Title: History of Circumcision from the Earliest Times to the Present - Moral and Physical Reasons for its Performance
Author: Remondino, Peter Charles, 1846-1926
Language: English
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No. 11 IN THE PHYSICIANS' AND STUDENTS' READY REFERENCE SERIES


HISTORY OF CIRCUMCISION FROM THE EARLIEST TIMES TO THE PRESENT.

MORAL AND PHYSICAL REASONS FOR ITS PERFORMANCE, WITH A HISTORY OF
EUNUCHISM, HERMAPHRODISM, ETC., AND OF THE DIFFERENT OPERATIONS
PRACTICED UPON THE PREPUCE.

BY

P. C. REMONDINO, M.D.
(JEFFERSON),

Member of the American Medical Association, of the American Public
Health Association, of the San Diego County Medical Society, of the
State Board of Health of California, and of the Board of Health of the
City of San Diego; Vice-President of California State Medical Society
and of Southern California Medical Society, etc.

[Illustration]

PHILADELPHIA AND LONDON:
F. A. DAVIS, PUBLISHER.
1891.

Entered according to Act of Congress, in the year 1891, by
F. A. DAVIS,
In the Office of the Librarian of Congress, at Washington, D.C., U.S.A.


Philadelphia Pa., U. S. A.:
The Medical Bulletin Printing House,
1231 Filbert Street.

[Illustration: HEBRAIC CIRCUMCISION]



PREFACE.


In ancient Egypt the performance of circumcision was at one time limited
to the priesthood, who, in addition to the cleanliness that this
operation imparted to that class, added the shaving of the whole body as
a means of further purification. The nobility, royalty, and the higher
warrior class seem to have adopted circumcision as well, either as a
hygienic precaution or as an aristocratic prerogative and insignia.
Among the Greeks we find a like practice, and we are told that in the
times of Pythagoras the Greek philosophers were also circumcised,
although we find no mention that the operation went beyond the
intellectual class. In the United States, France, and in England, there
is a class which also observe circumcision as a hygienic precaution,
where, from my personal observation, I have found that circumcision is
thoroughly practiced in every male member of many of the families of the
class,--this being the physician class. In general conversation with
physicians on this subject, it has really been surprising to see the
large number who have had themselves circumcised, either through the
advice of some college professor while attending lectures or as a result
of their own subsequent convictions when engaged in actual practice and
daily coming in contact both with the benefits that are to be derived in
the way of a better physical, mental, and moral health, as well as with
the many dangers and disadvantages that follow the uncircumcised,--the
latter being probably the most frequent incentive and determinator,--as
in many of these latter examples the operation of circumcision, with its
pains, annoyances, and possible and probable dangers, sink into the most
trifling insignificance in comparison to some of the results that are
daily observed as the tribute that is paid by the unlucky and unhappy
wearer of a prepuce for the privilege of possessing such an appendage.

There is one thing that must be admitted concerning circumcision: this
being that, among medical men or men of ordinary intelligence who have
had the operation performed, instead of being dissatisfied, they have
extended the advantages they have themselves received, by having those
in their charge likewise operated upon. The practice is now much more
prevalent than is supposed, as there are many Christian families where
males are regularly circumcised soon after birth, who simply do so as a
hygienic measure.

For the benefit of these, who may congratulate themselves upon the
dangers and annoyances that they and their families have escaped, and
for the benefit of those who would run into these dangers but for timely
warning, this book has been especially written. To my professional
brothers the book will prove a source of instruction and recreation,
for, while it contains a lot of pathology regarding the moral and
physical reasons why circumcision should be performed, which might be as
undigestible as a mess of Boston brown bread and beans on a French
stomach, I have endeavored to make that part of the book readable and
interesting. The operative chapter will be particularly useful and
interesting to physicians, as I have there given a careful and impartial
review of all the operative procedures,--from the most simple to the
most elaborate,--besides paying more than particular attention to the
subject of after-dressings. The part that relates to the natural history
of man will interest all manner of people. I regret that the tabular
statistics are not to be had, but in this regard we must use our best
judgment from the material we have on hand; at any rate, I have tried to
furnish a sufficiency of facts, so that, unless the reader is too
overexacting, he will not find much difficulty in arriving at a
conclusion on the subject.

P. C. REMONDINO, M.D.

SAN DIEGO, CALIFORNIA, 1891.



CONTENTS.


                                                        PAGE

PREFACE,                                                 iii

INTRODUCTION,                                              1

CHAPTER I.
ANTIQUITY OF CIRCUMCISION,                                21

CHAPTER II.
THEORIES AS TO THE ORIGIN OF CIRCUMCISION,                28

CHAPTER III.
SPREAD OF CIRCUMCISION,                                   34

CHAPTER IV.
CIRCUMCISION AMONG SAVAGE TRIBES,                         42

CHAPTER V.
INFIBULATION, MUZZLING, AND OTHER CURIOUS PRACTICES,      46

CHAPTER VI.
ATTEMPTS TO ABOLISH CIRCUMCISION,                         63

CHAPTER VII.
MIRACLES AND THE HOLY PREPUCE,                            70

CHAPTER VIII.
HISTORY OF EMASCULATION, CASTRATION, AND EUNUCHISM,       82

CHAPTER IX.
PHILOSOPHICAL CONSIDERATIONS RELATING TO EUNUCHISM AND
MEDICINE,                                                105

