
+those professing creeds, we find the least among the Jew; next among the
+Catholic; next comes the Episcopalian; then last the Presbyterian,--the
+oldest creed showing the greatest moral tendency, and that of poor Knox,
+which is the youngest, showing the least. This has certainly its
+physical effects, that are not without its influence in producing a
+greater or lesser length of life. The evolution of religion has here
+induced a lower moral tone and a resulting physical degeneracy.
+
+As observed by alienists, religions of different creeds have different
+tendencies in inducing insanity, both as to ratio of population and as
+to manifestations;[66] the Protestant, when unbalanced by religious
+cause, is generally controlled with some idea that shows itself in wild
+and erratic attempts at scriptural interpretation, caused by want of
+fixed dogmas and the unending splittings that are forever taking place
+in the new faith, and the persistent, intrusive, and belligerent spirit
+of proselytism that controls each new branch as it buds into existence.
+The Catholic has a fixed dogma, which the church attends to, and he
+neither feels called upon to make his neighbors miserable or himself
+insane in hunting up new interpretations. When he does go insane on the
+subject of religion, the cause, as a rule, can be traced to some real or
+imagined moral delinquency, which has brought all the terrors of the
+punishment of the damned forcibly and persistently to his disordered
+imagination. In the insane-asylums of Cork, in Ireland, with its
+overwhelming Catholic population, the ratio of inmates in regard to
+creeds is as that of one Catholic to ten of the Reformed religion,
+showing in the most conclusive manner the influence exerted by religion
+in this direction. On the other hand, the Jew has the simplest of
+religious creeds; he neither wastes useful time, robs himself of sleep,
+nor becomes dyspeptic in hunting for hidden meanings in some ambiguous
+scriptural phrase; he is satisfied with his creed, his dogmas are firmly
+anchored, and the nature of his religion being a sort of family
+congregation, he is not called upon to go out in search of proselytes,
+any more than the father of an already large family feels called upon to
+go out and hunt up the homeless, that he may convert his home into a
+promiscuous orphan-asylum. As before remarked, his creed is of the
+simplest, and there exists a complete and explicit understanding between
+his God and himself. There are no mystical, hidden meanings in Scripture
+for the Jew; nor does he dread any eternal, unheard-of, and inexplicable
+torments. His laws are very clear, and the punishments for their
+infraction very explicit. To the Jew it is a straight and well-lighted
+road, as far as religion is concerned. The writer has always felt that
+it took a mind that was incapable of appreciating simple truths, but
+that loved to hover on that mystical border-land on the confines of
+gloomy insanity that would allow its owner to seriously wander through
+and behold any theological beauties in Bunyan. To the Jew there is none
+of the gloomy, weird, mystical, mind-racking, ungodly theology that some
+of our creeds torture the poor brains of their professors with. As the
+wild Indian of the plains runs sticks through his anatomy and capers
+wildly about to torture his body, so some of the creeds delight in
+torturing their devotees. The Jewish religion is the one best suited to
+tranquilize the mind; it is very philosophical and rational. Were he to
+acknowledge Christ, he would not have to change his course of life to
+become a most exemplary Christian. The celebrated letter of Moses
+Mendelssohn to the Swiss clergyman, Lavater, in answer to a dedication
+of the latter to Mendelssohn, is probably the best exposition of the
+essence of the Jewish faith that can be found. Therein he says: "We
+believe that all other nations of the earth have been commanded by God
+to adhere to the laws of nature. Those who regulate their conduct
+according to this religion of nature and of reason are called _virtuous
+men of other nations_, and are the children of eternal salvation." Such
+a religion does not unsettle man's mind.
+
+These apparent digressions are made to show what additional factors
+exist, besides circumcision, to induce longevity in the Jewish race, and
+that the subject may be better understood; for these reasons the above
+comparisons have been made. Students of demographic science are well
+aware that form of government, religion, climate, diet, habit, and
+custom,--all have an important bearing on the mental and physical as
+well as on the moral nature of man. To the true student of his art all
+these conditions are but factors in the physical scale, and should so be
+considered without fear or favor; to him the whole world is but a unit,
+and the people upon its surface are but as one people, alike subject to
+the leveling laws of nature, which recognize neither royalty nor
+vagrant, nationality nor creed, color, condition, nor station in life or
+society.
+
+Professor Bernoulli, of Bale, found the Israelite less prolific than the
+Christian;[67] subject to less mortality, greater longevity, less
+still-born, less illegitimacy, less crime against the person, and less
+insanity and suicide, when compared with his Christian brother--all of
+which he attributes not to a superior physique or organism, but solely
+to the observance of the laws of their religion and to the nature of the
+same, which exercises a beneficial influence on the mind.
+
+B. W. Richardson, in his "Diseases of Modern Life," in speaking of the
+relation of race to disease, says: "Through the valuable labors of MM.
+Legoyt, Hoffmann, Neufville, and Mayer, we have obtained, however, some
+curious facts relative to the most widely disseminated of all races on
+the earth, the Jewish. These facts show that, from some cause or causes,
+this race presents an endurance against disease that does not belong to
+other portions of the civilized communities amongst which its members
+dwell. The distinctness of the Jews in the midst of other and mixed
+races singles them out specially for observation, and the history they
+present of vitality, or, in other words, of the resistance to those
+influences which tend to shorten the natural cycle of life, is
+singularly instructive.
+
+"The resistance dates from the first to the last periods of life.
+Hoffmann finds that in Germany, from 1823 to 1840, the number of
+still-born among the Jews was as 1 in 39, while with other races it was
+1 in 40. Mayer finds that in Furth children from one to five years of
+age die in the proportion of 10 per cent. among the Jewish, and 14 per
+cent. among the Christian population. M. Neufville, dealing with the
+same subject, from the statistics of Frankfurt, gives even a more
+favorable proportion of vitality to the Jewish child population.
+Continuing his estimates from the ages named into riper years, the value
+of life is still in favor of the Jews, the average duration of the life
+of the Jew being forty years and nine months and that of the Christian
+being thirty-six years and eleven months. In the total of all ages, the
+half of the Jews born reach the age of fifty-three years and one month,
+whilst half of the Christians born only reach the age of thirty-six
+years. A quarter of the Jewish population born is found living beyond
+seventy-one years, but a quarter of the Christian population is found
+living beyond fifty-nine years and ten months only. The Civil State
+extracts of Prussia give to the Jews a mortality of 1.61 per cent.; to
+the whole kingdom, 2.62 per cent. To the Jews they give an annual
+increase of 1.73 per cent.; to the Christian, 1.36 per cent. The
+effective of the Jews require a period of forty-one years and a half to
+double themselves; those of other races, fifty-one years. In 1849,
+Prussia returned one death for every forty-one of the Jews and one for
+every thirty-two of the remaining population.
+
+"The Jews escaped the great epidemics more readily than the other races
+with whom they lived. Thus, the mortality from cholera amongst them is
+so small that the very fact of its occurrence has been disputed. Lastly,
+that element of mortality, suicide, which we may look upon
+philosophically as a phenomenon of disease, is computed by Glatter, from
+a proportion of one million of inhabitants of Prussia, Bavaria,
+Wuertemburg, Austria, Hungary, and Transylvania, to have been committed
+by rather less than one of the Jewish race to four of the members of the
+mixed races of the Christian population. Different causes have been
+assigned for this higher vitality of the Jewish race, and it were indeed
+wise to seek for the causes, since that race which presents the
+strongest vitality, the greatest increase of life, and the longest
+resistance to death must in course of time become, under the influences
+of civilization, dominant. We see this truth, indeed, actually
+exemplified in the Jews; for no other known race has ever endured so
+much or resisted so much. Persecuted, oppressed by every imaginable form
+of tyranny, they have held together and lived, carrying on intact their
+customs, their beliefs, their faith, for centuries, until, set free at
+last, they flourish as if endowed with new force. They rule more
+potently than ever, far more potently than when Solomon in all his glory
+reigned in Jerusalem. They rule, and neither fight nor waste."[68]
+
+Richardson attributes the great benefits enjoyed in this regard by the
+Jewish race to the soberness of their lives. This position is, however,
+not altogether tenable, if by that we mean abstemiousness; they are
+extremely temperate, but not abstemious. Tissot, Cornaro, Lessius,
+Hufeland, Humphry, Sir Henry Thompson, as well as the older Greek and
+Roman authorities, all are agreed that an abstemious life is the one
+that is most conducive to long life. There is no race that is more
+proverbial for their good cheer and indulgence in the good things of the
+table than the Jewish; no race enjoys feasting any more than they, and
+from childhood they are accustomed to a generous and nutritious diet, as
+well as to their share of the wines with which their tables are
+supplied. Their greater thrift and application to business, their habits
+of economy and carefulness in business affairs enable them to better
+supply their tables. In California there is no class that lives better
+or whose tables are supplied so well either as to quality or quantity as
+those of the Jews, and yet no class is more exempt than they from the
+class of diseases that originate in too good living. As before remarked,
+in relation to the poor of that faith, who are unable to keep a servant,
+and who live in a combination of shop and home in the most unhygienic
+condition, disregarding ventilation and every other sanitary needs, but
+who, nevertheless, escape the evil results that would and do attend such
+social conditions among those of other races, so in this instance of
+good living: the better class of Jews do not suffer in anything near a
+like proportion to the better class Christians from diseases incident to
+too full habits and an inactive life. Richardson observes that he drinks
+less and that he eats better food than his Christian brother. In regard
+to the drinking habit, overindulgence is not a Jewish failing; they do
+not drink to excess, but total abstinence is not in their vocabulary. It
+is inconsistent with their idea of wine as being a gift of God, and
+something that is symbolical of good faith and thanksgiving. Nor is
+total abstinence consistent with their idea of generous hospitality. On
+the eighth day after birth the Jew tastes wine, and from the time he is
+able to sit at table he becomes familiar with its use. To him wine is
+not symbolical of either moral depravity, mental or physical
+deterioration, or of death. Their females are all accustomed to its use
+from childhood, but it does not cause them to become either immoral or
+unchaste; so that in neither sex does wine produce that moral and mental
+wreckage which abbreviates the length of human existence among those of
+other creeds. Radical fanaticism, that drives a tack with a maul and a
+twenty-penny spike with a tack-hammer, cannot be expected to study this
+or any other question in any rational manner; but to the sociologist,
+the question as to what produces this remarkable soberness, in the midst
+of the habitual and continued use of wine in the race from the time of
+its earliest history, is something worthy of calm and careful
+consideration. How much circumcision may have to do with this will be
+discussed in the medical part of the volume.
+
+In London, according to Dr. Stallard, the mortality among Jewish
+children from one to five years is only ten per cent., while among the
+children of the Christians it is fourteen per cent., the rate being
+analogous to that observed by Mayer among those of these ages in Furth.
+Among the London adults the average duration of life among the Jews is
+forty-seven years, while among the Christians it is only thirty-seven.
+
+Dr. Hough[69] has gathered some interesting historical and statistical
+matter bearing on the subject of Jewish resistance to disease and the
+benefit possessed by the race in relation to the immunity enjoyed by
+them in prevailing epidemics. The plague of 1346 did not affect them;
+according to Fracastor they escaped the typhus of 1505; Rau remarks
+their immunity to the typhus of 1824; Ramazzini noticed their exemption
+to the fatal intermittents of Rome, in 1691; and Degner says that they
+escaped the epidemic dysentery at Nimegue, in 1736. Richardson truly
+observes that "from epidemics the Jews have often escaped, as if they
+possessed a charmed life." This racial difference and benefit, when
+compared to other races, has more than once cost them dear. In the dark
+and ignorant ages, when men reasoned nothing from a physical basis, but
+attributed all and every phenomena to some supernatural agency, either
+heavenly or diabolical, it was but natural for such minds to associate
+this exemption with some purchased compact made with the devil, who was
+often also held accountable for the existence of the epidemics. The
+rational and law-of-nature observing Jew supposed to be in league with
+his satanic majesty could neither be seen nor heard in his own defense;
+consequently, massacres, pillaging, and such other barbarities that an
+insane popular fury could suggest, were the humane manifestations with
+which a Christian people visited their Jewish brothers, whose only sin
+consisted in worshiping the God of their fathers, and in strictly
+observing His laws and commandments.
+
+In France, Dr. Neufville found that, of one hundred children in the
+first five years of life, among the Jewish population, 12.9 die; while
+from the same number of the same aged class of Christians 24.1 die.
+One-half of all the Christians die at thirty-six years, and one-half of
+all the Jews at fifty-three years and one month.
+
+Dr. John S. Billings has gathered statistics relating to 10,618 Jewish
+families, consisting of 60,630 persons,[70] living in the United States
+in December, 1889, mostly descendants of Jews from the northern or
+middle nations of Europe. For our purpose only the deductions as to
+death-rate and tendency to longevity will be given. In this valuable
+paper Dr. Billings says: "When we come to examine the reports of deaths
+for five years furnished by these Jewish families, we find that they
+give an average annual death-rate of only 7.1 per 1000, which would be
+about one-half of the annual death-rate among other persons of the same
+average social class and condition living in this country." To this he
+adds that, provided the deaths at different ages among the Jews have
+been correctly reported, this race will, on comparison with those of
+other races, show a greater tendency to longevity, as the Jewish
+expectation of life is at each age markedly greater than that of the
+class of people who insure their lives, the average excess being a
+little over twenty per cent.
+
+In speaking of the death-rate among children, Dr. Billings makes the
+following comparisons: "The low death-rate among the Jews is especially
+marked among the children, and this corresponds to European
+experience. Thus in Prussia, in 1887, the death-rate of the Jews under
+fifteen years of age was 5.63 for 1000, while among the remainder of the
+people it was 10.46 per 1000." This result he accounts for partly to the
+fact that among the Jews illegitimacy is comparatively rare and to the
+high rate of mortality among the illegitimate born, which raises the
+average of the other classes.
+
+In regard to the immunity of the race from consumption or tubercular
+disease, the statistics of the above Jewish families gives to the Jews
+less than one-third of the number of deaths from these diseases than
+what occurs among the others as to the male population, and less than
+one-fourth as to the female population. These statistics coincide with
+the observations of the writer on this part of the subject, and are even
+more than corroborated by the French War-Office Reports from Algeria,
+where the deaths from consumption among the Christians amount to 1 for
+each 9.3 deaths, and among the Jews to 1 in 36.9, while among the
+Mohammedans it is only 1 in 40.7 deaths. In Algeria the relative
+mortality from all causes is only about three-fifths of that of the
+Christian, and the Turk, although seeming to enjoy a greater exemption
+from phthisical or tubercular diseases than the Jew, falls below the Jew
+in exemption from deaths due to general causes, as his mortality is
+one-eighth greater than that of the Jew. Dr. Billings gives us some
+interesting food for thought in the course of his article and some more
+particularly bearing on the subject of immunity from consumption. He
+asks: "Are these differences due to race characteristics, properly
+so-called, to original and inherited differences in bodily organization,
+or are they, rather, to be attributed to the customs, habits, and modes
+of life of the two classes of people?"
+
+Some years ago, Henry I. Bowditch, of Boston, put on foot an extended
+system of inquiry in regard to ascertaining the causes or antecedents of
+consumption in the State of Massachusetts. In answer to some of the
+questions of the circular, Rabbi Dr. Guinzburg, of Boston, answered as
+follows, under date of October 29, 1872:--
+
+1st. The number of Jews living in Boston is about 5000.
+
+2d. There certainly have not died of consumption, during the last five
+years, more than eight or ten Jews in the various congregations.
+
+To this Dr. Bowditch adds, as follows:--
+
+"If Dr. Guinzburg's data be correct, they show a very great immunity
+from consumption on the part of the Jews, compared with the citizens
+generally, as will be seen by the following comparison between these
+numbers and those procured from the Registration Reports, published by
+the State. In the report published in 1869, page 64, we find that for
+the five years preceding 1869 the annual average of deaths by
+consumption was 338 for every 100,000 living. These data from Dr.
+Guinzburg and the State Report give the following table:--
+
+                              Proportion of Deaths to
+                                 100,000 of Living.
+  All religions,                        338
+  Jews,                                  40
+
+"These statements from Dr. Guinzburg are confirmed by the following
+letter from Dr. A. Haskins, of this city. Dr. Haskins is connected with
+one of the Jewish benevolent associations for the benefit of the sick. I
+sent to him similar questions and make the following extracts from his
+reply:--
+
+"'I am generally employed in about sixty families (Jewish). I have had
+these families under my care for two and a half years. During this time
+I have seen but one case of consumption. I have averaged among these
+sixty families about two visits daily. In my other Jewish practice,
+which is not inconsiderable, I have in this time (two and a half years)
+seen two cases of consumption.... I am sorry I have no statistics
+whereby I could compare the two peoples, viz., Jews and Christians. I
+can, therefore, give you only my impressions. I should say that I find
+consumption less frequent among the Jews than among Christians. This
+would be my own impression without any data to fortify it.'
+
+"Dr. Waterman also sustains the same idea. The following extract will
+give some idea of his opportunities for observation and the sources of
+his deductions:--
+
+"'BOSTON, November 2, 1872. Dear Sir,-- ... First, I have attended four
+charitable associations; number about forty, fifty, sixty, and one
+hundred families. At present I only attend one, containing one hundred
+families, and on which I average a fraction over one visit a day. I
+have, besides, many private families among the Jews. I have attended but
+few cases of consumption, and I think the disease is not so prevalent as
+among Christians.'"
+
+The same report of Dr. Bowditch quotes from Stallard's "London Pauperism
+Amongst Jews and Christians," as saying that there is no hereditary
+syphilis, and scarcely any scrofula to augment the mortality in the
+Jewish families.
+
+In relation to the liability of the Hebrew race to phthisis, Richardson
+has the following at page 22 of his "Diseases of Modern Life": "The
+special inroads on vitality made on other races by disease are not
+easily determined, because of the difficulties arising from temporary
+admixture of race. I tried once to elicit some facts from a large
+experience of a particular disease, phthisis pulmonalis, and, as the
+results of this attempt may be useful, I put them briefly on record.
+
+"At a public institution at which large numbers of persons afflicted
+with chest diseases applied for medical assistance, and at which I was
+for many years one of the physicians, I made notes during a short
+portion of the time of the connection that existed between race and the
+particular disease I have instanced--phthisis pulmonalis, or pulmonary
+consumption. The number of persons observed under the disease was three
+hundred, and no person was put on the record who was not suffering from
+a malady pure and simple; I mean without complication with any other
+malady. They who were thus studied were of four classes: (_a_) those who
+were by race distinctly Saxon; (_b_) those who were of mixed race, or
+whose race could not be determined; (_c_) those who were distinctly
+Celtic; (_d_) those who were distinctly Jewish.
+
+"The results were, that of the three hundred patients, one hundred and
+thirty-three, 44.33 per cent., were Saxon; one hundred and eighteen,
+39.33 per cent., were of mixed or undetermined race; thirty-one, 10.33
+per cent., were Celtic; and eighteen, 6 per cent., were Jewish."
+
+Although Dr. Richardson admits it would be unfair to accept the above
+figures as a basis for general application, he argues that they are, on
+the average, sufficiently suggestive, as among the Saxons it was noticed
+that there were more cases in whom the disease was hereditary, while
+among the others it was generally acquired.
+
+In going over the subject of this question in regard to phthisis, we
+must admit that, although the Jew in his own home, synagogue, or in his
+social reunions, is not exposed to tubercular emanations, and that he
+has less chance of contracting the disease from tuberculous meats, he
+is, after all, a theatre-goer; a pretty constant inhabitant of the
+sleeping-car and hotel, as a commercial traveler and general merchant;
+and that, on the whole, he eats the same food, breathes the air and dust
+of the same streets, and drinks the same milk and water as the
+Christian, and, as observed by Dr. Billings, cooking destroys the
+bacillus in meats. So that the comparative exposure in this
+country--where the practice is not as prevalent as in Germany of eating
+raw minced-meat sandwiches--existing between the Jew and the Christian
+to tubercular infection from meat are about equal. The records of the
+Jewish Hospital of New York gives, out of 28,750 persons admitted, only
+44.17 per 1000 of its admissions as being due to consumption; while
+those of the Roosevelt Hospital, out of 25,583 admissions, gives a per
+1000 of 67.93.
+
+From what is known of the relation of syphilis to consumption, not only
+as affecting the primary individual, but the subsequent generations of
+the same, and the known greater exemption of the Jew to syphilitic
+infection, owing to the protecting influence of circumcision, it is safe
+to assert that therein is to be found one of the main reasons of the
+exemption of that race to consumption. If we but look at the
+geographical distribution of phthisis and the history of its progress,
+we shall find that it has had syphilis as its _avant courrier_ on more
+than one occasion. Lancereaux, in his "Distribution of Pulmonary
+Phthisis," points to the fact that where consumption has made its
+greatest ravages, and where it has nearly depopulated one of the great
+divisions of the globe,--namely, the groups of islands in the Pacific
+Ocean,--the disease had no existence at the beginning of the present
+century. Syphilis, scrofula, and a quick, galloping consumption have,
+since the last ninety years, taken off the greater part of the
+population. The same course of transition from the best of physical
+conditions to racial deterioration and extinction from the same relative
+condition of causes--syphilis, scrofula, and phthisis--has been observed
+among the open-air dwellers of the New Mexican Plains, in the mountains
+of Arizona, and on the arid wastes of the Colorado Desert, where the
+appearance of consumption cannot be attributed to housing or incipient
+civilization, as it is attributed to housing among the Chippeways,
+Sioux, or Mandans in the regions that formerly formed the Northwest
+Territory. The question is very plainly answered as to how consumption
+was introduced or whence it sprung that has so ravaged the Oceanic
+Islands. The sailors who first visited those islands were not, as a
+rule, a batch of consumptive tourists on a voyage in search of health or
+recreation; but we can well understand that the proverbially improvident
+mariner has not always had his health looked after by an Anson or a
+Cook, and that many a festive tar who induced the unsophisticated Indian
+maid to join him in worship at the shrine of Venus Porcina carried in
+the innermost recesses of the folds of his pendulous and sea-beaten
+prepuce the remnants of former Bacchanalian festivities performed in the
+questionable temples of Venus and Bacchus in Portsmouth or London.
+Consumption, as such, was neither imported nor propagated by Europeans
+into those islands, its original entry being in the shape of syphilis.
+Had it been the ancient mariners of old Phoenicia in the days of its
+circumcision, or the circumcised marines of the ancient Atlantean fleets
+from the sunken continent of Plato, instead of the uncircumcised
+sailors of modern England, that first and since visited those islands,
+it is safe to say that consumption would not now exist there. From this,
+it may be well to inquire what would be the relation between the Jewish
+race and consumption; were circumcision among them to be done away with,
+would it not be greatly on the increase?
+
+The weight of testimony is evidently convincing that the Jew has a
+greater longevity and stronger resistance to disease, as well as a less
+liability to physical ills, than other races; that all these exemptions
+or benefits are not altogether due to social customs is evident; how
+much circumcision may have to do in inducing these favorable conditions
+can be better appreciated by a consideration of how circumcision affects
+those of other races, and more particularly how its performance works
+changes in the individual in his general health and condition, and in
+doing away with many physical ailments that the individual was
+previously subjected to. So that the Jew cannot be said to be a loser by
+his observance of this rite, and he and his race have been well repaid
+for all the sufferings and persecutions that its observance has
+subjected them to. As observed by John Bell, "The preservation of health
+and the attainment of long life are objects of desire to every man, no
+matter in what age or country his lot is cast, nor by what arbitrary
+tenure he holds his life. They are the wish of the master and the slave,
+of the illiterate and the learned, of the timid Hindoo and the warlike
+Arab, of the natives of New Zealand not less than of the inhabitants of
+New England,--an indispensable condition for the greatest and longest
+enjoyment of the senses and propensities; for the widest range and
+exercise of intellect and gratification of the sentiments, whether these
+be lofty or ignoble, health, in any special degree, has ever been a fit
+subject of contemplation and instruction by the philosopher and
+legislator. Their advice and edicts on the means of preserving it have
+frequently been enforced as a part of religious duty, and, at all times,
+civilization, even in its elementary forms, has been marked by laws on
+this head. With the numerous and minute hygienic enactments of the great
+Jewish lawgiver for the guidance of the people of Israel we are all
+familiar. Prompted, we may suppose, in part by the example of Moses, and
+also by considerations growing out of the nature of the climate in which
+he lived, Mohammed incorporated with the mingled reveries, ethics, and
+blasphemies, which composed his Koran, dietetic rules and observances of
+regimen that are to this day implicitly obeyed by his zealous
+followers."[71]
+
+If circumcision is not a factor in the difference that exists between
+the Jewish race and other races, if it goes for nothing as an exemptor
+of disease and the promoter of longevity, then there must exist some
+other factor or cause that induces these conditions. What this factor
+is, the legislator, the sociologist, and the physician should make it
+their business to find out.
+
+
+
+
+CHAPTER XV.
+
+PREDISPOSITION TO AND EXEMPTION AND IMMUNITY FROM DISEASE.
+
+
+The peculiar differences that exist between different animals in regard
+to their susceptibility to the action of drugs is even more remarkable
+than the differences that exist in their susceptibility to certain forms
+of disease. We can understand and appreciate what Koch tells us in
+regard to the different susceptibilities exhibited by the house-mice and
+the field-mice to the anthrax bacillus, or why a nursing child should
+offer different results, when exposed to the diphtheria bacillus or the
+contagious poison of any of the exanthemata, from those witnessed in the
+meat or promiscuously dieted child. We can also appreciate that
+different individuals have different susceptibilities to disease, as
+well as we understand that the same degree is not always in an unvarying
+point of resistance or susceptibility in the same individual. The
+investigation and study of these conditions teach us, however, that
+there is a cause, or that there are causes that induce and modify this
+susceptibility. But there are conditions that are as yet beyond our
+comprehension. Take, for instance, two animals, both vertebrates,
+mammals, and dwelling together, eating the same food, and even having a
+mutual understanding or sympathy of mind and affections, having a like
+circulation, a like brain and nervous system, it would naturally be
+supposed that these two would exhibit a like susceptibility to the
+actions of narcotic poisons; but when we are told that one dog has
+taken 21 grains of atropia with impunity we are staggered. Atropia may
+not affect rabbits (as it does not), but the rabbit does not approach
+man in the same close relationship as the dog. Richardson administered
+to a healthy young cat 7 drachms of Battley's solution of opium, then 10
+grains of morphia, and a little later 20 grains more of morphia without
+rendering the cat unconscious. The same experimenter gave to a pigeon
+21, 30, and 40, then 50 grains of powdered opium on succeeding days with
+no bad effect. S. Weir Mitchell gave to three pigeons, respectively, 272
+drops of black drop, 21 grains of powdered opium, and 3 grains of
+morphia without any effect.[72] On the other hand, horses show a like
+susceptibility to man to the action of drugs. In the island of Ceylon, a
+sloth can take 10 grains of strychnia with safety,--chickens presenting
+a like immunity to the poisonous effects of this alkaloid. While the dog
+offers such a contrast to the action of drugs as compared to man, he is
+as subject to goitre, and they have been seen in a true state of
+cretinism.[73]
+
+An Apache, or Colorado Indian, will prefer a dessert of decomposed
+gophers to one composed of the best canned peaches or Bartlett pears; he
+will devour the mass without any resulting evil, while a German--after
+many generations of training on all forms of sausages in every degree of
+age and ripeness, and on every form of cheese, from the refreshing
+cottage cheese from curdled milk and the delicious cream cheese, down
+through to all and every grade as far as Limburgher, or maggoty, common
+cheese--has not, in every case overcome the tendency of the civilized
+intestine and constitution to the action of sausage poison, something
+that has no effect on the ordinary Indian, or on the uncivilized
+dweller north of the arctic circle. Even the house-dog, that faithful
+companion of man, in many cases living on exactly the same fare as his
+master, is insensible to the action of this poison. An Indian will gorge
+and gormandize, after a prolonged fast, on such quantities and qualities
+of food that, if the ordinary white man were to indulge in a like feast,
+he would be in imminent danger of literal rupture or explosion, or
+liable to end in sudden apoplectic seizures, or, in case of a too
+healthy and active digestion, liable, owing to a lack of a
+correspondingly active condition of the excretory organs, to go off in
+uraemic coma. This sporadic and fitful feasting has no perceptible effect
+on the Indian, who either simply works it off in exercise, or sleeps it
+off in a long and prolonged period of sleep, during which his lungs work
+with the deep and steady pull and persistence that a tug-boat exhibits
+when towing in a large ship against the tide and a head wind,--working
+in and out more air in one respiration than the ordinary white man will
+in a dozen. All these different conditions are more or less plain to us
+and as easy of explanation,--just as plain as to how and why some birds
+eat gravel to improve their digestion. In the cases of different
+susceptibility to the action of strychnia or of narcotics, the
+explanation must of necessity, for the present, be more or less
+speculative. But how are we to account, even in the way of speculation,
+for the peculiar immunity, lack of predisposition and hereditary
+tendencies to disease exhibited by the Hebrew, who, since the history of
+the world, has been a civilized and rational being,--even for decades of
+centuries before the civilization of Europe? Living under the same forms
+of government, climate, and shelter, practically using the same
+varieties of food and drink, he exhibits an entirely different vitality
+and resistance to disease, decay, and death,--being, in fact, a puzzle
+to the demographic student. The only really marked difference that
+exists between this race and the others lies in the fact that the Hebrew
+is circumcised, other differences not being sufficiently constant to be
+accounted as factors. Circumcision is, in the opinion of the writer, the
+real cause of the differences in longevity and faculty for the enjoyment
+of life that the Hebrew enjoys in contrast to his Christian brother.
+Christian and uncircumcised races may individually, or in classes,
+develop some peculiar immunity or exemption, as, for instance, the
+tolerance to arsenic exhibited by some German mountaineers, or the
+peculiar safety enjoyed by the butcher class from attacks of continued
+fever;[74] but these exemptions are purchased at the expense of the
+future, the effects of arsenic, long continued, finally having its
+morbid effects, and the very plethora which is the bulwark of resistance
+in the butcher, this plethora being in the end a treacherous foe,
+diseases result from it which make a sudden ending to this class when it
+is least expected.
+
+For an all around long-liver the Hebrew holds a pre-eminence, and, as
+the factor in this pre-eminence, circumcision has no counter-claimant.
+Circumcision is like a substantial and well-secured life-annuity; every
+year of life you draw the benefit, and it has not any drawbacks or
+after-claps. Parents cannot make a better paying investment for their
+little boys, as it insures them better health, greater capacity for
+labor, longer life, less nervousness, sickness, loss of time, and less
+doctor-bills, as well as it increases their chances for an euthanasian
+death.
+
+
+
+
+CHAPTER XVI.
+
+THE PREPUCE, SYPHILIS, AND PHTHISIS.
+
+
+It is not alone the tight-constricted, glans-deforming,
+onanism-producing, cancer-generating prepuce that is the particular
+variety of prepuce that is at the bottom of the ills and ailments, local
+or constitutional, that may affect man through its presence. The loose,
+pendulous prepuce, or even the prepuce in the evolutionary stage of
+disappearance, that only loosely covers one-half of the glans, is as
+dangerous as his long and constricted counterpart. If we look over the
+world's history, since in the latter years of the fifteenth century
+syphilis came down like a plague, walking with democratic tread through
+all walks and stations in life, laying out alike royalty or the vagrant,
+the curled-haired and slashed-doubleted knight, or the tonsured monk, we
+must conclude that syphilis has caused more families to become extinct
+than any ordinary plague, black death, or cholera epidemic. Without
+wishing to enter into a history of syphilis, it is not outside of the
+province of this book to allude to its frequency and spread.
+
+Syphilis is not restricted to classes by any means; it is not those of
+the lower class alone who are its victims. Dr. Fr. J. Behrend, in his
+work, "Die Prostitution in Berlin," observes that abolition of the
+brothels in that city in 1845, '46, '47 and '48, trebled the number of
+cases of syphilis treated at the Der Charite; in the year 1848 the cases
+of syphilis treated at that hospital numbered over 1800. It was also
+remarked during this period of legally-enforced virtue, that, as
+inconsistently as it might appear, the disease invaded the best of
+families. From Dr. Neumann, in his brochure entitled "Die Berliner
+Syphilisfrage," published in 1852, we learn that, in the Trades and
+Mechanics' Benevolent Union of Berlin, in 1849, 13.51 per cent. of the
+sick were so from syphilis.
+
+In the thirteenth volume of the _British and Foreign Medico-Chirurgical
+Review_, we find, in a review of the control of prostitution, an
+estimate in regard to the syphilization of a nation. The estimates are
+made on the most conservative figures, as, in the desire of the reviewer
+not to overestimate, he starts by figuring out the actual number of
+prostitutes in England, Wales, and Scotland to be only 50,000, when they
+were estimated, by those who had carefully studied the subject, as being
+more than double that number; the conservative estimate is, however,
+suitable for our purpose; so that we cannot be accused of overestimating
+the results. The portion of the review to which we wish to call
+attention is as follows:--
+
+"Though the result of the evidence contained in the first report of the
+commissioners on the constabulary force of England and Wales was that at
+that time about 2 per cent. of the prostitutes of London were suffering
+under some form of venereal disease, yet we will descend even lower, and
+presume that of one hundred healthy prostitutes, taken promiscuously
+from England and Scotland, if each submits to one indiscriminate sexual
+act in twenty-four hours, not more than one would become infected with
+syphilis, an estimate which is without doubt far too low; yet, if
+admitted to be correct, the necessary consequence will be, _that of the
+fifty thousand prostitutes five hundred are diseased within the
+aforesaid twenty-four hours_.
+
+"If we next admit that a fifth of these five hundred diseased women are
+admitted to hospital on the day on which the disease appears, it follows
+_that there are every day on the streets four hundred diseased women_.
+Let it be supposed that the power of these four hundred to infect be
+limited to twelve days, and that of every six persons who, at the rate
+of one each night, have connection with these women, five become
+infected, it will follow _that there will be four thousand men infected
+every night, and consequently one million four hundred and sixty
+thousand in the year_. Further, as there are every night four hundred
+women diseased by these men, one hundred and eighty-two thousand five
+hundred _public prostitutes will be syphilized during the year; hence,
+one million six hundred and fifty-two thousand five hundred cases of
+syphilis in both sexes occur every twelve months_.
+
+"If, then, the entire population had intercourse with prostitutes in an
+equal ratio, _the gross population of Great Britain, of all ages and
+sexes, would, during eighteen years, have been affected with primary
+syphilis_. Be it remembered, we do not assert that more than a million
+and a half of _persons_ are attacked every year, but that that number of
+_cases_ occurs annually in England, Wales, and Scotland, though the same
+individual may be attacked more than once. Although it is evident that
+all the estimates used for these calculations are (we know no other word
+that expresses it) ridiculously low, yet we find that more than a
+million and a half of cases of syphilis occur every year,--an amount
+which is probably not half the actual number. How enormous, then, must
+be the number of children born with secondary disease! How immense the
+mortality among them! How vast an amount of public and private money
+expended on the cure of this disease!"
+
+The same reviewer (P. S. Holland), in another article on the "Control of
+Prostitution," observes that among the British troops syphilis is one of
+the most frequent of diseases, about one hundred and eighty cases
+occurring annually among every one thousand soldiers.
+
+The effect of syphilis in depopulating the islands of the Pacific has
+been pointed out in a former chapter; the nature and origin of the
+disease that takes them off is unmistakable. Scrofula and rapid phthisis
+are taking off the inhabitants at a rate that, in those islands most
+affected, the native population will soon become extinct. According to
+Lancereaux, in the Marquesas group the women do not live beyond the age
+of thirty to thirty-five years, three or four months being the duration
+of the disease. Ellis, in his "Polynesian Researches," published in
+1836, remarks that at that date the disease, as above described, had but
+recently appeared. In the nineteenth volume of the "Archives de Medecine
+Navale," Rey mentions that at the Easter Island pulmonary phthisis is
+the dominant affection with the adults, and that scrofula is very
+prevalent with the children.[75]
+
+The effect of syphilization in inducing a scrofulous taint and the
+appearance of a rapidly-marching consumption among savage races has been
+well observed among the Indians in the southwestern parts of the United
+States, where the appearance of these fatal diseases can easily be
+traced to that as a cause. There is something peculiar about the
+Anglo-Saxon race that is fatal to the Indian; wherever they come in
+contact, the savage race begins physically and morally to crumble; the
+habits of the Anglo-Saxon in the matter of intemperance and his lust
+soon end the poor Indian; while, on the other hand, the Latin races mix
+with them without any physical detriment to the Indian. In what was
+formerly the Northwest Territory the French and Indian intermarried, and
+syphilis did not begin to tell on the Indian until the Americans settled
+the country. From these observations it is very evident that in the
+Polynesian Archipelago syphilis must have been the precursor of the
+phthisis and scrofula, as we know it to have been that which induced
+those diseases among the Indians of the Mississippi or Missouri Valleys,
+or of the Colorado and Mojave Deserts, or in the mountains and valleys
+of Arizona.
+
+On the other hand, circumcised races, whose women have not carried a
+syphilitic taint into the race, are as a class free from any syphilitic
+taint. Neither their teeth, physiognomy, skin, nor general condition
+denote any syphilitic inheritance. This is true of the Jewish
+descendants of Abraham, who have more strictly adhered to the
+non-intercourse or marriage with other races, and whose women have
+abstained from vice; the Arabian descendants of Ishmael have, in a great
+measure, also retained their marked family individuality, except it be a
+few tribes, who, by contact with the soldiery of European nations, have
+had their women corrupted and syphilis introduced into the tribe through
+this channel.
+
+Richardson, in his "Preventive Medicine," observing on the effects of
+syphilis in inducing deterioration of the organs of circulation and
+their degenerative changes, says that, in his opinion, syphilis is the
+progenitor of various diseases, and that those who give this opinion the
+greatest range are, unfortunately, nearest the truth. The breathing
+organs, he remarks, are distinctly susceptible to injury from this
+hereditary cause.
+
+In 1854, at the Metropolitan Free Hospital, situated in the Jews'
+quarter in London, Hutchinson observed that the proportion of Jews to
+Christians among the out-patients was as one to three; at the same time
+the proportion of cases of syphilis in the former to the latter was one
+to fifteen. Now, this result was not due to any extra morality on the
+part of the Jews, as fully one-half of the gonorrhoea cases occurred
+among those of that faith. J. Royes Bell also observes the less
+syphilization among circumcised races.[76]
+
+The absence of the prepuce and the non-absorbing character of the skin
+of the glans penis, made so by constant exposure, with the necessary and
+unavoidably less tendency that these conditions give to favor syphilitic
+inoculation, are not evidently without their resulting good effects. Now
+and then syphilitic primary sores are found on the glans, or even in the
+urethra or on the outside skin of the penis, or outer parts of the
+prepuce; but the majority are, as a rule, situated either back of the
+corona or on the reflected inner fold of the prepuce immediately
+adjoining the corona, or they may be in the loose folds in the
+neighborhood of the frenum, the retention of the virus seemingly being
+assisted by the topographical condition and relation of the parts, and
+its absorption facilitated by the thinness of the mucous membrane, as
+well as by the active circulation and moisture and heat of the parts. It
+must be evident that but for these favoring conditions the inoculation
+or infection would and could not be either as sure or as frequent. Any
+protecting mechanical aid that interferes with these favoring conditions
+grants an immunity to the individual, even when he is freely exposed;
+this protection has often been obtained by applying to the glans and
+penis a substantial coat of some tenacious oil like castor-oil, which
+was afterward gently washed off, first in a shower of tepid water and
+afterward in a tepid bath of warm water and borax.
