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diff --git a/23135.txt b/23135.txt new file mode 100644 index 0000000..30ff4a5 --- /dev/null +++ b/23135.txt @@ -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 +of OVER 600 PAGES EACH; richly illustrated with 380 CHOICE +WOOD-ENGRAVINGS, many of them original. + +Sold by subscription, or sent direct on receipt of +price, shipping expenses prepaid. + +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. + +EXAMINE THE FOLLOWING PAGES. + +F. A. DAVIS, Publisher, + +1231 Filbert Street, Phila., Pa. + +BRANCH OFFICES: + +_CHICAGO, ILL.--24 Lakeside Building, 214-220 S. Clark St. +NEW YORK CITY--117 W. 42d Street. ATLANTA, GA.--26 Old Capitol. +LONDON, ENG.--40 Berners St., Oxford St., W._ + +ORDER FROM NEAREST OFFICE. + + + + +_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 + +*** END OF THIS PROJECT GUTENBERG EBOOK HISTORY OF CIRCUMCISION *** + +***** This file should be named 23135.txt or 23135.zip ***** +This and all associated files of various formats will be found in: + https://www.gutenberg.org/2/3/1/3/23135/ + +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) + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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