CHAPTER X.
HERMAPHRODISM AND HYPOSPADIAS,                           117

CHAPTER XI.
RELIGIO MEDICI,                                          134

CHAPTER XII.
HEBRAIC CIRCUMCISION,                                    143

CHAPTER XIII.
MEZIZAH, THE FOURTH OR OBJECTIONABLE ACT OF SUCTION,     150

CHAPTER XIV.
WHAT ARE THE BENEFITS OF CIRCUMCISION?                   161

CHAPTER XV.
PREDISPOSITION TO AND EXEMPTION AND IMMUNITY FROM
DISEASE,                                                 183

CHAPTER XVI.
THE PREPUCE, SYPHILIS, AND PHTHISIS,                     187

CHAPTER XVII.
SOME REASONS FOR BEING CIRCUMCISED,                      200

CHAPTER XVIII.
THE PREPUCE AS AN OUTLAW, AND ITS EFFECTS ON THE GLANS,  206

CHAPTER XIX.
IS THE PREPUCE A NATURAL PHYSIOLOGICAL APPENDAGE?        217

CHAPTER XX.
THE PREPUCE, PHIMOSIS, AND CANCER,                       226

CHAPTER XXI.
THE PREPUCE AND GANGRENE OF THE PENIS,                   236

CHAPTER XXII.
THE PREPUCE, CALCULI, AND OTHER ANNOYANCES,              248

CHAPTER XXIII.
REFLEX NEUROSES AND THE PREPUCE,                         254

CHAPTER XXIV.
DYSURIA, ENURESIS, AND RETENTION OF URINE,               275

CHAPTER XXV.
GENERAL SYSTEMIC DISEASES INDUCED BY THE PREPUCE,        284

CHAPTER XXVI.
SURGICAL OPERATIONS PERFORMED ON THE PREPUCE,            302

NOTES TO TEXT,                                           323

WORKS AND AUTHORITIES QUOTED,                            336

INDEX,                                                   339



INTRODUCTION.


This book is the amplification of a paper, the subject of which was, "A
Plea for Circumcision; or, the Dangers that Arise from the Prepuce,"
which was read at the meeting of the Southern California Medical
Society, at Pasadena, in December, 1889. The material gathered for that
paper was more than could be used in the ordinary limits of a society
paper; it was gathered and ready for use, and this suggested its
arrangement into book form. The subject of the paper was itself
suggested by a long and personal observation of the changes made in man
by circumcision. From the individual observation of cases, it was but
natural to wish to enlarge the scope of our observation and comparison;
this naturally led to a study of the physical characteristics of the
only race that could practically be used for the purpose. This race is
the Jewish race. On carefully studying into the subject, I plainly saw
that much of their longevity could consistently be ascribed to their
more practical humanitarianism, in caring for their poor, their sick, as
well as in their generous provision for their unfortunate aged people.
The social fabric of the Jewish family is also more calculated to
promote long life, as, strangely as it may seem, family veneration and
family love and attachment are far more strong and practical among this
people than among Christians, this sentiment not being even as strong in
the Christian races as it is in the Chinese or Japanese. It certainly
forms as much of a part of the teachings of Christianity as it does of
Judaism, Buddhism, or Confucianism, only Christians, as a mass, have
practically forgotten it. The occupation followed by the Jews also in a
certain degree favors longevity, and the influence on heredity induced
by all these combined conditions goes for something. But it is not alone
in the matter of simple longevity--although that implies
considerable--that the Jewish race is found to be better situated.
Actual observations show them to be exempt from many diseases which
affect other races; so that it is not only that they recover more
promptly, but that they are not, as a class, subjected to the loss of
time by illness, or to the consequent sufferings due to illness or
disease, in anything like or like ratio with other people.

There is also a less tendency to criminality, debauchery, and
intemperance in the race; this, again, can in a measure be ascribed to
their family influence, which even in our day has not lost that
patriarchal influence which tinges the home or family life in the Old
Testament. Crimes against the person or property committed by Jews are
rare. They likewise do not figure in either police courts or
penitentiary records; they are not inmates of our poor-houses, but, what
is also singular, they are never accused of many silly crimes, such as
indecent exposures, assaults on young girls; nor do they figure in any
such exposures as the one recently made by the _Pall Mall Gazette_.

After allowing all that, which we can, in its fullest limit, to
religion, family, or social habit, there is still a wide margin to be
accounted for. This has naturally let the inquiry, followed in the
course of this book, into a careful review of the Jewish people; into
their religion and its character, its relation to other creeds, and to
the world's history; into their many wanderings, and into the
dispersion, and we have even been obliged to follow them into the midst
of the people among whom they have become nationed, to try, if possible,
to find the cause of this racial difference in health, resistance to
disease, decay, and death. It has been necessary, in following out the
research, to give a condensed _résumé_ of the religious, political, and
social condition of the Jewish commonwealth, which, although in a state
of dispersion, still exists. I need offer no apology for the extended
notice this has received in the course of the book. We read with
increasing interest either Hallam or May, Buckle or Guizot, through the
spasmodic, halting, retrograding, advancing, erratic, aimless, and
accidental phases that England has plowed through, from the days of
goutless, simple, and chaste, but barbarian England of the Saxons, to
the present civilized, enlightened, gouty, "Darkest England" of General
Booth; and, after all is said and done, we are no wiser in any practical
resulting good. We simply know that the English people, so to speak,
have, as it were, gone through the figures of some social aspects, as if
dancing the "Lancers," with its forward and back movements, gallop,
etc., and have finally sat down, better dressed and better housed, but
in an acquired state of moral and physical degeneration. The Briton of
Queen Victoria is not the Briton of Queen Boadicea, either morally or
physically. On the other hand, the system of sociological tables adopted
by Herbert Spencer would have but little to record for some six thousand
years--either in religion, morals, or physique--as making any changes in
the history of that simple people which, in the mountainous regions of
Ur, in distant Armenia, started on its pilgrimage of life and racial
existence; in one branch of the family--that of Ishmael--the changes to
be recorded are so invisible that its descendants may really be said to
live to-day as they lived then. So that I do not feel that I need to
apologize for the space I have given to this subject in the course of
the book. The causes that make these racial distinctions should be of
interest alike to the moralist, theologist, sociologist, and to the
physician.