+
+Horner, formerly of the navy, in his interesting little work on "Naval
+Practice,"[77] relates that it was customary, in the older navy of the
+United States, to allow public women to come on board at some of the
+ports and to go down to the men between decks, the Department of the
+Navy being probably actuated by the same humane principle that used to
+induce some of the West Indian cannibals to lend their wives to their
+prisoners of war who were intended, in the shape of roast or
+_fricandeau_, to grace the festive board, as it was deemed inhuman by
+these philanthropists to deprive a man of his necessary sexual
+intercourse, even if they were soon to roast him and pick his bones.
+They may, however, have been selfish in the matter, as by some
+authorities it is represented that this was done to improve the flavor
+of the prisoner, who was said to offer a more savory dish through this
+considerate treatment, the strong flavor that the semen gives to flesh
+being well eradicated by free fornication. Whether it was through these
+motives of humanitarianism, or the feeling that an American tar was the
+equal of the British tar, whose praises and equality Sir Joseph Porter,
+K.C.B., writes a song about in "Pinafore," who had as much right to
+contract a left-handed marriage as any Prince of Wales or any other
+prince or crowned head of Europe, the women were, nevertheless, allowed
+to go down between decks in preference to giving the men indiscriminate
+liberty on shore, the government further providing for their welfare by
+causing the assistant surgeon to examine the women at the gangway or
+hatchway, to see that they were not diseased. Horner relates the
+ludicrous appearance presented by a near-sighted assistant at one of
+the hatchways while making this professional examination, surrounded by
+the sailors and marines, who were greatly-interested spectators. Had the
+government provided a pot of castor-oil wherein the tar could dip his
+penile organ, as bridge piles are dipped into a creasoting mixture,
+these humiliations to our professional brother could have been avoided.
+
+In the conclusion to be reached, circumcision is not put forward as the
+only exempting element or preventive measure that deserves all the
+credit for the immunity that the Jews enjoy from syphilis, or to the
+absence of hereditary diseases that are secondary or due to the presence
+of that disease in the parents, as considerable credit is to be given to
+the well-known chastity of their females. This chastity is, in a great
+measure, due to the inseparable conditions of their religion,--moral and
+social fabrics which are welded into one. Their charity assumes the most
+practical form, so that it is not possible for one of their females to
+have to resort to a life of prostitution to save herself or her children
+from starvation, as, unfortunately, is too often the case in Christian
+communities, where religion is put on and off with Sunday clothes. The
+temperance and sobriety, as well as the economy and industry of the
+father, are not without a good moral as well as a hereditary effect on
+the daughters, who are neither rendered brutal nor demoralized through
+the example and instigation of drunken fathers. They have, therefore, a
+better average homelife, to which they cling and which protects them.
+The aid and benevolent associations of the Jews are among the most
+efficacious of charitable institutions, and no class gives more freely
+or generously for this purpose. The Home for Aged Hebrews in New York is
+an example of the character with which they dispense charity. We need
+not, therefore, be surprised to find, in statistics of illegitimacy by
+religious denominations taken in Prussia, that the Jewish women are
+three times as chaste as the Catholics and more than four times as
+chaste as the Evangelists.[78] The Jew has, therefore, two avenues of
+infection from syphilis cut off,--the lesser liability due to his
+circumcision and the chastity of the women.
+
+Richardson mentions the immunity of the Jewish race from tubercular
+disease, and notices the well-known relation existing between a
+syphilitic taint and a phthisical tendency. The comparative statistics
+offered by the Mohammedans, Jews, and Christians in regard to deaths
+from consumption have already been mentioned in a former chapter, they
+being as four Christians to one Jew, while the Mohammedan, from his
+greater abstemiousness and temperance to assist him, shows a still lower
+percentage than the Jew. There can be but little doubt that to this
+particular and well-marked less syphilization the Hebrew race owes much
+of its exemption from many other diseases and its greater resistance to
+ordinary ailments and epidemic diseases.
+
+The relative less frequency of syphilis among all circumcised people is
+noticed by Dr. Bernheim, in his brochure "De la Circoncision," he being
+the surgeon of the Israelitish Consistory of Paris. His utterances on
+this subject are worthy of attention, he having not only paid particular
+attention to this, but having had unusual opportunities for the basis of
+his opinions. Dr. Bernheim looks upon coition as a frequent source of
+tubercular infection, and the sensitive and absorbing covering of the
+uncircumcised glans as a ready medium of transmission of the virus from
+one system to the other. He calls attention to the frequent granular
+condition of the uterine os, in confirmed cases of tuberculosis, as
+something that is too much overlooked. This view of the case, from Dr.
+Bernheim's stand-point, is worthy of greater consideration than it has
+generally received at the hands of the profession.
+
+The great number of examples that have recently come to light in
+connection with the direct inoculability of tubercular consumption, both
+in the later works on phthisis and in the medical press, are not without
+interest or without a lesson. The case recorded within the past year of
+a healthy chambermaid, who was immediately inoculated with tubercular
+matter with rapidly-following constitutional effects through a scratch
+on the hand, received from the sharp edge of a broken china cuspidor
+that a consumptive was using, is one of these cases that are to the
+point; so it is evident that the uncircumcised need not always wait for
+the degeneration of syphilis into syphilitic phthisis or syphilitic
+scrofula to become a consumptive, but it is within the greatest range of
+possibility and probability that he may become at once a consumptive
+through an excoriation or abrasion received during coition with a
+tubercular woman. So many tubercular prostitutes ply their trade, or, to
+be more definite, so many prostitutes become tubercular, and in its
+different stages follow their occupation as the only means of keeping
+out of the poor-house, that man runs as much if not more risk, in
+consorting with the class, of contracting tuberculosis than that of
+contracting syphilis.
+
+There is something about syphilis that is not generally noticed; we are
+all well acquainted with the dire results that usually follow syphilitic
+infection, its course through every stage of suffering and misery, its
+transmission and effects in tubercular meningitis or in syphilitic
+affections of the mesentery through heredity in children, and of the
+many horrible cases of destruction of tissue, in skin, mucous membrane,
+cartilage, or bone, with their attending mutilations and disfigurations;
+but there is no record of the great number of cases, and very few
+physicians of any extended practice but who can recall some such cases,
+where, after undoubted syphilitic infection, with the usual course of
+primary sores and secondary eruption, the patient has suddenly blossomed
+out into a state of robust health that his system was an entire stranger
+to before the infection. The writer has, in the course of a long
+practice, seen a number of such results follow both the infection
+attended with a miliary eruption and that followed by the large
+small-pox-appearing eruption, both kinds being preceded by the primary
+sore; and these results have been observed in cases of both what are
+called the soft and multiple and the hard or Hunterial initial sore.
+Some of these cases rapidly gained in flesh, with an evident increase in
+the redness of their blood, increasing in vigor and strength with a very
+perceptibly less tendency to attacks from accidental or previously
+subject-to diseases.
+
+The same result has been observed to follow an attack of small-pox with
+some individuals, and the writer well remembers a similar result
+following a very extraordinary event. The subject was a man well known
+among his old comrades of the First Minnesota Infantry as "Duke," and to
+many of the older practitioners of Wabashaw County, of that State, as
+"Old Duke." In early life he was sickly and weakly, never having fully
+recovered from a malarial fever contracted in the Mexican war. Coming to
+Minnesota, he adopted the life of a raftsman, with all the
+irregularities that accompanied such a life. On one occasion, after a
+protracted spree, feeling the need of stimulation and not having the
+wherewith to procure it, he secured a jar in which a snake and several
+other reptiles were preserved in spirits, and drank the fluid contents.
+He was, some days afterward, taken violently ill with a high fever and
+racking pains, ending in an eruption of boils that covered him from head
+to foot; he made a slow and tedious recovery; but when recovered he
+seemed to have become imbued with a constitution resembling
+_lignum-vitae_, for a more stubborn-twisted constitution never existed
+than that of "Old Duke." The power of resistance that this man developed
+was something wonderful. Dr. C. P. Adams, of Hastings, Minnesota, and
+the St. Paul physicians who were connected with the regiment well
+remember, though, wiry, precise, and soldierly "Duke," who, even in the
+old Army of the Potomac, immersed up to his ears like the rest of the
+army in the mud and dirt of the encampment of Falmouth, above
+Fredericksburg, came out on general inspection as prim as if he had just
+stepped out of a bandbox, for which he received a medal for soldierly
+conduct and bearing.
+
+These apparent digressions are not made either to be tedious or to weary
+the reader, nor without an object. They are made to show that, whereas
+syphilis is looked upon as such a deadly disease, and it may be said to
+be the sole cause of fear to the assiduous worshiper at the shrine of
+Venus Porcina, there is another still more fatal danger awaiting him,
+ambushed in the folds of the vaginal mucous membrane, or coming along
+silently out of the cervical canal,--like the legions of Cyrus stealing
+along the dry bed of the Euphrates into ancient Babylon, to fall
+unawares on the feasting Nebuchadnezzar on that fatal night. So, in like
+manner, the virus of tuberculosis, either extruding from a granular os
+or from its neighborhood, gradually moves down on the unsuspecting,
+uncircumcised, and easily inoculable-surfaced glans penis, to infect the
+system with a tubercular poison that has no such exceptions as those
+above noted, as at times are the followers of syphilis. It is not alone
+the individual himself that may be the sufferer from this poison, but
+his progeny for several generations may have to suffer for the infection
+thus received, just as much as they would were that infection to have
+been syphilitic. As before remarked, this has heretofore not
+sufficiently occupied the consideration of the profession, and, as it
+cannot certainly be denied that such a source of tubercular infection is
+both possible and probable, the subject is entitled to more serious and
+deliberate consideration than that which has heretofore been paid to it.
+
+Tuberculosis certainly has these two channels of entrance: either
+through direct infection or through an evolutionary process resulting
+from syphilis. The appearance and vital statistics offered by the French
+War Office in regard to the Algierine provinces, the report of the
+United States Census, the opinion of Dr. Billings deduced from the
+census reports, the opinions of Hutchinson, Richardson, Bernheim, and
+many other observers, as well as the personal but unrecorded
+observations of many practitioners, all tend to bear testimony to the
+remarkable difference that exists between circumcised and uncircumcised
+races in regard to the ravages of consumption. Is circumcision a factor
+in this difference, or is it not? If it is, then circumcision should
+receive more attention than it has; if it is not, then we should not be
+idle in hunting up the cause of difference, for an ounce of prevention
+is certainly worth in this regard a whole pound of Koch's lymph as a
+curative agent.
+
+
+
+
+CHAPTER XVII.
+
+SOME REASONS FOR BEING CIRCUMCISED.
+
+
+The surgical and medical history of circumcision is intimately connected
+with the remotest ages, this being, in fact, the earliest surgical
+procedure of which we have any record. From the same records we obtain
+hints as to two conditions for which circumcision probably was
+suggested, either as a preventive or as a remedy.
+
+Jahn, in speaking of the people by whom the early Hebrews were
+surrounded, mentions their idolatrous practices, and that their peculiar
+forms of Pagan worship were accompanied by indulgence in fornication,
+lascivious songs, and unnatural lust. Others of their neighbors
+worshiped the "_hairy he-goat_," with which they also practiced all
+manner of abominations. Sodomy, or pederasty, seemed a sort of religious
+ceremony with some of these heathen nations; from a religion it
+necessarily became a social practice; this, in connection with the
+phallic practices and worship, necessitated frequent exposure of the
+male member. The evil results, to say nothing of the disgusting and
+demoralizing tendency of these practices of the Pagan, were evidently
+well known to the Jews. The contrast between the physique and health of
+the pastoral habits, out-of-door life and simple diet of the Jews, and
+the necessary opposite condition of health and physique due to luxury
+and to these practices among their neighbors, could not have escaped
+their attention. How much onanism had to do with the establishment of
+circumcision may well be conjectured. Again, the other hint is in
+reference to procreation, as some stress is laid to the connection
+between the conception of Sarah and the circumcision of Abraham. Here we
+have suggestions of a preventive to onanism, and a cure to male
+impotence when due to preputial interference.[79]
+
+Strange as it may seem, these two important results, due to
+circumcision, seem to have been lost sight of for some thousands of
+years, as even the able works of the physicians of the latter part of
+the last century have nothing to say connecting onanism and
+circumcision. Neither the works of Tissot on male onanism nor the
+pioneer work of Bienville on nymphomania speak of the presence of the
+prepuce in the male, or of the nymphar or clitorian prepuce in the
+female, as being causative of, or their removal curative of, either
+masturbation, satyriasis, or nymphomania; moral, hygienic, and internal
+medication being by both these authors considered to be all that our
+science could offer or do to alleviate or cure this unfortunate class.
+It is only of late years that circumcision, in its true relations to
+onanism, has received full consideration. In regard to its being a cure
+of impotence, its recognition has been of longer duration.
+
+It is related by Leonard, in his "Memoires,"--who, in his capacity of
+hair-dresser in ordinary to her Majesty, the unfortunate
+Marie-Antoinette, had ample opportunity for picking up all the domestic
+small talk of the royal family and their affairs,--that Louis XVI, in
+addition to all his troubles and the indignities which he suffered,
+besides finally being beheaded, was afflicted with a congenital phimosis
+which prevented the flow of semen from properly discharging itself. It
+appears that his Majesty was no little annoyed at not being able to
+procure an heir to his throne. His royal sister-in-law, the Countess
+d'Artois, had given birth to a prince, the Duke of Angouleme, who was
+the heir presumptive to the throne in case of the non-issue from Louis;
+another sister-in-law had been brought to bed with a royal princess, and
+here was the king himself without any prospective possibility of any
+heir. Like all kings, he was more or less unreasonable; so he blamed his
+first surgeon in ordinary for all these short-comings,--as if it were
+the duty of these court surgeons, among their many other tribulations,
+to furnish heirs to thrones. The surgeon finally informed his Majesty
+that if he wished to become a father it would be necessary for him to
+submit to the slight operation that was the subject of the church
+festival of the first day of January, namely, the Feast of the
+Circumcision. His most Christian Majesty entered a protest to this
+acknowledgment that there was anything in Judaism worth imitating. The
+surgeon insisted that the operation celebrated on the first of January
+would put him in a way to have the much-desired heir. The king finally
+waived all objections from any religious scruples, but could not be
+brought to look at the prospective operation with any sentiments of
+agreeable expectation.
+
+The king finally became good-natured, and a touch of that plebeian
+jollity which at times made him quite agreeable spread over his features
+as he imagined the ludicrousness of the spectacle that would be
+presented by a king of France in the hands of these handlers of the
+scalpel, treating him like an African savage. He took some days to
+consider the matter. On the next day he informed M. Louis, his first
+surgeon in ordinary, that he had decided on submitting to the operation,
+and the day and hour were fixed. The royal circumcision, however, never
+took place, as it is most likely that in the privacy of his chamber his
+Majesty worked, like many a plebeian or man of low degree had done
+before him and has done since, to bring a refractory prepuce to terms.
+The king was somewhat of a mechanic, as his skill as a locksmith has
+passed into history; so that it is not unlikely that, with what little
+information he had on the subject, he managed to sufficiently dilate, by
+scarification and stretching, the preputial opening, as from the year
+1778 the queen had three children.
+
+Cases of attempted self-circumcision are not rarities, as people have
+some inexplicable idea that a self-inflicted cut is not as painful as
+one that is done by others. The writer well remembers being called to
+assist one of these domestic surgeons who had undertaken to circumcise
+himself with his wife's great scissors. The man had a very long but thin
+and narrow prepuce that had always been an annoyance to him. The writer
+had circumcised two of his children for the same malformation, and the
+father, seeing the benefit to these two, determined to share in the
+general benefit; but at the same time he arranged to do it all by
+himself, and give the family and the surgeon a sample of his courage and
+a simultaneous surprise party. Securing the scissors, he wended his way
+unperceived into the recesses of his wood-shed. The mental and physical
+anguish the poor man underwent, and what soliloquies he must have
+addressed to the rafters of the wood-shed while making up his mind and
+screwing up his physical courage for the last fell act with the
+scissors, can hardly be described, as, in all probability, they were of
+the most rambling and inconsistent order. At any rate, he must have
+reached a climax in time and grasped the fated prepuce with a revengeful
+glee, and, with all his powers concentrated in his good right hand, he
+must have closed the remorseless blades of the scissors on the unlucky
+prepuce. When the surgeon arrived at the scene of carnage, he was
+directed to the wood-shed, on the outskirts of which hovered the family,
+frantic with fear and apprehension; within, in the darkest corner, with
+wildly dilated eyes, and performing a fantastic _pas seul_, was a man
+with a huge pair of scissors dangling between his legs, warning all
+hands as they valued his life not to approach or lay a hand on him. He
+had shut the scissors down so that it clinched the thin prepuce, and
+there his courage and determination had forsaken him; he lost his
+presence of mind, and was not even able to take off the scissors; he had
+simply given one wild, blood-curdling yell--like the last winding notes
+from Roland's horn at Roncevalles--that had brought his family to the
+wood-shed-door, and they had then sent for a surgeon. New terrors here
+awaited the unlucky victim for self-circumcision. He dreaded lest the
+surgeon should accidentally have it enter his mind to finish the
+operation with the scissors, and in that case he would be helpless, as
+the surgeon would, undoubtedly, have a sure and tender hold of it. After
+executing a number of _pas a deux_ on the Magilton step, while the
+surgeon endeavored to reassure him and gain his confidence, promising to
+remove the scissors without inflicting any further harm, he was finally
+allowed to approach, and, while the patient assumed a Taglioni attitude
+on one foot, the other leg being extended at right angles with the body
+and his hands clawing the air, the scissors was removed. The patient,
+through the aid of lead lotions and a week's rest, made a good recovery
+with a whole prepuce, chagrined at his failure, but happy to have
+escaped immediate pain.[80]
+
+There is not much doubt but that the operation could have been
+suggested by its, at times, spontaneous performance, a case of which, by
+Cullerier, and some other additional cases have been mentioned in a
+former chapter. Cases occur at times, also, wherein the person having a
+previously normal and uninterfering prepuce has, through either herpetic
+inflammations or through impure connection, spurious gonorrhoea, or the
+use of some venereal-disease preventing-wash after connection, produced
+some irritation resulting in the abnormal thickening of the inner fold,
+or an interstitial deposit at the junction of the skin and mucous
+membrane, with consequent constriction, this deposit finally forming a
+hard, inelastic ring, which prevented a free exposure of the glans and
+interfered in sexual connection. In such cases,--like in stricture of
+the meatus,--any mechanical interference short of cutting with a knife
+only aggravates the existing difficulty, and it is not uncommon to have
+such cases apply for assistance after they have in vain tried to dilate
+the constricting preputial orifice. In the early writings of the Greeks,
+it is mentioned that among the Egyptians circumcision exempted them from
+a certain form of disease that affected the penis. Philon mentions
+particularly the immunity that the operation conferred against a species
+of affection which Michel Levy asserts to have been a gangrenous
+disease. So that, outside of any religious significance, there is no
+doubt that, in individual cases, circumcision has more than once been
+suggested, although it cannot be said that such individual cases would
+ever, or could, lead to its becoming a national or racial, much less a
+sectarian, rite.
+
+
+
+
+CHAPTER XVIII.
+
+THE PREPUCE AS AN OUTLAW, AND ITS EFFECTS ON THE GLANS.
+
+
+Ricord has well termed this appendage to civilized man "a useless bit of
+flesh." Times were, however, when--man living in a wild state, and when
+in imitation of some of our near relatives with tails and hairy bodies;
+when he still found locomotion on all-fours handier than on his two
+feet; when in pursuit of either the juicy grasshopper or other small
+game, or of the female of his own species to gratify his lust, or in the
+frantic rush to escape the clutches, fangs, or claws of a pursuing
+enemy, he was obliged to fly and leap over thorny briars and
+bramble-bushes or hornets' nests, or plunge through swamps alive with
+blood-sucking insects and leeches--Ricord's definition would certainly
+have been inapplicable. In those days, but for the protecting double
+fold of the preputial envelope that protected it from the thorns and
+cutting grasses, the coarse bark of trees, or the stings and bites of
+insects, the glans penis of primitive man would have often looked like
+the head of the proverbially duel-disfigured German university student,
+or the Bacchus-worshiping nose of a jolly British Boniface. So that in
+those days, unless primitive man was intended to have an organ that
+resembled a battle-scarred Roman legionary, a prepuce was an absolute
+necessity.
+
+With improvement in man's condition and his gradual evolution into a
+higher sphere, the assumption of the erect posture, and the great stride
+in civilization that originated the invention of the manufacture of the
+perineal band, which not only protected the glans in its thorny passage
+through life, but also acted like a protecting aegis to the scrotum and
+its contents, the prepuce became a superfluity; not only a superfluity,
+but, now that its natural office had been replaced by the perineal
+cloth, it actually began to be a nuisance, as its former free contact
+with the air had retained it in a state of vigorous and
+disease-resisting health which was now fast departing. As Montesquieu
+observes, in the causes that led to the decline and fall of the Roman
+Empire, those seasons of trials, tribulations, and struggle for
+existence are those of health and progress and healthy life, and the
+periods of luxury and idleness are those of degeneracy and decay. So
+with the prepuce, the luxury and idleness, voluptuousness and consequent
+feasting incident to its being supplanted in its original functions by
+the perineal cloth, which left it thenceforth unemployed, led it in the
+pathway of disease and death. This first innovation in civilization was
+to the prepuce the beginning of its decay and fall. Like Belshazzar in
+his great banquet-hall in ancient Babylon, the prepuce might have read
+the hand-writing on the wall, "_Mene, Mene, Tekel, Upharsin_," and
+foreseen the gory end that awaited it. Like to other human affairs,
+however, even in his fallen estate a kind word can be said for the
+prepuce. Puzey, of Liverpool, has found it of extreme value, and even
+unequaled by any other part of the body, for furnishing skin-grafts,[81]
+these grafts showing a vitality that is simply phenomenal, considering
+the laxity of its tissues and its seemingly adipose character. There is
+no doubt, however, that for skin-transplanting there is nothing superior
+to the plants offered by the prepuce of a boy, and where any large
+surface is to be covered this should undoubtedly be chosen, as offering
+the greatest and quickest success and the least chances of failure.
+This is really the only disadvantage that can be charged against
+circumcision, as in a strictly circumcised community they would be
+debarred from this great advantage. An uncircumcised individual could be
+procured, however, to supply the deficiency. It is related that in the
+latter part of 1890, a Knight Templar, in Cincinnati, required a great
+supply of grafts or skin-plants to cover a largely-denuded surface, and
+that the whole of his Commandery chivalrously and generously supplied
+the needed skin-plants in a body. A few healthy prepuces would have been
+more efficacious. In advising the use of the prepuce for these purposes
+it must not be overlooked that in case of a white man it would not do to
+use skin of any other color besides his own. We have no data to base any
+assertion as to the relative action of skin-grafts taken from Mongolians
+or Indians, but we have very reliable data in relation to the
+proliferating action of those of the negro,[82] which induces a growth
+of epidermis of its own kind; so that preputial grafts from the negro,
+combining the extra vitality and proliferation of the preputial tissue
+with the strong animal vitality of the negro, if applied to a white man,
+might not produce the most desirable cosmetic effects, especially if on
+one side of the countenance.
+
+But, taken as a whole, when considered in its relation to onanism,
+nocturnal enuresis, preputial calculus, syphilis, cancer, and a lot of
+nervous and other ailments, or induced abnormal physical conditions, we
+can really conclude that the days of the prepuce are past and gone, that
+it has outlived its usefulness, and that those whom a religious or civil
+ordinance or custom happily makes them rid of it are people to be
+greatly envied. As Sancho Panza remarked, "God bless the man who
+invented sleep," so we may well join in blessing the inventor of
+circumcision, as an event that has saved some parts of the human family
+from much ill and suffering.
+
+Phimosis is an ancient attendant on our inheritance of the prepuce, we
+being, in fact, born with it; this is the rule. There are, however,
+exceptions to this rule, which, singularly enough, are found to be
+hereditary. The writer has met with a number of such instances, and they
+have always been found to have been family traits. Within the past year,
+after attending a confinement, his attention was called to the child by
+the nurse, who thought that the child was deformed; the nurse,
+singularly enough, never having seen a natural-looking glans penis in
+all her life, was astonished at the size and appearance of the member.
+On examination, the organ showed a complete absence of prepuce. On
+inquiry, the father and another son, born more than twenty years
+previously,--this comprising every male member of the family,--were
+found to have been thus born, with the glans fully exposed. The family
+is now residing in San Diego, and is naturally one of more than superior
+physical health and intelligence. I saw another family similarly
+affected in the north of France, and of individual cases, without
+knowing the history of the rest of the family, I have seen a large
+number. As the prepuce can be observed in every stage of disappearance
+among mixed races, it would seem that in time it would disappear
+altogether. Its effectual absence in so many cases evidently belongs to
+some evolutionary process, and shows beyond question that nature does
+not insist on its presence either as a necessity or as an ornament.
+
+The word or term "phimosis" is derived from two Greek roots, signifying
+"string" and "to tighten," or "to tie with a string." Galen, from its
+signification, accepted the word, and from him it has been transmitted
+through the different epochs of medicine down to our own times. In
+virtue of its etymological significance, it was formerly applied to any
+stenosis or closure of duct or aperture, but at present the term is used
+simply to denote that constriction that affects the prepuce, and which
+prevents the glans from being passed through the preputial orifice.
+Phimosis is said to be congenital or natural and acquired. The first of
+these is the common lot of all, as a rule, and with some it remains so
+throughout life. As babyhood advances in boyhood and boyhood into youth,
+the prepuce gradually becomes lax and distensible, and in proportion to
+the existence of these conditions it also loses in its length. Where,
+however, the distal end persists in its constricted condition it is
+drawn forward as the penis increases in bulk.
+
+In many cases its tightness prevents the escape of the sebaceous matter
+that collects in the sulcus back of the corona, and the resulting
+irritation on the surface of the glans and the inner mucous fold of the
+prepuce ends in an inflammatory thickening of the latter, its inner
+surface becoming thick, undilatable, hard, and unyielding, all the
+natural elasticity that should be present having departed, with more or
+less inflammatory thickening and adhesions between the two layers of
+skin that form the prepuce. In this unyielding tube the glans is
+imprisoned and compressed, often suffering the tortures that the
+"maiden" of the dungeons of the Inquisition inflicted on the unhappy
+heretics. It becomes elongated, cyanosed, and hyperaesthetic; the meatus
+of the urethra is congested and hypertrophied, the corona is undeveloped
+and often absent, the glans having, on the whole, the long-nosed,
+conical appearance of the head of a field-mouse. There are hardly five
+per cent. of the uncircumcised but who suffer in some degree from this
+constricting result of the prepuce, to a greater or less extent.
+
+On the other hand, the unconstricted glans penis assumes the shape and
+appearance that is seen in the circumcised. The head is shorter, the
+face flat and abrupt, and the meatus, instead of being at the end of a
+conical point, is situated on the smooth, rounded front of the glans,
+and does not differ in color from the covering of the glans itself. From
+the superior commissure of the meatus to the sulcus in the rear of the
+corona its topographical outline may be said to describe two opposite
+segments of a circle, as seen in the cuts representing the glans in its
+natural shape. The corona is prominent and well developed.
+
+The opponents of circumcision base much of their opposition to the fact
+that circumcision interferes with the natural condition of the parts.
+The question may well be asked, which of these two shaped glans is the
+natural product as nature intended it should be? It is a well-known fact
+that the most forlorn and mouse-headed, long-nosed glans penis will,
+within a week or two after its liberation from its fetters of preputial
+bands, assume its true shape. We may naturally inquire if nature made
+the glans of a certain shape, which seems to be the proper shape for
+copulative purposes, only to have the condition most effectually
+abolished by a constricting, unnatural band? How much the shape of this
+glans, from meatus to corona, may have to do with retaining the urethra
+to a healthy and normal calibre and condition has not been inquired
+into, but, as far as the writer has observed, a normal glans seems to
+have less abnormalities of the urethra, and in treating such cases he
+has always found that when the urethra of one of these normal-glans
+subjects was affected it was far easier to manage; on the other hand,
+secondary and even a tertiary recurrence to an operation is often the
+fate of a long, narrow, conical-pointed penis.
+
+Phimosis is known to have been a cause of male impotence by its direct
+interference with the outward flow of the seminal fluid; but, although
+we have cases where impregnation has taken place by the aid of a warm
+spoon and a warm syringe, as in the case related in a former chapter, it
+must be admitted that the corona is not without some functional office
+in the act of procreation. Its shape indicates a valve action like that
+of the valve in a syringe-piston, and if we examine the two extremes of
+these conditions of glans--one devoid of corona, as many are, and the
+other with the corona in its most pronounced form, when in a state of
+erection--the difference, either in the appearance of the two organs or
+in the different philosophical action and results that must necessarily
+follow the use of these two differently shaped glans, will at once be
+apparent. Unfortunately--or, as many may consider it, most
+fortunate--the female organs are not always so shaped as to be in
+themselves wholly favorable to impregnation. The wearing of corsets, the
+habitual constipation of females, the relaxed and unnatural condition of
+the uterine ligaments and vagina in civilized women, all favor uterine
+displacement, with any or all forms of uterine ailments. To this we may
+add the effect of repeated miscarriages, application of astringent
+washes, irregular menstruation, etc., all of which conditions often
+result in an elongation of the neck, constriction of the cervical canal,
+with the external os placed on the depended point of the sharply pointed
+cervix, which is liable to point in any direction. Just imagine one of
+these conditioned females and one of the mouse-headed, corona-deficient,
+long-pointed glans males in the act of copulation! The conical penis
+finds its way in the reflected fold of the vagina, while the point of
+the uterus may be two or three inches in some other direction, making
+impregnation wholly impossible; besides, in the normal-shaped penis, the
+corona acting as a valve, behind which the circular muscular fibres of
+the vagina close themselves, tends to retain the seminal fluid in front,
+while the very shape of the organ assists in straightening out the
+vaginal canal and to bring the uterus in proper position. In the long,
+thin, narrow and pointed glans, devoid of corona, there is no mechanical
+means to retain the seminal discharge. Some years ago some one
+introduced the idea of postural copulation, to be tried in cases of
+sterility, and it has been found that impregnation would take place in
+some cases where it had formerly appeared impossible, this position
+having the effect of righting malpositions during the act, which were
+the cause of the sterility; but it stands to reason that, where the
+shape of the organ is such that it further favors malpositions, as well
+as where it offers no obstacle to the vagina immediately expressing or
+dropping out all the seminal fluid, impregnation is more difficult, and
+that, where the uterine deformity is coincident with this condition of
+penis to assist, it becomes well nigh impossible. Fodere mentions a
+penis about the size of a porcupine-quill on an adult male, and Hammond
+mentions one of the size of a lead-pencil in diameter and two inches in
+length. From total absence of the penis, either through disease or
+accident, to the diminutive organs mentioned by Fodere and Hammond, and
+on up to the full-sized and normal-shaped organ, we have every degree of
+sizes and shapes, and with these go every conceivable degree of ability
+or faculty for impregnation.
+
+Aside from the foregoing considerations, there are others equally
+important. Although Greece was involved for years in war and ancient
+Troy was destroyed and all its inhabitants slaughtered because of the
+seduction of one woman; and Semiramis, through her beauty, got all her
+successive husbands in chancery; and poor, susceptible Samson, from
+firing Philistine vineyards and killing lions bare-handed, and the
+Philistines by the thousands with the jaw-bone of an ass, was reduced
+through Delilah to bitter repentance and turning Philistine mill-stones;
+and we know that the familiar infatuation of Antony for Cleopatra ruined
+Antony; and we are familiar with the well-known maxim of the French
+police-minister, that to catch a criminal it was but necessary to first
+locate _the woman_ and the man would soon be found,--society has
+determined to ignore the influence of the animal passions as factors in
+our every-day life, or factors in the estrangements, coldness, and the
+bickerings that end in divorces. Not to shock the reader with detailed
+accounts as to what an important factor the shape of the penis may be in
+the domestic economy, I will refer the reader to Brantome's works.
+
+Although the councils of the older church were not above giving these
+conditions their calm and deliberate consideration, which resulted in
+the foundation of the present physical considerations in relation to
+divorce laws, such studies or considerations are at present only touched
+upon gingerly and with apologies for doing so, as if the "study of man"
+was of any less importance to-day from what it was in the days of Moses,
+the elder church, or when Pope formulated his oft-quoted but
+little-followed maxim, that "the proper study of mankind is man." The
+present miscalled "delicacy of sentiment" is about as misplaced a
+condition of disastrous and misleading morality as was the out-of-place
+and untimely bravery of poor old Braddock when refusing Washington's
+advice at the Monongahela. The success and beauty of the Mosaic law is
+its squarely facing the conditions of actual life, and its absence from
+nonsense or nauseating sentimentality. Were our present churches to
+observe more of this plain talk, for which the good old Anglo-Saxon is
+as fully expressive and convincing as the old Hebrew, and deal less in
+rhetorical flourishes and figurative mean-nothings to tickle the ears of
+our modern Pharisees, mankind as well as womankind would be infinitely
+so much the better off, mentally, morally, and physically, and there
+would be less of the conflict between science and religion. Luther's
+dream of restoring religion to its primitive purity has come to but as
+poor realization at the hands of his so-called followers, which leads
+one to think that if the martyrs of the Reformation could come back and
+see the fruits of their martyrdom--suffered that pure religion might
+live--they would conclude that, for all the resulting good accomplished,
+they might as well have kept a whole skin and a whole set of bones.
+
+In cases of pronounced phimosis the aperture in the prepuce may not be
+in a line with the meatus, and the resulting discharge of urine or the
+ejaculations of seminal fluid may from this cause be unable to find an
+egress. The fluid escaping from the urethra will, in case the opening is
+at the side or upper part of the prepuce, cause it to balloon out until
+a sufficient quantity is thrown out so as to distend, the opening as
+well as the prepuce, before it can find its way out; in such cases
+impotency is liable to be as complete as in those cases of stricture
+wherein the seminal fluid is forced backward into the bladder. Having
+given this general view of the effects of phimosis as it may affect man
+in the shape of his organ, which may have a serious result in his
+domestic relations or in becoming a father, we will proceed to the
+consideration of diseases and conditions that phimosis encourages and to
+which it renders man more liable. In the consideration of these cases it
+must not be forgotten that the sexual relations are much more to man or
+woman than is generally acknowledged. The days for the establishment of
+the Utopian republic of Plato are not yet with us. That Platonic love
+does exist is true, as it has in the past and will in the future.
+Scipio, refusing to accept the beautiful betrothed bride of an enemy as
+a present, or Joseph leaving his coat-tail in the hands of the amorous
+bride of the eunuch Potiphar, with the suicide of Lucretia, in the past,
+are events which virtue and modern continence probably duplicate every
+day; but these are exceptions to the rule. Physicians daily see
+evidences of the most devoted Platonic affection in either sex, but they
+also see enough of the opposite side of the question to convince them
+that in the majority of cases the sexual relations are the bond of
+union, as well as the mainspring of love. As observed by Montesquieu,
+the bride of a first-class Turkish eunuch has but a sorry time, and a
+woman of the same calibre of mind as that possessed by the ordinary
+Circassian or Armenian bride cannot be in a much happier condition with
+a husband partly eunuchised by a constricted prepuce.
+
+
+
+
+CHAPTER XIX.
+
+IS THE PREPUCE A NATURAL PHYSIOLOGICAL APPENDAGE?
+
+
+By many surgeons the idea of circumcision, unless connected with an
+immediate demand for interference,--such as a phimosis unmanageable by
+any other means, an induced phimosis from gonorrhoea or other
+irritation, syphilis in its initiatory sore, cancer or some such
+cause,--is looked upon as an unwarrantable operation, a procedure not
+only barbarous, painful, and dangerous, but one that directly interferes
+with the intentions of nature. The prepuce is by many looked upon as a
+physiological necessity to health and the enjoyment of life, which, if
+removed, is liable to induce masturbation, excessive venereal desire,
+and a train of other evils. The question then resolves itself, What is
+the real physiological status of this appendage, if it has any, and, if
+it is a physiological appendage, when does it merge into a pathological
+appendage? As by some it is held that the prepuce enjoys the same right
+to live and exist as the nose, ear, or a limb, which are only subject to
+amputation in case of a serious disease, they should be reminded that
+they are not taking into consideration that the nose and ear are
+calculated to warn us of danger, and that our legs are very useful; as
+even the great orator Demosthenes, by the timely and rapid use of his
+legs, was enabled to escape from a battle, where his oratory was of no
+avail against the illiterate javelins of the unscholarly Macedonians. If
+the prepuce only was endowed with an olfactory sense,--as, for instance,
+if a nervous filament from the first pair of nerves had been sent down
+alongside of the pneumogastric and then, by following the track of the
+mammary and epigastric arteries, had at last reached the prepuce, where
+the olfactory sense could have been turned on at will, like an
+incandescent lamp,--it might have been a very useful organ, as in that
+sense it could have scented danger from afar, if not from near, and
+enabled man to avoid any of the many dangers into which he unconsciously
+drops. But, seeing that the prepuce, to say nothing of being neither
+nose, eye, nor ear to warn one away from danger, or a leg to run away on
+after once in it, having not even the precautionary sensitiveness of a
+cat's moustachios, it cannot, in any way that we can see, be compared to
+any other useful part of the body.
+
+All attempts to find reasons for its existence that are of real benefit
+to man have so far proved unsatisfactory, and, unlike the reasons for
+its removal, are, as a rule, founded on speculation. To further reason
+out the why and wherefore of its existence or of its summary surgical
+execution, we must consider its shifting positions as to the effects it
+produces, as well as to its conditions at different ages, sitting on its
+case like an impartial jury in the case of some unconvicted but
+diabolically-inclined criminal.
+
+As before remarked, we are, as a rule, born with this appendage, just as
+much as we are with the appendix vermiformis, which rises up, like
+Banquo's ghost, whenever we eat tomatoes or any small-seeded fruit. This
+prepuce is then long, and the penis is found at the end of an
+undilatable canal, which is formed by the constricted prepuce; at this
+early stage of our existence it is often additionally bound down to the
+glans by a greater or less number of adhesions. We are then in what many
+term a state of physiological phimosis, that being a perfectly natural
+condition, and one consistent with health; at least, we imagine it is
+normal.
+
+Phimosis in childhood is generally considered a physiological state,
+only to be taken as a pathological condition under certain
+circumstances. Preputial adhesions may, according to many observers,
+also be classed as physiological at an early period of life, as it is by
+them considered as congenital, and common enough to warrant its being
+classed as normal. As to the first, or phimosis, it undoubtedly is a
+physiological condition during infancy; but why, we do not know; and it
+is also a fact that from birth to puberty it remains so in fully over
+one-half of the cases. Out of 98 children, from one week to sixteen
+years of age, examined by Dr. Packard, the prepuce was entirely
+unretractable in 54, partly so in 3, and wholly so in 36; while in 1 it
+only half-covered the glans and in 4 the glans was wholly uncovered, 1
+of these 4 being an infant only five weeks old.