Ecclesiastical writers and moralists, as well as writers of fiction or
dramatizers, can write on anything they please, and it is eagerly taken
up and read by the people generally, either of high or low degree,
alike; and somehow these people seem never to require an apology on the
part of the author, for having attempted rapes, seductions, or even
unavoidable fornication committed through the leaves of the story, or
having it imaginably take place between acts on the stage. But if the
physician writes a book touching anything connected with the generative
functions, and with the best intent and for the good of humanity, he is
expected to make some prefatory apology. He is supposed to address a
public who all of a sudden have become intensely moral and extremely
sensitive in their modesty. Why things are thus I cannot explain. They
are so, nevertheless. From the time that the celebrated Astruc wrote his
treatise on female diseases, near the end of the seventeenth
century,--who felt compelled by the extreme modesty of the people in
this particular--but who, outside of medicine, were about as virtuous as
the average Tabby or Tom cats in the midnight hour--to write the chapter
touching on nymphomania in Latin, so as not to shock the morbidly
sensitive modesty of the French nobility, who then enjoyed _Le Droit de
cuissage_,--down through to Bienville, who wrote the first extended work
on nymphomania, and Tissot, who first broached the subject and the
danger of Onanism, all have felt that they must stop on the threshold
and "apologize." Tissot, however, seemed to possess a robust and a plain
Hippocratic mind, and as he apologized he could not help but see the
ridiculousness of so doing, as in the preface to his work we find the
following: "Shall we remain silent on so important a subject? By no
means. The sacred authors, the Fathers of the Church, who present their
thoughts in living words, and ecclesiastical authors have not felt that
silence was best. I have followed their example, and shall exclaim, with
St. Augustine, 'If what I have written scandalizes any prudish persons,
let them rather accuse the turpitude of their own thoughts than the
words I have been obliged to use.'"

For my part, I think that people who can go to the theatre and enjoy "As
in a Looking-Glass," and witness some of the satyrical or billy-goat
traits of humanity so graphically exhibited in "La Tosca," with evident
satisfaction; or attend the more robust plays of "Virginius" or of
"Galba, the Gladiator," with all its suggestions of the Cæsarian
section, and the lust and the fornications of an intensely animal Roman
empress, without the destruction of their moral equilibrium or tending
to induce in them a disposition to commit a rape on the first met,--I
think such people can be safely intrusted to read this book.

And as to the reading public, there are but few general readers who
could honestly plead an ignorance of the "Decameron," Balzac, La
Fontaine, "Heptameron," Crébillon _fils_, or of matter-of-fact Monsieur
le Docteur Maitre Rabelais,--works which, more or less, carry a moral
instruction in every tale, which, like the tales of the "Malice of
Women," in the unexpurged edition of the literal translation of the
"Arabian Nights," contains much more of practical moral lessons, even if
in the flowery and warm, spiced language of the Orient, than any
supposed nastiness, on account of which they are classed among the
prohibited. To these, and the readers of Amelie Rives's books, or other
intensely realistic literature, I need not imitate the warning of
Ansonius, who warned his readers on the threshold of a part of his book
to "stop and consider well their strength before proceeding with its
lecture." Metaphorically speaking, the general theatre-going, or modern
literature-reading public, can be considered pretty callous and morally
bullet proof. I shall therefore make no apology.

Some fault may, perhaps, be found with some of the occasional style of
the book, or with some of the subjects used to illustrate a principle.
To the extremely wise, good, and scientific, these illustrations were
unnecessary; this need hardly be mentioned; and the passages which to
some may prove objectionable were not intended for them, either with the
expectation of delighting them or with the purpose of shocking them.
These passages, they can easily avoid. This book, however, was written
that it might be read: not only read by the Solon, Socrates, Plato, or
Seneca of the laity or the profession, but even by the billy-goated
dispositioned, vulgar plebeian, who could no more be made to read cold,
scientific, ungarnished facts than you can make an unwilling horse drink
at the watering-trough. Human weakness and perversity is silly, but it
is sillier to ignore that it exists. So, for the sake of boring and
driving a few solid facts into the otherwise undigesting and unthinking,
as well as primarily obdurate understanding of the untutored plebeian, I
ask the indulgence of the intelligent and broad-minded as well as the
easily inducted reader. Cleopatra was smuggled into Cæsar's presence in
a roll of tapestry; the Greeks introduced their men into Troy by means
of a wooden horse; and the discoverer of the broad Pacific Ocean made
his escape from his importunate creditors disguised as a cask of
merchandise. So, when we wish to accomplish an object, we must adopt
appropriate means, even if they may apparently seem to have an entirely
diametrically opposite object. The Athenian, Themistocles, when wishing
to make the battle of Salamis decisive, was inspired with the idea of
sending word to the Persian monarch that the Greeks were trying to
escape, advising him to block the passage; this saved Greece.