+
+Dr. Packard also gives the result of 172 examinations by himself, of
+from twelve to seventy-three years of age, and 106 examinations by Dr.
+Maury, a total of 278, in whom 100 had a long prepuce, 97 a
+partly-covered glans, and 81 (of whom 2 had been circumcised) in whom
+the glans was exposed.[83] As to adhesions, there is an unaccountable
+diversity of opinion as to their constancy as a natural condition, being
+frequent enough to class them as physiological occurrences. Dr. A. B.
+Arnold, of Baltimore, states that his experience in reference to
+preputial adhesions leads him to conclude that the frequency of its
+occurrence has been much overstated. In the number of children that he
+has circumcised, which exceeds 1000, he has met with it in less than
+four per cent. of the cases. He also mentions that in the adult the
+adhesions show greater firmness.[84]
+
+On the other hand, Dr. Bernheim, of the Paris Israelitish Consistory,
+observes that, of over 3000 newborn whom he has examined, with but few
+exceptions he found the presence of preputial adhesions. He remarks,
+however, that in the majority these are detached or broken by the first
+attempt at erection.[85]
+
+Bokai, out of 100 children, found 8 who were over seven years of age,
+who were perfectly free; while of the remaining 92 under that age 6 more
+showed no adhesions and 86 had various degrees of adhesions.[86]
+
+Dr. Holgate, of the out-door department of Bellevue, considered that all
+phimosic cases have adhesions; while Dr. Moses, of New York, out of some
+fifty circumcisions performed at the eighth day, found only adhesions
+three times.[87]
+
+These observations are, however, in perfect accord. If we connect the
+statement of Dr. Arnold, in regard to the increasing character of the
+firmness in the adhesions of the adult, with the statement of Dr.
+Bernheim, that the first erection is often sufficient to break up the
+existing adhesions in the infant, we must conclude that they are nothing
+more at first than a slight agglutination, which the slight manipulation
+required to properly locate the position of the glans, and to space out
+the prepuce preparatory to the operation of circumcision, must, in the
+majority of cases, be sufficient to liberate the prepuce from the glans;
+this is evident also from the statement of Dr. Moses, who only found six
+per cent. of the cases operated upon by him as being so affected.
+
+The writer has been present at a large number of Hebrew circumcisions
+performed on the eighth day, and from that up to the sixth month (as in
+many communities they wait until a number of children are collected, so
+to speak, before sending for the mohel, who may reside at quite a
+distance), and in all of those witnessed he has never seen any
+complications from adhesions; but cases of adhesion have been often
+encountered from the second to the eighth year, and it has always been
+the case, as a rule, that the older the child the greater the firmness
+of the adhesion. In these cases the practice generally advised of using
+a probe is not practicable, as the person is more apt to wound the sound
+prepuce than to tear the adhesions; the practice most effectual is to
+hold the glans firmly but gently with the thumb and forefinger of the
+right hand, and then to draw the prepuce as firmly back with its fold
+held in the forefinger and thumb of the other. It is a more expeditious
+mode, and the least painful; by this method extensive adhesions can
+readily be broken up; vaselin and a piece of fine lint should then be
+interposed for a couple of days to prevent a re-adherence.
+
+Another co-existing condition with phimosis, very often found, is a
+shortening of the frenum. Dr. Jansen, out of 3700 soldiers of the
+Belgian army, found 12.3 per cent. with this pathological condition and
+2.5 per cent. with a narrow prepuce.[88]
+
+Take the three conditions above enumerated,--phimosis, preputial
+adhesions, and short frenum,--all are but a departure from a normal, in
+a greater or less degree; and whether the resulting discomfort consists
+in mere mechanical impediment to urination, erection, or as a factor in
+nocturnal enuresis, dysuria, impotence, either through reflex action or
+interference with emission, malposition of the urethral orifice during
+copulation owing to any of these conditions, or in any of the nervous
+derangements that may accompany this condition, or in the more serious
+results, ending in positive deformity of body or limb, or in the
+warping of moral sentiments, or, even further, in inducing insanity, it
+cannot well be seen how the conditions that will certainly produce these
+results, in a more or less degree, can ever, in any logical sense, be
+considered a physiological condition.
+
+There are certain conditions to life, up to the time of birth, which,
+unless they then cease at once to exist, immediately become from a
+physiological into very serious pathological conditions. These are well
+understood, and have their reasons for existing during our pre-natal
+existence; but the prepuce has no known function during uterine life or
+subsequently; and there being no valid reason for its existence, there
+are certainly no logical grounds for its being considered a
+physiological condition, especially when the serious results attending
+the most accentuated form of the above three conditions are considered,
+and as its necessity, in cases of its entire absence, has not yet been
+demonstrated.
+
+It can well be said that about two-thirds of mankind are affected in a
+greater or less degree with these pathological conditions, causing them
+more or less annoyance. Of these, a certain percentage suffer a life of
+continued misery, as a direct or indirect result of these conditions.
+
+As to the actual necessity of a prepuce existing, or as to what
+annoyances or diseases persons are subjected to who are born without it,
+there is a most singular and expressive silence in medical literature.
+It stands to reason that, if it is a necessity, some one person should
+have found it out long ago, and there should then be some evidence to
+present in relation thereto. There are cases reported in some of the
+older surgeries wherein an attempt has been made, in the absence of a
+prepuce, to restore or manufacture one by means of a plastic operation.
+Vidal describes such an operation,[89] but there is no reason given as
+to why the operation was undertaken; there is no record of any diseased
+condition which it was intended either to cure or to alleviate; so that
+we are left to infer that the person simply submitted to the operation
+from purely cosmetic reasons. The Hebrews of Palestine, after the Roman
+conquest, or those in Italy or Spain, attempted a like operation, but
+not from any reason of lessened health or to restore any lacking
+physiological action, their aim having simply been to hide their
+identity, for the purpose of escaping persecutions, exactions, or
+annoyances, either from their rulers or their fellow-citizens.
+
+Dr. A. B. Arnold, in a paper on circumcision, read before the Academy of
+Medicine of Baltimore, argues that it is not difficult to divine the
+purposes of the prepuce, holding that it is necessary to protect the
+tactile sensibility of the glans, due to the presence of the Pacinian
+bodies which Schweigger Seidel discovered in the nerves, and that a
+better provision than the anatomy of the prepuce cannot be conceived for
+shielding the very vascular and sensitive structure of the glans from
+external sources of irritation and friction, that might rouse the
+sensibility of this organ, which, on physiological grounds, may cause
+early masturbation; further arguing that, the corona being undoubtedly
+the most excitable part of the glans, its denudation by circumcision
+leaves it more apt to be affected by chance titillations.[90] In this
+latter view of the case the preponderance of views is, however, in the
+opposite direction. J. Royes Bell states that, owing to the induration
+of the glans through the means of circumcision, masturbation and
+syphilis are less rife amongst the circumcised than amongst the
+uncircumcised.[91] M. Lallemand, whose experience in the treatment of
+seminal emissions is of the greatest value, looked upon circumcision as
+one of the means of curing those diseases, looking on the diminished
+irritability of the glans resulting from the operation as the curative
+element.[92] Dr. Cahen, in a "Dissertation sur la Circoncision," in
+1816, before the Faculty of Medicine of Paris, called the attention to
+the diminished sensibility of the glans induced by circumcision. Dr.
+Vanier, of Havre, looks upon the prepuce as the most frequent cause of
+onanism. "If the prepuce is lax, its mobility produces an irritation to
+the highly irritable and sensitive nervous system of the child by the
+titillation in its movements on the glans; if too tight and constricted,
+then it compresses the glans, and by its irritation it leads the child
+to seize the organ."[93] So that in either case he looks upon the
+prepuce, through the sensitiveness it retains and induces in the glans,
+as the principle cause of masturbation. M. Debreyne, the Trappist monk
+and physician of La Trappe, who has paid considerable attention to
+medicine as applied to morality, practically makes the same
+observations. In children who have not yet the suggestions of sexual
+desire imparted by the presence of the spermatic fluid, the presence of
+the prepuce seems to anticipate those promptings. Circumcised boys may,
+in individual cases, either through precept or example, physical or
+mental imperfection, be found to practice onanism, but in general the
+practice can be asserted as being very rare among the children of
+circumcised races, showing the less irritability of the organs in the
+class; neither in infancy are they as liable to priapism during sleep as
+those that are uncircumcised.
+
+Dr. Bernheim says that "the prepuce may be said in general to be an
+appendage to man, if not positively harmful in some cases, at least
+useless, requiring constant care, the neglect of which is liable to
+entail disease and suffering; the irritation it produces through the
+sebaceous secretion is a frequent cause of masturbation which nothing
+short of circumcision will remedy."
+
+Through middle life, unless the prepuce be the subject of some vicious
+conformation, little inconvenience may result from its presence, except
+it be from the dangers to infections already pointed out during this
+period of life; an ordinarily movable and retractable prepuce will not
+acquire the condition of phimosis, unless it be through disease or
+accident; but with our entrance into old age, or after having passed our
+vigorous prime, the torment of the days of our infancy and childhood
+come to harass us again. Persons given to corpulency, with a long
+prepuce, are apt to become affected with phimosis in their latter years,
+as such persons are more subject to loss of their sexual vigor and power
+of erection than lean and spare people; in these, the gradual diminution
+of the size of the erectile tissues of the organ and its retraction
+allows of the reconstriction of the preputial opening, which, in the
+end, will not allow the prepuce to be drawn back over the gland. These
+conditions are followed by the irritating affections incident to
+phimosis of our earlier life, with the modification that age has induced
+in making us subject to more serious and fatal ailments, both locally
+and generally.
+
+
+
+
+CHAPTER XX.
+
+THE PREPUCE, PHIMOSIS, AND CANCER.
+
+
+In the _British Medical Journal_ of January 7, 1882, there is an
+interesting article by Jonathan Hutchinson on the "Pre-cancerous Stage
+of Cancer." In this article he states that, whereas, twenty years
+previously, his suggestion had been to treat all suspicious sores as
+being due to syphilis until a clearer diagnosis could be made out, he
+"had more recently often explained and enforced the doctrine of a
+pre-cancerous stage of cancer. According to this doctrine, in most cases
+of cancer, either of penis, lips, tongue, or skin, there is a
+stage--often a long one--during which a condition of chronic
+inflammation only is present, and upon this the cancerous process
+becomes ingrafted. Phimosis and the consequent balanitis lead to cancer
+of the penis.... A general acceptance of the belief that cancer usually
+has a pre-cancerous stage, and that this stage is the one in which
+operations ought to be performed, would save many hundreds of lives
+every year.... Instead of looking on whilst the fire smouldered, and
+waiting till it blazed up, we should stamp it out on the first
+suspicion.... What is a man the worse if you have cut away a warty sore
+from his lip; and, when all is done, a zealous pathologist demonstrates
+to you that the ulcer is not cancerous, need your conscience be
+troubled? You have operated in a pre-cancerous stage, and you have
+probably effected a permanent cure of what would soon have become an
+incurable disease. I do not wish to offer any apology for carelessness,
+but I have not in this matter any fear for it."
+
+In view of the great frequency of the occurrence of cancer of the penis,
+and the facts pointed out by Roux, that, after the removal of the
+cancerous prepuce or a portion of the penis for cancer, in case of a
+recurrence the disease does not do so in the penis, but that it attacks
+the inguinal glands, showing conclusively that the prepuce is the
+inciting cause as well as the initial point of attack, the sentiments in
+the foregoing paragraph, taken from the words of Hutchinson, are worthy
+of our most careful consideration.
+
+M. Roux, Surgeon to the Charite, during the second decade of the present
+century, first called the attention of the French profession to the
+intimate relation or dependence that cancer of the penis bears to
+phimosis. In England he was preceded in this field of surgical
+investigation by William Hey, whom Roux met in London in 1814. Hey had
+then operated by amputation of the penis on twelve cases of cancer, nine
+of whom had had phimosis at the time of the development of the cancer.
+Wadd at this time also published a work on the subject, but, although he
+noticed that phimosis was a cause of cancer, he did not fully grasp the
+subject as Hey and Roux had done, as he believed a cancerous diathesis a
+primary necessity, and did not then recognize that the primary cause was
+fully to be found in the prepuce itself.
+
+Roux was probably the first to point out the peculiarly local character
+of penile cancer, as there is no locality wherein a timely operation is
+less apt to be followed by a recurrence. He records a number of cases
+where the prepuce alone was affected when first seen, but none wherein
+the glans was attacked and where the prepuce was exempt, giving ample
+evidence of the original starting-point of the disease.[94]
+
+Erichsen also remarks on the little liability to recurrence of cancer of
+the penis after a timely operation; he divides the cancer to which the
+penis is subject to as being of two distinct kinds,--scirrhus and
+epithelioma. The latter variety commences as a tubercle in the prepuce,
+and, according to Erichsen, does not occur in the body of the penis
+except as a secondary infiltration or deposit.[95] Travers states that
+Jews who are circumcised are not subject to either form of cancer.[96]
+
+Repeated attacks of herpes preputialis and some consequent point of
+induration are looked upon by Petit-Radel, Chauvin, and Bernard as
+frequent starting-points for the cancerous affection of the prepuce. The
+aged or persons of lax fibre being more subject to these inflammatory
+attacks, are also the most frequent victims of cancer in this situation.
+The celebrated Lallemand, in regard to the tendency to cancer induced by
+the presence of the prepuce, observes as follows:--
+
+"Besides simple balanitis ... there also result various indurations,
+which are proportionate in their degree to the length or time and
+intensity with which the inciting inflammatory conditions have existed.
+I have repeatedly found the mucous lining of the prepuce thickened,
+hardened, ulcerated, and nodulated; at other times converted into a
+fibrous or even into cartilaginous tissue of excessive thickness; in
+others, still, in which it had assumed a scirrhous and cancerous nature.
+I have repeatedly operated on such cases, wherein the prolongation of
+the prepuce was the only recognized primary cause, the subjects being
+often countrymen of from fifty to sixty years of age, who had never
+known any women except their own, but who had, nevertheless, been long
+sufferers from balanitic attacks, accompanied by abundant acrid
+discharges, swellings of the prepuce, with more or less consequent
+excoriations and narrowing of the preputial orifice."[97]
+
+Claparede sums up the inconveniences and dangers to which the possessor
+of a prepuce is liable to suffer from, as follows: "The retention of the
+sebaceous secretion is liable to alter its character, converting it into
+an acrid, irritating discharge, which induces more or less burning,
+smarting, itching, excoriations, and swelling, which, affecting the
+little glands situated about the corona and sulcus, induces them to
+secrete an altered and vicious secretion. In this manner a simple
+elongation of the prepuce will produce an inflammation of the surface of
+the glans (balanitis), or that of the prepuce itself (posthitis), or the
+two conjoined (balano-posthitis), complicated possibly with phimosis. By
+an extension to the mucous membrane of the urethra of the same condition
+of the inflammatory process, we have blennorrhagia; blennorrhagia is
+liable to be followed by inguinal swellings or tenderness, orchitis,
+stricture, and prostatic disease; the formation of preputial calculus,
+from retention of the urine in the prepuce; and cancer is apt to be the
+end of any of these conditions."[98]
+
+J. Royes Bell, in Ashhurst's "International Encyclopaedia of Surgery,"
+observes as follows: "Carcinoma attacking the genital organs usually
+assumes the form of epithelioma; the other kinds are rarely met with.
+Epithelioma may invade the prepuce, or the whole penis, or any part of
+it. The most common age for it is fifty years or over. In the great
+majority of cases there has existed a congenital or acquired phimosis. A
+contusion or a urinary fistula may be the exciting cause. With a
+phimosis the parts are not kept clean, but the gland is macerated and
+rendered tender and excoriated by retained secretions, and the
+irritation causes an epithelioma to grow in those predisposed to the
+disease, as is found to be the case when the tongue is irritated by a
+broken tooth, or the scrotum by the presence of soot in its folds.
+Syphilis has no direct influence in inducing the disease, but a
+syphilitic chap or ulcer may be the starting-point of an epithelioma.
+Two kinds of epithelioma affect the penis,--the indurated and the
+vegetating, or cauliflower growth.... The nature of the disease, in
+either the prepuce or the glans, is masked by a phimosis.... The
+prognosis in these cases is much more hopeful than in epithelioma, in
+other situations.... Sir William Lawrence operated on a patient who was
+quite well years afterward, and Sir William Ferguson amputated the penis
+of a man of note in the political world, who lived many years after the
+operation, and died at an advanced age."
+
+Agnew, of Philadelphia, describes an epithelioma of the prepuce
+occurring in persons past middle life, beginning as a tubercle, crack,
+or wart, for which he advises an early circumcision; he admits, however,
+to not having sufficient data to determine whether Jews and circumcised
+persons are exempt from carcinoma of the penis; but as its usual
+starting-point he evidently admits to be in the prepuce, circumcision
+must certainly be a preventive to its appearance. Gross gives
+substantially the same opinion as Agnew in this regard. Dr. John S.
+Billings, in his article on the "Vital Statistics of the Jews," in the
+January _North American Review_, of 1891, on the subject of cancer,
+observes as follows:--
+
+"As regards cancer and malignant tumors, we find that the deaths from
+these causes among the Hebrews occur in about the same proportion to
+deaths from other diseases as they do in the average population. But as
+the ratio of deaths to population is less among the Jews, so the ratio
+of deaths from malignant diseases to population is also less. Among the
+living population the proportion found affected with cancer among the
+Jews was 6.48 per 1000, while of those reported sick by the United
+States census of 1880, for the general population, the proportion was
+10.01 per 1000."
+
+There are no convenient data as to the prevalence or percentage of cases
+of cancer among the Arabian or Mohammedan population of Asia and Africa,
+but the above comparison of 6.48 per 1000 among the Jews of the United
+States, against 10.01 per 1000 of the general population, shows that the
+circumcised race does, in the instance of cancer, certainly enjoy a
+certain amount of immunity, having in this regard not quite such an
+exemption as they enjoy from consumption, but still sufficient to assist
+in making them longer-lived and more able to enjoy life and die a less
+lingering and painful death.
+
+It is surprising that, in view of the fact that carcinoma of the penis,
+starting with such frequency in the prepuce, should have left any doubt
+but that with the absence of this appendage there would follow less
+liability to cancer. Cullerier informs us that he had several times
+amputated the penis for cancerous diseases, but that he is unable to
+tell us whether the persons were affected with phimosis, remarking that
+on the last case he had observed the indurated remains of the prepuce;
+he had, however, recognized the necessity of freely exposing the gland
+in cases where, from continued irritation and inflammation, there was
+danger of cancer formation.
+
+Nelaton describes two varieties of cancer that affect the penis,--that
+which attacks the integument and that which attacks the glans. The
+first of these varieties he observes as generally beginning as a
+hardened nodule in the prepuce, which becomes at once more or less
+thickened and indurated. He gives Lisfranc the credit of pointing out
+the fact, that, even in the most hopeless-looking case, the glans and
+body of the penis may be simply pushed back and compressed, but
+otherwise sound, and that before resorting to an amputation of the whole
+organ it is better to make a careful exploratory dissection in search of
+the penis, as it oftentimes happens that the prepuce and integument can
+be dissected off, leaving the organ intact. He also mentions that
+elephantiasis of the penile integument generally begins in the prepuce.
+
+Baron Boyer believed that the vitiated preputial secretion allowed to
+remain beneath the prepuce was one of the causes of cancer of the penis,
+observing that it would be interesting to know whether cancer of the
+penis was a rarity among circumcised people, such as the Jews and
+Mohammedans.[99]
+
+It is easy to perceive why or how Agnew, Gross, Cullerier, and many of
+those who have written on the subject, have failed to appreciate the
+existence of the prepuce as an exciting cause, or as being, in the
+majority of instances, the part primarily attacked. The nodule,
+excoriation, or abrasion that develops into a cancer generally produces
+more or less local disturbance; in many it produces a phimosis that is
+only relieved by the ulcerative process that exposes the gland, which
+may by that time itself be attacked or even destroyed. They are then
+seen by either the rural practitioner or the family physician, but
+before submitting to an operation they run the gauntlet of many
+physicians, and, when it comes to operating, they generally apply to
+some one of great skill and reputation. By this time there is little
+left of the organ, and, as a rule, the party is unable to tell where the
+disease originated, whether in the prepuce or glans, to them the swollen
+prepuce seeming to be the whole organ. Of late years, however, it has
+been pretty well established that it generally begins in the prepuce,
+and the great number of amputations of the penis on record for this
+disease does not lead one to believe that it is as rare a disease as was
+formerly believed. In Langenbeck's _Archiv_, Bd. xii, 1870, Dr.
+Zielewicz reports fifty cases of amputation of the penis by the
+galvano-cautery loop, mostly for carcinoma, one of the fifty being for
+gangrene and one other for a large papillary tumor. That one surgeon was
+able to report forty-eight cases of carcinoma or cancer that were
+treated by one special system of operating tells us plainly enough that
+the unfortunate possessor of a prepuce, no matter how normal or
+unobjectionable it may seem to be in the prime of man's existence, or
+however physiologically necessary it may be deemed, runs too many risks
+in holding on to his possessions.
+
+The views set forth by Hutchinson in the beginning of this chapter are
+precisely those that are held by the writer, who would even go further,
+by advising all such as have, in their youth or since, suffered with
+balano-posthitis in any degree or form, or whose prepuce shows a
+tendency to elongation with age, to have the same removed at once; where
+the prepuce is not redundant, but only tight, a slight operation, such
+as slitting, will at once remove the possibility of any future danger,
+without keeping a man from his business a single day.
+
+It may here be remarked that, although always favorably impressed with
+the great benefits arising out of circumcision, nothing ever resulted in
+such a serious consideration of the subject as seeing a professional
+brother dying with a cancerous affection of the penis. The disease had
+originated in the mucous lining of the prepuce, and when seen in
+consultation with his attending physicians the gland had already
+disappeared and the inguinal glands were affected. The man was in the
+prime of life, and, aside from the local trouble, a specimen of perfect
+health and physique. He informed us that while a youth he had suffered
+from repeated attacks of herpes preputialis; that he had suggested
+circumcision more than once to his father, who also was a physician, but
+who, unfortunately for the son, could not see any merit in circumcision.
+To his eyes there was nothing that circumcision could do but what could
+be accomplished by washing and personal attention to cleanliness. When
+older, the prepuce gave him less trouble, and for a long time after his
+marriage it ceased to trouble him altogether. The idea of the necessity
+of circumcision did not occur to him again until the appearance of the
+cancerous disease; even then, not appreciating the danger, and looking
+upon the trouble as a simple transient result of some inflammatory
+action, he waited until the parts would be in a better state or
+condition of health before resorting to an operation,--that time never
+came.
+
+Although to Roux, Wadd, and Hey the credit must be given for bringing
+the subject of cancer of this organ so prominently before the
+profession, the knowledge of the existence of the disease has long been
+a matter of record. Patissier, in the fortieth volume of the "Dict. des
+Sciences Medicales," quotes from the third volume of the "Memoires de
+l'Academie Royale de Chirurgie," that in 1724 an officer, aged fifty,
+was attacked by a cancerous affection originating underneath the
+prepuce; at the time he consulted MM. Chicoineau and Sonlier the
+disease had existed for two years, the inguinal glands were implicated,
+and even the suspensory ligament was affected. These surgeons,
+nevertheless, determined upon an operation, and, after a long chapter of
+haemorrhagic accidents, the patient finally made a recovery. Another
+case, quoted by Patissier, was operated upon by M. Ceyrac de la Coste,
+the patient a man of sixty, the disease originating, like the preceding
+case, underneath the prepuce.
+
+Warren, in his "Surgical Observations on Tumors," observes that cancer
+of the penis begins by a warty excrescence on the glans or prepuce.
+Walshe, in his work on the "Nature and Treatment of Cancer," says: "The
+disease may commence in almost all parts of the organ, but the glans and
+prepuce are by far its most common primary seats. It may originate
+either from a warty excrescence or a pimple, or it may infiltrate the
+glans, or appear as a complication of venereal ulceration. Phimosis,
+either congenital or acquired, is an exceedingly common accompaniment,
+and it appears probable that the irritation occasioned by this condition
+of the parts may act as an exciting cause of the disease in persons
+predisposed to cancer. Circumcision is, therefore, an advisable
+prophylactic measure, where the constitutional taint is known to
+exist."
+
+
+
+
+CHAPTER XXI.
+
+THE PREPUCE AND GANGRENE OF THE PENIS.
+
+
+Another accompaniment of that preputial appendage is gangrene of the
+penis, which, like carcinoma, starting in at the prepuce, may invade the
+pubes and scrotum. This disease is not so rare as to merit the little
+attention it has received from our text-books. M. Demarquay has
+collected the history of twenty-five cases; from him we learn that the
+prepuce is the most frequent seat of the start of the affection, from
+whence, according to Astruc, it rapidly spreads to the skin of the whole
+organ, and then attacks the corpora cavernosa; it may even extend as
+high as the umbilicus. This disease spares no age; it attacks young and
+old alike.
+
+There is not a case recorded of this disease that particularized any
+other starting-point than the swelling, tension, active or passive
+congestion that takes place in the integument of the penis. By this it
+must not be understood that the initial disease or inflammatory action
+that produces the gangrene must necessarily have its seat in the
+integument, but that it is the integument of the penis (and especially
+that of the prepuce) in which, through the laxity of its tissues,
+passive congestion is favored that the gangrenous action begins. That
+this is the actual case there can be but little doubt about, as, even
+where the gangrene invades the body of the penis itself, even where the
+inflammatory action may have started from a violent urethritis, that
+condition of blood which favors gangrenous results will be found to
+have begun during its state of stasis, where it has parted with much of
+its watery element, as well as considerable of its vitality, while in
+its slow, tedious, and obstructed passage through the prepuce. Some of
+this dark, thickish blood, finding its way from the integumentary return
+circulation to that of the deeper structure, becomes there a mechanical
+as well as a pathological cause for that impediment to the free
+circulation of the parts, through its altered physiological condition.
+The deeper structures of the penis, besides their own blood-supply,
+carry back into the deeper or systemic circulation a large supply from
+the integumentary tissues, when in the latter, owing to the greater
+supply due to any inflammatory action, the blood-current is delayed and
+impeded in its lax and easily-dilatable tissues, and blood-changes occur
+favoring the gangrene in the deeper tissues, so that, whether the
+gangrene first takes place in the body of the penis or in the scrotum,
+it will be in the prepuce or adjoining integument that its real
+originating causes will be found.
+
+Baron Boyer, in speaking of the inflammation of the penis, observes that
+the intensity of the swelling, great pain, and difficulty of urination
+that follow have led many to believe that the inflammation of the deeper
+structures really always formed a part of the disease. In otherwise
+healthy and vigorous subjects it does not, however, extend beyond the
+skin, as has been demonstrated where the resulting gangrene from excess
+of inflammatory action has ended in resolution, the deeper tissues not
+having been found to be injured. It is only where the tone of the
+general system is lowered, through disease, age, or other deteriorating
+conditions, that the whole organ is liable to become affected or to
+break down.
+
+Boyer, in the tenth volume of his "Treatise on Surgical Affections,"
+gives several examples of this affection not due to age: one case was a
+person, simultaneously attacked by an adynamic fever and a
+blennorrhagia, who suffered from gangrene of the penis; the local and
+constitutional disturbance was not high, however, and the patient
+escaped with the simple loss of the prepuce.
+
+Another case admitted to the Charite, aged thirty-six, was afflicted
+with a blennorrhagia, upon which an attack of low fever supervened. The
+penis inflamed, became engorged and livid, and soon gangrenous symptoms
+presented themselves, making rapid progress; at first the integument
+alone was affected, but later all the structures became implicated and
+the penis was completely destroyed, the sloughs detaching themselves in
+shreds, leaving a conical stump that healed but slowly.
+
+One case, a young man of twenty, also at the Charite, was admitted with
+adynamic fever; a few days after admission the prepuce was observed to
+be somewhat inflamed; in spite of all treatment this progressed so
+rapidly that the purple discoloration presaged a gangrene, which was not
+slow in following; the focus seemed to be at the superior and back
+portion of the prepuce; an incision evacuated a quantity of purulent,
+serous fluid; the disease, however, extended up the organ as far as its
+middle before its actions ceased; the sloughs were then cast off, when
+it was found that part of the gland and a portion of the cavernous body
+had followed the integument in the general wreck, subjecting the patient
+to intolerable pain during micturition. After the recovery from the
+fever, the remaining portion of the gland and the mutilated parts of the
+cavernous body were amputated to remedy this condition; the patient
+subsequently admitted to have had a blennorrhagia at the time of his
+admission to the hospital.
+
+The gangrenous action may, in proportion to the low condition of the
+patient, be as proportionately rapid. Another case from Boyer, quoted
+from the works of Forestus, relates how the whole organ underwent such
+speedy disorganization that its liquefied remains were found in a
+poultice, which had been applied with a view of relieving the
+congestion,--a very dear price to pay for retaining the prepuce, that
+the exquisite sensitiveness of the tactile faculty for enjoyment,
+resident in the corona of the gland, might not be interfered with.
+
+Gross does not mention this affection in his work on surgery, but Agnew
+devotes considerable space to its description, dividing the disease into
+two forms: the inflammatory, such as may follow venereal primary sores
+or operations on the penis, not excepting circumcision; and the
+obstructive variety, such as may follow embolism or any mechanical
+obstruction, either purposely or accidentally applied. Of the latter he
+gives a number of quoted instances; he only admits seeing one case, that
+of an aged man in the Pennsylvania Hospital, in whom the disease was
+caused by embolism of the dorsal artery.
+
+J. Royes Bell, in the "International Encyclopaedia of Surgery," pays more
+attention to it than any of our American authors; mentioning, among the
+causes which may give rise to it, the exanthemata, especially small-pox,
+and the poisoning by ergot of rye and erysipelas. Among the local causes
+lie mentions phimosis, paraphimosis, and balano-posthitis.
+
+Bell quotes the case reported by Mr. Partridge, in the sixteenth volume
+of the "Transactions of the Pathological Society of London," wherein a
+sober man, aged forty, lost the whole of his penis up to the root,
+during the course of a typhus fever. Also the case reported by Mr. Gay,
+in the thirtieth volume of the same "Transactions," wherein a
+cabinet-maker, aged thirty-one, lost his penis through the probable
+results of rheumatic phlebitis, and due to the presence of a plug in the
+internal iliac vein. In the twelfth volume of the "Transactions" of the
+same society he finds the record of the case of a soldier who lost his
+penis through gangrene induced by syphilitic phagedena.
+
+In the consideration of the subject of the prepuce as connected with
+penile gangrene, it must not be overlooked that the presence of a
+prepuce may be the inciting cause of some rheumatic affection (the
+writer has repeatedly seen such), just as such cases are often the
+result of stricture; as cases of rheumatism that have resisted all
+remedial means, but that have readily given way to the dilatation of a
+stricture, are by no means uncommon; not a mere muscular reflex
+rheumatic pain, but even when accompanied by a rheumatic blood
+condition. So that even in such a case as above reported as being due to
+rheumatic phlebitis, or the case reported in the fortieth volume of the
+"Dictionaire des Sciences Medicales" by Patissier, wherein a man lost
+penis and scrotum through gangrene, induced by urinous infiltration, may
+all in the origin be due, if not to the immediate, to the remote effects
+of the presence of the prepuce.
+
+In the first volume of the _Journal of Venereal and Cutaneous Diseases_
+the writer reported a case of the complete loss of penis in a young man
+as a result of phagedena due to syphilis. The man had had a long and
+pendulous prepuce; in his case, had circumcision been performed in early
+childhood, it would have lessened the chances of primary infection, and
+had it been performed after his infection, it would have removed one
+cause--if not the principal cause--of the ease with which the phagedenic
+action was inaugurated. The case already mentioned as an example of
+spontaneous and natural circumcision belongs to the gangrenous results
+following phimosis, ending with the loss of the prepuce. In Maclise's
+"Surgical Anatomy" several specimens of deformity are figured, showing
+the results of this mildest of the effects of a phagedenic action. The
+beginning of the interference in the return preputial circulation
+undoubtedly always takes place over the superior aspect of the corona,
+where the pressure of the glans is most sharply defined against the
+inner fold of the prepuce.
+
+There are milder conditions, wherein the circulation of the prepuce is
+materially interfered with, both through the lax tissues of the parts
+and the peculiar anatomical construction and shape of the neighboring
+parts, wherein, without going as far as gangrenous breakdown, the person
+suffers considerably nevertheless, and is placed in danger of losing his
+penis; for, as observed by Patissier, whenever a person affected with a
+gonorrhoea is attacked by a putrid or any low-grade fever, he runs the
+greatest danger of losing his virile member through gangrene.
+
+Even where phimosis does not exist, but only the long, lax, and
+retractable prepuce, that is considered a perfectly physiological
+condition, the prepuce is liable to cause very distressing and
+complicating annoyances during the progress of other diseases. The
+writer has noticed that cases with a thick, leathery, and redundant
+prepuce, even when perfectly retractable, are more liable to require the
+use of the catheter during the course of a continued fever. Such a
+condition is also a very frequent accompaniment of prostatic
+obstruction. So often has this been noticed that its association with
+prostatic trouble or disease tends to the belief that the irritation
+produced by this condition of prepuce often lays the foundation for
+prostatic disease in not a few cases.[100] In elderly people, with the
+atrophied penis and elongating prepuce, the constant moisture from the
+urine on the inner fold and glans adds greatly to the irritation as well
+as to the discomfort of the patient.
+
+A number of affections are accompanied by oedema, especially toward the
+latter stages of the disease; such, for instance, as the ending of cases
+of mitral insufficiency. In these, the distension of the prepuce and the
+resulting balano-posthitis is at times a source of great distress, and
+at times the resulting engorgement produces a retention of urine. It was
+after an attendance on one such case that required daily and frequent
+puncturings for its relief, but which, in spite of all care, finally
+became gangrenous, that a fellow practitioner cheerfully submitted to
+circumcision, to avoid the possibility of any such complication
+occurring to embitter his closing illness.[101]
+
+The prepuce is the starting-point of many of the cases of penitis and
+retention of urine that often accompany attacks of gonorroea; especially
+can this result be anticipated where the prepuce is long, pendulous, and
+with its veins in a varicose condition. Why it should be so is
+self-evident. Anything that will add to the interference of the return
+circulation only exaggerates the tendency to penis engorgement; this
+increases the difficulty of urination, which, by the retention that
+results, in turn increases the constriction at the root of the penis,
+and adds to the already difficult return circulation. The bladder by its
+urine, and the penis by its blood, actually form, by their mutual
+pressures, an impassable dam at the root of the organ. That this is the
+true condition has been more than once verified from the instant relief
+given to the whole condition by the prompt employment of the supra-pubic
+puncture or aspiration, as catheterization in such cases is altogether
+out of the question, and should never be attempted or employed unless a
+soft catheter can be inserted.
+
+A person laboring under a continued fever has his blood in a condition
+to favor sphacelus; with the slow-moving current of vitiated blood and
+its retention in such lax tissues as those of the prepuce, through the
+medium of the enlarged preputial veins, coupled with the lessened
+sensibilities of the bladder and his perhaps semi-conscious or
+unconscious condition, and an equally unconscious bladder, he is, to say
+the least of it,--if in possession of a prepuce,--also the unconscious
+possessor of a certain degree of percentage, no matter how small or
+fractional that may be, of recovering from his fever without his penis.
+Dr. W. W. McKay, of the U. S. Marine Hospital Service of San Diego,
+attended a case of typho-malarial fever in consultation with me, where,
+but for the persistent, intelligent, but delicate use of the catheter
+for nearly three weeks the penis would have become gangrenous. The
+subject was an uraemic, irritable, nervous, leathery-prepuced individual;
+the organ was unusually large, the skin of the penis thick, and it was
+only by keeping the bladder empty that prevented a state of engorgement
+that would have effectually interfered with further catheterization. As
+it was, the penis was often dank, livid, and discolored from the passive
+engorgement.
+
+The writer saw a similar case with the late Dr. F. H. Milligan, of
+Minnesota. The congestion in this case was due to a gonorrhoeal
+inflammation involving the skin of the whole penis, retention having
+followed painful micturition, and the swelling of the penis following
+the retention; the prepuce was enormously distended, and the penis
+seemed in a state of erection as far as dimension and rigidity were
+concerned. The man, a steam-boat cook, informed us that it was fully
+twice as large as when rigidly erect in health. All efforts to reduce
+the swelling were unavailing; neither punctures, leeches, nor
+scarifications were of any avail; catheterization was impossible, but,
+after relieving the bladder by the supra-pubic aspiration, the patient
+experienced some relief. He, nevertheless, lost the whole skin of the
+penis, with that of the pubis and on the front of the scrotum. The man
+ran into a low form of fever, with uraemic symptoms; the stench was so
+great that it was almost impossible to remain in the same room with him;
+but he finally made a slow and very tedious recovery. In healing there
+was considerable downward curvature of the penis, which, however, did
+not prevent him from following his old, dissolute course of life.[102]
+
+A calm, unprejudiced consideration of the subject of the liability of
+the uncircumcised races dwelling in the temperate and semi-tropical
+countries to cancer, gangrene, and elephantiasis might well lead one to
+ask: Why are we afflicted with a prepuce? We can understand how a man
+may become gouty, and become a subject in the end for a gangrene of the
+extremities; or how senile gangrene may, through a series of
+pathological processes and blood changes, with the aid of age, finally
+be reached; or how, by a like course of diseased processes, we reach the
+apoplectic stage. These conditions, however, can be put off, or partly,
+if not wholly avoided, by a proper course of life, and, at the worst,
+it is only after the fires of our youth and prime have completely burned
+out, that these conditions are liable to claim us as their lawful
+victim. Not so, however, with some of these conditions that may end in
+penile gangrene; that are liable to pounce upon us unawares, like an
+Apache in an Arizona canyon; or as the hired mercenaries of old Canon
+Fulbert did upon poor Abelard in his study, and, without further ado or
+ceremony emasculate man as effectually as the most exacting Turk could
+demand, with a veritable _taille a fleur de ventre_ operation.
+
+Nature has her own ways of protecting what there is of any utility;
+there is a law of the survival of the fittest that we all appreciate.
+If, then, this penile appendage is of any utility, why is it that,
+unlike the rest of the body, it falls such an easy victim to gangrene?
+The procreative function seems to be, in a sense, one of the main cares
+of nature in its relation to the animal as well as the vegetable
+kingdom; but here is a useless bit of skin, adipose tissue, mucous
+membrane, and some connective tissue, that on the least provocation is
+liable to go off into a gangrene and drag one of the main generative, or
+even all the procreative, apparatus into the general wreck. Nature
+certainly never intended anything of the kind. To be generous, and not
+libel nature, we must conclude that the prepuce is a near relative to
+the fast-disappearing climbing-muscle; very useful in our primitive,
+arboreal days, when we needed such a muscle to reach our perch for the
+night, and a prepuce or something of the kind, in default of a
+breech-cloth, to protect the glans penis from being scratched by the
+briars or thorny and rough bark of the trees in our ascent. The prepuce
+was well enough in our primitive and arboreal days,--ages and ages ahead
+of our cave and lake dwellings,--when the notch in a tree and its rough
+bark formed our couch; but in these days of plush-cushioned pews and
+opera-seats, cosy office-chairs, car-seats, and upholstered furniture or
+polished-oak seats, it serves no intelligent purpose.