There is a weird and ghostly but interesting tale connected with the
Moslem conquest of Spain, of how Roderick, the last of the Gothic kings,
when in trouble and worry, repaired to an old castle, in the secret
recesses of which was a magic table whereon would pass in grim
procession the different events of the future of Spain; as he gazed on
the enchanted table he there saw his own ruin and his country's and
nation's subjugation. Anatomy is generally called a dry study, but, like
the enchanted brazen table in the ancient Gothic castle, it tells a no
less weird or interesting tale of the past. Its revelations lighten up a
long vista, through the thousands of years through which the human
species has evolved from its earliest appearance on earth, gradually
working up through the different evolutionary processes to what is
to-day supposed to be the acme of perfection as seen in the
Indo-European and Semitic races of man. Anatomy points to the
rudiment--still lingering, now and then still appearing in some one man
and without a trace in the next--of that climbing muscle which shows man
in the past either nervously escaping up the trunk of a tree in his
flight from many of the carnivorous animals with whom he was
contemporary, or, as the shades of night were beginning to gather
around him, we again see him by the aid of these muscles leisurely
climbing up to some hospitable fork in the tree, where the robust habits
of the age allowed him to find a comfortable resting-place; protected
from the dew of the night by the overhanging branches and from the
prowling hyena by the height of the tree, he passed the night in
security. The now useless ear-muscles, as well as the equally useless
series of muscles about the nose, also tell us of a movable, flapping
ear capable of being turned in any direction to catch the sound of
approaching danger, as well as of a movable and dilated nostril that
scented danger from afar,--the olfactory sense at one time having a
different function and more essential to life than that of merely noting
the differential aroma emitted by segars or cups of Mocha or Java, and
the ear being then used for some more useful purpose than having its
tympanum tortured by Wagnerian discordant sounds. Our ancestors might
not have been a very handsome set, nor, judging from the Neanderthal
skull, could they have had a very winning physiognomy, but they were a
very hardy and self-reliant set of men. Nature--always careful that
nothing should interfere with the procreative functions--had provided
him with a sheath or prepuce, wherein he carried his procreative organ
safely out of harm's way, in wild steeple-chases through thorny briars
and bramble-brakes, or, when hardly pushed, and not able to climb
quickly a tree of his own choice, he was by circumstances forced up the
sides of some rough-barked or thorny tree. This leathery pouch also
protected him from the many leeches, small aquatic lizards, or other
animals that infested the marshes or rivers through which he had at
times to wade or swim; or served as a protection from the bites of ants
or other vermin when, tired, he rested on his haunches on some mossy
bank or sand-hill.

Man has now no use for any of these necessaries of a long-past age,--an
age so remote that the speculations of Ernest Renan regarding the
differences between the Semitic race of Shem and the idolatrous
descendants of Ham, away off in the far mountains and valleys of Asia
lying between the Mediterranean Sea and the Euphrates, seem more as if
he were discussing an event of yesterday than something which is
considered contemporary with our earlier history,--and we find them
disappearing, disuse gradually producing an obliteration of this tissue
in some cases, and the modifying influence of evolution producing it in
others; the climbing muscle, probably the oldest remnant and legacy that
has descended from our long-haired and muscular ancestry, is the best
example of disappearance caused by disuse, while the effectual
disappearance of the prepuce in many cases shows that in that regard
there exists a marked difference in the evolutionary march among
different individuals.

There is a strange and unaccountable condition of things, however,
connected with the prepuce that does not exist with the other vestiges
of our arboreal or sylvan existence. Firstly, the other conditions have
nothing that interferes with their disappearance; whereas the prepuce,
by its mechanical construction and the expanding portions which it
incloses, tends at times rather to its exaggerated development than to
its disappearance. Again, whereas the other vestiges have no injury that
they inflict by their presence, or danger that they cause their
possessors to run, the prepuce is from time of birth a source of
annoyance, danger, suffering, and death. Then, again, the other
conditions are not more developed at birth; whereas the prepuce seems,
in our pre-natal life, to have an unusual and unseen-for-use existence,
being in bulk out of all proportion to the organ it is intended to
cover. Speculation as to its existence is as unprolific of results as
any we may indulge in regarding the nature, object, or uses of that
other evolutionary appendage, the appendix vermiformis, the recollection
of whose existence always adds an extra flavor to tomatoes, figs, or any
other small-seeded fruits.

We may well exclaim, as we behold this appendage to man,--now of no use
in health and of the most doubtful assistance to the very organ it was
intended to protect, when that organ, through its iniquitous tastes, has
got itself into trouble, and, Job-like, is lying repentant and sick in
its many wrappings of lint, with perhaps its companions in crime
imprisoned in a suspensory bandage,--what is this prepuce? Whence, why,
where, and whither? At times, Nature, as if impatient of the slow march
of gradual evolution, and exasperated at this persistent and useless as
well as dangerous relic of a far-distant prehistoric age, takes things
in her own hands and induces a sloughing to take place, which rids it of
its annoyance. In the far-off land of Ur, among the mountainous regions
of Kurdistan, something over six thousand years ago, the fathers of the
Hebrew race, inspired by a wisdom that could be nothing less than of
divine origin, forestalled the process of evolution by establishing the
rite of circumcision. Whether this has been beneficial or injurious to
the race will be, in a measure, the object of the discussion in this
book.

One object of this book is to furnish my professional brothers with some
embodied facts that they may use in convincing the laity in many cases
where they themselves are convinced that circumcision is absolutely
necessary; but, having nothing in their text-books to back up their
opinion with, their explanations are too apt to pass for their mere
unfounded personal view of the matter. If the patient, or the parents of
the patient, ask the physician for his authority, he is at a loss, as
there is nothing that deals with the subject in any extended manner; so
that this book has been written in as plain English as the
subject-matter could possibly allow, so that non-professionals could
easily read and understand it. I have often felt the need of such a
work; people can understand emergency or accident surgery, military
surgery, or reparative surgery, but such a thing as surgery to remedy a
seemingly medical disease, or what might be called the preventive
practice of surgery, is something they cannot understand. First, and not
the least, among the incentives to skepticism on this subject is the
unwelcome fact of a surgical operation, which, no matter how trivial it
may seem to the surgeon, is a matter of considerable magnitude to the
patient, his parents, or friends; there are risks, pain, worry,
annoyances, and expenses to be undergone,--considerations which, either
singly or unitedly, often lead one to reason against the operation, even
when otherwise convinced of its need or utility.

The hardest to convince are those, however, who insist on having a
four-and-a-half-foot-gauge fact driven through their two-foot-gated
understanding, without it ever occurring to them that the gate, and not
the fact, is the faulty article, Some of these gentry are very
unconvincible. They at times remind one of that description given by
Carlyle in regard to one of the Georges, who found himself, when Prince
of Wales, leading an army in Flanders, and actually engaged in a
battle. His Royal Highness was on foot, and was seen standing facing the
enemy, with outstretched legs, like a Colossus of Rhodes, impassive and
stolid,--the very impersonification of Dutch courage and aggressiveness.
There he stood, unconscious whether he was at the head of an army or
single attendant; he might be overridden and annihilated, overturned and
expunged, but there he would most assuredly stand and fall, if need be;
overwhelming squadrons, by their impetus and weight, might ride him down
and crush him; but one thing was most certain, this certain fact being
that he never could be made to retreat or advance, as no impression from
front or rear could convince him of the necessity of either.

Then, there is our statistical friend, who cannot discriminate between
the exception and the rule by any common-sense deductions. He must have
all the authentic, carefully-compiled statistics before he can allow
himself to form any opinion. As long as there is the smallest fraction
of a decimal unaccounted for in a mathematical way, this individual is
inconvincible. These men pride themselves upon being methodically exact;
they express their willingness to be convinced if you can present
acceptable proofs; but, trying to present simple rational proofs to
these individuals is considerably like presenting a meal of boiled pork
and cabbage to a confirmed and hypochondriacal dyspeptic,--it only
increases their mental dyspepsia.

Had Columbus waited to discover America, or had Galileo waited to
proclaim the motion of the earth, until authorized to a serious
consideration of the matter by properly-tabled statistics, they would
have waited a long, long time; and, it may be added, the inconveniences
that attend the proving of a negative will so interfere with the proper
arrangement of statistical matter which relates to the prepuce and
circumcision that, before such tables could be satisfactorily and
convincingly constructed, time and the evolutionary processes that
follow it will bid fair to completely remove this debatable appendage
from man. It may be at a very far-distant period that this evolutionary
preputial extinction will take place,--probably contemporary with the
existence of Bulwer's "Coming Race,"--but not at a too remote period for
the proper and satisfactory tabulation of the statistics.

The ideas of the etiology and pathological processes through which we
journey,--from a condition of health and good feeling to one of disease,
miserable feeling, and death,--as described in, or rather as they
control the sentiment and policy of, this work, are such as have been
followed by Hutchinson, Fothergill, Beale, Black, Albutt, and
Richardson, so that if I have totally ignored the old conventional
systems, with their hide-bound classification of diseases to control the
etiology, I have not done so without some reliable authority. In
studying the etiology of diseases we have, as a rule, been content to
accept the disease when fully formed and properly labeled, being
apparently satisfied with beginning our investigation not at the initial
point of departure from health, but at some distant point from this, at
the point where this departure has elaborated itself, on favorable
ground, into a tangible general or local disease. As truthfully observed
by T. Clifford Albutt: "The philosophic inquirer is not satisfied to
know that a person is suffering, for example, from a cancer. He desires
to know why he is so suffering,--that is, what are the processes which
necessarily precede or follow it. He wishes to include this phenomena,
now isolated, in a series of which it must necessarily be but a member,
to trace the period of which it must be but a phase. He believes that
diseased processes have their evolution and the laws of it, as have
other natural processes, and he believes that these are fixed and
knowable." To do this, the physician must travel beyond the beaten path
of etiology as found in our text-books. He must follow Hutchinson in the
train of reasoning that elucidates the pre-cancerous stage of cancer, or
tread in the path followed by Sir Lionel Beale, in finding that the
cause of disease depends on a blood change and the developmental defect,
or the tendency or inherent weakness of the affected part or organ; to
fully appreciate the inherent etiological factors that reside in man,
and which constitute the tendency to disease or premature decay and
death, we must also be able to follow Canstatt, Day, Rostan, Charcot,
Rush, Cheyne, Humphry, or Reveille-Parise into the study of the
different conditions which, though normal, are nevertheless factors of a
slow or a long life. We must also be able to appreciate fully the value
of that interdependence of each part of our organism, which often, owing
to a want of equilibrium of strength and resistance in some part when
compared to the rest, causes the whole to give way, just as a flaw in a
levee will cause the whole of the solidly-constructed mass to give way,
or a demoralized regiment may entail the utter rout of an army. As
described by George Murray Humphry, in his instructive work on "Old
Age," at page 11:--