+
+Emasculation has never been looked upon with favor by its victim, and it
+would be but natural to suppose that man would take every precaution
+against the accidental occurrence of such an undesired condition. The
+writer well remembers that, in his "Tom Sawyer" days on the banks of the
+upper Mississippi, in the happy days of the crack rafting crews, before
+the introduction of the towage steamer, when the river towns were more
+or less terrorized by wild gangs of these men, some of whom were always
+fighting and quarreling and drinking when not at work. In the lot there
+was one man with a great reputation at a rough-and-tumble fight. His
+main hold was that he generally tried to emasculate his adversary by
+destroying the physiological condition of the testicle. The man was not
+a large or powerful man, nor was he a great boxer or wrestler, but this
+reputation made him feared by all the bullies on the river. The report
+that not a few who had tackled him had subsequently been of no value,
+either as fornicators or fecundators, or had to be castrated on account
+of the resulting testicular degeneration, seemed in no way to encourage
+any one to wish to meet him in a personal encounter. It would seem as if
+the desire to avoid such an accident--provided persons knew the dangers
+that lurk in a prepuce--would induce many to submit to circumcision.
+That many more do not do so can only be attributed to the general human
+wish to escape a less present evil for a greater unknown one, being
+evidently deterred by the prospective pain that must be suffered
+immediately.
+
+There is a question that should interest man above that of the simple
+loss of penis. It appears that there is a powerful moral effect that
+follows this loss, as might, in the majority, be anticipated. According
+to the experience of Civiale, many who have lost the penis, through
+amputation for disease or through disease itself, end in suicide. He
+mentions particularly a patient at the Charite who had lost his penis,
+who, finding no other means to take himself off, saved up sufficient
+opium, from that given him to calm his pains, to take all at one dose
+and commit suicide. In the London _Lancet_ for March 27, 1886, there is
+reported a discussion on this subject, to which the reader is referred,
+as it fully covers the moral and physical effects of castration and
+penis amputation for disease. M. Roux, who amputated the penis of a
+brother of Buffon, in 1810, reported that, in that case, M. Buffon lost
+none of his customary gayety.
+
+
+
+
+CHAPTER XXII.
+
+THE PREPUCE, CALCULI, AND OTHER ANNOYANCES.
+
+
+From an article published in the New York _Medical Times_ of March,
+1872, from the pen of Dr. J. G. Kerr, of Canton, China, we learn that
+phimosis is not an uncommon occurrence among the Chinese. As has been
+demonstrated by C. H. Mastin, of Mobile, climate is a great factor of
+calculus. ("Transactions International Medical Congress" of 1876, page
+609.) That of China seems a most favorable climate in this regard; so
+that, between the prevalence of phimosis among the Chinese and the
+calculus-producing tendency of the climate, China may be said to be the
+classic land of preputial calculi, as England is that of the gout, or
+the United States that of delirium tremens. From Dr. Kerr we learn that
+the occurrence of these concretions were, as a rule, multiple, and that
+in two cases that fell under his observation the number of stones from
+each individual exceeded one hundred. In one case there were forty, and
+in three cases there were between twenty and thirty. These were of
+different sizes and weight, some being an inch and five-eighths in
+diameter, and from that size down to where one hundred and sixteen taken
+from one individual case only weighed one ounce. The tendency to
+calculous disease in that climate may well be imagined, when the same
+observer relates a case of urinary infiltration into the skin on the
+under side of the penis that gave rise to the formation of a collection
+of calculi in that locality, four of which were the size of pigeons'
+eggs; and another case in which a urinary fistula induced the formation
+of a calculus in the groin, near the scrotum, the calculus weighing two
+and a half drachms and measuring one and a half inches by three-quarters
+of an inch in diameter.
+
+Claparede mentions a case in the practice of M. Dumeril, in which the
+stone extracted from the prepuce weighed two hundred and twenty-five
+grammes, or about eight ounces. Civiale speaks of a young man of twenty
+with phimosis, who, after practicing sexual connection for the first
+time, experienced pain and a purulent discharge, from whom, on
+examination, he removed five stones as large as prunes. The patient had
+felt them in their position, but had imagined the condition to be a
+natural one.
+
+E. L. Keyes gives their composition as being of calcified smegma, urate
+of ammonium, triple and earthy phosphates and mucus, and as symptoms and
+results: pain, purulent discharges, interference with urination and the
+sexual act, involuntary emission, ulceration of the preputial cavity,
+and impotence.
+
+Enoch mentions a child of two years in the Charite, who, being operated
+upon for phimosis, was found to have a preputial calculus occluding the
+urethral meatus. At the autopsy a calculus as large as an egg was found
+in the bladder.
+
+The presence of these formations, although not necessarily dangerous in
+themselves, may, by their effects and in the irritation they induce, be
+the means of producing serious mischief. The only preventive or remedy
+for this condition is circumcision.
+
+Acquired phimosis has been mentioned as a result of inflammatory lotion,
+such as is connected with balano-posthitis; it sometimes happens that,
+the act of coitus being done forcibly, especially with public women, who
+are apt to use very astringent and constricting washes, the prepuce
+becomes injured, with the result of producing a phimosis. One man will
+produce the same results through the means of some vaunted wash or dip
+which is supposed to act as a prophylactic to any venereal infection.
+One patient had developed a chronic herpetic affection by the constant
+use of an iodized ointment which he regarded as an infallible
+prophylactic. Many cases of phimosis result from the attending
+inflammation that follows on the liberal domestic application of nitrate
+of silver to an abrasion after connection, in the mistaken idea that the
+party labors under, that he is destroying some venereal virus.
+
+By the irritation that all these applications and accidents induce,
+warts and vegetations are the but too frequent results. These I have
+never seen in a circumcised individual, and their occurrence and
+frequency, as well as persistency, are directly proportionate with the
+degree of tightness, thickness, or redundancy of the prepuce and the
+irritability of the gland. As remarked by Lallemand, in reference to the
+victim of nocturnal enuresis becoming a future victim of nocturnal
+emissions, so it may be said of the person subject in early life to
+either warts, excoriations or vegetations on the penis, that it is this
+class that furnishes in after life the subjects for cancerous disease as
+well as furnishing the easiest victims for venereal infection. These
+warts, although easily removed, have a tendency to recurrence,
+especially as long as the moist bed that has once grown them there is
+still vegetating.
+
+The prepuce is liable to indurations and hypertrophy. Of the first
+anomaly, the London _Lancet_ of 1846 has a record of two cases in which
+paraphimosis was induced in elderly subjects, and of one in which it
+induced phimosis. Since then a number of cases of thickening and
+induration have been reported. Hypertrophy may take place in any degree,
+varying from the mere leathery and overpendulous but unobstructive
+prepuce to the case recorded by Vidal, in the fifth volume of his
+"Pathologie Externe et Medecine Operatoire," which happened in the
+practice of M. Rigal, de Gaillae. The hypertrophied prepuce was
+something enormous, and hung down to below the patient's knees; it was
+pear-shaped, with the base hanging downward; this base was as large as a
+man's head. This prepuce was successfully removed by M. Rigal, who
+presented the specimen before the Paris Surgical Society, who were then
+discussing a somewhat similar but not so extensive a case, presented by
+M. Lenoire. Vidal mentions having operated on a number of cases of this
+deformity of the prepuce in various degrees of growth.
+
+As a rule, simple hypertrophic disease of the penile integument does not
+interfere with the sexual functions of the male organ after its removal;
+it being susceptible of complete removal in exaggerated cases, even
+without touching the body of the organ. There are exceptions to this
+rule, however, when even this otherwise non-malignant disease may entail
+the loss of all the genitals. In the London _Lancet_ of July 11, 1846,
+at page 46, there is a record of a remarkable case of this nature
+reported by F. H. Brett, Esq., F.R.C.S. The case was that of a locksmith
+of forty years of age, who was naturally much phimosed. The penis was
+enormously enlarged, as well as the scrotum, which was more or less
+ulcerated and full of sinuses filled with a serous pus; some six months
+prior to the final operation, a part of the prepuce was removed to
+facilitate urination, but the whole mass had to be subsequently removed,
+including the whole of the skin of the penis and the scrotum, the
+testicles having been carefully dissected out and recovered with some
+skin flap.
+
+In this case the disease was believed to have originated from a perineal
+fistula. The pathological investigation in the case, however, by Mr.
+Quekett, who submitted the mass to a microscopical examination,
+confirmed Mr. Brett in his original opinion that the disease had the
+same pathological conditions as the similar disease found in India,
+where it originates from local inflammatory causes. In this case the
+preputial irritation was, in all probability, the precursor of the
+conditions that led to the perineal fistula, the patient having had a
+stricture for some twelve years. Mr. Brett states that the man had been
+abandoned by his wife on account of his previous sexual disability, and
+on account, as well, of his having been incapacitated from following any
+vocation. After the operation all his functions were restored and his
+organs were sound.
+
+Nelaton records a case reported by Wadd, in 1817, of an African negro so
+affected, whose penis measured fourteen inches in length and twelve and
+a half inches in circumference; also the case reported by Gibert, of
+Hospital St. Louis, of a subject "with a penis the size of a mule's."
+
+Mr. Brett attributes the recovery of his case as being due in a great
+measure to the moral support given to the patient from the knowledge
+that his procreative organs were not interfered with, and on the same
+grounds he attributes the great fatality previously attending the
+operation to the fact that it previously had been the custom in many
+cases to make a clean general _taille a fleur de ventre_, sacrificing
+all the genital organs. In simple hypertrophy, he considers that the
+body of the penis and the testicles will always be found to be in a
+normal condition; a careful dissection of the parts will invariably save
+not only the man's sexual functions, but his moral stamina, which he
+sadly needs in such an emergency. In the discussion on this subject
+heretofore mentioned as taking place in the London Medical Society, Mr.
+Pye, Mr. John A. Morgan, and others insisted on the necessity of
+retaining the testicles, whenever possible, in all these sweeping
+operations upon the genitals, they being actually necessary for the
+moral and physical support of man, Mr. Morgan observing that their
+removal would depress parts controlled by the sympathetic system.
+
+
+
+
+CHAPTER XXIII.
+
+REFLEX NEUROSES AND THE PREPUCE.
+
+
+We have seen in the previous chapters what the immediate effects of the
+prepuce may lead to; we have followed its local effects in childhood to
+youth, thence into what it does in our prime, and we have seen how, when
+we are on the down grade, owing to the increase of years, then, like the
+minute-men of Concord, wakened up by Paul Revere's classic ride, hanging
+on to the rear of the retreating and disheartened British, it harasses,
+worries, and downs a man here and there, striking down the man as if it
+had some undying, irremediable spite, which nothing but his misery and
+death could alleviate. Some authorities will argue that all that is
+required is cleanliness; that all men need do is to be like a true
+American, with the old Continental watchword of "eternal vigilance is
+the price of liberty" in continued active practice. A bowlful of some
+antiseptic wash and a small sponge should always be at hand, and he
+should be as industrious as if haltered in a tread-mill; he should make
+this a part of his toilet, and his daily and hourly care. This will, we
+are told, lessen his chances of becoming a victim to the many ills that
+lie in wait for him, all on account of the glory, honor, and comfort of
+wearing a prepuce, which is a perfectly physiological appendage.
+
+From these visible and apparently easily understood conditions and
+results we are now to enter a broad field, wherein the prepuce seems to
+exercise a malign influence in the most distant and apparently
+unconnected manner; where, like some of the evil genii or sprites in
+the Arabian tales, it can reach from afar the object of its malignity,
+striking him down unawares in the most unaccountable manner; making him
+a victim to all manner of ills, sufferings, and tribulations; unfitting
+him for marriage or the cares of business; making him miserable and an
+object of continual scolding and punishment in childhood, through its
+worriments and nocturnal enuresis; later on, beginning to affect him
+with all kinds of physical distortions and ailments, nocturnal
+pollutions, and other conditions calculated to weaken him physically,
+mentally, and morally; to land him, perchance, in the jail, or even in a
+lunatic asylum. Man's whole life is subject to the capricious
+dispensations and whims of this Job's-comforts-dispensing enemy of man.
+
+As strange as it may seem, this field of knowledge, this field of misery
+and suffering, disease and distortion, of physical and mental obliquity,
+presided over by this preputial Afrit of malignant disposition, was an
+unknown, undiscovered, and therefore unexplored region for some
+thousands of years, and it remained for an American to discover and
+describe this vast territorial acquisition, and to annex it to the
+domain of medicine, which, through its skill, could modify the influence
+of the evil genius that there presided and spare humanity much of the
+ills to which it had been subjected.
+
+In this regard, Louis A. Sayre was to medicine what Columbus was to
+geography. Neither Strabo nor Herodotus had anything to say regarding
+what existed beyond the pillars of Hercules, and neither Hippocrates nor
+Galen had anything in regard to this preputial Merlin, which in their
+day, even, had its existence. Neither did Tissot nor Bienville, the two
+pioneers in the field of our knowledge regarding onanism and
+nymphomania, dream of the existence of this one cause of the diseases
+to which they gave so much time and study. It is only some twenty years
+since Louis A. Sayre read his paper, entitled "Partial Paralysis from
+Reflex Irritation Caused by Congenital Phimosis and Adherent Prepuce,"
+before the American Medical Association. This was the starting-point
+from whence the profession entered into what had previously been a
+veritable "Darkest Africa."
+
+When we read that only some fifty years before the times of Columbus
+Christian Europe had no lunatic asylum,--not that there was a lack of
+lunatics or that the existence of lunacy was entirely ignored, but that
+the then state of medicine and the general intelligence was not
+emancipated from the idea of demoniacs,--and we are told that the
+lunatics were in many instances hung, quartered and burned, hooted and
+chased about the streets, or chained in gloomy dungeons; until, as
+related by Lecky, a Spanish monk named Juan Gilaberto Joffe, filled with
+compassion at the sight of the maniacs who were hooted by crowds through
+the streets of Valencia, founded an asylum in that city. His movement in
+this direction called the attention of the Church and people to this
+class in a practical light, and from Spain a more enlightened idea in
+regard to this class swept onward throughout Europe. As observed, it
+seems strange to us of the present day that such ignorance in these
+matters should, or could, have so long existed. It seems impossible for
+us to conceive how these conditions of incoherent action and of mental
+derangements could have existed and their causes have not been fully
+appreciated; and yet we were not above, some twenty years ago only,
+subjecting children to punishment and scoldings for being addicted to
+nocturnal enuresis, or of accusing cases of nocturnal and involuntary
+emissions as being due to masturbation. The child was allowed then to
+grow up paralytic, or with a deformed limb, or continually punished to
+correct what was imagined to be a condition of willful carelessness,
+irritability, or willful moral perversion. Perversion, stupidity, and
+irritability of the mind or temper were not known to depend, in many
+instances, on preputial irritation; children were, accordingly, worried
+and punished for something over which they had no earthly control or the
+least volition. Humanity cannot, at present, sufficiently appreciate
+what Louis A. Sayre has done in its behalf. It is here that we realize
+the hidden wisdom of the Mosaic law and the truth of the assertion of
+the late Dr. Edward Clarke, that, "The instructors, the houses and
+schools of our country's daughters, would profit by reading the old
+Levitical law. The race has not yet outgrown the physiology of Moses."
+
+These irritations from the preputial irritability are not always so slow
+moving as to span over either months or years in their fell work.
+Instances of their sudden action have been sufficiently recorded as to
+warrant them as being classed as causative agents in acute affections
+that instantly threaten life. In the London _Lancet_ of May 16, 1846,
+there is a record of a very peculiar case reported to the London Medical
+Society by Dr. Golding Bird: "The case was that of a child seven or
+eight weeks old only, an out-patient of Guy's Hospital. The child had
+become almost lifeless immediately after nursing, and to all appearances
+looked as if under the influence of some narcotic. It had not, however,
+had anything of the kind given to it, nor had it sustained a fall, nor
+was the head so large as to lead to suspicion of congenital
+hydrocephalus. On inquiring if the child passed water, the answer led to
+an examination of the prepuce, which was found to be elongated, and had
+an aperture only of the size of a pin-hole, like a puncture in the
+intestines. The urine was dribbling out; it was evident that the child
+had never completely emptied its bladder. Mr. Hilton slit up the
+prepuce, and all the symptoms were immediately relieved and soon
+entirely removed." Dr. Bird referred to a case which he had related to
+the Society some years before, which was reported in the _Lancet_ at the
+time, of a child who fell a victim to a malformation of this kind, and
+after death the bladder and ureter were found like those of a man who
+had long suffered from stricture. Mr. Hilton has seen many cases similar
+to the one mentioned by Dr. Bird. The greatest benefit resulted from
+slitting up the prepuce. In this case the benefit was very remarkable, a
+partial paralysis of the left side, under which the little patient
+labored, being quite removed in twenty-four hours.
+
+In this case the difficulty was evidently both the result of mechanical
+pressure and reflex irritation. A somewhat similar case as to its
+results is given by Dr. Sayre, to whom the case was reported by Dr. A.
+R. Mott, Jr., of Randall's Island, in January of 1880: "John English,
+aged 46, native of England, widower, clerk; admitted to workhouse
+hospital. Patient had been at work for a week as a prisoner; on the 23d
+of December was noticed to be restless and uneasy, and finally, in the
+evening, he fell from his bunk in a fit. During the next forty-eight
+hours he had several convulsions, and during the intervals lay in a
+semi-comatose condition, showing no consciousness except to stir a limb
+when pinched. Pulse, 120; temperature, 1011/2 deg.; respiration, 18.
+Swallowed nothing, and passed faeces in bed. Continued in this condition
+until December 25th (temperature having fallen to 100 deg.), when a string
+was discovered passed twice around the penis behind corona and tied, the
+long prepuce serving to conceal it from observation. While not
+sufficiently tight to occlude the urethral canal, still a firm,
+indurated band remained after the string was cut, and did not disappear
+for four or five days.
+
+"Within one hour after the removal of the string the man sat up and
+asked for milk, and from this time remained perfectly well (was under
+observation for three months). He declared that he remembered nothing
+that had taken place during the past three days; had never had fits,
+denied venereal diseases, was moderately addicted to drink, but had led
+a 'virtuous life since the death of his wife, two years before.'"
+
+The following case in the practice of Dr. F. J. Wirthington, of
+Livermore, Pa., was also reported to Dr. Sayre: "When the child was
+born, he was considered the biggest and finest boy that had been born in
+the community for a long time, until, when he was about two and a-half
+years old, and being sick, a doctor was called in, who told them that
+their child was paralyzed, the paralysis being in his lower extremities,
+and who treated him with the usual nerve-tonic and with electricity.
+Notwithstanding all this, the boy went steadily down, and the paralysis
+continued until he was seen by Dr. Wirthington. The child was then
+unable to walk; on examination, the prepuce was found to be adherent
+almost all the way around the glans penis. Behind the corona was a solid
+cake of sebaceous matter. The case was promptly operated upon, and,
+although the previous attendant had not found any cause to account for
+the paralysis, a rapid recovery took place, the boy being able to walk
+even before the complete cicatrization of the wound, and was soon the
+picture of health."
+
+Dr. T. F. Leech, of Attica, Fountain County, Ind., reports a case of a
+fourteen-month-old child, who had been the terror of all that part of
+the town for over six months, as he cried constantly. Except when asleep
+or nursed by his mother, he would lie perfectly still and squall, not
+showing any disposition to sit up; nor did he like to be raised up. He
+was very nervous, and would have times when his limbs would be rigid.
+This state of things grew worse, until the child was accidentally seen
+by Dr. Leech, who, on examination, found a contracted and adherent
+prepuce, the child being at the time in a high fever and suffering great
+nervous excitement. An operation by slitting and breaking up the
+adhesion afforded immediate relief; the spinal irritation, partial
+paralysis of the lower extremities, spasms during urination, and all
+trouble disappeared as if by magic.
+
+Prof. J. H. Pooley, of Columbus, Ohio, reported the case of a fine,
+healthy boy who, up to three months before being seen professionally,
+had always been well and in perfect health. His condition was found by
+Professor Pooley to be one of localized chorea, manifesting itself in
+constant convulsive movements of the head. They were nodding or
+antero-posterior movements, alternating with lateral or shaking and
+twisting motions; these movements had become almost constant during the
+waking hours of the child. There was no distortion of the features nor
+any choreic movements of the extremities; indeed, the whole affection
+consisted in the nodding and shaking movements of the head referred to.
+These were almost incessant, sometimes slow and almost rhythmical, then
+for a minute or two rapid and irregular, seeming to fatigue the little
+fellow, and accompanied by a fretful, whimpering cry. The child had been
+subjected to a variety of treatment, but without any benefit or effect
+of any kind. Upon the most careful examination of the patient and his
+history, Professor Pooley could not discover anything that seemed to
+throw any light upon the case, except a condition of well-marked
+phimosis. Acting upon this, the Professor immediately circumcised the
+child, and from the very day of the operation the spasmodic action began
+to diminish, and in two weeks he was entirely well, without any other
+treatment of any kind.
+
+Dr. W. R. McMahon, of Huntington, Indiana, has reported three cases of
+epilepsy in children caused by congenital phimosis that were entirely
+relieved by an operation without any subsequent return of the
+difficulty. One of the cases was in a boy ten years old, with very firm
+preputial adhesions and a high grade of inflammation of the parts.
+
+Dr. J. D. Griffith, of Kansas City, Mo., operated on a case of phimosis
+on a child nearly three years of age, who was afflicted with repeated
+attacks of convulsions and paralysis of the hips and lower extremities;
+the little fellow had as many as fifteen convulsions in a day; the
+patient was greatly troubled with painful urination and priapism. On
+examination at the operation, a firmly adherent prepuce and a large roll
+of caseous matter was found just back of the corona. A complete recovery
+followed the removal of these conditions.
+
+The above cases are taken from the paper read before the Section of
+Diseases of Children at the International Medical Congress of 1887, by
+Dr. Sayre. It contains a number of additional cases of an analogous
+character to the above, reported to him by physicians in different parts
+of the country. They show the variety, extent, and far-reaching
+character of the diseases induced by any preputial irritation. Dr. G. L.
+Magruder, of Washington, D. C., in the same paper, has a record of
+twenty-five cases of various nervous disturbances which he had entirely
+relieved by circumcision or dilatation, without any medication whatever.
+Dr. Magruder, in concluding his report, in which he quotes the authority
+of Brown-Sequard, Charcot, and Leyden, as having noticed serious nervous
+disturbances resulting from reflex irritation due to affections of the
+genito-urinary organs, observes as follows:--
+
+"From the foregoing, I think that we are justified in the conclusion
+that phimosis and adherent prepuce give rise to varied troubles of more
+or less gravity, manifesting themselves either in the muscular, osseous,
+or nervous systems; and that the removal of these abnormal conditions of
+the penis frequently affords marked relief, and, at times, perfect and
+permanent cure."
+
+In the discussion that followed the reading of Dr. Sayre's paper, Dr. De
+Forest Willard, of Philadelphia, remarked that he had operated by simply
+stripping back the prepuce and that he did not circumcise, but that he
+looked upon the subsequent cleanliness of the parts as the greatest
+safeguard, not only as against reflex irritation, but also against
+masturbation. Retained filth and smegma are far more likely to call a
+boy's attention to his penis by their unrecognized irritative effects
+than washing can possibly do. His practice is in accordance with the
+belief that young children can be relieved by the simpler methods, such
+as dilatation; but he also observes that when a child has reached eight
+or ten years of age, and has never been able to expose the glans,
+contraction is almost certain to be present, and circumcision must be
+performed. In adults there is rarely any escape when the prepuce is
+tight.
+
+Dr. I. N. Love, of St. Louis, said: "It has been my judgment and my
+practice for many years, in these reflex irritations, to pursue the
+radical course of circumcision. I believe thoroughly in the Mosaic law,
+not only from a moral but also from a sanitary stand-point. All genital
+irritation should be thoroughly removed. It is all very well to instruct
+the mother or the nurse to keep the parts within the prepuce clean, but
+they can not or will not do it. Complete and proper removal of the
+covering to the glans takes away all the cause of disturbance. Dr. Sayre
+takes a more pronounced position on this subject than the majority of
+those who have discussed his paper. An improper performance of a
+surgical procedure is no argument against the operation, but rather
+against the operator. For the reasons I have given, I am in favor of the
+radical application of the Mosaic rite of circumcision."
+
+Dr. J. Lewis Smith, the president of the Section, believed in the evil
+results of the reflex irritation due to abnormality of the prepuce. In
+many instances the causative relation of the preputial disease to the
+symptoms which it produces is not so apparent as it may be in others,
+but after correct treatment of the prepuce they disappear. There was one
+result of phimosis which, he observed, neither Professor Sayre nor those
+who contributed to his paper noticed. The expulsive efforts accompanying
+urination sometimes cause prolapsus of the rectum, and frequently
+produce inguinal hernia. In a lecture before the Harveian Society
+(_British Medical Journal_, February 28, 1880), Edmund Owen, Surgeon to
+St. Mary's Hospital and to the Hospital for Sick Children, says:
+"Perhaps the commonest cause of hernia in childhood is a small preputial
+or urethral orifice, and next to that I would put the smegma-hiding or
+adherent prepuce." Arthur Kemp (London _Lancet_, July 27, 1878), Senior
+House-Surgeon to the Children's Hospital, says: "Phimosis is a common
+occurrence, and numerous ill effects can undoubtedly be attributed to
+it;" and he alludes to the observation of Mr. Bryant, as published in
+his book on the "Surgical Diseases of Children": "In fifty consecutive
+cases of congenital phimosis, thirty-one had hernia, five had double
+inguinal hernia, and many had umbilical hernia besides. In no one was
+the hernia congenital, its earliest occurrence being at three weeks.
+Circumcision was performed in these cases, and all were much
+benefited."[103]
+
+During the session of the Ninth International Congress, where the above
+paper was read and remarks made, which appear in the third volume of its
+"Transactions," another paper was also presented by Dr. Saint-Germain,
+of Paris. The Doctor fully recognized the dangers from a narrow or
+adherent prepuce, but did not think that more than one case in three
+hundred really required circumcision; he believed in dilatation, as
+employed by Nelaton, with the exception that, whereas Nelaton employs
+three branches to his dilator, Saint-Germain preferred only a two-branch
+dilator.
+
+Dr. Lewis, the president of the Section, related a number of cases where
+the use of uncleanly instruments had resulted disastrously. But, for
+that matter, the same objection can be offered against dilatation, as a
+filthy instrument is as liable to infect the patient as a knife. There
+is no earthly excuse why a knife that has been used on a case of
+diphtheritic croup should be used some hours afterward to circumcise a
+child. As to the operation of dilatation practiced by Dr. Holgate, it
+can really be said to answer the _immediate_ demands, but how far its
+utility is efficient as to _permanent_ results Dr. Holgate has not
+given the profession any information.[104]
+
+One of the most interesting and instructive papers that it was ever the
+fortune of the writer to listen to, touching on the subject of reflex
+nervous diseases or neuroses due to preputial adhesions, was one
+prepared by Dr. M. F. Price, of Colton, California, and read at the
+semi-annual meeting of the Southern California Medical Society, at its
+Pasadena meeting in December, 1889. In the course of the paper he gives
+a considerable number of examples, of which some extracts are herewith
+given: One case was a boy aged seven, who for two years had had frequent
+attacks of palpitation of the heart; when seen by Dr. Price the little
+heart was laboring hard, beating at a furious rate (far beyond
+counting), with a loud blowing or splashing sound, and the pulse at the
+wrist a mere flutter. The breath was inspired in a series of jerks, the
+face flushed and somewhat swollen. The chest-wall was visibly moved at
+every thump of the heart. The doctor attended the child for a month
+without the little patient making any appreciable improvement. Some time
+during this period of observation the father happened to mention that
+the boy sometimes complained of his penis hurting him at the time of an
+erection. This led the doctor to examine the parts, when he found a long
+prepuce, with a mucous membrane adherent to the glans, about a line
+beyond the corona, the whole circumference of the organ. With the use of
+cocaine and a blunt instrument the adhesions were removed, with an
+immediate amelioration of all the reflex symptoms. The very next
+paroxysm was lighter and less exhausting; the improvement was
+continuous. The child soon went to school and had no further trouble;
+but, in the doctor's opinion, the two years' hard struggle have not
+been without its evil results on the constitution and organism of the
+child.
+
+The next case was born November 2, 1888; a large, healthy boy at birth.
+By June of the following year the child was afflicted with what the
+mother called "jerky spells;" up to this time the boy seemed listless,
+did not care to sit up, and seemed from some cause to be in more or less
+pain, with his eyes turned to the left. The parents dreaded that the
+child, their only one, would turn out idiotic. The spasmodic spells
+alluded to were of a tetanic nature, the body being thrown backward; his
+head and eyes continued to be turned to the left, and nothing could
+attract the child's attention. The boy cried night and day, but he was
+in good flesh, had all the teeth he should have, bowels were regular,
+and the appetite good. Whatever the doctor did in the medical way seemed
+to be of no avail. One day, however, he thought of examining the
+prepuce, thinking, perhaps, that it might be contracted and that the
+convulsive movements might be reflexes from the parts. On examination
+the prepuce was found elongated and distended, with a very minute
+opening; this was dilated with difficulty, when the inner fold was found
+adhering almost the whole extent of the glans; the dilatation and
+breaking down of these adhesions was slowly persevered in, until
+sufficient dilatation was obtained and the glans was freed. From the
+very first operation the convulsions commenced to diminish, both in
+force and frequency, and a constant and rapid improvement of the child
+took place. Six months afterward the boy was perfectly normal, stood by
+himself, played with play-things, and was an interested member of the
+family circle.
+
+Case No. 3 was a repetition of Case No. 2, except that, with the
+experience of the latter case, the doctor wasted no time with
+medication, but proceeded at once to examine the prepuce, which was
+found to be very long, and with a pin-hole opening. The dilatation of
+this and the breaking up of the adhesions gave immediate relief. During
+the course of the paper he quoted the case related by Brown-Sequard, and
+recorded in the New York _Medical Record_, vol. xxxiv, p. 314, where he
+"related a very interesting case that presented all the rational signs
+of advanced cerebral disease, a case that he considered quite hopeless,
+that was relieved by an operation for phimosis and the treatment of an
+inflammatory condition of the glans penis." To use Brown-Sequard's own
+words, "So rapid was the recovery that within six weeks from the day of
+the operation he presented himself at my office perfectly well in every
+respect."
+
+In the early part of this book, in speaking of female circumcision, it
+was mentioned that when the medical part of the volume should be reached
+some medical reasons for its necessity would be given. Dr. Price, in his
+paper, gives some information on this subject, which is of the greatest
+interest. In the course of the paper he says as follows: "Nor do I think
+these reflex neuroses from adherent prepuce wholly confined to the male
+sex. The preputium-clitoridis may be adherent and produce in the female
+similar reflexes. During the session of the American Medical
+Association, held in Chicago in 1874, I think, I attended one afternoon
+a clinical lecture by Dr. Sayre. A little girl, fourteen years of age,
+but about the size of a seven-year-old child, was brought in, who had
+never walked nor spoken, but with quite an intelligent countenance, who
+was in constant motion, and who presented very many nervous symptoms.
+Dr. Sayre examined her, and found the prepuce adherent the whole extent
+of the clitoris. He gave it as his opinion that here was the primary and
+sole cause of the symptoms, and that appropriate treatment shortly after
+birth would have prevented all the serious consequences so painfully
+apparent, and which was then too late to remedy.
+
+"I once had occasion to pass a catheter into the bladder of a lady who
+presented an innumerable train of nervous symptoms, often bordering on
+insanity, but was unable to do so without exposing the parts. Although
+the meatus could be distinctly felt, the catheter would not enter. On
+exposure to view, an opening was seen in the clitoris, which was firmly
+bound down by preputial adhesions near the extremity of the organ.
+Entering the catheter at this point, it readily passed through the
+clitoris, then down through a passage under the mucous membrane to the
+natural site of the meatus, on into the urethra, and through into the
+bladder. In the light of recent experience, my opinion now is, that here
+was the cause of all the nervous symptoms in this case."
+
+The relative disposition in regard to the irritability of the external
+sexual organs as existing in the female, when contrasted with the male,
+is, for some reason, not sufficiently considered or understood. The idea
+of masturbation or of irritation from the genitals ending in reflex
+neuroses is always, as a rule, associated with the male, and that it has
+not been more associated with the female has deprived her of the same
+benefit that the prosecution of the study in this regard has been to the
+male sex. Masturbation among the feeble-minded, which is so common,
+must, of necessity, have for its determining cause a foundation of
+morbid irritability of the sexual organs. This is well known to be so
+among the males, whose hands seem instinctively to be drawn to those
+parts. Dr. C. F. Taylor, of New York, in an article on the "Effect of
+Imperfect Hygiene of the Sexual Function," published in the _American
+Journal of Obstetrics_ for January, 1882, gives us an account of his
+investigations in this regard, with the following results: "In an asylum
+for the feeble-minded of both sexes, it was found that the habit was
+about equal in the two sexes, there being only this difference: that the
+females began to masturbate one or two years earlier than the males, and
+that the habit, once established, was found to be more persistent than
+in the males. It was, further, ascertained that the habit came
+naturally, without the aid of precept or example to either sex."
+
+It may well be a question as to whether the feeble-mindedness be not a
+reflex condition from this excessive morbid irritability of the sexual
+organs. There is not much doubt but that, if one of the cases reported
+by Dr. Price had not been circumcised, the expressionless, listless
+infant would have grown, in time, into a masturbating, feeble-minded,
+idiotic creature, as many others, so situated, have done before it. Now,
+would it have been logical to have laid the morbid irritability of its
+generative organs to its feeble-mindedness, when its feeble-mindedness
+was fully demonstrated to have been wholly dependent on the sexual
+irritation? From these premises we might take another step forward, and
+ask whether, under a proper hygienic prophylaxis,--which would involve a
+thorough inspection of the genitals of _all_ children reported to be
+either physically or mentally deficient,--such a course would not
+greatly diminish the number of paralytics, feeble-minded, and generally
+deficient of both sexes? If the results in private practice are any
+criterion, it is safe to assert that a strict adherence to the Mosaic
+law for the males and to some of the African customs for the females
+would most assuredly relieve all these cases that might come under the
+caption of results of reflex neuroses. Twenty years ago this subject
+was, to the body of the profession, a _terra incognita_ in regard to the
+male, and, as the female is similarly subject to the same morbid
+influence, it is to be hoped that in the present decade she will receive
+the same attention which the profession is now beginning to pay to the
+male sex.[105]
+
+In the foregoing parts of this chapter, examples of reflex neuroses have
+been given to show the different effects that genital irritation will
+produce. The cases given were chosen for the diversity of variety of
+symptoms, and as cases representing the affection, without any other
+complication. Many more could have been added, but they are unnecessary.
+In the writer's practice there has been a number of cases in the adult
+that have exemplified that this form of ailment is by no means
+restricted to children, as has been shown in the case reported by Dr.
+Mott to Dr. Sayre, in regard to the middle-aged man with a string about
+his penis. One of these cases was that of a young man, six feet in
+stature, broad-shouldered, and well built. He applied for relief for a
+dyspepsia that affected his stomach and also his heart. The man had an
+apparently feeble and irritable heart; cold, clammy skin; disturbed
+digestion, and uneasy sleep; was constipated and flatulent. No treatment
+seemed to make any impression upon his case. At last he began to
+emaciate and look haggard. His mind was also becoming visibly weaker,
+was attacked by dizziness, and on several occasions he fell in a fit.
+With this condition he at last began to have frequent nocturnal
+emissions. On account of the latter his genital organs were examined,
+and the penis was found smaller than the average, with a long and narrow
+prepuce. The glans could easily be uncovered, but the tightness of the
+prepuce and its unyielding qualities made paraphimosis a possibility; so
+that the young man, having once or twice had considerable difficulty in
+returning the prepuce to its place, never attempted its retraction
+again. There were no adhesions, but the inner fold of the prepuce had
+been thickened by balanitis. Seeing the need of circumcision _for the
+local benefit_, the operation was suggested with a view of relieving the
+pressure on the glans, which was looked upon as the probable cause, in
+his broken-down condition, of the advent of the nocturnal emissions. He
+gladly submitted, and, to the surprise of both physician and patient,
+_all_ his troubles disappeared, and he at once became a changed man. So
+impressed was he with the result, that, on his return to his home, he
+examined his younger brother, and, finding him with a like long, narrow
+prepuce, he immediately brought him in and had him circumcised, as a
+prophylactic against his being subjected to the risk of lost health as
+he himself had suffered.
+
+Another case, a man of forty-five, also a farmer, was afflicted with
+dyspepsia, palpitation of the heart, general debility, constipation,
+constant headache, etc. He could not cut up an armful of wood without
+bringing on palpitations and gaseous eructations, or being upset for the
+day; and after having connection with his wife he generally had a
+terrific headache, lasting for two or three days;[106] he could stand no
+protracted mental effort, even such as is required to make an addition
+of a long line of figures, or the least business worry, without the
+supervening headache. All treatment against these conditions was
+useless; the colon was kept empty, the diet was changed; pepsin and
+bismuth, tonics, frictions, Turkish baths, and all hygienic observances
+and moral treatment were all of no avail. One day, on consulting the
+writer, he complained of a pruritus at the head of the penis. On
+examination it was found that he had a narrow, long prepuce, a
+congenitally-contracted meatus, and was then suffering with a slight
+balanitis. He was very careful to keep the parts clean, but, he informed
+me, that in spite of all precautions, these attacks would come on. The
+mucous covering of the inner fold of the prepuce and glans was so
+irritable that connection often brought it about. The glans was small
+and elongated, with the meatus red, and with lips oedematous and
+congested. To free him from this tormenter, circumcision was advised.
+The party could not, however, remain away from home for the time
+required for the operation; so that a compromise operation was
+performed,--one that would not keep him from business, and, at the same
+time, relieve the contracting pressure on the glans. This was by
+Clouquet's operation and bandaging back the prepuce over the penis, back
+of the corona,--an operation that, in my hands, has often filled all the
+desired purpose. The meatus was also incised. After the operation _all_
+of his troubles disappeared, as they had done in the preceding case, and
+he was soon a hearty and well man, able to chop wood, attend to
+business, and, in case of need, do family duty for a Turkish harem
+without recurrence of his old tormenting, dyspeptic palpitation or
+sick-headache.