"The first requisite for longevity must clearly be an inherent or inborn
quality of endurance, of steady, persistent nutritive force, which
includes reparative force and resistance to disturbing agencies, and a
good proportion or balance between the several organs. Each organ must
be sound in itself, and its strength must have a due relation to the
strength of the other organs. If the heart and the digestive system be
disproportionately strong, they will overload and oppress the other
organs, one of which will soon give way; and, as the strength of the
human body, like that of a chain, is to be measured by its weaker link,
one disproportionately feeble organ endangers or destroys the whole. The
second requisite is freedom from exposure to the various casualties,
indiscretions, and other causes of disease to which illness and early
death are so much due."

In following out our study of diseases, we have been too closely
narrowed down by the old symptomatic story of disease; we have too much
treated surface symptoms, and neglected to study the man and his
surroundings as a whole; we have overlooked the fact that there exists a
geographical fatalism in a physical sense as well as the existence of
the influence of that climatic fatalism so well described by Alfred
Haviland, and the presence of a fatalism of individual constitution as
well, which is either inherited or acquired. The idea that Charcot
elaborates, that, as the year passes successively through the hot and
the cold, through the dry and the wet season, with advancing age the
human body undergoes like changes, and diseases assume certain
characteristics, are also points that are overlooked; and nowhere is
this latter view seen to be more neglected than in the relations the
prepuce bears to infancy, prime and old age, as will be more fully
explained in the chapters in this book which treat of cancer and
gangrene. Admitting that Haviland has exaggerated the influence of
climate as an etiological factor in its specific influence in producing
certain diseases; or that M. Taine claims more than he should for his
"Thèorie des Milieux," or influence of surroundings; or that Hutchinson
has drawn the hereditary and pedigreeal fatherhood of disease too
finely; it must also be admitted that the solid, tangible truths upon
which these authors have founded their premises are plainly visible to
the most skeptical; the architectural details of the superstructure may
be defective, but the foundation is permanent.

From the above outline it will be easier for the reader to follow out
the reasons, or the whys or wherefores, of the views expressed on
medicine in the course of the book; and, although I do not wish to enter
the medical field like a Peter the Hermit on a new crusade, to lure
thousands into the hands of the circumcisers, nor, as a new Mohammed,
promise the eternal bliss and glory of the seventh heaven to all the
circumcised, I ask of my professional brothers a calm and unprejudiced
perusal of the tangible and authentic facts that I have honestly
gathered and conscientiously commented upon from my field of vision,
which will be plainly presented in the following pages. I simply have
given the facts and my impressions: the reader is at liberty to draw his
own conclusions.

If I have been too tedious in the multiplication of incidents in support
of certain views, I must remind the reader that the verdict goes to him
who has the preponderance of testimony, and that many a lawsuit is lost
from the neglect, on the part of the loser, to secure all the available
testimony. Having brought the subject of circumcision before the bar of
public opinion, as well as that of my professional brother, I would but
illy do justice to the subject at the bar, or to myself, not to properly
present the case; as it was remarked by Napoleon, "God is on the side of
the heaviest artillery," and he who loses a battle for want of guns
should not rail at Providence if, having them on hand, he has neglected
to bring them into action.

The reasons for the existence of the book will become self-evident as
the reader labors through the medical part of the work. Our text-books
are, as a class, even those on diseases of children as a specialty,
singularly and unpardonably silent and deficient on the subject of
either the prepuce and the diseases to which it leads, or circumcision;
and even our surgical works are not sufficiently explicit, as they deal
more with the developed disease and the operative measures for its
removal than on any preventive surgery or medicine. Our works on
medicine are equally silent, and, although from a perusal of the latter
part of the book the prepuce and circumcision will be seen to have
considerable bearing on the production and nature of phthisis, this
subject would, owing to our strabismic way of studying medicine, look
most singularly out of place in a work devoted to diseases of the lungs
or throat. Owing to this poverty of literature on the subject, and that
the library of the average practitioner could therefore not furnish all
the data relating to it that the profession have in their possession, a
book of this nature will furnish them the required material whereupon to
form the basis of an opinion on the subject.

To argue that the prepuce is not such a deadly appendage because so many
escape alive and well who are uncircumcised, would be as logical as to
assume that Lee's chief of artillery neglected to properly place his
guns on the heights back of Fredericksburg. He had asserted, the night
before the battle, that not a chicken could live on the intervening
plateau between the heights and the town. On the next day, when these
guns opened their fire, the Federals were unable to reach the heights,
while many men were for hours in the iron hail-sweeping discharges of
that artillery that mowed them down by whole ranks, and yet the majority
escaped alive. We take the middle ground, and, while admitting that many
escape alive with a prepuce, claim that more are crippled than are
visibly seen, as, like Bret Harte's "Heathen Chinee," the ways of the
prepuce are dark and mysterious as well as peculiar.

A discussion of the relative merits of religious creeds, when considered
in relation to health, has been, from the nature of the subject of the
book, unavoidable. Modern Christianity but very imperfectly explains why
this rite was either neglected or abolished. Frequent reference is made
to what Saint Paul said and did, but, as Saint Paul was not one of the
Disciples, it is inexplicable wherefrom he received his authority in
this matter, seeing that the Disciples themselves had no new views on
the subject. To the student who prefers to study his subject from all
its aspects, the question naturally arises, "Where, when, and why came
the authority that abolished this rite?" There is one probable
explanation, this being that Paul, who was the real promulgator of
Gentile Christianity, had to establish his creed among an uncircumcised
race; although, as we shall see, devotees have not scrupled to sacrifice
their virility in the hope of being more acceptable to God and to be
better able to observe His commandments, and others, in their blind
bigotry, have not objected to sitting naked on sand-hills, with a
six-inch iron ring passed through the prepuce, it is very evident that
the Apostle Paul's good sense showed him the uselessness of attempting
to found the new creed, and at the same time hold on to the truly
distinctive marking of Judaism among Gentiles, the Hebrew race being
those among whom he found the least converts, as even the Disciples and
Apostles in Palestine disagreed with him. In the words of Dr. I. M.
Wise, it was impossible for the Palestine Apostles, or their flock,
either to acknowledge Paul as one of their own set or submit to his
teaching; for they obeyed the Law and he abolished it; they were sent to
the house of Israel only, and Paul sought the Gentiles with the message
that the Covenant and the Law were at an end; they had one gospel story
and he another; they prophesied the speedy return of the Master and a
restoration of the throne of David in the kingdom of heaven, and he
prophesied the end of the world and the last day of judgment to be at
hand; they forbade their converts to eat of unclean food, and especially
of the sacrificial meats of the Pagans, and he made light of both, as
well as of the Sabbath and circumcision. In the attempted reconciliation
that subsequently took place in Jerusalem at the house of James, the
Jacob of Kaphersamia of the Talmud, Paul was charged by the synod of
Jewish Christians "with disregarding the Law, forsaking the teachings of
Moses, and attempting to abolish circumcision." He was bid to recant and
undergo humiliation with four other Nazarenes, that it might be known
that he walked orderly and observed the Law; Paul submitted to all that
was demanded.

This, in short, with the exception of the sayings of Paul on the
subject, which are all secondary considerations, is really all that
there is relating to the abolishment of circumcision by the Christians.
The real Disciples and Apostles believed in Jesus with as much fervor as
Paul, but it is singular that they who were with the Master should
always have insisted on the observance of the Law, while Paul as
energetically insisted on its abolishment.

From these premises, I have seen fit to inquire into the relative merits
of the three religions practiced by what we call the civilized nations,
as they affect man morally, physically, and mentally. I have given the
facts, my impressions, and reasons for being so impressed; from these,
the reader can easily see that religion has more to do with man's
temporal existence than is generally believed; its discussion is not,
therefore, out of place in this book.

Repetitions in the course of the work have been unavoidable. This is not
a novel nor a work of fiction, and wherever the want of repetition would
have been an injury, either to the proper representation of a fact or a
principle, the repetition has not been avoided. In describing the
operations, I had desired to avoid any too numerous descriptions, as
that is confusing, but have thought it best to give a number, as the
reader will thereby obtain the views of the different operators, the
mode of the operation often being an index to the view of the operator
in regard to the needs or utility of a prepuce. In the general plan of
the work, I have adopted the idea and the historical relation carried
out by Bergmann, of Strasburg, who included all the mutilations
practiced on the genitals while discussing the subject of circumcision,
they being, in the originality of performance, somewhat intimately
connected; this also tends to make the subject more interesting as a
contribution to the natural history of man,--something in which all
intelligent persons are more or less interested.

P. C. REMONDINO, M.D.
SAN DIEGO, CALIFORNIA.

[Illustration: EGYPTIAN CIRCUMCISION.

(From Chabas and Ebers' description of the bas-relief found in the
temple of Khons, near the great temple of Maut, at Karnac.)]



CHAPTER I.

ANTIQUITY OF CIRCUMCISION.


If the ceremonials of the Catholic Church or the High Church
Episcopalians carry us back into the depths of antiquity, or, as
remarked by Frothingham, that the ceremonies of St. Peter, at Rome,
carried him back to the mysteries of Eulesis, to the sacrificial rites
of ancient Phoenicia, to what misty antiquity does not the contemplation
of the rite of circumcision take us? The Alexandrian library, with its
vast collection of precious records, could probably have furnished us
some information as to its origin and antiquity; but Moslem fanaticism,
with its belief in the all-sufficiency and infallibility of the Koran,
was the destruction of that wonderful repository. We must now depend
wholly on the relation of the Old Testament or on what has since been
written by the Greek and Italian historians as to its origin and
practices. The Egyptian monuments and their hyeroglyphics give us no
information on the subject further back than the reign of Rameses II;
while the oft-quoted Herodotus wrote some fourteen centuries after the
Old Testament relation, and Strabo and Diodorus some nineteen centuries
after the same chronicler. We have, therefore, in their chronological
order, first, the relation of the Bible; then the Egyptian monuments and
their revelations; and, thirdly, the information gathered by Pythagoras,
Herodotus, and other philosophers and historians. To these three
sources we may add the misty mixture of tradition and mythological
events, whose beginnings as to period of time are indefinite. These are
the sources from which we are to determine the origin and antiquity as
well as the character of the rite.