+
+The writer has resorted to circumcision in many cases to improve the
+temper and disposition of children, with the best of results, and in one
+case, in association with another physician, performed the operation on
+a lunatic, whose lunacy ran to women and girls, with whom he would fall
+desperately in love, without any encouragement or provocation, or even
+acquaintance; finally reaching spells of such incoherence of action and
+speech that confinement would be required. The peculiarity of his
+hallucinations called attention to the genital organs. This man had
+never masturbated, and was, when well, a compactly-built, active, and
+intelligent man. By occupation he was a contractor, and a man of more
+than usual executive ability besides. On examination it was found that
+he was a subject of congenital phimosis, never having been able to
+uncover the glans. He had been in the habit of washing out the preputial
+cavity by the aid of a flat-nozzled syringe. The prepuce was long, but
+not thick; nevertheless, it was inelastic and very firm. The examination
+seemed to have a good mental effect upon the man, as it made him quite
+rational for the moment. He entered into the idea that this condition
+had some connection with his derangement very intelligently, even
+suggesting many symptoms and attacks that he had suffered from childhood
+up as probably gradual-stepping processes through which his present
+condition had been reached. He cheerfully submitted to a thorough
+circumcision, which had the effect of ameliorating his condition. He was
+subsequently sent to an asylum, where, after a short time, he was
+discharged well. Some years afterward, conscious of feeling a return of
+the mental derangement, he voluntarily applied for admission to the same
+institution and remained until better.
+
+This case is very instructive. The patient readily connected his
+mental trouble, by a retrospective view through a series of
+gradually-increasing troubles, that originated in the preputial
+condition, to the phimosed condition of that appendage, and he was
+certain that this prepuce had been at the bottom of all the physical and
+mental trouble he had experienced. The reflex nervous train of
+affections had undoubtedly produced some localized lesion in the
+brain-structure. The natural sound, healthy organism of that organ, and
+the bright, active nature of his mind, however, prevented a total
+wreckage of the mental faculties. It is safe to assume that, had he had
+the ordinary listless, unresisting mind, disposed to brood, and easily
+cast down, he would, from the first derangement, have become a hopeless
+and demented lunatic. The circumcision could not undo all the mischief
+that had been accomplished, some of which had certainly left a permanent
+taint, but the mildness of his future attacks and the better exercise of
+his volition were the undoubted results of the operation.
+
+
+
+
+CHAPTER XXIV.
+
+DYSURIA, ENURESIS, AND RETENTION OF URINE.
+
+
+Any dissertation on circumcision and its many uses, either prophylactic
+or curative, would be incomplete without a reference to enuresis;
+another reason for making a somewhat full reference to the subject would
+be the undecided position that this morbid condition seems to occupy in
+medical literature, as well as the meagre and unsatisfactory treatment
+it has received by the majority of those who have mentioned it. It is
+anomalous, to say the least, to find, in general or special literature,
+enuresis mentioned as a diseased condition peculiar from babyhood to
+puberty; to find it fully described and to have it stated that it is a
+widely-prevalent distemper, affecting both sexes alike; to know that it
+is an annoying, intractable, persistent condition, wearing to the child
+in every sense, subjecting it to a demoralizing mortification as well as
+to unmerited scoldings, humiliations, and punishments, and that its
+habit, in badly-ventilated quarters, will breed other diseases,[107] as
+well as that its continued action tends to the development of onanism,
+with its long and widely-ramifying trains of physical and social ills;
+and to find works especially devoted to children's diseases silent on
+the subject. Knowing all these things, and also that Ultzmann,
+Lallemand, and others who have treated this affection, mention it as a
+children's disease, it is unaccountable to reason out why most of our
+text-books and treatises on children's diseases should be so remarkably
+and unreasonably silent. It certainly cannot be laid to its lacking in
+study material, as the author of "Quain's Dictionary of Medicine" says:
+"It is one relative to which much might be written without exhausting
+the subject, the pathology of which has wide and manifold relations....
+There appears to be something analogous between this condition and that
+which determines in after life the seminal emissions under similar
+circumstances." Our American works are notably deficient in this regard;
+although Stewart, of New York, in his "Diseases of Children," published
+over fifty years ago, devotes a chapter to dysuria and one to retention
+of urine, treating the subject quite fully, even down to the description
+of preputial calculi; he, however, failed to notice that the irritation
+of preputial constriction or adhesions will produce both conditions,
+and, following many of the authors of the time, as has been done since,
+he adopted the urino-digestion theory of acid and irritating urine, due
+to faulty digestion, of Prout and Magendie, who looked to regulating the
+digestion of the child, or the mother who nursed it, as the only method
+of cure; the lithic-acid diathesis being, in their opinion, the main
+thing to be guarded from.
+
+Other works that mention these conditions are equally on the wide sea of
+speculation, as they all, more or less, look upon the treatment that
+they advise as indefinite and unsatisfactory, showing an equal want of
+sound anchorage-grounds for their etiological reasonings. Dillnberger,
+of Vienna, in his hand-book of children's diseases, mentions enuresis,
+but has nothing better to offer for its relief than that advised by
+Bednar, who followed a systematically-timed period of awakening,
+gradually lengthened out, from the time of putting the child to bed. In
+addition, he advises internal medication, and, like Ultzmann, he
+recognizes the possibility of a local cause in little girls, in whom he
+advises the local application of nitrate of silver. Edward Ellis
+mentions dysuria, and a long prepuce is noticed among its numerous
+causes. The works that give the subject the most intelligent treatment
+(the word "intelligent" is here used advisedly, and is in reference to
+the results obtained) are those of West, of London, and Henoch, of
+Berlin. West, in his "Diseases of Children," says: "In the child,
+however, we sometimes find the symptoms produced by difficulty in making
+water owing to the length of the prepuce and the extreme narrowness of
+its orifice, which may even be scarcely large enough to admit the head
+of a pin. This congenital phimosis is, I may add, not an infrequent
+occasion of incontinence of urine in children, and is also an exciting
+cause of the habit of masturbation, owing to the discomfort and
+irritation which it constantly keeps up. In every case, therefore, where
+any difficulty attends the passing or the retention of the urine, or
+where the practice of masturbation is suspected, the penis ought to be
+examined, and circumcision performed if the preputial opening is too
+small. This little operation, too, ought never to be delayed, since, if
+put off, adhesions are very likely to form between the glans and the
+foreskin, which render the necessary surgical proceeding less easy and
+more severe."
+
+In the "Lectures on Diseases of Children," Henoch, of Berlin, says: "I
+need scarcely add that an examination of the external genitals should
+never be omitted in any case of dysuria during childhood. You will not
+infrequently discover a phimosis which interferes more or less with the
+discharge of urine and retains portions of the latter behind the
+foreskin, where it may decompose and give rise to an inflammatory
+condition of the prepuce, with painful dysuria.... This is also true of
+the occasional adhesion of the labia minora in little girls, like the
+similar adhesion of the foreskin in boys. It is almost constant in the
+first period of life, but sometimes persists to the end of the first
+year; can usually be torn by the handle of the scalpel, and rarely
+requires an incision. In a few cases this adhesion appeared to me to be
+the cause of the dysuria, which disappeared after the separation of the
+labia from one another."
+
+Henoch, however, does not seem to have grasped the full relation that
+the natural phimosis of young children bears to dysuria, as he here
+follows the prevailing opinion, that where by dint, push, hauling, and
+hard work the prepuce can be pushed back phimosis does not exist, as
+well as the general apathy to the fact that a prepuce can exert a very
+injurious influence by its pressure, even when not adherent and very
+retractable; such a prepuce is often attended by balanitis and
+posthitis, with an accompanying difficult, frequent, and painful
+urination. In a case which will be related farther on, in the discussion
+of the systemic effects of a long, contracted prepuce, as it induces
+diseased action by continuity of tissues, there is an account of a death
+of a two-year-old child which we can assume to have had its original
+starting-point in a condition of phimosis. Henoch, however, rather
+attributes the death in that case to what may well be considered the
+result of a cause, leaving the original cause more to appear as a final
+accessory condition.
+
+My reasons for this view of the subject are simply owing to the fact
+that I do not believe that a child can long be afflicted with the
+_ischuria phimosica_ of Sauvages without having the urinary organs
+beyond more or less seriously affected from the mere retention alone,
+irrespective of any reflex irritation from the pressure on the glans or
+of any from the irritation of the peripheral nerves; the dilatation of
+the adjacent cavities or channels and the deposit of calcareous matter
+being facilitated by the retention of urine and its naturally altered
+condition owing to that retention. So that dysuria in young children,
+beginning in a slightly phimosed condition, or in the irritability of
+the glans and meatus, due to its preputial covering, it is safe to
+assume, may produce a train of symptoms ending in permanently-injured
+health, or even death. The irritating urine of a slight access of fever
+may, by its passage over the irritable mucous lining of the prepuce, be
+the initial starting-point of a serious or fatally-ending disease. In
+all of these, it must be admitted, the presence of the prepuce is either
+actively or passively the cause of the most serious disease processes
+that may follow.
+
+Ultzmann, of Vienna, in his work on the "Neuroses of the Genito-Urinary
+Organs," gives the subject of enuresis considerable attention. It is not
+a work on diseases of children, but it, nevertheless, goes into the
+subject as if it were, and furnishes the profession with considerable
+information. He defines enuresis to be the passage of urine of a normal
+quality in a child who, with the exception of this involuntary
+urination, is healthy. In the first periods of life, a slight vesical or
+intestinal expulsive effort is sufficient to overcome the guarding
+sphincter muscles at their outlet; the child first obtains a voluntary
+control of the rectal sphincter; and, generally, with the second year it
+gains control of the vesical. Those who pass their second year without
+obtaining this control, but in whom the organs and urine are normal, may
+be said to be afflicted with enuresis. He divides enuresis into three
+varieties; that involuntary urination which takes place at night during
+sleep he terms the _nocturnal_; that which takes place while climbing,
+laughing, coughing, or in the course of any violent muscular exercise is
+the _diurnal_; and that wherein the involuntary evacuation takes place
+day and night alike he terms as the _continued_. This last is again
+subdivided into the continuous and periodical. As a cause, he cites
+anaemia, scrofula, rachitis; but adds that physical debility is not
+necessary for its presence, as well-developed, vigorous, puffy children
+are as liable to be affected as thin and scrawny ones; while not all
+scrofulous or rachitic children are so affected, only a small portion
+being enuretic. Sex has no influence on the liability that tends to
+being attacked, the proportion between the sexes being about equal. As
+to age, he finds the greatest proportion to be between three and ten
+years, but he has often treated those of either sex even at the age of
+fourteen and up to seventeen years. It is absolutely necessary to
+examine the external genitals and the urine of those affected by this
+disease, as phlegmasiae of the vagina, of the vestibule or urethra in
+girls, or the practice of onanism, or lithiasis, cystitis, or pyelitis
+may be the cause of the disease. Girls are apt to be found affected with
+polypoid excrescences at the meatus, which when removed will cause the
+enuresis to disappear.
+
+From the above it will be observed that Ultzmann has paid much attention
+to these neuroses; but it will also be remarked that neither the
+balanitis, collection of infantile smegma, preputial adhesions nor
+irritations are taken into any account as possible factors of either
+dysuria or enuresis; he has followed more or less an electrical form of
+treatment for genito-urinary neuroses, the rectal rheophore being one of
+his favorite modes of treating enuresis; in his etiological views of
+these disturbances he has adhered more or less to the views of
+Trousseau, Bretonneau, and Dessault, who looked upon a debilitated or
+anomalous condition of the vesical neck as the cause of the majority of
+neuroses in that region.
+
+It may be asked why these celebrated and observing physicians have
+neglected the preputial condition, if, as it is claimed, it is, in
+itself, so important and sure a factor of the derangements at the
+vesical neck? To answer this, or to explain any marked discrepancy that
+may occur in medicine between minds equally as acute and observing, it
+is but necessary to observe that there is, in medicine, to a certain
+extent, a like rule of inheritance, education, with fashion or custom of
+habit of thought and practice, as we find in religion. Canon Kingsley
+and Froude are equally as acute and discerning as the late Cardinal
+Newman, but that did not necessitate their following that prelate into
+the foremost ranks of the Catholic Church; and Pere Hyacynthe was
+equally as intelligent as Cardinal Newman, but that did not prevent him
+from leaving the fold into which the Cardinal had entered from out of
+the Reformed Church. Some are born Catholics or Protestants, and are so
+with vehemence; others are born in these religions, but are only
+lukewarm in their doctrinal observance; while others reason and jump the
+traces in either direction. The followers of the destructive theories of
+Bronssais could not see the errors of their ways, and neither could they
+be made to see the merits of a less interfering form of medical
+practice. Trousseau was himself at one time tainted with Bronssaisism,
+but, like Paul of Tarsus, he was made to see the error of his way, as he
+relates, through a case of gout that he nearly laid out in trying to lay
+out the disease antiphlogistically.
+
+I do not assume that preputial irritation is at the bottom of _all_
+cases of dysuria or enuresis, any more than it would be rational to deny
+that cases of circumcision performed in some cases of diabetic enuresis
+have proved fatal as a result of the operative interference; but it is
+safe to assume that, in the great number of cases in whom some
+irritating conditions were found and removed, the enuresis or dysuria
+was due to such preputial irritation. It is also logical to assume, with
+West and Henoch, that the organ should in all cases be examined, and its
+condition rendered as harmless as possible. That the condition of
+preputial irritation has not been fully recognized by all parties as a
+cause of enuresis does not do away with the fact that it does exist, any
+more than the refusal of the prelates and doctors of Salamanca to listen
+to Columbus did away with the fact of the existence of the American
+continents.
+
+A. L. Ranney, in his "Lectures on Nervous Diseases," pages 174, 175,
+speaks of enuresis in children as being a reflex cachexia, "excessive
+stimulation of the centripetal nerves connected with the so-called
+'vesical centres' of the spinal cord,"--a condition which may be
+produced by either worms in the intestines or by preputial irritation.
+Ranney advises a careful exploration of the urethra and rectum in these
+cases, and the elimination of all local causes of the conditions.
+
+Probably the most remarkable case of the immediate continuous effects
+resulting from phimosis is the one recorded by Vidal, in the fifth
+volume of the third edition of his "Surgery." This was a young man with
+a congenital phimosis, having but a very small aperture; on an operation
+to relieve the phimosis there was a gush of water, but this only fell at
+the feet of the patient, without being ejected at any distance; the
+urethra was found to have undergone precisely the same dilatation back
+of this preputial orifice that it usually undergoes back of a stricture;
+the whole urethra from the meatus backward was found to have exceeded
+the calibre of that of the vesical neck; the bladder was greatly
+dilated.
+
+
+
+
+CHAPTER XXV.
+
+GENERAL SYSTEMIC DISEASES INDUCED BY THE PREPUCE.
+
+
+Aside from all the local affections or reflex neuroses, either mental or
+physical, that a prepuce may induce, there are an innumerable train of
+diseases that may originate in this one cause that at first sight would
+seem to have no connecting-link with any preputial condition.
+
+It has already been suggested that the prepuce does not at all ages bear
+the same analogous relation to man. In childhood, especially during our
+earliest years, it is out of all proportion in size when compared to the
+rest of the organ, or to any use it may have placed to its credit. Man
+does not, then, certainly need that refinement of nervous sensitiveness
+in the corona that is useful in after life in inducing the flow or
+ejaculation of the seminal fluid; neither is there at that age much of a
+corona to protect. In middle life, or what might be called the
+procreative period of man, when the corona would seem to require all its
+excitability or sensitiveness, seems to be the very season in life when
+the glans is most apt to remain uncovered; so that nature and this
+hypothetical idea of the use of the prepuce are evidently at variance.
+So we go through childhood with this long funnel-shaped appendage into
+manhood, when the increasing size of the body of the penis restores a
+sort of equilibrium between the size and bulk of the organ and its
+integumentary covering. At this period, as we have seen, although it
+does not, from the equilibrium restored, and the more or less use to
+which it is subjected, induce any great immediate or uncomplicated
+troubles, it nevertheless endangers the existence of the penis through
+the accidental course of some putrid or continued fever, or it subjects
+man to the manifold dangers of venereal or tubercular infections.
+
+In advanced age, owing to the diminution in size of the organ, the
+prepuce resumes the proportionate bulky dimensions of childhood, and as
+the organ recedes and becomes more and more diminutive, the prepuce
+again, like in childhood, begins to tend to phimosis; the urine of the
+aged is also more irritating and prone to decomposition or putrefaction,
+and the constant state of moisture that the preputial canal of the aged
+is necessarily kept in, either by frequent urination or the incomplete
+emptying of the urethra that is peculiar to old age, and which results
+in more or less dribbling, is a powerful factor in inducing the many
+attacks of posthitis and balanitis, as well as those attacks of
+excoriation and eczema which are so annoying to the aged. I have often
+seen such cases happening to men past fifty, who, being widowers, and
+never having had anything of the kind, as well as being in the most
+complete ignorance of the nature of the disease, have, from delicacy and
+fear that the disease might induce some suspicions as to their conduct
+in the minds of those whose good opinions they value above all else,
+gone on suffering untold miseries, especially if the urine were in the
+least diabetic.
+
+One such case that fell under my observation not only produced such
+misery as to entail a loss of rest and of appetite, but even induced
+such a disturbance of assimilation and nutrition that the resulting
+hypochondriacal condition that developed from these enervating causes
+ran the patient into a low condition, ending in complete prostration of
+all vital powers and death, without the intervention of any other
+disease. The subject was a timid, retiring man of about fifty-five
+years, and this was the first and only time that the prepuce had ever
+caused him any annoyance,--a circumstance which greatly preyed upon his
+mind, as he could not disconnect it with the idea that it must be
+suspected as venereal, although he had always led a most continent life
+since the death of his wife. This is, of course, an extreme case; but as
+it is a result beginning in a certain condition, be it an extreme,
+erratic, or infrequent occurrence, it is, nevertheless, an example of
+what may happen in advanced life, even where the prepuce has never
+before been a source of the least disturbance or annoyance. Persons who,
+with the increase of years, are also liable to an increase of adipose
+tissue, are more subject to this dwindling down of the penis and
+consequent elongation of the prepuce, with all the attendant annoyances,
+than thin or spare people.
+
+In this irritation that the prepuce is liable to cause, we have not only
+to encounter the dangers that its thickenings or indurations may bring
+on in their train, in the shape of cancer, gangrene, or hypertrophies,
+but other and no less serious results are liable to follow a herpetic
+attack, or in consequence of an attack of balanitis or posthitis. The
+dysuria attending any of these conditions may be the initial move for
+such a serious complication that life may be brought to a sudden end,
+even in infancy, to say nothing of the ease with which life is taken off
+in after years and in old age; with debilitated and imperfect kidney
+action, it takes very little to hustle us off from life's foot-bridge.
+
+A case as occurring in Henoch's clinic, already mentioned or referred to
+in a previous chapter, shows what a simple phimosis is capable of
+inducing. In the history of the case the phimosis and the resulting
+retention in the preputial cavity no doubt were the causes of the
+calculus found there; and the succeeding calculi and abnormal condition
+of the urinary organs, we can safely assume, were a subsequent creation
+to that in the prepuce. The case is taken from Henoch's "Lectures on
+Diseases of Children," Wood Library edition, page 256, and is as
+follows:--
+
+"A. L., aged two, admitted November 28, 1877. Quite well nourished, but
+pale. Complete retention of urine for two days; slight redness and
+marked oedema of penis, scrotum, and perineum. The foreskin cannot be
+retracted, on account of phimosis. Abdomen distended, hard, and
+sensitive, the dilated bladder extending a few fingers' breadth above
+the symphysis. In order to introduce the catheter, it was first
+necessary to operate upon the phimosis, during which a calculus, which
+completely occluded the meatus, was removed. The catheter, when
+introduced into the bladder, removed a quantity of cloudy urine. The
+oedema, rapidly disappeared under applications of lead-wash, but on
+November 29th vomiting and diarrhoea occurred during the night, with
+rapid collapse; December 1st, death. Autopsy: In the bladder, a
+sulphur-yellow stone, as large as a hen's egg, completely filling the
+organ; similar calculi, from the size of a pea to that of a bean, in the
+pelvis of the left kidney; right kidney normal."
+
+In the above case, the oedema of the penis, scrotum, and perineum was as
+much a result of the distension of the bladder by the retained urine
+interfering with the return circulation from the oedematous parts as the
+different appearances of diseased conditions were a result of the
+primary phimosis; yet this case, if seen during its early infancy, when
+probably the contraction of the preputial orifice was as yet not so
+well marked, would have been pronounced one in which it would be
+needless and barbarous to perform circumcision upon. We would most
+assuredly have to wander aimlessly and unprofitably in the region of
+speculation to build up the etiology of the above-related case and reach
+the culmination there found, unless we accept the one that it was all,
+from first to last, the result of the phimosis.
+
+Jonah, pitched overboard at sea to appease the tempest and swallowed by
+the whale, became convinced finally that he had better return to Nineveh
+to preach reform; while Pharaoh would not let the children of Israel
+depart even after Moses had so frightened him--as it is related in the
+rabbinical traditions compiled by the Rev. T. Baring-Gould, M.A.--that
+the royal bowels were completely relaxed at the sight of the snakes
+turned loose about the royal throne,--a circumstance which nearly lost
+him his claim to divinity, which was based on the fact that his bowels
+moved only once a week, as in this case they not only moved out of time
+and in the most unkingly manner, so that the noble king hid underneath
+the throne, but before even Pharaoh could disengage himself from the
+royal robes, which event could hardly have raised him in the estimation
+of the gentlemen eunuchs of the bed-chamber. Those who unwound the mummy
+of Pharaoh tell us that he had the appearance of a self-willed,
+despotic, but intelligent, old gentleman; but the above rabbinical
+relation, from Baring-Gould's "Legends of the Patriarchs and Prophets,"
+seems to have had no convincing effect on Pharaoh; so we must not be
+surprised if even a case like the one from Henoch's clinic would, with
+many, carry no conviction.
+
+In the second volume of Otis on "Genito-Urinary Diseases," of the
+Birmingham edition, at page 380, there is an interesting account of a
+physician who, in youth, was troubled with an annoying prepuce, which,
+from frequent attacks of balanitis, had finally become more or less
+adherent to the glans penis; up to the age of nineteen he had been
+unable to completely uncover the glans. By six months of hard and
+persistent labor he had finally broken up these adhesions. At the age of
+twenty-two he married, and he then ruptured the frenum, which bled
+profusely and left him sore for some days. Then for twenty-seven years
+he had no further trouble, but at the end of that time he began to
+experience what he believed were attacks of dumb ague, and the scrotum
+began to swell and felt sore on firm pressure. Heavy, aching pains then
+followed. This condition of things lasted for over five years, varied by
+the appearance of carbuncles on the nose and elsewhere, to relieve the
+monotony of the thing. From this time on, abscesses began to form in the
+scrotum and into the integument of the penis, burrowing forward into the
+prepuce, which was much swollen and painful. A gangrenous opening
+effected itself in the dorsal surface, which relieved him somewhat. The
+patient was finally examined by Dr. Otis, who found a badly strictured
+urethra, the strictures beginning at the meatus, and at intervals
+extended down as far as two and three-fourths inches. The case had no
+venereal history, the patient never having had any disease or anything
+of the kind. The strictures were plainly the result of the
+balano-posthitic attacks as much as they were the cause of the
+degeneration of the mucous membrane in the lower urethra, that allowed
+of the infiltration of urine into the tissues, which caused all the
+systemic disturbances, abscesses, misery, and agony of the patient,
+depriving him of comfort, sleep, or ability for labor, and which sent
+him here and there in search of health and relief.
+
+It would seem really as if a prepuce was a dangerous appendage at any
+time, and life-insurance companies should class the wearer of a prepuce
+under the head of hazardous risks, for a circumcised laborer in a
+powder-mill or a circumcised brakeman or locomotive engineer runs
+actually less risk than an uncircumcised tailor or watchmaker. They
+recognize the danger that lurks in a stricture, but what a prepuce can
+and does do, they entirely ignore. I have not had any opportunities for
+comparison, but it would be interesting to know, from the statistics of
+some of these companies, how much more the Hebrew is, as a
+premium-payer, of value to the company than his uncircumcised brother.
+Were they to offer some inducement, in the shape of lower rates, to the
+circumcised, as they should do, they would not only benefit the
+companies by insuring a longer number of years, on which the insured
+would pay premiums, but they would be instrumental in decreasing the
+death-rate and extending longevity.
+
+I have seen so many cases of stricture whose origin could be traced to
+balanitis that it can almost with confidence be assumed that, wherever
+there is a long prepuce with a red and inflamed meatus in a child, that
+unfortunate child will be a victim of fossal strictures when arrived to
+manhood, and that, moreover, he will be a surer victim to the reflex
+neuroses which so often accompany strictures, and which have been so
+ably described by Otis, than the victim of uncomplicated strictures
+acquired in the worship of Venus. There is no end to the misery that
+these poor fellows have to suffer, besides the habitual hypochondriacal
+condition into which the accompanying physical depression, throws them;
+it unfits them for business, any undertaking, or even for social
+enjoyment or entertainment; they keep themselves and their families in
+continued hot water. These subjects are, also, more prone to gouty and
+rheumatic affections, asthma, and other neuroses.
+
+Among the many cases of nervous disorders simulating other diseases that
+I have seen relieved were two Jewish lads with an imperfection of the
+meatus. They were two brothers, and from the history of the cases, and
+that given me by the mother of the lads in regard to the father, the
+malformation must have been hereditary and congenital. It consisted of a
+partial occlusion of the meatus by a false membrane, which divided the
+meatus in two, horizontally, but which was closed at the posterior end
+of the lower passage, which readily admitted a probe from the front as
+far as the occlusion, about a third of an inch to the rear. The
+restoration, or rather the making the anterior urethra and meatus to
+their normal condition, relieved both boys of asthma, under which they
+had labored for years.
+
+The many cases simulating the general disturbances that accompany many
+kidney disorders, that are simply the result, in their primary causes,
+of preputial irritation and the disturbances to the kidney function due
+to the same cause, have long induced me to look upon the prepuce as a
+great and avoidable factor to some of the many forms of kidney diseases,
+prostatic enlargements, vesical diseases, and many other diseases of the
+urinary organs, which we know full well can result from strictures, as
+the latter need not always act in a purely mechanical mode to do its
+full extent of mischief.
+
+One result of these preputial irritations not generally or particularly
+mentioned in any of our text-books--a condition far-reaching as regards
+its own results, and more annoying and serious than it appears at first
+sight--usually begins with a reflex irritability of the anal sphincter
+muscle, or a rectal irritation of the same order, which in time produces
+such organic change that an hypertrophied and irritable, indurated,
+unyielding muscle is the result. Agnew, of Philadelphia, describes the
+condition, but does not mention this frequent cause under the name of
+sphincterismus; once this is established, the train of resulting
+pathological or diseased conditions that may follow are without
+end.[108] This is no fancy sketch, nor will the student of the pedigree
+and origin of diseases feel that the case is exaggerated or imaginative.
+These are some of those cases that are always ailing, never well and
+really never sick, but who are, nevertheless, gradually breaking down
+and finally die of what is termed "a complication of diseases," before
+living out half their term of life.
+
+How this happens is simple enough--the straining required to produce an
+evacuation is out of all proportion with the character of the discharge;
+such patients often complain of being constipated when the evacuations
+are semi-fluid; this straining is followed by a dilatation and
+consequent loss of power of the rectum, which becomes pouched and its
+mucous membrane thickened; the whole intestinal tract sympathizes and
+digestion is interfered with, and the forcible expulsive efforts affect
+all the abdominal and thoracic organs in a more or less degree, laying
+the foundation for serious organic diseases. Now, this condition, which
+may be said to be no more than one of obstinate constipation, is a far
+more reaching condition and a far more injurious state than can be
+imagined at a first glance. Constipation is not, as a rule, always
+accompanied by the indigestion, either stomachic or intestinal, that
+goes with this condition; the contents of the intestines in simple
+constipation may simply lack fluidity without undergoing putrefactive
+fermentation, but in this condition the undigested and retained
+intestinal contents do undergo that change, resulting in the generation
+of material whose re-absorption produces a toxic condition of the blood,
+from whence begins a series of serious organic changes in the blood, and
+from this in the organs.
+
+To the practical physician these changes are evident and their cause
+just as plain, and it is just here where the laity lack the proper
+education, and where they should understand that the intelligent
+physician generalizes the disease and only individualizes the patient;
+and it is this ignorance on the part of the laity that gives to
+empiricism and quackery that advantage over them, as they look upon all
+disease as a distinct individual ailment, that should have an equally
+distinct and individual therapeutic agent to cope singly with. The laity
+know very little of these things, and in their happy ignorance care
+still less for the finer definitions of or of the clinical importance of
+toxaemia, or the processes of abnormal conditions that lead up to such a
+state, or the results that may follow when that condition is once
+reached. To them, dyspepsia is an indigestion ascribable to the stomach,
+and a sick-headache is ascribed to something wrong about the stomach or
+liver.
+
+The laity have never been called upon to answer the questioning of the
+late Prof. Robley Dunglison: "What do you mean, sir, by biliousness? Do
+you mean, sir, that the liver does not secrete or manufacture a
+sufficiency of bile, or not enough? Do you mean that the bile-material
+is left in the blood, or too much poured in? Do you mean that there is
+an excess in the alimentary canal, and a deficiency elsewhere? Please,
+sir, explain what you really mean by the term 'bilious!'" The Professor
+had a way about him that at least made one stop and seriously inquire,
+before adopting any random notion in regard to medicine. It is to be
+regretted that, in the humdrum tread-mill work of many physicians, they
+even have to drop into the commonplace way of treating dyspepsias and
+such ailments without any further inquiry. A farmer knows better than to
+drive a dishing wheel, or with merely having a nail clinched in the
+loose shoe of a valuable horse; but he is fully satisfied to do so in a
+metaphorical sense, as regards his own constitution, and the mere hint
+from his physician that he had better lay up for repairs, or that there
+is something wrong about him that will require investigation, and that
+there is an ulterior cause to his feeling tired, headachy, or dyspeptic,
+or an allusion that there is something systemic, as a cause, to his
+momentary attacks of disordered vision or amaurosis, will generally make
+him look on the doctor with mistrust.
+
+The merchant, banker, and mechanic are not up to Professor von Jaksch's
+ideas of toxaemia,--that toxaemia may be exogenous or endogenous, or that
+the latter is further subdivided into three more varieties,--and, what
+is worse, he cares still less. The above three classes of humanity, when
+sick, simply would want to know if Professor von Jaksch was good on
+dyspepsia, the measles, or typhoid fever. They care very little that he
+divides endogenous or auto-toxaemia into that produced by the normal
+products of tissue-interchange, abnormally retained in the body, giving
+rise to uraemia, toxaemia from acute intestinal obstruction, etc., the
+above being the first division. The second depends on the outcome of
+pathological processes, which change the normal course of assimilation
+of food and tissue-interchange; so that, instead of non-toxic, toxic
+matter is formed. The second group he names noso-toxicoses, which he
+subdivides into two principal divisions:--
+
+(_a_) The carbohydrates, fats, or albuminous matter, which may be
+decomposed abnormally and give rise to toxic products, _e.g._, diabetic
+intoxication, coma carcinomatosum.
+
+(_b_) A _contagium vivum_ enters the body through the skin, or the
+respiratory or digestive tract, and develops toxic agents in the tissues
+on which it feeds, as in infectious diseases.
+
+In the third group the toxic substance results from pathological
+non-toxic products, which again produce a toxic agent, only under
+certain conditions. This group he calls auto-toxicoses, and includes in
+it poisonous substances, resulting from decomposition of the urine in
+the bladder, under certain pathological conditions, and giving rise to
+the condition called ammoniaemia. (_Medical News_ of January 7, 1891;
+from _Wiener klinische Wochenschrift_ of December 25, 1890.)
+
+As observed above, unfortunately the patients know nothing, nor can they
+be made to understand these conditions, that are only reached through
+labyrinthic pathological processes, and, what is still worse, this way
+of looking at disease is incompatible with the idea of specific-disease
+treatment, which to them looks more practicable and quick, and which is
+also more to their liking. They cannot see any sense in such reasoning,
+which to them is something eminently impracticable; neither can they see
+a reasonable being in the doctor who practices on such, as they call
+them, _theories_.
+
+The practical physician, however, sees in Professor von Jaksch's
+summary the turning-point of many a poor fellow's career,--from one of
+comparative health into one of organic disintegration, decay, and
+dissolution,--all the required processes starting visibly from the very
+smallest of beginnings; any obstruction in the urinary tract or
+intestinal canal being sufficient to start any of the conditions which
+end in toxaemia; and, from a careful observation running over several
+years, I do not think that I am assuming too much in saying that a
+balanitis is often the tiny match that lights the train that later
+explodes in an apoplectic attack or sudden heart-failure due to toxaemia;
+the organic and vascular systems being gradually undermined until,
+unannounced and unawares, the ground gives way and the final catastrophe
+occurs,--unfortunately, an occurrence or ending looked upon as
+unavoidable by the friends of the victim. They cannot see any danger;
+the idea that diseases have the road paved, not only for an easy
+entrance but an easy conquest, by the action of these toxic agents on
+the tissues, is something that they cannot grasp. These blood changes or
+blood conditions are things too intricate, and the physician who
+understands them is, to them, a visionary and unpractical man. These
+conditions are, however, neither new nor unknown, and there is really no
+excuse for the ignorance exhibited in these matters by the general
+public, as it is through the blood that this mischief takes place. They
+can reason in their impotent way, that they should drench themselves
+with "blood tonics" and all manner of nauseous compounds to "purify"
+their blood, but the simple, scientific truth is something beyond their
+understanding, as well as something that they steel themselves against.
+
+Sir Lionel Beale, in observing the immense importance he attaches to
+blood composition and blood change in diseases of various organs, truly
+remarks that "blood change is the starting-point, and may be looked upon
+as the cause, of what follows," the other factor being the "'tendency'
+or inherent weakness or developmental defect of the organ which is the
+subject of attack;" to which he adds that he feels convinced that, if
+only the blood could be kept right, thousands of serious cases of
+illness would not occur; while the persistence of a healthy state of the
+blood is the explanation of the fact that many get through a long life
+without a single attack of illness, although they may have several weak
+organs; and that an altered state of the blood, a departure from the
+normal physiological condition, often explains the first step in many
+forms of acute or chronic disease. Sir Lionel has been a pioneer in the
+field of thought that looks for the cause of the disease, which, however
+remote it may be, should not be overlooked as a really primary
+affection. His extensive labor in the microscopic field has fully
+convinced him that many of the pathological changes in the different
+organs are due to what might be called some intercellular substance that
+is deposited from the blood. (Beale: "Urinary and Renal Disorders.")
+
+Toxic elements in the blood affect the kidneys in a greater or less
+degree, and there produce changes at first unnoticed,--at least, as long
+as the kidney can perform its function,--but the day arrives when, as
+described by Fothergill, blood depuration is imperfect, and we get many
+diseases which are distinctly uraemic in character, and ending in any of
+the so-called kidney diseases, Bright's disease being one of the most
+common. As observed by Fothergill, however, the kidney is not the
+starting-point, the new departure only taking place when the structural
+change on the kidney has reached that point that it is no longer equal
+to its function--the "renal inadequacy" of Sir Andrew Clarke. (J. Milner
+Fothergill, in the _Satellite_, February, 1889.)
+
+During the Bradshawe lecture, Dr. William Carter made the following
+remarks: "According to Bonchard, one-fifth of the total toxicity of
+normal urines is due to the poisonous products re-absorbed into the
+blood from the intestines, and resulting from putrefactive changes which
+the residue of the food undergoes there." In the course of the lecture,
+Dr. Carter fully explains that one of the benefits derived from milk
+diet in Bright's disease is the small residuum deficient in toxic
+properties, and lays great stress on the employment of intestinal
+disinfectants or antiseptics that exercise their influence throughout
+the whole tract, suggesting naphthalin as peculiarly efficacious,
+thereby cutting off one source of blood contamination at its source.
+Although these are recent developments in medicine, Bonchard mentions
+that in the practice of M. Tapret cases treated on this principle did
+well. (Braithwaite's _Retrospect_, January, 1889.)
+
+Persons laboring under this toxic condition of the blood, with a
+consequent deterioration in the texture and the physiological function
+of the vital organs, are of that class that easily succumb to injuries
+or serious sickness, and of that class to whom a surgical operation of
+even medium magnitude is equal to a death-warrant.
+
+The above conditions are an almost constant attendant on that condition
+of the sphincter described by Agnew as sphincterismus, which also is
+productive of haemorrhoids and fissure, and often of fistula. That
+sphincterismus is caused in many cases by preputial irritation is as
+evident as that the same affection, or haemorrhoids or any other rectal
+or anal affection, will, in its turn, produce vesical and urethral
+reflex actions, and primarily functional and secondarily organic changes
+in those parts. Besides, the great number of cases wherein the gradual
+and progressive march of each pathological event could be traced with
+accuracy has convinced me of the true cause of the difficulty being the
+result of reflex irritation.
+
+Delafield, in his "Studies in Pathological Anatomy," gives, as the first
+form of pneumonia, that from heart disease; in the days of Broussais
+this would have sounded absurd, but, to-day, some forms of heart disease
+are known to be the regular sequences of some particular form of kidney
+disease, just as some form of pneumonia attends an affected heart and
+that some forms of pneumonia degenerate into phthisis. When the blood
+change is an established fact, it is only a question as to which is the
+weak organ, and the organism of the individual will decide whether it
+will be a simple sick-headache or the beginning of a pneumonia ending in
+phthisis.
+
+I have purposely dwelt on this part of this subject, owing to the recent
+origin and publication of many of the views connected with it; also on
+account of the greater ease of making the subject plain by fully
+discussing each step of the process; and if the views of Sir Lionel will
+be recalled, that a toxic element in the blood is the starting-point,
+and that an irritable or weakened organ invites destruction,--the
+induction of serious and fatal kidney disorder by the transmitted
+irritability and consequent injury to the kidney produced by preputial
+irritation in the first instance, and the supplemental blood-poisoning
+by intestinal absorption of septic matter, which soon brings about Sir
+Andrew Clarke's "inadequacy of kidney,"--all will be readily understood.
+When this point is reached, a too hearty meal, exposure to variable
+weather, or a little extra care or anxiety, are sufficient, as
+determining causes, to bring life into danger.
+
+As pointed out, many cases of Bright's disease or other renal difficulty
+have their origin in this distant but visible source, and, although
+malarial poisoning and a great number of other causes will produce the
+same particular organic changes and diseases, this condition must be
+admitted as one of the frequent causes. The influence of the
+genito-urinary tract on the rest of the economy, and the importance of
+the sympathy it excites, or how quickly, by its being irritated, some
+apparently dormant pathological condition will be awakened to life and
+activity, is not sufficiently appreciated. As observed by Hutchinson, a
+patient who has once been the subject of intermittent fever is more
+prone, on catheterization, to have a urethral chill and fever than one
+who had never had the fever. (Hutchinson: "Pedigree of Diseases.")
+
+Ralfe observes, in his "Kidney Diseases," that long-standing disease of
+the genito-urinary passages must be reckoned as among the chief
+etiological factors of chronic interstitial nephritis (page 227). The
+condition of the kidneys in cases of strictures of long standing is
+known not to be a reliable one, and any incentive to dysuria or to
+retention, no matter how slight, is apt to lead, eventually--and that
+even in very young subjects--to that toxic condition mentioned in a
+former part of this chapter as one of von Jaksch's subdivisions of
+toxaemia, the ammoniaemia of Frerichs; this condition being the fatal
+ending of the case of the two-year-old child mentioned by Henoch, who
+died after the relief of a retention due to phimosis and calculi
+resulting from the phimotic occlusion. Having seen so many cases wherein
+the conditions described in this chapter were so apparently--whether
+from ammoniaemia due to infection, or toxaemia from the urinary tract, or
+uraemic toxaemia from the intestinal tract--all due to some preputial
+interference or irritation, I cannot help but feel that in these
+conditions--which, singularly, are not so prevalent with the Hebrews as
+with Christians--we have one factor in the cause of the shorter and more
+precarious vitality of the latter.
+
+Morel, in his "Traite des Degenerescences Phisiques," ably discusses the
+degenerative and morbific influences and results of toxaemia, as well as
+he clearly defines their sources. The connection between toxaemia and
+mental affections has already been shown, and Prof. Hobart A. Hare, in
+his instructive and interesting prize essay on "La Pathogenie et la
+Therapeutique de l'Epilepsie (Bruxelles, 1890)", mentions that
+convulsive disorders resulting from the presence of some toxic substance
+are of frequent occurrence. How much this may enter as a partial factor
+into many of the cases of epilepsy which are classed in the order of
+"reflex" may well challenge our consideration. Hare lays great stress on
+the necessity of circumcision wherever there is an indication of
+preputial local irritation. "If practicable, circumcision should be
+performed; it is an operation with but small risk or danger, and easy of
+performance. In such circumstances it is always permissible to
+circumcise, were it for no other end than an acknowledged attempt to
+reach a cure."
+
+
+
+
+CHAPTER XXVI.
+
+SURGICAL OPERATIONS PERFORMED ON THE PREPUCE.
+
+
+In operative interference there is one point which should not be lost
+sight of, this being that the length and bulk of the prepuce in a great
+measure depends on the constriction at its orifice; if the orifice is
+small, the prepuce tight and inelastic, every erection, by putting the
+penis-integument on the stretch, adds to its bulk,--nature naturally
+trying to make up the deficiency,--the two points of resistance being
+where the glans pushes it ahead, having the constricting orifice for a
+hold or purchase, and the skin at the pubes, which is called upon to
+furnish the extra tissue for the time being needed during erection,
+which should be supplied by the prepuce--this being the only office
+which I have been able to assign to this otherwise useless but very
+mischievous appendage. In cases where preputial irritation produces more
+or less priapism, the continued stretching of this integument causes a
+marked increase in its growth, which is mostly added forward. It was on
+this principle or its recognition, that Celsus devised his operations,
+and on which the persecuted Jews undertook to recover their glans by
+manufacturing a prepuce; and, although the trial was not reported as
+being very successful, I do not doubt but that, if the skin could have
+been drawn sufficiently over so as to constrict it anteriorly so as to
+give the glans a purchase, as in the case of phimosis with an inelastic
+prepuce, the operation could be more of a success; all that is required
+is the continued extension and the prepuce might be made to rival in
+length the labia majorae of the females of some African tribes, or the
+pendulous buttocks of the Hottentot Venus.
+
+I have employed the knowledge of this elasticity and source of supply of
+the penis-integument, on more than one occasion, in recovering the
+denuded organ with skin. A number of cases are on record where, owing to
+the want of that artistic and mechanical knowledge without which no
+surgeon is perfect, the operator has drawn forward the skin too tight in
+circumcising, after which, owing to the natural elasticity of the skin,
+the integument has retracted, leaving the penis like a skinned eel or
+sausage. This accident is even liable to occur where the skin has not
+been tightly drawn, but where subsequent erections have torn through the
+sutures, and where the natural retraction of the skin has laid the organ
+bare for some distance. I have seen a number so recorded, but do not
+remember seeing any remedy suggested, it seemingly being accepted that
+the recovery must take place by gradual granulation,--a necessarily very
+slow process, owing to the constant interference by--the always present
+in such cases--unavoidable erections.
+
+Several years ago I advised circumcision to a gentleman owing to a
+contracted condition of the muscles of one hip and thigh, which was
+threatening to render him a deformed cripple; he had a congenital
+phimosis and a very irritable glans penis. The operation was performed
+in a proper manner by a surgical friend, but this friend, unfortunately,
+was a great believer in antiseptic and wet dressings. A few days after
+the operation he called upon me to ask me to go and see the patient, as
+they were both in a pickle, the patient being exceedingly angry, being
+in constant misery, and the penis so denuded by the giving way of the
+sutures--owing to the erections--that it looked to the patient as if he
+never could have a whole penis again, and the doctor saw no way out of
+the difficulty; the penis was, in reality, a dilapidated and
+sorrowful-looking appendage, and anything else but a thing of beauty or
+pride; it was raw, angry-looking, and bleeding at every move; the first
+wink of sleep was followed by an attempt at erection that raised the
+patient as effectually as an Indian would in scalping him; so that,
+taken altogether, the penis, anxious countenance, and the flexed
+position of the whole body to relieve the tension on the organ, the man
+looked about as battered, cast down, and sorrowful as Don Quixote did in
+the garret of the old Spanish inn, with his plastered ribs and
+demolished lantern-jaw.
+
+Luckily, the patient was seen before the retracted portion of the penile
+integument had had a chance to condense and indurate. The bed was
+slopping wet with the drenchings of carbolized water that the penis had
+undergone, the man's clothing was necessarily damp, and the whole
+bedding and clothes were steamy,--all of which greatly added to his
+discomfort and tendency to erections. The man was washed, placed in a
+new, clean, and dry bed, and his clothing changed. The organ was then
+forced backward until the preputial frill or edge was approximated to
+the cut end of the penis-skin, where it was made fast by an
+uninterrupted suture around the whole of the circumference. A short
+catheter, about three inches in length,--the catheter being as full size
+as the urethra would comfortably hold, and of the best and thickest of
+the red, stiff variety,--was introduced into the urethra. This protruded
+about half an inch beyond the meatus. A stiff, square piece of
+card-board was pierced and slipped over this, and then adhesive rubber
+straps were brought from the integument to this little platform, the
+first being from the median line of the scrotum, lifting the sac forward
+and upward. The pubes were shaved and the next four straps started from
+the root of the penis, each strap being split at the glans-end so as to
+encircle the protruding end of the catheter. By these means the skin was
+brought back and firmly supported over the penis, toward the glans; and,
+in case of any erection, the act would only assist in drawing the
+covering farther over the penis as the pasteboard platform and adhesive
+straps formed the distal end of an artificial phimosis. The catheter
+allowed of free urination, and the scrotum was further held up in
+position by a flat suspensory bandage passed underneath the scrotum and
+fastened over the abdomen near each hip. The penis wound was then
+dressed with a very little benzoated oxide-of-zinc ointment passed
+between the adhesive straps; a bridge-support placed over the hips to
+support the bed-clothes, and all was finished, and full doses of bromide
+of sodium and chloral were ordered at bed-time. When the dressings were
+removed, five days afterward, all was healed, the sutures removed, and
+the suspensory alone replaced. The patient had not been troubled with
+any more erections or annoyances of any kind. These are the points which
+often do more or less mischief: wet dressings are uncomfortable and
+favor erections, while the effect of the weight and action of the
+scrotum in drawing backward on the integument should not be overlooked;
+in addition, it should not be overlooked that we have it in our power to
+produce, so to speak, an artificial phimotic action, which has the same
+traction on the penis-integument that the natural phimosis induces.
+
+The foregoing method, to be used in these cases, has proved very
+serviceable in my hands, and it is here given that it may assist others;
+as there is no need of waiting for granulations or of allowing the
+patient to undergo so much misery, which, besides the local injury,
+cannot help but affect the general health very injuriously. The penis
+can stand any amount of forcing backward; it stands this in cancer or
+hypertrophy of the prepuce, or in the inflammatory thickenings that
+precede gangrene of the prepuce, in any extended degree; becoming, for
+the time being, more or less atrophied. As has been shown by Lisfranc,
+the penis can be made nearly to disappear into the pubes; so that we are
+not as helpless in these cases as our text-books would have us believe.
+
+In infants, and in young children below the age of ten or twelve, the
+Jewish operation, as modified and done in accordance with the dictates
+of modern surgery, will be found the most expedient. By this method we
+avoid the need of any anaesthetic agents, which are more or less
+dangerous with children, as well as the need of sutures, which are
+painful of adjustment and very annoying to remove in those little
+fellows who dread new harm; there is also much less risk of
+haemmorrhages, as the frenal artery is not wounded. In children of a year
+or over, a very good result will be found often to follow Cloquet's
+operation, care being taken to carry the slitting well back, as well as
+care in taking it on one side of the frenum, so as to avoid any wound of
+that artery, the subsequent dressing being a small Maltese-cross
+bandage, pierced so as to admit the glans to pass through; the prepuce
+is retracted and the tails folded over each other and held there by a
+small strip of rubber adhesive plaster; a little vaselin prevents the
+soiling by urine underneath. This last operation is short and very
+easy, is not painful, nor does it require much manipulation; it is only
+one quick cut on the grooved director and it is over; by the retraction
+of the prepuce, the longitudinal cut becomes a transverse one, making
+the prepuce wider and shorter at once; the glans soon develops and
+remains uncovered. As there is a very small wound to heal over, the
+repair is very prompt.
+
+In adults with a very narrow, thin, not overlong prepuce, a very good
+result often follows a combination of the dorsal slit with the inferior
+slit alongside of the frenum of Cloquet. The narrower and tighter the
+prepuce, the better the result, as the cuts are at once converted from
+longitudinal into transverse wounds, and the organ at once assumes the
+shape and condition of a circumcised organ, without having suffered any
+loss of substance; three stitches or sutures in each cut (silver or
+catgut) adjust the cut edges; a small roller of lint and adhesive
+plaster, placed so as to shoulder up against the corona, completes the
+dressing. Where this operation is practicable, by the thinness and
+narrowness of the prepuce, it has many advantages. I have repeatedly
+performed it on lawyers, book-keepers, clerks, and even laboring men,
+who have gone from the office to the courts, counting-rooms, or stores
+without the least resulting inconvenience or loss of time. In laborers
+it is better to perform the operation on a Saturday evening, which gives
+them a rest of thirty-six hours before going to their labor again. The
+operation is comparatively painless and almost bloodless, as there need
+not be more than half a teaspoonful of blood lost during the operation;
+there is no danger of any subsequent haemorrhage, and, with proper
+precautions against the occurrence of erections, from seventy-two to
+ninety-six hours is sufficient for a complete union; the sutures are
+then removed and a simple lint and adhesive-plaster dressing worn for a
+few days more. In many, no more dressings are required. In many cases,
+with a properly adjusted dressing, that comes forward underneath so as
+to include the frenum, the simple dorsal slit is sufficient; but if any
+of the prepuce depasses the dressing underneath, it will puff and become
+oedematous and require frequent puncturing. To avoid it, it is better to
+make the Cloquet slit at once. This operation is of no value, and
+perfectly impracticable in a thick, pendulous prepuce. Absorption will
+often remove considerable preputial tissue, but where there is too much
+its very bulk interferes with its removal by any natural means.
+
+Dilatation is recommended by a number of surgeons, but, I must admit, in
+my hands it has always proved a failure; it may be, that if the
+subsequent history of the cases reported as so operated upon had been
+carefully traced, the reports would not have been so good. Nelaton,
+whose dilating instrument is generally recommended, seems, himself, to
+prefer some of the circumcising methods, as in the volume on "Diseases
+of the Genito-Urinary Organs," in his "Surgery," being the sixth volume
+of the revised edition of 1884, by Despres, Gillettte, and Horteloup,
+the subject of dilatation is dismissed in two short lines. St. Germain,
+of Paris, uses, as has been before observed, a two-bladed forceps, used
+after the manner of Nelaton, and reports good results. Dr. J. Lewis
+Smith agrees in his statements with Dr. St. Germain. Dr. Holgate, of New
+York, reports a like experience. In my own practice the prepuce has
+often been made _temporarily_ lax and retractable, but with the usual
+results of the return of the contraction, with a possible thickening of
+the inner fold, as a result of the interference; so that only in case of
+any immediate demand, where the tight prepuce is producing irritation,
+either through pressure or adhesions, or retained sebaceous matter, do I
+ever resort to dilatation; always, however, even then, not as a final
+operation, but merely as preparatory procedure toward a future operation
+of a more efficient order.
+
+In cases of timid adults, who refuse all kinds of operative
+interference, good results may be obtained by the use of a mild
+lead-wash or cold tea-baths and the introduction of flat layers of dry
+lint interposed between the prepuce and the glans; this has a very good
+effect in keeping the parts apart and dry, and may in time produce a
+certain amount of dilatation; but even when this is done, unless it will
+render the foreskin sufficiently loose to allow of its being kept
+finally back of the corona, it is, after all, but a temporary makeshift.
+The corona should be exposed and kept clear of the preputial covering;
+anything short of this will not give all the good results to be desired.
+I have more than once performed a secondary operation on Jews, who had
+been imperfectly circumcised by not having the prepuce removed
+sufficiently, and in whom the subsequent contraction of the preputial
+orifice had re-covered part of the glans, and only lately visited a
+four-year-old boy, circumcised when eight days old, in whom the prepuce
+covered half of the glans, the corona acting as a tractive point from
+which the penile integument was being drawn forward. In this case the
+simple pierced-lint Maltese cross was used, with an adhesive band to
+hold the tails down behind and around the penis just back of the corona.
+
+These means, although not circumcision either in a surgical or in the
+Hebraic religious sense, are, nevertheless, sufficient in a medical
+sense for all desired purposes; provided, however, that there is no
+resulting constriction, or a mild condition of paraphimosis, back of
+the corona, and that the whole of the glans is sufficiently uncovered,
+and that no abnormal dog-ears are left to garnish each side of the penis
+like an Elizabethan frill or collar; although Agnew holds that, in
+slitting, the practice adopted by many of rounding off the corners is
+mostly superfluous, as nature will do so itself in time.
+
+The ordinary way of performing the operation by modern surgeons is by
+what is known as the Bumstead circumcision. It was not an invention of
+Bumstead, but was adopted by him in preference to all others. The
+requisites are a sharp-pointed bistoury, blunt-pointed scissors, and a
+pair of Henry's phimosis forceps, with fine needles and fine oculists'
+suture silk. The penis is allowed to hang naturally and the position of
+the corona glandis marked on the outer skin with a pen and ink, which is
+to serve as a guide for the incision. The prepuce is now drawn forward
+until this line is brought in front of the glans and grasped between the
+blades of the forceps. The prepuce is now transfixed, and, with a
+downward cut, that portion is severed; the knife's edge is now turned
+upward and the excision finished. The forceps are now removed and the
+integument allowed to retract; with the scissors the inner mucous fold
+is now split along the dorsum and trimmed off so as to leave about half
+an inch in front of the corona. The parts are then brought together with
+the continuous suture and dressed according to the fancy of the surgeon.
+Care must be taken _not to bruise_ the parts with the forceps, as, in
+such cases, sloughing of the sutured edges will be the result instead of
+union. I have seen this accident happen more than once, in one case
+being followed by a penitis that seriously complicated matters.
+
+It has been my practice to use fine silver-wire and catgut sutures in
+all operations on the prepuce; they excite less suppuration as well as
+less irritation. In case of need, the silver can be left in longer, and
+they are much easier of removal than the silk; besides, they have the
+advantage of not cutting. In the after-treatment the same general plan
+can be followed as with any amputated stump, except that it must not be
+forgotten that at the end of this organ dwells what has been termed the
+_sixth_ sense, and that heat and moisture are very apt to awaken the
+dormant energies of the organ, even after it has undergone cruel
+mutilation, and even has suffered considerable loss of blood; for that
+reason it is best always to avoid wet or sloppy dressing, or too much
+ointment, as they are more apt to cause erection than to do any good.
+Besides, I find water does here, as elsewhere, interfere with the
+deposited plastic matter, properly organizing into cicatricial tissue;
+so that I prefer a snug, dry dressing, which is left on for four or five
+days without being interfered with, and light covering, plain diet,
+quiet, with fifteen grains each of bromide of sodium and chloral hydrate
+at bed-time to insure rest and freedom from annoying erections. Where
+the organ is large in its flaccid state, it is better to support it on a
+small oakum-stuffed pillow, made for the purpose, than to let it hang
+downward. Should the stitches give way and the skin tend to retract, the
+plan proposed on a previous page can be followed to advantage. In
+urinating, care must be taken not to soil the dressings; some patients
+are very careless about this if not warned. The penis should hang nearly
+perpendicular while in the act, and all dribbling should have ceased and
+the meatus and underneath be mopped dry with some soft cotton before
+raising the organ; nothing so irritates the parts, retards union, or is
+more offensive than a urine-saturated dressing.
+
+Dr. Hue, of Rouen, uses an elastic ligature, which he introduces into
+the dorsal aspect of the prepuce by means of a curved needle. This he
+ties in front, and in three or four days it cuts its way through.
+Although Hue reports a large number so operated upon, the tediousness of
+the procedure and the swelling and oedema, as well as the active pain
+that must necessarily accompany the operation, will hardly recommend the
+ligature in preference to the incision by the knife.
+
+Dr. Bernheim, the surgeon of the Israelitish Consistory of Paris, has
+operated on over eleven hundred circumcisions, besides the cases of
+phimosis occurring in his general practice. His opinion of the procedure
+of M. de Saint-Germain by dilatation is not favorable. He has employed
+it in a number of cases of phimosis, at the time unfit for a more
+radical operation. He has, however, observed that cicatricial
+thickenings and recontractions are very apt to occur, and, as to the
+septic accidents mentioned in connection with circumcision, he has noted
+that they are as liable to occur in hands that are as careless and
+slovenly with what they do with their dilating forceps as they are with
+what they do with their bistouries. Dr. Bernheim prefers the
+circumcision forceps of Ricord, as modified by M. Mathieu. This
+instrument he prefers by reason of its gentler pressure, which, at the
+same time, is all-sufficient to properly fix the prepuce. In applying
+the forceps, he includes as little as possible of the lower part,
+keeping away as much as possible from the frenic artery. The dorsum of
+the inner fold he cuts with the scissors. In children under two years of
+age, he simply turns this back over the free edge of the integument; in
+children over two years of age, he uses serres-fines. In children, he
+uses a piece of lint dressing steeped in a watery solution of boracic
+acid; in adults, he uses iodoform-gauze dressings. He finds cases unite
+in from three to ten days. Dr. Bernheim warns us against using
+antiseptics on infants or young children, in connection with the
+after-dressing of circumcision. Neither phenic acid, corrosive
+sublimate, nor iodoform are well borne by these young subjects, and he
+has seen serious results follow upon as light an application as a 1/100
+solution of phenic acid. In a number of cases he reports operating with
+the galvano-cautery of Chardin, instead of the knife. These operations
+were bloodless, and cicatrization was as rapid as when the knife was
+used. He has in several cases operated by the dorsal incision, owing to
+disease of the prepuce not allowing any other operation.
+
+In France, the Bumstead operation is known under the title of Ricord's
+procedure. Lisfranc, Malapert, M. Coster, and Vidal all have operations
+which are not as useful as Ricord's, and have not, therefore, come into
+general use. M. Sedillot condemns the dorsal incision as leaving two
+unsightly-looking flaps. The reverse, or inferior incision of M. Jules
+Cloquet is likewise not in favor with either Malgaigne or Ricord. This
+inferior incision or section, alongside of the frenum was first advised
+by Celsus. M. Cullerier contented himself with slitting the inner
+preputial fold, longitudinally, from its junction with the skin backward
+to the corona. M. Chauvin, by the aid of a complicated instrument with
+barbed points, drew out the mucous fold as far as possible before
+excising.
+
+There is something unaccountable in the difference in results that
+various operations give in the hands of different surgeons. It must be
+that all methods are correct _with properly-chosen cases_ and when
+properly _performed_, as well as properly looked after subsequently to
+the operation. It must not be expected, however, that, in operations
+where the kindly assistance of nature is a thing contemplated in
+absorbing superfluous tissue, the case will at once give satisfaction to
+all. These cases must have the required time before judgment can be
+passed upon the merits of the operation, just as required time in cases
+of dilatation or in the method of M. Cullerier will often demonstrate
+that the benefits are but transient, and that often even cases that have
+been so operated upon will require a complete circumcision, _a la_
+Ricord or _a la_ Bumstead, owing to the resulting thickening induration
+and overconstriction, when, if left alone, the dorsal slitting or the
+inferior incision of Cloquet would have previously given satisfactory
+results.
+
+The final cosmetic results in the combined Cloquet and dorsal-slit
+operation, for instance, depend on, first, properly choosing the case.
+One on whom the operation is unadaptable it is useless to attempt it on,
+as a future circumcision or tedious and annoying re-operation of
+trimming would be required. The next care is to properly cut through all
+constricting bands, which, like fine, tough strings, will be found to
+encircle the penis. These must be carefully clipped with a fine pair of
+strabismus scissors, as these bands do not give way, either then or
+afterward, of their own accord, but form the nucleus for stronger
+constricting bands for the future. Then you must be sure to cut far
+enough back, either above or below, until you have reached where you
+obtain the normal and largest calibre of circumference of the penis. The
+adaptation of the edges of the parts and the proper application of a
+smooth, equal pressure, by means of the lint strap, is of the next
+importance; and then comes the strapping of the whole surface for about
+an inch and a half back of the corona, which should and must include all
+the tissues of the preputial part of the frenum. A neglect or careless
+performance of any of the details, or the carelessness of the patient in
+not keeping the dressing clean, necessitating its change before the
+fourth day, all tend not only to interrupt the union, but to mar the
+future cosmetic results as well. It may be asked why all this care and
+trouble, and not circumcise at once? As already observed, this operation
+admits of the patient following his business; whereas circumcision, on
+the male, will assuredly lay him up for four or five days, and perhaps
+ten days,--something that many, be they rich or poor, cannot afford, and
+will not submit to.
+
+The cosmetic condition of the penis as a copulating organ is a thing of
+some importance, and this should not be overlooked; for, although the
+particular dimension, shape, or peculiarity of the penile end never
+figures prominently in the complaints of women who apply for
+divorce,--the charges being everything else under the sun,--it can
+safely be assumed that this organ and its condition is the original,
+silent and unseen, as well as unconscious power behind the throne that
+is at the bottom of the whole business in more than one case. Like the
+fable of the poor lamb that the wolf wished to devour: the real reason
+of his wishing to kill him was that he might eat him, the pretext set
+forth by the wolf that the lamb had encroached on his pasture, muddied
+his brook, or kept him awake by his bleating having been disproven by
+the lamb. Besides, it is well not to leave any distinctive or
+distinguishing mark, like an individual baronial crest, on the head of
+the organ.
+
+To return, however, to the operative procedures, we find that Dr. Vanier
+finds that the operation of Cloquet by incision alongside of the frenum
+has the advantage of not leaving any deformity--contrary to the opinion
+of Ricord and Malgaigne. He, in fact, holds this procedure in such high
+esteem that he considers that Cloquet deserves great credit for reviving
+this old Celsian operation. H. H. Smith, in his "Operative Surgery,"
+coincides with Vanier in his favorable opinion of this method, as he
+there says: "Frequent opportunities of testing the advantages of the
+plan of Cloquet having satisfied me of its value, I do not hesitate to
+recommend it as that best adapted to the adult, because it fully exposes
+the glans and leaves little or no lateral deformity, as is frequently
+the case with the dorsal incision,"--an opinion that I can fully agree
+with, from the results of the same operation in my hands, although I
+have used the method even on infants. Vanier does not approve of the
+dorsal incision unless it is made V-shaped, as it otherwise leaves the
+unsightly lateral flaps, but thinks well of the modification of
+Cloquet's practiced by M. Vidal de Cassis, which is performed in the
+following manner: The patient stands before the operator, who remains
+sitting; the operator seizes the prepuce on its dorsum and draws it
+toward him; he then introduces a narrow, sharp-pointed bistoury, with
+its point armed with a small waxen bullet, down alongside of the frenum
+until he reaches the pouched extremity of the preputial cavity at this
+point; the point of the bistoury is now made to transfix the waxen
+bullet and out through the skin, which from this point is divided from
+behind forward. Vanier very sensibly suggests that the operation that is
+effectual, and which can be accomplished in the least number of
+movements or _temps_, as being the least likely to cause extensive pain
+and agony, should be the one preferred, and that the aim of the surgeon
+should be to simplify the operation by reducing the number of necessary
+movements. For this reason, where an excision of considerable amount of
+tissue is required by the nature of the case, he prefers another
+operation, performed by Lallemand,--that of making a dorsal transfixion
+and cutting off the two lateral flaps, which can all be done in three
+movements.
+
+It makes but little difference as to which operation is performed on the
+adult, but that the subsequent dressing will exercise a good or evil
+influence, and greatly assist not only in the present comfort or
+discomfort of the patient, but in the ultimate result as well. Bearing
+these points in view, Charles A. Ballance, of St. Thomas's Hospital, has
+adopted the following procedure:--
+
+"When the patient is etherized, the outline of the posterior border of
+the glans is marked on the skin with an aniline pencil. The skin of the
+prepuce is slit and removed up to the aniline line. The mucous membrane
+is next cut away, leaving only a free edge of about one-eighth of an
+inch in width. Any bleeding which occurs should be entirely arrested,
+and asepsis must be insured by frequent sponging with carbolic or
+sublimate solution. Numerous coarse-hair stitches are then inserted, so
+as to bring accurately together the fresh-cut edges of the skin and
+mucous membrane, and subsequently, after a further sponging and drying,
+a piece of gauze two layers of thickness, and wide enough to reach from
+the root of the penis nearly to the meatus, is wrapped loosely around
+the penis and secured by several applications of the collodion-brush.
+The setting of the collodion is hastened by the use of a fan, so that
+the air is kept in motion, and the patient should not be allowed to
+recover from the anaesthetic until the dressing is quite firm and hard.
+This dressing forms a carapace for the penis, protecting it from the
+bedclothes and effectually preventing the annoying and distressing
+erections. Mr. Ballance reports excellent results from this dressing."
+(Braithwaite's _Retrospect_, July, 1888.)
+
+In applying the above dressing, the shrinking incident to the drying of
+the collodion must not be overlooked, and the gauze layers must be
+loosely applied, as they would otherwise become too tight. The dressing
+is a very ingenious and serviceable one.
+
+Mr. A. G. Miller, at a meeting of the Edinburgh Medico-Chirurgical
+Society, reported a new method of dressing after circumcision. "It
+consisted in first closely suturing the skin and mucous membrane by
+numerous catgut sutures, then painting the surface with Friar's balsam
+and covering it over with two or three layers of cotton wadding, on
+which the balsam is poured. The glans penis was left sufficiently free
+to allow of water passing. The band or ring of dressing should be at
+least one inch broad. The dressing was not suitable for young infants
+who were frequently wetting. In the case of older children, they might
+be allowed to go about on the second or third day, when the dressing
+would be quite dry, and would not be required to be changed or renewed."
+(Braithwaite's _Retrospect_, January, 1888.)
+
+Any constricting or immovable and inelastic dressing is subject to the
+same objections as plaster-of-Paris dressings in thigh-fractures,--that
+of being dangerous and not expedient, unless the patient is constantly
+under your eye.
+
+Dr. Neil Macleod, in the _Edinburgh Medical Journal_ for March, 1883,
+advises a procedure that has always looked favorably to me, and which I
+once put in practice through the means of the ordinary ptosis
+fenestrated forceps, in place of the ordinary circumcision forceps, the
+sutures being introduced through the fenestra and the prepuce cut off on
+the outer side of the forceps, the thickness of the steel arm on the
+outer side of the fenestra allowing of the properly-sized border for the
+hold of the sutures. Dr. Macleod places his sutures all in position
+before making any incisions,--a procedure which will be found to save
+the patient considerable pain; as with many the seizing and holding of
+the edges of the skin and mucous membrane and the forcible pressure
+exerted by the fingers or forceps while the needle is being forced
+through is the most painful part of the operation. In doing this, care
+must be taken to allow sufficient length to each thread to make two
+sutures, as well as care must be taken to properly pull out the thread
+in the centre between the four folds of tissue and to cut it
+equidistant, after the ablation of the prepuce, a blunt hook being used
+to fish up the threads from the preputial opening.
+
+Erichsen favors the Jewish operation in young children, as being the
+easiest and safest of performance. Slitting, or the inferior or superior
+incision, he thought, left too much of the prepuce, which, wherever
+there is a tendency to phimosis, should be entirely removed, "with a
+view of preserving the health and cleanliness of the parts in after
+life." In the phimosis that is acquired by old men, he found dilatation
+with a two-bladed instrument to be sufficient, provided the indurated
+circle was made to yield. For the circumcision of adults he has invented
+an adjustable shield, something like the Jewish spatula, with which he
+protects the glans.
+
+Gross (the elder) used both slitting on the dorsum and circumcision. He
+found neither objection nor deformity in the flaps left by the dorsal
+incision, as they were only temporary; in some cases, he simply followed
+the practice of Cullerier, of making multiple slits in the constricting
+and inelastic mucous membrane.
+
+Agnew believes in circumcision in the treatment of reflex troubles. He
+relates a case, in the second volume of his "Surgery," of eczema
+extending over the abdomen, of over a year's standing, cured in a child
+by circumcision; he operates by incision on the dorsum, in which he
+leaves nature to make away with the flaps, or he circumcises by the
+Bumstead method.
+
+Van Buren and Keyes recommend both the incision on the dorsum and the
+operation of Ricord; where the mucous membrane alone is tight and
+constricted, they follow Cullerier's method of either single or multiple
+incisions of the inner coat. They lay great stress on the necessity of
+keeping the patient quietly in bed to insure rapid and complete union.
+
+My friend, Dr. Robert J. Gregg, of San Diego, has lately operated on a
+number of cases, the operation being perfectly painless, the little
+patients submitting to it and feeling no more pain than if it were
+having its toe-nails trimmed, the local anaesthesia being produced by the
+hypodermatic injection of cocaine. This procedure is now used to a
+considerable extent throughout the country, and it is a far safer and
+more comfortable performance than either etherizing or chloroforming, as
+the sudden and spasmodic filling of the lungs of young children--who
+will resist and hold their breath for a long time, then suddenly
+inhale--with anaesthetic vapor is almost unavoidable, having in two
+instances nearly lost two children from such an accident.
+
+Dr. G. W. Overall, in a late _Medical Record_, which is quoted in the
+_Journal of the American Medical Association_ of February 21, 1891,
+gives the description of a very good and painless method of producing
+this local anaesthesia; for it need hardly be said that with a nervous,
+irritable child the introduction of the hypodermatic needle is as
+formidable an operation as either slitting or the Jewish operation. Dr.
+Overall is in the habit of holding a solution within the preputial
+cavity and then to introduce the needle in the mucous fold, having
+previously applied a light rubber band back of the corona, on the outer
+integument, so as to act like a tourniquet and limit the action of the
+anaesthetic effect to the prepuce. By this procedure he avoids all pain
+and the operation can be performed while the child is even amusing
+itself, care being taken that it does not see it. Sutures that require
+removal should not be used, according to the Doctor, and the operation
+thereby becomes a perfectly painless and unalarming performance to the
+patient in all its details.
+
+
+
+
+NOTES TO TEXT.
+
+
+    [1] "Letters of Certain Jews to Monsieur Voltaire, Containing an
+          Apology for their own People." Pages 451-476. Translated by
+          Dr. Lefann. Philadelphia, 1848.
+
+    [2] "Circoncision chez les Egyptiens." Brochure by F. Chabas. Paris,
+          1861.
+
+    [3] "Atlantis." By Ignatius Donnelly. Page 472.
+
+    [4] _Ibid._, page 115.
+
+    [5] _Ibid._, page 234.
+
+    [6] _Ibid._, page 178.
+
+    [7] "Circumcision." A. B. Arnold. _New York Med. Record_, Feb. 13,
+          1886.
+
+    [8] "Atlantis," page 178.
+
+    [9] This word is, in the Mandan, _Maho-peneta_; in the Welsh,
+          _Mawr-penaethir_. "Atlantis," page 115.
+
+    [10] "Cyclopedia of Biblical, Theological, and Ecclesiastical
+          Literature," vol. viii, page 58. Article, Phallus.
+
+    [11] "Origine, Signification et Histoire, de la Castration, de
+          l'eunuchism, et la circoncision." Par. F. Bergmann. Published
+          in the "Archivio per le Traditione Populaire," 1883.
+
+    [12] "Dictionaire des Sciences Medicales." Par une Societe de
+          medecins et de Chirurgiens. Paris, 1826, 60-volume edition.
+
+    [13] Dr. Delange mentions a peculiar social habit or custom among a
+          tribe of Arabians that in a sociological sense is worth
+          mentioning. He observes that for these dances females are
+          preferred, but owing to the peculiar habit about to be related
+          it is impossible to have any of the village women in Algeria
+          assist at this part of the festivities; hence the men have to
+          do the dancing. It appears that the females of one tribe--this
+          being the tribe of Ouleds-Nails, who live on the southern
+          borders of Algiers--are in the habit, when young, of
+          emigrating to the oases of the Sahara, which are occupied by
+          the French and traveling Arabs, where they give themselves up
+          to a life of prostitution. After having exercised this life
+          for some years they return to the tribe with a dowry in money,
+          besides an ample supply of clothes and jewelry,--the result of
+          their economy,--which enables them to contract favorable
+          marriages. This practice is so common in this one particular
+          tribe, and so much have they monopolized the profession of
+          courtesan, that the name of the tribe of Ouleds-Nails is in
+          Arabia synonymous with that of courtesan. These young women
+          dance every evening in the Arab cafes, and are at times
+          employed to do the dancing at Arab feasts. For this reason no
+          self-respecting Arab woman ever allows herself to dance in
+          public, or why the practice of both sexes dancing together is
+          not practiced in Algerian villages, as a man would thereby
+          consider himself disgraced.--Dr. Delange, in _Receuil de
+          Memoires de Medecine de Chirurgie et de Pharmacie Militaire_,
+          No. 105, August, 1868.
+
+    [14] "Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim
+          Interpretis primarii, De Turcarum Liturgia, peregrinatione
+          Meccana, Circumcisione, AEgrotorum Visitatione," etc. Oxonii,
+          1690.
+
+    [15] Michel Le Feber. "Le Theatre de la Turquie." Paris, 1681.
+
+    [16] "La Circoncision, Sa Signification Social et Religieuse." Par
+          M. Paul Lafargue, in the _Bulletins de la Societe
+          d'Anthropologie de Paris_. Tome x, 3d fascicule, Juin a
+          Octobre, 1887.
+
+    [17] "Circumcision." By A. B. Arnold. _New York Med. Record_, Feb.
+          13, 1886.
+
+    [18] Bancroft's "Native Races," vol. ii, page 278.
+
+    [19] "Recherches Philosophiques sur les Americains, ou Memoires
+          Interessants pour servir a l'Histoire de l'Espece Humaine."
+          Par M. de P. Edition par Dom Pernety. Tome ii. Article,
+          Circoncision, Berlin, 1774.
+
+    [20] "The Family, a Historical and Social Study." By Charles
+          Franklin Thwing. Boston, 1887.
+
+    [21] The "Recherches Philosophiques sur les Americains" and Virey,
+          in the 24th volume of the "Dictionaire des Sciences
+          Medicales," are very full on this subject, and for fuller
+          information the reader is referred to those works.
+
+    [22] "Cause Morale de la Circoncision des Israelites, Institution
+          Preventive de l'Onanisme des Enfants." Par le Docteur Vanier,
+          du Havre. Paris, 1847.
+
+    [23] "Annual Report of the Bureau of Ethnology." By J. W. Powell.
+          Washington, 1881, 1882.
+
+    [24] "Among Cannibals, or Four Years' Travels in Australia." By Carl
+          Lumholtz. Page 46. Charles Scribner & Son, 1889.
+
+    [25] These interesting historical facts in relation to the holy
+          prepuce were published in the _Journal l'Excommunier_ in
+          January of 1870, when the writer was in France. They were
+          contributed by A. S. Morin, of Miron, a learned
+          historiographer and antiquary. Europe has not recovered from
+          its love of the supernatural that it had so strongly in the
+          middle ages. The blood of St. Gennaro still liquefies once a
+          year, and many churches still claim to possess the identical
+          winding sheet that served our Lord prior to his resurrection,
+          as well as more than one church has the holy cloth that St.
+          Veronica used on the way to Calvary, which has an impression
+          of the face of the Saviour.
+
+    [26] This church has a remarkable history connected with its
+          foundation. The tradition relates that in the dark ages some
+          sacrilegious soldier had robbed a church in the neighborhood
+          of its holy vessels of gold and silver. In the vessel in the
+          Tabernacle there happened to be a consecrated wafer. The
+          soldier journeyed on to Turin to dispose of his plunder, when,
+          on arriving at the spot on which the church now stands, the
+          wafer is said to have ascended miraculously to some distance
+          above the soldier's head, while at the same time the mule he
+          rode, being imbued with more religious piety than his master,
+          reverently knelt down on his front legs. The holy wafer was
+          now encircled by a halo of shining light; this, with the
+          kneeling donkey and the soldier raining blows on the pious
+          animal, while he himself was unconscious of the presence of
+          the host above him, attracted the attention of the populace,
+          who apprehended the soldier, on whom the stolen vessels were
+          found. The bishop in his pontificial robes, in solemn
+          procession, received the consecrated wafer, which promptly
+          descended into pious hands. The donkey was adopted by the
+          bishop and the soldier was promptly hanged, in accordance with
+          the general treatment of thieves in those days. The writer has
+          more than once seen a flagstone inclosed within a railing that
+          occupies the central spot of the floor or pavement of the
+          church, it being the identical spot on which the donkey knelt.
+
+    [27] Rush's "Medical Inquiries," vol. i, page 217.
+
+    [28] Fothergill. "Gout in its Protean Aspects," page 158.
+
+    [29] "Philosophy of Magic," from the French of Eusebe Salverte, vol.
+          ii, page 143.
+
+    [30] "Dictionaire des Sciences Medicales." Cullerier. Article,
+          Phimosis. Vol. xli.
+
+    [31] Bergmann has gone into this subject at length, and the writer
+          has drawn freely from his brochure on "Castration and
+          Eunuchism," reprinted from the "Archivio per le Traditione
+          Populaire" of 1883.
+
+    [32] "The Hermit." By the Rev. Charles Kingsley. See Introduction.
+
+    [33] "Dictionaire des Sciences Medicales," vol. liv, page 570.
+
+    [34] _Ibid._, page 567.
+
+    [35] _Ibid._, page 570.
+
+    [36] "Cyclopedia of Biblical, Theological, and Ecclesiastical
+          Literature," vol. iii, page 351.
+
+    [37] Smollett gives a good account of the Carthagena expedition in
+          his "Roderick Random," and for a good satisfactory detail of
+          the blundering Walcheren expedition the reader is referred to
+          Harriet Martineau's "History of England," vol. i, pages 269,
+          272, 273, and 354.
+
+    [38] Schoopanism, or paederastia, is at times practiced by the
+          Omahas, and the man or boy who suffers as the passive agent is
+          called _min-quga_, or hermaphrodite.--"Third Annual Report of
+          the Bureau of Ethnology." By J. W. Powell. Washington, 1881,
+          1882.
+
+    [39] When the missionaries first arrived in this region they found
+          men dressed as women and performing women's duties who were
+          kept for unnatural purposes. From their youth up they were
+          treated, instructed, and used as females, and were even
+          frequently publicly married to the chiefs or great
+          men.--Bancroft's works, vol. i, "Native Races," page 415.
+
+    [40] "Recherches Philosophiques sur les Americains," tome ii.
+
+    [41] "The History of the Hebrew Commonwealth." From the German of
+          John Jahn, D.D. Page 25. Oxford, 1840.
+
+    [42] "L'Hermaphrodite devant le Code Civil." Par le Docteur Charles
+          Debierre. Bailliere et Fils. Paris, 1886.
+
+    [43] "Recherches Philosophiques sur les Americains," tome ii, page
+          78.
+
+    [44] "L'Hermaphrodite devant le Code Civil." Debierre.
+
+    [45] _Occidental Medical Times_, Sacramento, Cal., October, 1890,
+          page 543.
+
+    [46] "Dictionaire des Sciences Medicales," vol. xxxi., page 41.
+
+    [47] _British and Foreign Medico-Chirurgical Review_, vol. xviii,
+          1856.
+
+    [48] "L'Hermaphrodite devant le Code Civil." Debierre.
+
+    [49] Sir Thomas Brown's works, vol. ii, "Religio Medici."
+
+    [50] "The Bible and other Ancient Literature in the Nineteenth
+          Century." L. T. Townsend, D.D. Chautauqua press, 1889. See
+          pages 32-45.
+
+    [51] "The Religions of the Ancient World." George Rawlinson, M.A.
+          Alden edition of 1885. Page 174.
+
+    [52] "The Intellectual Development of Europe." John W. Draper. Vol.
+          ii, page 113.
+
+    [53] _Ibid._ vol. ii, page 122.
+
+    [54] In "Clarke's Commentary," vol. i, page 113, the reason of
+          choosing the eighth day is given. Circumcision was not only a
+          covenant, but an offering to God; and all born, whether human
+          or animal, were considered unclean previous to the eighth day.
+          Neither calf, lamb, or kid was offered to God until it was
+          eight days old.--Lev., xxii, 27.
+
+    [55] A father circumcised his children and the master his slaves. In
+          case of neglect the operation was performed by the magistrate.
+          If its neglect was unknown to the magistrate, then it became
+          the duty of the Hebrew, upon arriving of age, to either do it
+          himself or have it done.--"Clarke's Commentary," vol. i, page
+          113.
+
+    [56] Bishop Newton points out the remarkable analogy that marks the
+          Hebrew race as descendants of Isaac and the Arab race as the
+          descendants of Ishmael, from whom sprung the Saracenic people.
+          These are the only two races that have gone on in their purity
+          from their beginning. They intermarry only among themselves
+          and have, alike, the same customs and habits as their fathers.
+          The sculptured faces of the Hebrew on the Babylonian monuments
+          are the same faces that are met in the synagogues of Paris or
+          New York. So with the descendants of Ishmael, in whom there
+          flows partly the blood of the dominant element of ancient
+          Egypt; neither custom, habit, nor physiognomy have changed. In
+          these two races, as observed by Bishop Newton, we have an
+          ocular demonstration of the Divine origin of our faith, if
+          verification of Scripture history is any criterion.--"Clarke's
+          Commentary," vol. i, page 111; also, Hosmer's "Story of the
+          Jews," page 5.
+
+    [57] "Cause Morale de la Circoncision." Vanier, du Havre. Pages
+          40-45.
+
+    [58] "De la Circoncision." Par le Dr. S. Bernheim. Page 7. Paris,
+          1889.
+
+    [59] "Cyclopedia of Biblical, Theological, and Ecclesiastical
+          Literature," vol. ii, page 350.
+
+    [60] Among the Semitic race, however, it seems possible to bring
+          forward better evidence than this of an early Stone Age. If we
+          follow one way of translating we find, in two passages of the
+          Old Testament, an account of the use of sharp stones or stone
+          knives for circumcision,--Exodus, iv, 25: "And Zipporah took a
+          stone"; and Joshua, v, 2: "At that time Jehovah said to
+          Joshua, Make thee knives of stone." ... The Septuagint
+          altogether favors the opinion that the knives in question were
+          of stone, by reading, in the first place, a stone or pebble,
+          and, in the second, stone knives of sharp-cut stone. These are
+          mentioned again in the remarkable passage which follows the
+          account of the death and burial of Joshua (Joshua, xxiv, 29,
+          30),--"And it came to pass, after these things, that Joshua,
+          the son of Nun, the servant of Jehovah, died, being a hundred
+          and ten years old, and they buried him in the border of his
+          inheritance in Timnath Serah, which is in Mount Ephraim, on
+          the north side of the hill of Gaash." Here follows, in the
+          LXX, a passage not in the Hebrew text, which has come down to
+          us: "And there they laid with him in the tomb, wherein they
+          buried him there, the stone knives wherewith he circumcised
+          the children of Israel at the Gilgals, when he led them out of
+          Egypt, as the Lord commanded. And they are there unto this
+          day." The rabbinical law, in connection with this subject,
+          reads as follows: "We may circumcise with anything, even with
+          a flint, with crystal (glass), or with anything that cuts,
+          except with the sharp edge of a reed, because enchanters made
+          use of that, or it may bring on a disease; and it is a
+          precept of the wise men to circumcise with iron, whether in
+          the form of a knife or scissors, but it is customary to use a
+          knife." This mention of the objectionable nature of the reed
+          as a circumcising medium is attributed to the danger that may
+          arise from splinters. The Fiji Islanders use both a rattan
+          knife and a sharp splinter of bamboo in performing
+          circumcision and in cutting the umbilical cord at child-birth.
+          Herodotus mentions the use of stone knives by the Egyptian
+          embalmers. Stone knives were supposed to produce less
+          inflammation than those of bronze or iron, and it was for this
+          reason that the Cybelian priests operated upon themselves with
+          a sherd of Samian ware (Samia testa), as thus avoiding danger.
+          There seems, on the whole, to be a fair case for believing
+          that among the Israelites, as in Arabia, Ethiopia, and Egypt,
+          a ceremonial use of stone instruments long survived the
+          general adoption of metal, and that such observances are to be
+          interpreted as relics of an earlier Stone Age.--"Researches
+          into the Early History of Mankind." By Edward B. Tylor. Pages
+          217-220. London, 1870.
+
+    [61] The cannibals of Australia do not eat white people, as the
+          flesh of these produces a nausea, which the flesh of the
+          vegetable-fed blacks does not do. The rice-fed Chinese are
+          considered a treat, and these are slaughtered in great number,
+          ten Chinamen having been served up at one dinner.--"Among
+          Cannibals." By Carl Lumholtz. Page 273.
+
+    [62] "Cause Moral de la Circoncision." Par le Dr. Vanier. Page 266.
+
+    [63] _Ibid._, page 288.
+
+    [64] _Cincinnati Clinic_, vol. ii, page 165.
+
+    [65] "The Story of the Jews." Hosmer. Page 263.
+
+    [66] "Traite d'Hygiene, publique et privee." Michel Levy. 2d.
+          edition, vol. ii, page 754.
+
+    [67] _Ibid._
+
+    [68] "Diseases of Modern Life." B. W. Richardson. Page 19.
+
+    [69] "Longevity and other Biostatic Peculiarities of the Jewish
+          Race." By John Stockton Hough, M.D. _New York Med. Record_,
+          1873.
+
+    [70] "Vital Statistics of the Jews." By Dr. John S. Billings. _North
+          American Review_, No. 1, vol. 152, page 70, January, 1891.
+
+    [71] "On Regimen and Longevity." By John Bell, M.D. Page 13.
+
+    [72] _British and Foreign Medico-Chirurgical Review_, vol. xliii,
+          page 539.
+
+    [73] _Ibid._, vol. xlii, page 17.
+
+    [74] In "Influence of the Trades on Health," Thakrah mentions the
+          peculiar exemption enjoyed in this regard by the butcher
+          class. He quotes Tweedie in saying that he never saw a butcher
+          admitted to the fever hospital.
+
+    [75] Lancereaux. "Distribution de la Phthisie Pulmonaire."
+
+    [76] Ashhurst. "Int. Enc. Surgery."
+
+    [77] Horner. "Naval Practice."
+
+    [78] _Cincinnati Lancet and Observer._, vol. xvi, 1873.
+
+    [79] It may well be a question of some interest whether the atrophy
+          of the testicle in the aged may not at times be partly due to
+          the compression exercised by the prepuce on the glans through
+          reflex action, and whether at times the virility that is
+          departing cannot be restored by circumcision in such cases. I
+          have seen such results, being guided to the idea by the
+          Biblical relation in the case of Abraham.
+
+    [80] This patient subsequently died of a uraemic complication
+          following on an attack of fever. The man was in his prime, and
+          had been of most exemplary habits. The fever that he had was,
+          I had every reason to believe, directly due to the results of
+          imperfect blood depuration incident on the irritability of his
+          kidneys, which, retroactively, again allowed the uraemic
+          condition to assume that dangerous degree that suddenly and
+          very unexpectedly to his friends and family ushered the
+          patient into eternity. This man had only been merely
+          inconvenienced by his prepuce up to the time that it caused
+          his death. It is interesting to observe what little trifles
+          bring about the end of some men. The unlucky habit of putting
+          the royal countenance on paper brought Louis XVI to a sudden
+          halt at Varennes, and his head to the scaffold. The lucky
+          meeting of the _aides_ of Bonaparte and Desaix between Novi
+          and Marengo gave to France its empire and to Europe the
+          enlightenment that was diffused by that event. If such trifles
+          affect individuals and nations, we must not be astonished that
+          the little useless prepuce should be endowed with the
+          mischief-working power of the historical old cow and kerosene
+          lamp that reduced Chicago to ashes.
+
+    [81] In the London _Lancet_ for 1885 there is a very interesting
+          communication at page 46 on this subject. There is no doubt
+          but that the prepuce offers the best skin-grafting material.
+
+    [82] In the seventeenth volume (third series) of "Guy's Hospital
+          Reports" there is a most interesting report at page 243 of a
+          case of skin-grafting that was performed by Thomas Bryant. The
+          case was an extensive ulcer resulting from an injury. Bryant
+          took some skin-grafts from the man's arm and some from a
+          colored man in an adjoining bed. The account gives the daily
+          report as taken from the note-book of Mr. Clarke, and is
+          accompanied by a colored plate to illustrate the subject; the
+          proliferation of the black skin is astonishing. In closing the
+          report Mr. Clarke says: "But in the figures depicted the
+          amount of increase in the black patches will be well seen. In
+          ten weeks the four or five pieces of black skin, which
+          together were not larger than a grain of barley, had grown
+          twentyfold, and in an another month the black patch was more
+          than one inch long by half an inch broad, the black centres of
+          cutification having clearly grown very rapidly by the
+          proliferation of their own black cells."
+
+    [83] _American Journal Med. Sciences_, vol. lx.
+
+    [84] "Circumcision." By Dr. A. B. Arnold, of Baltimore.
+
+    [85] "De la Circoncision." By Dr. S. Bernheim. Paris.
+
+    [86] The reader is referred to a very interesting paper detailing
+          conditions of adhesions in the _American Journal Med.
+          Sciences_ for July, 1872. It is taken from the Hungarian of M.
+          Bokai.
+
+    [87] _New York Med. Journal_, vol. xxvi.
+
+    [88] _American Journal Med. Sciences_, vol. lx.
+
+    [89] Dr. Vanier describes this operation of Celsus mentioned by
+          Vidal in his work on "Circumcision," at page 294, which
+          consisted in making, by a circular incision immediately back
+          of the glans, like in a circular amputation, a complete
+          detachment of the integument from back of the corona. The
+          penis was then made to retreat into the sheath thus made and a
+          short catheter introduced into the urethra, to the end of
+          which the free end of the new preputial fold was made fast, a
+          piece of oiled lint being interposed between the raw inner
+          surface and the glans. Another operation consisted in
+          forcibly drawing the integument forward and in making a number
+          of transverse incisions in the integument so as to assist its
+          extensibility. By these means it was drawn sufficiently
+          forward so as to fasten it to a canula or catheter made fast
+          in the urethra. But it can well be imagined that a person must
+          possess the most exalted idea of the physiological needs of a
+          prepuce and feel the most sensitive need of such an appendage
+          to submit to the first of these operations, although it is
+          more than probable that many Jews submitted to the operation
+          in the days of Celsus to avoid being exiled or plundered of
+          all their possessions. The resulting prepuce could not have
+          been a much more unsightly appendage than that which ornaments
+          the overburdened virile organ of many Christians, and there is
+          no doubt but that in many cases they passed muster.
+
+    [90] "Circumcision." Dr. A. B. Arnold.
+
+    [91] Ashhurst. "Int. Enc. Surgery," vol. vi.
+
+    [92] "Pertes Seminales."
+
+    [93] "Circoncision." Dr. Vanier, du Havre.
+
+    [94] "Dictionaire des Sciences Medicales."
+
+    [95] Erichsen's "Surgery," page 1144. Edition of 1869.
+
+    [96] _Medical News_ of Philadelphia, page 115. Vol. for 1860.
+
+    [97] "Pertes Seminales." In the fourth American edition of the
+          English translation of McDougall of Lallemand we find that he
+          fully appreciated the dangers that lurk in a prepuce. At page
+          216 he says: "Such is the condition which the parts present in
+          cases of recent balanitis, and these are the inflammations and
+          ulcerations that cause more or less extensive adhesions of the
+          prepuce to the glans. Such adhesions are generally cellular,
+          but sometimes fibrous or even cartilaginous, according to the
+          severity and frequent repetition of the inflammation. Various
+          degrees of induration also results according to the intensity,
+          the duration, and the frequency of the phlogosis. Thus, I have
+          often found a mucous membrane hardened, thickened, and covered
+          with numerous papillae, sometimes fibrous or cartilaginous,
+          with three times its natural thickness. I have also met with
+          cases in which the prepuce has become cancerous. I have
+          operated in several cases of cancer of the penis, too, which
+          certainly arose from no other cause. The patients were
+          generally peasants between fifty and sixty years of age, who
+          had never known other than their own wives, but who had
+          frequently suffered from balanitis attended by abundant
+          discharge, swelling of the prepuce, and excoriation of its
+          opening, which was so contracted as to prevent the passage of
+          the glans. I have seen one case, also, in which balanitis,
+          irritated by a forced march and the abuse of alcoholic
+          stimulants, passed into gangrene, by which the greater part of
+          the glans was destroyed. Such have been the accidents which I
+          have observed on those whose prepuce was too narrow to permit
+          the glans being uncovered; accidents which I can only
+          attribute to the long retention of the sebaceous matter in a
+          kind of _cul-de-sac_, into which a certain quantity of urine
+          passes every time the patient makes water."
+
+    [98] Claparede. "La Circoncision."
+
+    [99] Baron Boyer. "Traite des Maladies Chirurgicales," vol. x, page
+          370.
+
+    [100] I have practiced considerably among the Jewish people, but I
+          have never seen their elderly men suffer with prostatic
+          troubles like our own people who are uncircumcised. From
+          having observed the tendency to prostatic complications in
+          young people with troublesome prepuces, and that the great
+          number of the elderly people who are affected with prostatic
+          disease or enlargement are the unlucky possessors of long or
+          large prepuces, I have arrived at the conclusion that the
+          prepuce can be entered as a factor in the etiology of enlarged
+          prostate.
+
+    [101] I have now under my care a poor consumptive who has all the
+          appearance of having always been as virtuous as Joseph, but
+          who, unlike Joseph, has from infancy had as a constant
+          companion a long, miserable, smegmanous, and annoying prepuce.
+          The young man has an oedema which first affected his feet, but
+          one day, owing to the irritation of a slight balanitis, the
+          prepuce swelled at once; it proceeded through the penis
+          integument to the scrotum; the penis itself retracted, leaving
+          the integument and scrotum to assume a translucent, puffy,
+          cork-screw appearance and attitude; from its labyrinthic
+          passage the urine slowly dribbles during urination in a
+          scalding stream. In addition to the physical sufferings, he is
+          tormented by the knowledge that his friends attribute all his
+          disease and troubles--since the occurence of the penile
+          oedema--to the fact that his earlier manhood must have been
+          indiscreet, as well as sinful. The laity cannot connect any
+          penile, scrotal, or testicular disease with anything except
+          venereal disease; and if the physician attempts to explain
+          matters, they simply look upon it as the good-natured and
+          well-intentioned efforts of the doctor to deceive them and to
+          cover up the shortcomings of some frail mortal. Many a poor
+          fellow has to leave this world under a cloud of mistrust and a
+          bad odor of past deviltry to which he is not entitled, and
+          suffer all this in addition to all his physical ills, owing to
+          his having been ornamented through life with an annoying
+          prepuce,--the luckless heritage of having been born a
+          Christian. Columbus in chains moralizing on the ingratitude of
+          this world is nothing to the poor invalid with a swollen
+          prepuce, innocently acquired, silently "cussing" the ignorance
+          of his relatives and friends.
+
+    [102] This patient, on convalescing, suffered considerable from the
+          action of numerous small carbuncles, resulting from the
+          toxaemic condition induced by the partial suppression of urine
+          that he at times suffered from, and, when nearly well, brought
+          on a serious relapse by the mail-bag appendage at the penis
+          working up the organ into a state of erection. While so
+          situated he had intercourse, and from 99 deg. his temperature
+          immediately rose to 1041/2 deg., where it remained for several days,
+          lengthening out his illness by several weeks, into a
+          long-protracted convalescence. The man is not yet circumcised,
+          and, from the knowledge that I have of his tendency to uraemia,
+          I feel that, although in his prime, a fever or an accident may
+          take him off at any moment.
+
+    [103] In looking over the literature of reflex neuroses and more
+          direct injurious results, I find that George Macilwain, in a
+          work on "Surgical Observations on the More Important Diseases
+          of the Mucous Canals of the Body," published in London in
+          1830, calls special attention to the case of a man aged
+          thirty-eight, admitted to the Finsbury Dispensary, and who was
+          in the care of Mr. Hancock. The patient was suffering from
+          excruciating pain in different joints, the pain being so
+          great that he was confined to his bed and unable to stand on
+          his feet. He was unable to rest at nights, and neither
+          rheumatic nor any other apparently suitable treatment was of
+          any service. Rigors were soon added to his other troubles, and
+          during their continuance the pain in his joints was greatly
+          aggravated. He was referred to Mr. Macilwain for treatment,
+          who promptly relieved him by the removal of a urethral
+          stricture, which had quietly been the cause of all the
+          disturbance. It is particularly interesting that even at that
+          early day the reflex neuroses and complications that may arise
+          from the irritability of the genito-urinary organs were so
+          well understood. How well Dr. Macilwain appreciated the nicety
+          of these relations can be seen from his remarks in connection
+          with the above case, in which he says: "It may be observed
+          that the severity of the symptoms is not always commensurate
+          either with the duration of the disease or the degree of
+          stricture, and that, although the progressive development of
+          them varies considerably in rapidity, in different
+          individuals, it is, nevertheless, in the latter stages, always
+          more rapid." Macilwain also graphically describes the
+          insidious approach of these genito-urinary troubles. In
+          speaking of stricture he says: "Although minute inquiry
+          generally informs us that the stricture has been of some
+          standing, and in some instances has existed for years, yet it
+          may happen that it is only a few months or a year since the
+          patient's attention has been directed to the disease. This is
+          very intelligible; for, in conformity with what we observe in
+          other parts of the body, the bladder has a power of
+          accommodating itself to a change of circumstances. Its
+          strength, for a long time, may increase so correctly in
+          proportion to the increase of the obstacle which opposes the
+          ejection of its contents that a very considerable period
+          elapses before the difficulty in making water becomes
+          cognizable to the patient, or it occasions an annoyance so
+          trifling as scarcely to excite his attention. This increase of
+          strength in the bladder frequently renders the formation of
+          stricture so insidious that the urethra at the affected part
+          is very narrow before the individual is aware of the existence
+          of any contraction whatever; the bladder, however, at length
+          becomes unable to empty itself, and the abdominal muscles and
+          diaphragm powerfully act as coadjutors, so that each effort to
+          make water is accompanied by a straining which is very
+          distressing, and the complete evacuation of the bladder is
+          often not accomplished even by these combined forces. The
+          straining which accompanies stricture, and which seems
+          necessary to evacuate the bladder, although it be occasionally
+          exceedingly annoying to the patient at the time, is more
+          important with reference to the results which are its
+          consequence. I am firmly of opinion that there are a great
+          number of patients laboring under hernia which has been
+          produced by no other cause. I must confess that I had seen a
+          great number of instances of stricture in ruptured patients
+          before I drew any inference from the observation of their
+          co-existence." The foregoing observations of Macilwain, made
+          in 1830, are here reproduced for their clearness of expression
+          and explanation, as well as to show what injuries can be
+          produced on the young child afflicted with phimosis. We are,
+          as surgeons, familiar with the anatomical and pathological
+          changes there are undergone by the bladder and its lining
+          membrane, as well as in the ureters and kidneys, in many
+          cases of stricture, as well as of the great amount of
+          prostatic irritability and enlargement that is due to the same
+          cause. How similarly these results can be and are actually
+          produced by phimosis is undeniably expressed by the
+          post-mortem appearances in the poor infant described by
+          Golding Bird to the London Medical Society, and mentioned in
+          the London _Lancet_ of May 16, 1846. The bladder and ureter
+          were like those of a man who had long suffered from stricture.
+          From the remarks of Dr. J. Lewis Smith, that phimosis may be
+          productive of inguinal hernia and prolapsus of the rectum, and
+          the observations of Edmund Owens and Arthur Kemp, both high
+          authorities on children's diseases, being both connected with
+          children's hospitals, as well as the remarks of Mr. Bryant in
+          his "Surgical Diseases of Children," who all concur in looking
+          upon phimosis as a great factor in hernia, Bryant having
+          observed thirty-one in fifty consecutive cases of phimosis, we
+          are certainly warranted in assuming that phimosis is not only
+          a mere local timely inconvenience that will disappear with the
+          approach of puberty, but a condition which, in the more easily
+          affected organism of the child,--lacking, as it does, that
+          resistance that comes with our prime,--is productive of
+          serious harm; as even the first few years of life, even a few
+          months of infant life, with a phimosis, are sufficient to so
+          change the structures of parts that the poor child will grow
+          into a man with an impaired kidney or sacculated ureter. The
+          strain required to induce a prolapsus of the bowel or a
+          rupture into the inguinal canal is exerted as much on the
+          bladder, ureter, and kidney as on the other localities.
+          Physicians who have taken the pains to observe must have
+          noticed, more than once, how the child afflicted with a
+          phimosis has not only at times to wait for the stream of urine
+          to appear, there seemingly being some obstruction to its
+          starting, but how often such a case is afflicted with a
+          stammering, halting urination. A child thus started out into
+          life, with a defective kidney or kidneys, is sadly handicapped
+          in his usefulness, comfort, or in properly competing in the
+          race of life. No parent would for a moment think of starting
+          his son in life by giving him a business that is heavily
+          mortgaged at the start, but many a parent unconsciously
+          launches the unsuspecting child into a life of such ill
+          health--resulting from a simple narrow prepuce--beside which a
+          heavy mortgage or a heavy yearly tribute would be but a mere
+          trifle. I have seen such men, who in after life, broken-down
+          and perfectly physical wrecks, would gladly have given all
+          their wealth and been willing to have some genii set them down
+          in the middle of the Sahara, shirtless and pennyless, provided
+          they had their health. To say nothing of the trifling loss of
+          the prepuce, these parties would gladly have had a foot or a
+          leg go with the prepuce if necessary, and have their health.
+
+    [104] I have often performed dilatation where, for some reason,
+          either the timidity of the parents or the health of the child
+          seemed to contraindicate any more radical procedure. It is
+          customary to advise mothers or the nurses to retract the skin
+          daily, but even after a good dilatation I have found as sudden
+          a recontraction, and even in the majority of cases, where
+          daily drawing back the skin might have been practicable, the
+          cries and struggles of the child are a positive prohibition to
+          these instructions being carried out; it is not once in ten
+          times that it can be carried out. I have seen two very
+          annoying cases of paraphimosis resulting from this procedure,
+          the struggles of the child having prevented the return of the
+          prepuce to its proper place, and the violent crying and
+          sobbing of the child having assisted to congest the organ.
+
+    [105] It may well be a question, considering the well-established
+          fact that nervous injuries and affections are easily
+          transmissible and become hereditary, how much
+          feeble-mindedness is due to an heredity originally induced in
+          either parent through reflex neuroses from the genital organs.
+          The Jews have a very small percentage of feeble-minded; it is
+          true that they have not any inebriates to assist in their
+          manufacture, but still the absence of these well-pronounced
+          cases of reflex neuroses among the race must be largely
+          ascribed to their practice of circumcision, as that operation
+          cures the gentiles so afflicted.
+
+    [106] I have seen precisely similar conditions resulting from a
+          sphincterismus being relieved by anal dilatation. I had one
+          such case who had fallen into the hands of a quack, who made
+          him believe that he was being affected with incipient
+          softening of the brain; systematic dilatation or a rupture of
+          the sphincter _a la_ Van Buren is the appropriate remedy.
+
+    [107] In the first volume of the "American and English Encyclopedia
+          of Law" there is an interesting account of a young child (who
+          had been bound out by the parish officials) who murdered his
+          little bed-fellow and, on trial and conviction, was sentenced
+          to be hanged, but who was reprieved by royal favor on account
+          of his tender years, the sentence being changed to
+          imprisonment for life. The little fellow was only eight years
+          of age. On the trial the boy said he was driven to commit the
+          crime because the other child soiled the bed. The two children
+          being both paupers, it may well be imagined that their bedding
+          was none of the cleanest at the best, or that their bed-room
+          had the best of ventilation. As at the time the murder was
+          committed English paupers were not treated in the most humane
+          manner, it is not surprising that a nervous, sensitive child
+          would, under such a combination of circumstances, be converted
+          into an insane murderer.
+
+    [108] The study of prematurely acquired impotence in the male is a
+          most interesting one. I have frequently seen it result from
+          the presence of anal or rectal irritation, from haemorrhoids. I
+          have seen cases who could not have erections, and in whom all
+          sexual desire was extinct at a very early age, who have
+          informed me that, although unable to have sexual intercourse
+          because of the total absence of sexual desire, the flaccidity
+          of the organ, and the want of sound physiological organic
+          functional activity to suggest the thought, they had,
+          nevertheless, frequently been the victims of nocturnal
+          emissions before the total extinction of the function. As a
+          rule, much of this premature impotence--induced by either
+          irritation of the genital organs or rectal or anal
+          troubles--runs its unfortunate possessor through such a course
+          of physical incidents as described by Hammond, as the wild
+          Indians of the Southwest induce in the _mujerado_. At first
+          the sound organ responds in a natural manner to any stimulus
+          that may affect it, but soon a local satyriacal condition is
+          set up, which, running a more or less rapid period of intense
+          activity, soon leaves its victim completely, permanently, and
+          hopelessly impotent, even as much so as if eunuchized in the
+          most approved manner. Hammond's description of the manner in
+          which these unfortunates are manufactured is an interesting
+          addition to the facts contained in the natural history of man,
+          and is as follows: "A _mujerado_ is an essential person in the
+          saturnalia, or orgies, in which these Indians, like the
+          ancient Greeks, Egyptians, and other nations, indulge. He is
+          the chief passive agent in the pederastic ceremonies which
+          form so important a part in the performances. These take place
+          in the spring of every year, and are conducted with the utmost
+          secrecy, as regards the non-Indian part of the population. For
+          the making of a _mujerado_ one of the most virile men is
+          selected, and the act of masturbation is performed upon him
+          many times every day; at the same time he is made to ride
+          almost continuously on horseback. The genital organs are thus
+          brought, at first, into a state of extreme erethism, so that
+          the motion of the horse is sufficient to produce a discharge
+          of seminal fluid, while at the same time the pressure of the
+          body on the animal's back--for the riding is done without a
+          saddle--interferes with their proper nutrition. It eventually
+          happens that, though an orgasm may be caused, emissions can no
+          longer be effected, even upon the most intense degree of
+          excitation. Finally, the accomplishment of an orgasm becomes
+          impossible; in the meantime the penis and testicles begin to
+          shrink, and in time reach their lowest plane of degradation.
+          But the most decided changes are at the same time going on,
+          little by little, in the instincts and proclivities of the
+          subject. He loses his taste for those sports and occupations
+          in which he formerly indulged, his courage disappears, and he
+          becomes timid to such an extent that, if he is a man occupying
+          a prominent place in the council of the pueblo, he is at once
+          relieved of all power and responsibility, and his influence is
+          at an end. If he is married his wife and children pass from
+          under his control,--whether, however, through his wish or
+          theirs, or by the orders of the council, I could not
+          ascertain. They certainly become no more to him than other
+          women and children of the pueblo." Hammond examined one of
+          these men, who had, as he himself informed him, formerly
+          possessed a large penis and testicles "grande como
+          huevos,"--as large as eggs. The penis was in its flaccid state
+          and about an inch and a half in length, with the glans about
+          the size of a thimble, which it very much resembled in shape.
+          The glandular structure of the testicles had disappeared; they
+          were atrophied, little besides connective tissue remaining. He
+          examined another _mujerado_ in the pueblo of Acoma, who had
+          been so made when at about the age of twenty-six. The penis
+          was not more than an inch in length and about the diameter of
+          the little finger, and of the testicles there was apparently
+          nothing left but a little connective tissue. Both of these men
+          had high-pitched voices. The last one examined was then
+          thirty-six years of age. (Hammond: "Male Impotence.") The
+          foregoing detailed description shows an extreme degree of
+          results produced by an equally extreme degree of intense and
+          persistent irritation applied to the genital organs, purposely
+          employed to obtain certain results. In the cases cited the
+          irritation or excitation is directly applied, but it is safe
+          to assume that reflex irritability from the anus or rectum,
+          or from that of a stricture or of a prepuce, will in some
+          cases produce a certain degree of excitation in the testicles
+          that may result in their functional or organic derangement, in
+          a degree proportionate to that of the amount of excitation
+          from which they have suffered. That the testicles are very apt
+          to suffer from the existence of a stricture is a well-known
+          fact. I have myself worried over a case of stricture, in whom
+          the attempted passage of a filiform bougie was always
+          immediately followed by a severe attack of epididymitis, and
+          who had always been afflicted with a tenderness and a tendency
+          to inflammation of the testes. I have also noticed a much
+          greater tendency to orchitis in the wearer of an irritating
+          prepuce than where it was absent; so that the presence of a
+          satyriacal tendency, no matter in what proportion of a degree
+          it may be present, can safely be assumed to result in a
+          corresponding degree of apathy, due to an actual physical
+          degeneration of the parts. That these conditions, when present
+          in any degree of permanency or persistence, will in the end
+          induce early impotence, I have no reason to doubt. In this
+          regard we must not overlook the fact that persons with
+          phimosis, stricture, or other genital irritants and
+          impediments, are more liable to be afflicted with haemorrhoids,
+          prolapsus ani, or other anal and rectal irritation, which
+          retroactively assist in bringing about the condition under
+          question. How much this may have to do with certain prolific
+          peculiarities among the Jews may well be questioned; it is a
+          well-known fact that in London the Jewish excess of male
+          births has been as high as eighteen per cent., while among the
+          Christian or Gentile population it is only six and one-half
+          per cent.,--a somewhat analogous condition of proportion being
+          also observable in the United States. Here, it is accounted
+          for, in a measure, by Dr. Billings, in the following words:
+          "This comparatively large proportion of males among the Jews
+          is probably due to the fact that the death-rate of their
+          infants is less for males, as compared with females, than it
+          is among the average population." Children gotten during the
+          prime of life of the parents are naturally more virile and
+          have better stamina than those gotten before full maturity is
+          reached. If the father is on the verge of impotency just about
+          the time he is expected to beget his best offspring, that
+          offspring cannot be expected to present an extra amount of
+          vitality, virility, or physical stamina; hence, the prepuce
+          can be brought in as directly tending--in no matter how small
+          the degree it may be, but nevertheless a factor--to the
+          physical degeneracy of the race, as well as it demonstrates
+          the existence of some law for the production of the sexes
+          which we do not as yet fully comprehend. Aside from the above
+          considerations, there are those of the actual bar to the
+          increase of population which the prepuce induces, either by
+          primarily being the cause of impotence or by direct
+          interference, as already mentioned, and the impotence that
+          naturally results from the causes set forth in this note. The
+          results of a prepuce are certainly such as must act like a
+          moist, warm, and oily poultice to the irritability induced in
+          the most confirmed Malthusian when contemplating the--to
+          him--rapid and unwarranted increase of population.
+
+
+
+
+WORKS AND AUTHORITIES QUOTED.
+
+
+These pour le doctorat en Medecine, par J. B. B. Edmond Nogues, sur la
+Anatomie, Physiologie, et Pathologie du Prepuce. Paris, 1850.
+
+These a la faculte de Medecine de Strasbourg. Par J. B. A. Chauvin.
+Consideration sur le Phimosis et Operation de la Circoncision par un
+procede nouveau. Strasbourg, 1851.
+
+De la Circoncision chez les Egyptiens. F. Chabas. Paris, 1861.
+
+Cause Morale de la Circoncision des Israelites. Vanier, du Havre. Paris,
+1847.
+
+La Circoncision, son importance dans la Famille et dans l'Etat. Par le
+Docteur Claparede. Paris, 1861.
+
+Dissertation sur la Circoncision, sons les rapports religieux,
+hygieniques, et Pathologiques. Par le Docteur Moyse Cahen. Paris, 1816.
+
+Origine, Signification, et Histoire, de la Castration, de l'Eunuchisme,
+et de la Circoncision. Par le Docteur F. Bergmann de Strasbourg.
+Archivio per le Tradizioni Populari, vol. ii.
+
+Darstellung der Biblichen Krankheiten. Von Dr. J. P. Trusen. Posen,
+1843.
+
+Archives Israelites de France, No. 9, 4em annee, Septembre, 1843.
+
+Bulletins de la Societe d'Anthropologie de Paris. Tome x (serie iii), 3d
+fascicule, Juin a Octobre, 1887.
+
+Recueil de Memoires de Medecine, de Chirurgie, et de Pharmacie
+Militaires. Tome xxi (serie iii), No. 105, August, 1868.
+
+Traite d'Hygiene, publique et privee. Michel Levy. 2d ed. Paris, 1850.
+
+Neuroses des Organes Genito-Urinaires de l'homme. Ultzmann. Paris, 1883.
+
+L'Hermaphrodisme, sa Nature, son Origine, ses Consequences Sociales. Par
+le Docteur Charles Debierre. Paris, 1886.
+
+L'Onanisme. Tissot. Lausanne, 1787.
+
+Traite de la nymphomanie. Dr. Bienville. Amsterdam, 1784.
+
+La Folie Erotique. Par Prof. B. Balt. Paris, 1888.
+
+Des Pertes Seminales Involontaires. Lallemand. Paris, 1836.
+
+Spermatorrhoea. Lallemand and Wilson. Philadelphia, 1861.
+
+The Philosophical Dictionary. Voltaire. London, 1765.
+
+Oeuvres Completes, avec notes, etc. Montesquieu. Paris, 1838.
+
+Dictionaire d'Hygiene, publique et de salubrite. Tardieu. Paris, 1862.
+
+Guide du Posthetomiste. Par le Docteur L. Terquem. Paris.
+
+La Circoncision et ses suites. Par A.S. Morin. Ext. du Journal
+l'Excommunie, January, 1870.
+
+La Circoncision. Par le Docteur S. Bernheim.
+
+Circumcision. By Dr. A. B. Arnold, of Baltimore. Reprint from the New
+York Medical Journal of February 13, 1886.
+
+Among the Cannibals. By Carl Lumholtz. New York, 1889.
+
+Recueil de Questions proposes par une Societe de savants voyageant an
+Arabie, Michealis. Amsterdam, 1774.
+
+Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim Interpretis
+primarii, De Turcarum Liturgia, peregrinatione Meccana, Circumcisione,
+AEgrotorum Visitatione, etc. Oxonii, 1690.
+
+Le Theatre de la Turquie. Michel Le Feber. Paris, 1681.
+
+Recherches Philosophiques sur les Americains, ou Memoires Interessants
+pour servir a l'Histoire de l'Espece Humaine. Par M. de P. Augumentee
+par Dom Pernety. Berlin, 1774. (Also the first edition of the same work
+printed at Cleves in 1772.)
+
+History of the Hebrews' Second Commonwealth. Wise. Cincinnati, 1880.
+
+History of the Hebrew Commonwealth. Jahn. Oxford, 1840.
+
+Jews' Letters to Voltaire. Philadelphia, 1848.
+
+The Jewish Nation. Revised by Kidder. New York, 1850.
+
+The Jews Under Roman Rule. By W. D. Morrison. New York, 1890.
+
+The Story of the Jews. By James K. Hosmer. New York, 1887.
+
+The History of the Jews. By the Rev. H. H. Milman. New York, 1843.
+
+Early Oriental History. By John Eadie, D.D., LL.D. London, 1852.
+
+The Bible and the Nineteenth Century. By L. T. Townsend, D.D. New York,
+1889.
+
+Legends of the Patriarchs and Prophets. By the Rev. S. Baring-Gould. New
+York, 1884.
+
+The Religions of the Ancient World. By George Rawlinson, M.A. New York,
+1885.
+
+The Hermits. By the Rev. Charles Kingsley. New York, 1885.
+
+Letters on Demonology and Witchcraft. Letters addressed to J. G.
+Lockhart, Esq., by Sir Walter Scott. London, 1831.
+
+The Philosophy of Magic, Prodigies, and Apparent Miracles. From the
+French of Eusebe Salvert. New York, 1855.
+
+Atlantis, the Antediluvian World. Donnelly. New York, 1882.
+
+Sir Thomas Browne's Works. London, 1852.
+
+Physical Education, or the Health Laws of Nature. By Felix Oswald, M.D.
+New York, 1882.
+
+The Family: an Historical and Social Study. By Thwing. Boston, 1887.
+
+The Intellectual Development of Europe. By John W. Draper, M.D. New
+York, 1876.
+
+History of European Morals. By W. E. H. Lecky, M.A. New York, 1884.
+
+Longevity and other Biostatic Peculiarities of the Jewish Race. By John
+Stockton Hough. Reprinted from New York Medical Record, 1873.
+
+Vital Statistics of the Jews. By Dr. John S. Billings, in North American
+Review for January, 1891.
+
+On Regimen and Longevity. By John Bell, M.D. New York, 1842.
+
+Diseases of Modern Life. By B. W. Richardson, M.D. New York, 1876.
+
+Cyclopedia of Biblical, Theological, and Ecclesiastical Literature. By
+McClintock and Strong. New York, 1886.
+
+Early History of Mankind. Tylor. London, 1870.
+
+Dictionaire des Sciences Medicales. 60-vol. edition. Paris, 1816.
+
+British and Foreign Medico-Chirurgical Review, vols. for 1846, 1854,
+1856, 1858, 1863, 1868, and 1869. London.
+
+Braithwaite's Retrospect of Medicine and Surgery.
+
+The Chinese. By John Francis Davis, Esq., F.R.S. London, 1851.
+
+Massachusetts State Board of Health Report for 1873.
+
+On Diseases of Children. Stewart. New York, 1844.
+
+Diseases of Children. West. Philadelphia.
+
+Lectures on Diseases of Children. Henoch. New York, 1882.
+
+Women's and Children's Diseases. Dillnberger. Philadelphia, 1871.
+
+Male Impotence. Hammond. New York, 1883.
+
+Genito-Urinary Diseases. Otis. New York, 1883.
+
+Urinary and Renal Diseases. Roberts. Philadelphia, 1885.
+
+Urinary and Renal Disorders. Beale.
+
+Renal and Urinary Organs. Black. Philadelphia, 1872.
+
+Gout in its Protean Aspects. Fothergill. Detroit, 1883.
+
+Venereal Diseases. Bumstead and Taylor. Philadelphia, 1883.
+
+Traite sur les Maladies des Organes Genito-Urinaires. Civiale. Paris,
+1850.
+
+Pathologic Chirurgicale, tome vi. Nelaton. Paris, 1884.
+
+Pathologie Externe, tome v. Vidal (de Cassis). Paris, 1846.
+
+Guy's Hospital Reports, 3d series, vol. xvii. London, 1872.
+
+Transactions of the Ninth International Medical Congress, vol iii.
+Washington, 1887.
+
+American Journal of Obstetrics for January, 1882.
+
+On the Reproductive Organs. Acton. Philadelphia, 1883.
+
+Operative Surgery. Smith. Philadelphia, 1852.
+
+Operative Surgery. Stephen Smith. Philadelphia, 1887.
+
+System of Surgery. Gross. Philadelphia, 1859.
+
+Principles and Practice of Surgery. Agnew. Philadelphia, 1881.
+
+International Encyclopedia of Surgery. Ashhurst. Philadelphia, 1886.
+
+Science and Art of Surgery. Erichsen. Philadelphia, 1869.
+
+Diseases of the Kidneys. Ralfe. Philadelphia, 1885.
+
+The Clinic. Cincinnati, 1872.
+
+American Journal of the Medical Sciences for July, 1872; also vol. lx.
+
+New York Medical Journal, vols. xvi, xix, xxvi.
+
+Occidental Medical Times. Sacramento, October, 1890.
+
+London Lancet, 1875.
+
+Distribution Geographique de la Phthisie Pulmonaire. Lancereaux. Paris,
+1877.
+
+Annual Report of the Bureau of Ethnology. J. W. Powell. Washington,
+1884.
+
+Western Journal of Medicine and Surgery. Louisville, 1846.
+
+Native Races of the Pacific Coast. Bancroft. San Francisco, 1875.
+
+Encyclopedia Britannica, 9th edition.
+
+Classical Dictionary. Lempriere. New York, 1847.
+
+Commentary on the Bible. Clark.
+
+Satellite for February, 1889, and January, 1891. Philadelphia.
+
+Pedigree of Diseases. Hutchinson.
+
+Medical Inquiries. Rush. Philadelphia.
+
+Half-Yearly Abstract of the Medical Sciences, vols. xii and lx,
+Philadelphia.
+
+Cincinnati Lancet and Observer, vol. xvi.
+
+Statistics and Climate of Consumption. Millard.
+
+Traite des Maladies Chirurgicales, vol. x. Baron Boyer. Paris, 1825.
+
+Dictionary of Medicine. Quain. New York, 1884.
+
+
+
+
+INDEX
+
+
+Abolishment
+  of circumcision by Christians, 18;
+    by the Romans, 66
+  of eunuchism in Italy, 91, 96
+
+Abraham, 32
+
+Absence of penis, 13
+  of testicles, 105
+
+Abyssinians, carry off the male members of slain enemies, 30;
+  circumcised bishop among the, 64
+
+Acosta, Rev. Father, on Mexican circumcision, 47
+
+Adams, Dr. C. Powell, of Hastings, Minn., 198
+
+After-treatment of circumcised Hebrews, 158
+
+Agnew, D. Hayes, on penile cancer, 230;
+  on eczema as a reflex neurosis from phimosis, 320
+
+Albutt, T. Clifford, on primary cause of disease, 13
+
+American circumcision, 47;
+  infibulation and muzzling, 48
+
+Amputation of penis, 230, 233, 247
+
+Androgynes, 118
+
+Augleria, Pierre d', on American circumcision, 47
+
+Apis, the white bull, sacred to the Egyptians, 29
+
+Apollo Belvidere, as evidence of exactness of ancient sculpture, 62
+
+Apure Indians and their circumcision, 48
+
+Arabian circumcision, 38;
+  prostitutes, 323
+
+Arias Montan, on Mexico, 46
+
+Arnold, Dr. A. B., of Baltimore, 25, 219, 220, 223
+
+Asthma as a reflex neurosis from genital irritation, 291
+
+Australian circumcision, 44;
+  operation on the urethra, 56
+
+Author's modification of circumcision, 307
+
+Aztec circumcision, 46
+
+
+Ballance, C. W., dressing after circumcision, 317
+
+Bamboo stick worn in vagina as a chastity protector, 52
+
+Baptismal ceremonies of Omaha Indians, 56
+
+Barbarous Arabian marriage custom, 54
+  mutilations of Guamo and Othomaco Indians, 48
+
+Bas-relief representing Egyptian emasculation, 31
+
+Bassouto circumcision, 42
+
+Battos circumcision, 45
+
+Baumgartner's devout and chaste dervish, 49
+
+Beale, Sir Lionel, on blood changes, 296
+
+Bell, Dr. John, on Jewish hygiene, 181
+  Dr. J. Royes, 191, 223, 229, 239
+
+Bells, jingling of, under the skirts, denotive of Judean virginity, 52
+
+Belt of brass mail to insure female chastity, 51
+
+Berbers, mutilations of their prisoners, 30
+
+Bergmann, of Strasburg, 20, 27
+
+Bergson, Dr., 160
+
+Bernbeim, Dr., on freedom of Jews from syphilis, 195;
+  on preputial statistics, 220;
+  on circumcisial operation, 312
+
+Bernoulli, Prof., of Bale, 168
+
+"Beth Yosef" of Joseph Karo, 153
+
+Biblical vouching for homoeopathy, 113
+
+Billings, Dr. John S., U. S. Army, on Jewish vital statistics, 174;
+  on cancer amongst Jews, 230
+
+Bird, Dr. Golding, on phimosis, 257
+
+Bishop of Abyssinia accused of heresy on account of circumcision, 64
+
+Blood of prepuce sprinkled on bride's veil, 55;
+  sprinkled on ears of corn, 56
+  changes as starting-points of disease, 293, 298
+
+Bobovii, Alberti, on Mohammedan circumcision, 39
+
+Bogera, or African circumcision, 44
+
+Bokai, on preputial statistics, 220
+
+Bornean circumcision, 45
+
+Bowditch, Henry I., on Jewish vital statistics, 176
+
+Boyer, Baron, on cancer of the penis, 232;
+  on gangrene of the penis, 237
+
+Brett, Dr. F. H., case of hypertrophy of prepuce, 251
+
+Bryant, Thomas, on skin-grafting, 328
+
+Bumstead, on circumcision, 310
+
+Burial of Algerine prepuces in the sands of the deserts, 39
+
+
+Cahen, Dr., on diminished sensibility of glans after circumcision, 224
+
+Calculus, liability of the Chinese to preputial, 248;
+  Dr. J. G. Kerr, on preputial, 248;
+  C. H. Martin, of Mobile, on climatic influence on, 248;
+  Prof. Enoch, of Berlin, on preputial and vesical calculi, 249;
+  Claparede's case, 249;
+  composition of preputial, 249;
+  Civiale's case, 249;
+  induced by phimosis, 287
+
+Canary Islands, remains of an antediluvian world, 25
+
+Cancer of the penis, 232;
+  views of Jonathan Hutchinson as to its origin, 226;
+  pre-cancerous stage of, 226;
+  views of Lallemand, 228, 329;
+  statistics of, 231;
+  Cullerier on, 231;
+  fifty cases reported by Dr. Zielewicz, 233;
+  early mention of, 234;
+  views of Prof. John C. Warren, 235;
+  views of Walshe, 235
+
+Canon of St. John Lateran and his profane doubts, 74
+
+Carter, Dr. Wm., on toxic urines, 298
+
+Casalis, M., on Bassouto circumcision, 42
+
+Cases of spontaneous circumcision, 58
+
+Castration, etymology of the term, 80;
+  as a self-sacrifice to deities, 89
+
+Celsus, on Roman infibulation, 50;
+  on operations on the prepuce, 302, 313, 328;
+  originator of Cloquet's operation, 313
+
+Chabas, M., description of Egyptian _bas-relief_, 23
+
+Charlemagne endows an abbey with a holy prepuce, 72
+
+Charles V sacks Rome, and robbery of the holy prepuce, 73
+
+Chastity among Egyptian dervishes, 49;
+  belt of brass mail of the Ethiopians, 51;
+  plug of bamboo of Soudan, 51;
+  rings to insure chastity in the male mentioned by Nelaton, 54;
+  enforced among the Hindoo bonzes by infibulation, 54;
+  among the Cybelian priesthood, 89;
+  Greek monks, ideas of, 89;
+  comparative, among the different religious creeds of Prussia, 195
+
+Chinese, peculiar liability of, to calculous disease, 248;
+  considered a delicate diet by Australian cannibals, 327
+
+Chippeway Indians and circumcision, 23
+
+Chivalry of the male Hottentot, 60
+
+Christian abolishment of circumcision, 18;
+  circumcision in Abyssinia, 63
+
+Circumcised phallus as a religious and civic symbol, 35;
+  races peculiarly exempt from syphilis, 192
+
+Circumcising knife (see Knife).
+
+Circumcision, abolished by Christians, 18;
+  among Chippeway Indians, 23;
+  among the Atlanteans of Plato, 23;
+  among the Phoenicians, 34;
+  among the Egyptians, 34;
+  Arabian, 35, 54;
+  during the reign of Psammetich, 34;
+  civil and religious symbol of ancient Egypt, 35;
+  Aztec, 46;
+  among the Mijes, 46;
+  Mexican, 46;
+  Totonac, 46;
+  among the Orinoco Indians, 47
+  the climatic limits of, as a general rite, 47;
+  in the Island of Cosumel, 47;
+  in Yucatan, 47;
+  in old Florida, 47;
+  Apure Indians, 48;
+  among the Amazons, 56;
+  accidental case of, mentioned by Cullerier, 57;
+  spontaneous, 58;
+  abolished by the Romans, 66;
+  destroying marks of, 68;
+  of Abraham, 143;
+  Hebraic, 143;
+  not practiced in the wilderness, 143;
+  physical conditions that exempt Jewish children from, 144, 145;
+  description of Hebraic, by Montaigne, 146;
+  as a cure for epilepsy, 261;
+  as a preventive of hernia or rupture, 263;
+  as a preventive to prolapsus of the bowel, 263;
+  as a preventive of idiocy, 266;
+  as a cure for dyspepsia, 270, 271
+
+Civiale, on moral effects of penis amputation, 247;
+  case of phimosis and preputial calculi, 249
+
+Claparede, on evils resulting from the prepuce, 229;
+  on preputial calculi, 249
+
+Clarke, Sir Andrew, on renal inadequacy, 300
+
+Clavigero, on Mexican circumcision, 46
+
+Climatic limits of circumcision, 65
+
+Cloquet operation, 306, 316
+
+Colchis, colony of, 33
+
+Constantine punished circumcisers with death, 66
+
+Constipation as a divine attribute, 288;
+  as a result of phimosis and its results, 292
+
+Consumption, relation of, to Jewish race, 178, 179
+
+Controversy about the holy prepuce, 73
+
+Convent of St. Corneille and the holy knife, 78
+
+Convulsions induced by phimosis, 260, 261
+
+Cullerier, accidental circumcision, 57;
+  on penile cancer, 231
+
+Cybelian priesthood and castration, 89
+
+
+Dakotas, the white bull sacred among the, 26
+
+David and the Philistine prepuces, 31
+
+Debreyne, trappist, monk, and physician, 224
+
+Delange, on Arabian circumcision, 37
+
+Delpech, on female circumcision, 36
+
+Demarquay, on penile gangrene, 236
+
+Dervishes, holy and chaste, 49
+
+Difference between Turkish and Buddhist heaven, 116
+
+Dilatation of prepuce, 308, 312, 332
+
+Donnelly, Hon. Ignatius, on Atlantean circumcision, 23
+
+Dressing in cases of retraction of penile skin, 304;
+  C. W. Ballance's, after circumcision, 317;
+  A. G. Miller's, 318
+
+Du Bisson, on Soudanese harems, 52
+
+Dyspepsia induced by preputial irritation, 270, 271
+
+
+Ebers, Dr., on Karnac _bas-relief_, 23
+
+Eczema induced by phimosis, 320
+
+Effect of the holy prepuce on the hands of a lady, 74
+
+Effects of age on the prepuce, 285
+
+Egypt, uncircumcised persons not allowed to study in ancient, 34
+
+Egyptians emasculated their prisoners, 30
+
+Emasculation, its early practices and evolutions, 29;
+  of Uranos, 83
+
+Emperor Adrian forbids circumcision, 66
+
+Endurance and fortitude of Arabs, 55
+
+Enforced continence and its effects on the penis, 61
+
+Ennery, M., Grand Rabbi of Paris, 158
+
+Enoch, Prof., of Berlin, on preputial calculi, 249;
+  on results of phimosis, 266;
+  on enuresis, 277
+
+Enuresis, 275
+
+Epilepsy, induced by the prepuce, 258, 261, 301
+
+Epstein, Dr., of Cincinnati, 156
+
+Erichsen, Prof., on cancer of the penis, 228
+
+Ethics at the battle of Fontenoy, 76
+
+Ethiopian infibulation of infant females, 51
+
+Eunuchism, beneficial to guardians of public funds, 84;
+  as excluding from the priesthood, 90;
+  in Italy, 91;
+  in China, 91, 93;
+  in India, 92;
+  in the Soudan, 99;
+  and music, 94;
+  as a punishment, 97;
+  mortality attending its manufacture, 91, 92, 93, 99, 100, 107;
+  does not prevent copulation at all times, 92, 100, 101, 102, 103;
+  manner of procedure among the Pagan priesthood, 106;
+  prices of eunuchs, 99;
+  numbers annually made, 91, 98;
+  fecundating eunuch of Mecca, 100;
+  Velutti, the opera-singer, 102;
+  eunuchs as possessors of harems, 90;
+  eunuch warriors and statesmen, 90
+
+Evidence of circumcision on Egyptian monuments, 23
+
+Extraordinary results of phimosis, 282
+
+
+Female circumcisers in Arabia, 36
+
+Females subject to preputial reflex neuroses, 267, 268
+
+Flaccourt, M. Martin, account of the Madecasses, 54
+
+Fothergill and the unlicensed practitioner on renal pathology, 77
+
+French war-office records, on Jewish vital statistics, 175
+
+Frenum, statistics relating to abnormalities of, 221
+
+Frerichs' ammoniaemia, 300
+
+Fresnel, M., on marriage circumcision, 54
+
+Full-moon rites among the Bassouto maidens, 44
+
+
+Galen, on the flaccid virile member, 60, 61
+
+Gangrene of the penis, 236
+
+Golden padlocks worn on prepuce for five years, 54
+
+Greek and Roman statuary and the penis, 60
+
+Greek monks' object in infibulations, 54;
+  extreme ideas of chastity, 89
+
+Gregg, Dr. Robert J., operative procedure, 320
+
+Griffith, Dr. J. D., cases of reflex irritation, 261
+
+Gross, Prof. S. D., on penile cancer, 230;
+  operations, 320
+
+Grotius and the origin of the Peruvians, 46
+
+Guimara, the, 153
+
+Guinzburg, Dr., on Jewish vital statistics, 176
+
+Gumilla and his South American voyages, 47
+
+
+Haemostatic powders, 160
+
+Hare, Prof. Hobart A., on circumcision, 301
+
+Haskins, Dr. A., on Jewish vital statistics, 176
+
+Heaven, Turkish, 115;
+  Buddhist, 116
+
+Hebraic idea of parental origin of constitution of the child, 144
+
+Hebrew Consistory of Paris, 157
+
+Hebrew words in Central American languages, 24
+
+Hebrews, attempts to efface signs of circumcision, 69;
+  secretly circumcise their dead, 68;
+  Hebrew vital statistics, 169 to 179;
+  as proverbial good livers, 171;
+  escape epidemics, 173;
+  peculiarly free from syphilitic taint, 191;
+  their circumcision suitable to young children, 306
+
+Heliogabalus, Emperor, was circumcised, 66
+
+Henry III of France as a Moslem godfather, 64
+
+Henry V of England and the holy prepuce, 71
+
+Heraclius, Emperor, persecuted the Jews, 67
+
+Hermaphrodites, earliest mention of, 117;
+  pederasty causes belief in their existence, 118, 119, 120;
+  Debierre on, 123;
+  notable cases of, 124, 125, 127, 128
+
+Hernia induced by phimosis, 263
+
+Herodotus, his views adopted by Voltaire, 22;
+  visits Egypt, 34
+
+Herrera, on Mexican circumcision, 47
+
+Hey, Dr. William, on preputial cancer, 227
+
+Hindoo devotee wears a six-inch ring in prepuce, 54
+
+Hitouch, 156
+
+Holgate, Dr., of New York, on preputial adhesions, 220;
+  on preputial dilatation, 308
+
+Holy circumcision, 70, 78
+  prepuces, 70, 72
+  vinegar and its miraculous effects, 79
+
+Homer, Surgeon U. S. Navy, on the worship of Venus Porclna, 193
+
+Horrible marriage performance, 54
+
+Hottentot restriction on making twins, 60
+
+Hough, Dr., on Jewish longevity, 173
+
+Humphry, Geo. Murray, on "Old Age," 14
+
+Hutchinson, Dr. Jonathan, on the pre-cancerous stage of cancer, 226;
+  on urethral child, 300
+
+Hypospadias, as a heredity, 129;
+  artificially made, 56;
+  formerly led to belief in hermaphrodism, 129;
+  fecundation in, 129;
+  difficulty in determining sex owing to, 131
+
+
+Idiocy induced by phimosis and preputial adhesions, 265, 269
+
+Impious wretch steals the holy prepuce, 74
+
+Impotence, holy vinegar and shrinal observances in, 71 to 81
+
+Indians and circumcision, 46 to 48
+
+Induration of prepuce, 250
+
+Inflbulation practices, 48 to 52
+
+Isis inaugurates Osirian rites, 29
+
+Isserth, Rabbi Israel, 153
+
+
+Jansen, Surgeon of the Belgian Armies, on frenum deformities, 221
+
+Jews' letters to Voltaire, 22;
+  Jews (see Hebrews).
+
+Judaism unfavorable to religious insanity, 166
+
+Justinia, Emperor, persecuted the Jews, 67
+
+
+Karo, Joseph, and the "Beth Yosef," 153
+
+Kemp, Dr. Arthur, on phimosis as a cause of hernia, 264
+
+Kerr, Dr. J. G., on Chinese preputial calculi, 248
+
+Keyes, Dr. E. L., on composition of preputial calculi, 249, 264
+
+King David, the first homoeopathic patient, 113;
+  secures two hundred Philistine prepuces, 31
+
+Knife, circumcising, used in ancient Egyptian rite, 23;
+  of shell used by Tonga Islanders, 45;
+  of stone used by Australians, 45;
+  of the holy circumcision, 78;
+  made of rattan among the Fiji Islanders, 327
+
+
+Lafargue, on Australian circumcision, 44
+
+Lallemand, on masturbation, 223;
+  on tendency to preputial cancer, 228, 329;
+  on circumcision, 317
+
+Las Casas, on Aztec circumcision, 46
+
+Leech, Dr. T. F., on preputial irritation, 260
+
+Letenneur, Prof., on the knife of the holy circumcision, 78
+
+Life-insurance and the circumcised, 290
+
+Lisfrane, rules for operations on the penis, 232;
+  on recession of the body of the penis, 306
+
+Livingstone, on Bassouto circumcision, 44
+
+Longevity of Hebrews, 162, 169, 179
+
+Lonyer-Villermay, M., on female circumcision, 36
+
+Louis XVI as a candidate for the rite, 201
+
+Love, Dr. I. N, on the Mosaic law, 262
+
+Lumholtz, on Australian hypospadias, 56
+
+
+Macilwain, on reflex neuroses, 330
+
+Magruder, Dr. G. L., on reflex irritation, 261
+
+Maids as heat radiators, 114
+
+Maimonides, Jewish rabbi and physician, 32, 144, 153
+
+Malay circumcision, 45
+
+Malgaigne, operative views, 313, 316
+
+Mapato, or mystery hut, 42
+
+Marriage preceded by circumcision, 54
+
+Martius and Spix, on circumcision on the Amazon, 56
+
+Mastin, Dr. C. H., on calculous disease, 248
+
+Masturbation, 224
+
+Maury, Dr. Frank, on preputial statistics, 219
+
+McLeod, Dr. Neil, circumcision operation, 318
+
+McMahon, Dr. W. R., on reflex epilepsy, 261
+
+Mendelssohn, Rabbi Moses, 164, 168
+
+Mexican circumcision, 46
+
+Mezizah, or act of suction, 150
+
+Milah, 156
+
+Miracles performed by the holy prepuce, 70 to 74
+
+Mishna, the, 153
+
+Mohammed, 65
+
+Mohel, 157, 158
+
+Moses, Dr., of New York, preputial statistics, 220
+
+Moses circumcises his son, 150
+
+Mott, Jr., Dr. A. R., cases of reflex irritation, 258
+
+Music, first schools of, 94
+
+Music at Algerine circumcision, 39;
+  at Mohammedan, in Asia, 39;
+  at Turkish feast, 41
+
+
+Nelaton, case of infibulation, 54;
+  on penile cancer, 231;
+  on penile hypertrophy, 252
+
+Nelson, Lord, disregard for red tape, 77
+
+New Caledonian circumcision, 45
+
+Newton, Sir Isaac, and the storm-predicting cow, 77
+
+Nicaraguan baptism of blood, 56
+
+
+Oath of mohel, 158
+
+Oath, Egyptian manner of making oath, 35
+
+Obod, Battle of, 36
+
+Operations on the prepuce, 302;
+  Cloquet's, 306;
+  Bumstead's, 310;
+  Hue's, 312;
+  Bernheim's, Sedillat's, 313;
+  Chauvin's, 313;
+  Cullerier's, 313;
+  Vanier's, 316;
+  Vidal de Cassis', 316;
+  Lallemand's, 317;
+  A. G. Miller's, Neil McLeod's, 318;
+  Erichsen's, 319;
+  Gross's, 320;
+  Van Buren and Keyes', 320;
+  D. Hayes Agnew's, 320;
+  Overall's procedure, 321
+
+Origin of phallic worship, 29
+  of human slavery, 29
+
+Orinoco, circumcision on the, 47
+
+Orloth, penis or prepuce? 31
+
+Osiris vanquished by Typhon, 28
+
+Othomacos Indians and their bloody rite, 48
+
+Owen, Dr. Edmund, on phimosis, 263
+
+
+Packard, Dr., on preputial statistics, 219
+
+Papal indulgences to worshipers of holy prepuce, 72
+
+Paralysis induced by phimosis, 259
+
+Penis, absence of, 132;
+  diminutive specimens, 213;
+  amputation of, 230, 233, 234, 247;
+  cancer of, 232;
+  gangrene of, 236;
+  hypertrophy of, 248, 251, 252
+
+Periah, 156
+
+Persecutions on account of circumcision, 66
+
+Phoenician origin of circumcision, 22
+
+Phimosed penis on ancient statues, 60
+
+Phimosis, 218, 221;
+  as a cause of hernia, 263
+
+Physicians as practical Christians, 141
+
+Pooley, Prof. J. H., case of preputial irritation, 260
+
+Pope, Rabbi Rav, and the _Guimara_, 153
+
+Portuguese sailors as Mohammedan proselytes, 40
+
+Potentia generandi, 103
+  coeundi, 104
+
+Prepuce, infibulated, 54;
+  swallowed by mother, 54;
+  fired off in gun, 54;
+  holy, 71;
+  useful for skin grafts, 207;
+  absence of, 209;
+  influence on man at different ages, 225;
+  induration of, 250;
+  warts of, 250;
+  reflex neuroses from, 256
+
+Preputial miracles, 72;
+  statistics, 219;
+  adhesions, 219, 220;
+  calculi, 248
+
+Price, Dr. M. F., on reflex neuroses, 265;
+  on female preputial irritation, 267, 268
+
+Primitive phallic rites, 28
+  homoeopaths, 113
+
+Procedure in retraction of skin of penis after circumcision, 304
+
+Proselytes, Mohammedan, how circumcised, 40, 41
+
+Public women between decks in U. S. Navy, 193
+
+Puzey, Dr., of Liverpool, on preputial skin grafts, 207
+
+Pythagoras 32;
+  visits Egypt, 34
+
+
+Ralfe, on causes of interstitial nephritis, 300
+
+Rameses II, circumcision of his sons, 23
+
+Ranney, Prof. A. L., on enuresis, 282
+
+Reconstruction of a prepuce, 68, 69, 328
+
+Rectum, prolapsus of, induced by phimosis, 263
+
+Reflex neuroses from preputial irritation, 254, 330, 331
+
+Regulations of French Hebrew consistories of 1854, 157
+
+Religion, its connection to insanity, 166
+
+Resectricis nympharum, profession of, 36
+
+Restriction on impregnation, 57;
+  on twins, 60
+
+Retraction of skin of penis after circumcision, 303
+
+Richardson, Dr. B. W., on relation of race to disease, 169, 170, 171, 177
+
+Ricord's definition of the prepuce, 206;
+  operations on the prepuce, 313
+
+Roman infibulation, 58
+
+Royal decree of 1845 in France, 157
+
+Roux, on cancer of the prepuce, 227
+
+Rush, Benjamin, and the cancer quack, 77
+
+
+Saint-Germain, Dr., on preputial abnormalities, 264
+
+Saint Foutin and his shrine, 78
+
+Saint Guerluchon at Bourg-Dieu, 79
+
+Saint Guignole and the miraculous phallus, 80
+
+Saint Coulombs and the miraculous prepuce, 70
+
+Saturnus the first eunuchiser, 83
+
+Sayer, Prof. Lewis A., contributions to medical science, 255
+
+Scythians carry off heads of the slain, 30
+
+Self-circumcision, attempt at, 203
+
+Semiramis first employs eunuchs, 85
+
+Severus Sulpicius, on effects of climate, 50
+
+Sham battles at circumcision feasts, 37, 41, 42, 44
+
+She-circumcisers, 36
+
+Shrine for the recovery of impotent males, 79
+
+Smith, Dr. J. Lewis, on preputial irritation, 263
+
+Solomon, Dr., of Brunswick, on suction, 158
+
+Soudanese chastity protector, 52
+
+Sphincterismus due to phimosis, 292
+
+Spiked chastity belt in Naples museum, 52
+
+Stallard, Dr., on Jewish vital statistics, 173
+
+Sterility cured at sacred shrines, 71 to 81
+
+Stricture of urethra and phimosis, 289, 290
+
+Styptics used by mohels, 158, 159
+
+Syphilis, statistics relating to, 187 to 199
+
+Syphilis and scrofula, 190
+
+
+Taylor, Dr. C. F., on masturbation, 269
+
+Totonac circumcision, 46
+
+Tonga Islanders' rite, 45
+
+Toxaemia, resulting from phimosis, 293;
+  of von Jaksch, 294
+
+Tube, penis carried in, 56
+
+Tunca Indian circumcision, 56
+
+Turkish circumcision, 39 to 41
+
+Tylor, on the Stone Age and circumcision, 336
+
+
+Van Buren and Keyes, on circumcision, 320
+
+Vanier du Havre, Dr., 54, 224;
+  on operations, 316
+
+Venus, birth of, 84
+
+Vidal de Cassis, on preputial operations, 316
+
+Virey, account of Hindoo bonze, 54
+
+Virgins' chain of bells in ancient Judea, 52
+
+Vital statistics of Jews, 169 to 179
+
+Voltaire, on origins of circumcision, 22
+
+Von Jaksch's definition of Toxaemia, 294
+
+
+Wadd, Dr., on preputial cancer, 227;
+  on hypertrophy of penis, 252
+
+Walshe, on preputial cancer, 235
+
+Warren, on preputial cancer, 235
+
+Warts of penis and prepuce, 250
+
+Waterman, Dr., on Jewish vital statistics, 177
+
+Wax images of penis deposited on shrines, 79
+
+Welsh words in Mandan language, 24
+
+Wet dressing objectionable after circumcision, 304, 311
+
+White Bull, sacred among Sioux and Egyptians, 26;
+  origin of sacredness, 29
+
+Willard, Dr. De Forest, observations on the prepuce, 262
+
+Wine at circumcision feasts, 151
+
+Wirthington, Dr. F. J., on preputial irritation, 259
+
+Wise, Dr. I. M., on St. Paul the apostle, 19
+
+Warman, Prof., of Brooklyn, on circumcision, 26
+
+
+
+
+THE THREE FOLLOWING PAGES ARE REDUCED
+FAC-SIMILES OF PAGES FROM
+
+STANTON'S
+
+Practical and Scientific Physiognomy;
+
+OR,
+
+HOW TO READ FACES.
+
+BY
+
+MARY OLMSTED STANTON.
+
+The ablest, most entertaining, trustworthy, and exhaustive treatise of
+the kind in the English language. Complete in two Royal Octavo volumes
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+
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+
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+_FAC-SIMILE PAGE FROM "STANTON'S PHYSIOGNOMY"--Reduced._
+
+HOW TO REDUCE SIZE WITHOUT LOSING STRENGTH.  1109
+
+voice. A thorough-bred person may belong to the artistic, mechanical,
+or scientific classes, either appreciatively or executively;
+he must exhibit both gentleness and spirit, as occasion requires; he
+must be governed by the law of justice; he must make the comfort
+of his associates his concern, and do what is _right_ in order to
+enhance their happiness.
+
+The facial indications of those who are not thorough-bred,
+speaking physiologically, are as follow: A coarse, thick skin; a
+"muddy" complexion, or one permanently blotched, pimpled, or
+discolored; dull eyes, very small or very large and bulging;
+coarse hair, or that which is very light or colorless,--that is to say,
+of no _decided_ hue. I regard very light colored, pallid people as
+morbid varieties; also those with irregular teeth, a very small or
+ill-shapen nose, small nostrils, perpendicular jaws, exposed gums,
+open mouth, receding chin, or one that projects greatly forward,
+ending in a point; thin, pallid, dry lips; hollow cheeks, flat upper
+cheeks. ugly or ill-shapen ears, a voice weak, thin, hoarse, shrill
+or nasal; a long, cylindrical neck; a high, narrow forehead.
+
+The undue development of certain organs and systems of the
+body induces abnormal conditions, as, for example, an excessive
+disposition of fatty tissue. When the appetite is voracious, or the
+nutritive system uncommonly active, too much of the carbonaceous
+elements of the food are eliminated, or, as it often occurs, too much
+carbonaceous food, such as white bread, potatoes, etc., is consumed
+for the needs of the body; the consequence is an excess of fat,
+which, in many subjects, impedes respiration, prevents activity,
+and gives a generally uncomfortable feeling. For this condition a
+spare diet is often prescribed, but as this is felt to be a hardship,
+and as few who attempt it succeed in continuing it long enough to
+produce satisfactory results, it is pronounced a failure.
+
+For this class of people there is a very agreeable and sure
+method of reducing the bulk without reducing strength and without
+compelling too great a sacrifice of the appetite.
+
+
+HOW TO REDUCE THE SIZE WITHOUT LOSING STRENGTH.
+
+A diet which will attain this result is easily obtained, and of
+it the subject can use a quantity sufficient to allay the craving
+for food.
+
+This diet consists of absolutely _raw_ foods, nothing cooked
+being allowed. This diet, of course, must consist mainly of fruits,
+nuts, grains, milk, and, when flesh-meat is desired, a Hamburg
+beefsteak may be partaken of; this steak is raw beef chopped fine
+and seasoned with onion, salt, pepper, or other condiments; to
+this may be added raw oysters and clams. Every kind of fruit
+
+
+
+
+_FAC-SIMILE PAGE FROM "STANTON'S PHYSIOGNOMY"--Reduced._
+
+SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON. 1143
+
+is a dangerous being); he should develop his friendliness, love of
+children, and of the opposite sex; in short, he should be a _lover_
+of _humanity_.
+
+
+THE SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON.
+
+[Illustration: FIG. 300--EDWARD JENNER, M.D. (CELEBRATED ENGLISH
+PHYSICIAN, AUTHOR, AND DISCOVERER OF VACCINATION.)
+
+No scientific physiognomist could mistake this face for other than that
+of a physician, and an earnest and attentive one as well, as evidenced
+by the signs of "natural physician" in the cheek-bones, in the attitude
+of the head and neck, and by the thoughtful, observant expression of the
+eye. The combination of systems in this subject is such as is most
+frequently observed among physicians, viz., the supremacy of the osseous
+and brain systems. The muscular, thoracic, and vegetative powers all
+assist in this combination by their development. The signs for
+Conscience and Firmness are apparent. Love of Home and Patriotism rank
+high. Benevolence, Amativeness, Love of Young, Mirth, Approbation,
+Self-esteem, Modesty, Friendship, Alimentiveness, Sanativeness,
+Pneumativeness, and Color combine to form a lovely domestic and social
+nature. The form, size, and peculiarities of the nose claim attention.
+It is a nose denoting Constructiveness, Originality, and logical power.
+The signs for Hope, Analysis, Mental Imitation, Human Nature, Ideality,
+Sublimity, Construction, and Acquisition are strongly delineated.
+Self-will is normally developed, while Size, Form, Observation, Weight,
+Locality, Calculation, and Memory of various sorts are manifest. The
+signs of Language in the eye and mouth denote fluency, while the
+practical faculties, being dominant, would give clearness, perspicacity,
+and directness to his style of expression, either oral or written. Time,
+Order, Reason, and Intuition are well developed. The long-continued
+observation and experiments of this noble physician in his endeavor to
+protect humanity from the ravages of small-pox by his discovery of
+vaccination, met at last with a suitable recognition, for he received by
+a vote of Parliament the sum of L30,000, and special honors were awarded
+him. It is a singular fact that all of the benefactors of the human
+race--those who have benefited it by discoveries of any kind
+whatever--have met with the most violent opposition, treachery, and
+often disgrace, before they could make the world see the value of their
+discoveries. Such was the case with Dr. Jenner, but his firmness and
+truth at last gained the victory.]
+
+The best _form_ for a surgeon who attempts the most severe
+operations is the round build of body and head, and many of them
+are of this shape. The muscular system should be supreme, with
+the brain system a close second, the bony and thoracic systems
+about equal and next in development.
+
+The muscular tissue is _comparatively unfeeling_--insensitive;
+
+
+
+
+_FAC-SIMILE PAGE FROM "STANTON'S PHYSIOGNOMY"--Reduced._
+
+OTHER CLASSES OF SURGEONS" 1145
+
+in the body. Form and Size are also requisite to aid the memory of
+the shape and relative position of each part, and to assist Locality.
+Human Nature is essential in order that he may be _en rapport_
+with his patients, and also to enable him to _divine_ instinctively all
+bodily and mental states. He should be a good physiognomist, and
+be well versed in the _pathology_ of physiognomy. He must have
+large Observation, in order to take cognizance of the most minute
+changes and appearances. Calculation is a useful trait also, as it
+is required in many ways in the medication and treatment of the
+wounded, as in chemistry and in making surgical implements, etc.
+He should have large Friendship; in order to attach his patients to
+him and to command their esteem; enough Benevolence to sympathize,
+but not enough to weaken the feelings when severity is required.
+The faculty of Amativeness is necessary to _comprehend_ the nature of
+the opposite sex; Love of Young also, that he may inspire children with
+love and confidence.
+
+The sense of Weight should be a strong one, for the muscular
+sense is dependent upon its power in order to _gauge_ the amount
+of force to be used in handling instruments and in bandaging
+wounds, limbs, etc. Executiveness is required to assist authority
+and give resistance. Self-will is another ally most necessary, as
+well as Analysis, Time, Order, and Reason. A fair share of
+musical ability is required to assist the ear in making examinations
+of the heart and lungs, and in auscultation for various other purposes.
+If to these faculties one adds large Intuition, he has a fine
+bodily and mental equipment for the practice of surgery.
+
+
+OTHER CLASSES OF SURGEONS.
+
+Many army surgeons are characterized by a round and broad
+form, with broad, rather low, and round heads; short, round arms,
+and round and tapering fingers. This build is the most suitable
+for those severe operations which require the greatest exhibition of
+force, endurance, and coolness; another class of surgeons--those
+who undertake the more delicate and less forceful operations--are
+characterized by about an equal development of the brain and
+muscular systems. This class of surgeons tend naturally to the
+treatment of those finer, less difficult, and more delicate cases of
+operative surgery, such, for example, as treatment of the ear, the
+eye, etc. This class of surgeons require a fine endowment of the
+brain and nervous system. In short, the muscles as well as nerves
+of this class must be sensitive to a great degree, and this combination
+calls for a fine and high organization.
+
+The surgeon should be something of an actor in order to
+know when to be sympathetic and when to be severe. Yet he
+
+
+
+
+  +--------------------------------------------------------------+
+  | Transcriber's Notes and Errata                               |
+  |                                                              |
+  | Footnotes 25-30 have been renumbered in sequence.            |
+  |                                                              |
+  | The anchor for footnote 102 was missing. Has been inserted   |
+  | at the appropriate place.                                    |
+  |                                                              |
+  | 'oe' ligatures have been expanded to separate 'o' and 'e'    |
+  | characters.                                                  |
+  |                                                              |
+  | The following words were found in both hyphenated and        |
+  | unhyphenated forms once each.                                |
+  |                                                              |
+  |                |bed-clothes   |bedclothes   |                |
+  |                |co-existence  |coexistence  |                |
+  |                |short-comings |shortcomings |                |
+  |                                                              |
+  | The word 'pre-cancerous' occurred four times in the text,    |
+  | while 'precancerous' occurred twice, both in the index.      |
+  | These index entries have been hyphenated.                    |
+  |                                                              |
+  | The following typographical errors have been corrected.      |
+  |                                                              |
+  |                |Error        |Correction   |                 |
+  |                |route        |rout         |                 |
+  |                |prepuse      |prepuce      |                 |
+  |                |a a          |a            |                 |
+  |                |siezes       |seizes       |                 |
+  |                |Sterilite    |Sterilite    |                 |
+  |                |others       |others'      |                 |
+  |                |Tranyslvania |Transylvania |                 |
+  |                |occasian     |occasion     |                 |
+  |                |suprised     |surprised    |                 |
+  |                |function     |junction     |                 |
+  |                |orginated    |originated   |                 |
+  |                |smoulderd    |smouldered   |                 |
+  |                |wes          |was          |                 |
+  |                |tisses       |tissues      |                 |
+  |                |dut          |but          |                 |
+  |                |innner       |inner        |                 |
+  |                |may          |many         |                 |
+  |                |brakemen     |brakeman     |                 |
+  |                |thinnes      |thinness     |                 |
+  |                |totel        |total        |                 |
+  |                |America      |American     |                 |
+  |                                                              |
+  +--------------------------------------------------------------+
+
+
+
+
+
+End of the Project Gutenberg EBook of History of Circumcision from the
+Earliest Times to the Present, by Peter Charles Remondino
+
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