Voltaire found in the subject of circumcision one that he could not
satisfactorily make enter into his peculiar system of general
philosophy. For some reason, he did not wish that the Israelites should
have the credit of its introduction; were he to have admitted that, he
would have had to explain away the divine origin of the rite,--something
that the Hebrew has tenaciously held for over thirty-seven centuries.
Voltaire thought it would simplify the subject by making it originate
with the Egyptians, from whom the Hebrews were to borrow it. To do this
he adopted the relation of Herodotus on the subject. His treatment of
the Jewish race, however, brought out a strong antagonism from those
people to his attacks, and in a volume entitled, "Letters of Certain
Jews to Monsieur Voltaire,"--being a series of criticisms on his
aspersions on the race and on the writings of the Old Testament (written
by a number of Portuguese, German, and Polish Jews then residing in
Holland[1]),--they proved conclusively that the Phoenicians had borrowed
the rite from the Israelites, as they (the Phoenicians) had practiced
the rite on the newborn, whereas, had they followed the Egyptian rite,
they would have only circumcised the child after its having passed its
thirteenth year,--these being the distinctive differences between the
Jewish and Egyptian rites.

Luckily, in the small temple of Khons, which formed an annex to the
greater temple of Maut, at Karnac, there was found a _bas-relief_,
partly perfect, which goes far toward giving light on the subject of
Egyptian circumcision. The upper part of the sculpture was so defaced
that the upper portions of four of the five figures were destroyed, but
the lower portions were so perfect in every detail as to furnish a full
history of the age of the candidates for the rite and the manner of its
performance. It is further interesting from the fact that it establishes
also the time during which the rite was so performed. M. Chabas and Dr.
Ebers argue, from the founder of the temple having been Rameses II, that
the sculpture refers to the circumcision of two of his children. The
knife appears to be a stone implement, and the operator kneels in front
of the child, who is standing, while a matron supports him in a kneeling
posture, and she holds his hands from behind him.[2] In this
_bas-relief_ we can see the great difference that existed between the
two forms of the operation, that of the Hebrews being performed, as a
rule, on the eighth day after birth, while in the _bas-relief_ they are
ten or twelve years old.

Although tradition and mythology veil past events in more or less
obscurity, they do, in regard to circumcision, furnish considerable
explanatory light on matters which would be otherwise hard to reconcile.
Circumcision has been performed by the Chippeways, on the Upper
Mississippi, and its modifications were performed among the Mexicans,
Central Americans, and some South American tribes of Indians, as well as
among many of the natives dwelling among the islands of the Pacific
Archipelago. There is a tradition, mentioned by Donnelly in connection
with the sunken continent of Atlantis, that Ouranos, one of the
Atlantean kings, ordered his whole army to be circumcised that they
might escape a fatal scourge then decimating the people to their
westward.[3] This tradition tells us that the hygienic benefits of
circumcision were recognized antediluvian facts, as it also points out
the way by which circumcision traveled westward across to the Western
World. As Donnelly has pointed out, many of the Americans possessed not
only traditions, habits, and customs that must have come from the Old
World, but the similarity of many words and their meaning that exists
between some of the American languages and those of the indigenous
inhabitants that have still their remains in spots on the southwestern
shores of Europe--the ancient Armorica whose colony in Wales still
retains its ancient words--leaves no room for doubt that at one time a
landed highway existed between the two worlds. The Mandans, on the Upper
Missouri, have many words of undoubted Armorican origin in their
vocabulary,[4] just as the Chiapenec, of Central America, contains its
principal words denotive of deity, family relations, and many conditions
of life that are identically the same as in the Hebrew,[5] the name of
father, son, daughter, God, king, and rich being essentially the same in
the two languages. It must have been more than a passing coincidence
that gives the Mandans some of their most expressive words from the
Welsh, or that gave to Central America many cities bearing analogous
names with the cities of Armenia.[6] Canadian names of localities, as
well as those of the Mississippi Valley, denote the French origin of
their pioneers, as well as the names of Upper California denote the
nationality and creed of its first settlers. So that there is nothing
strange in asserting that American civilization and many of the customs
as found in the fifteenth century by the early Spanish discoverers were
nothing more than the remains of ancient and modified Phoenician
civilization, among which figured circumcision.

Dr. A. B. Arnold, of Baltimore, argues that, with the present state of
our anthropological knowledge and the material that research has been
able to furnish, we need no longer be surprised to find customs, laws,
and morals, among nations living in regions of the world widely apart
from each other, which betray an identity of origin and development, and
that beliefs and institutions, whether wise or aberrant, grow up under
apparently dissimilar circumstances, circumcision forming no
exception.[7] Dr. Arnold leaves too much to chance. It is hardly likely
that the similarity that existed between the architecture of the
Phoenicians and the Central Americans, as evinced in their arches; in
the beginning of the century on the 26th of February; the advancement
and interest taken in astronomical science; the coexistence of pyramids
in Egypt and Central America; that five Armenian cities should have
their namesakes in Central America, should all be a matter of accident.
The historiographer of the Canary Islands, M. Benshalet, considers that
those islands once formed a part of the great continent to its west;
this has been verified by the discovery of many sculptured symbols,
similar in the Canaries and on the shores of Lake Superior, as well as
by the discovery of a mummy in the Canaries with sandals whose exact
counterparts were found in Central America.[8] A compound word used to
signify the Great Spirit being found identical in the Welsh and Mandan
languages, each requiring five distinct sounds to pronounce, words as
intricate as the passwords of secret societies, can hardly be said to be
the result of chance.[9] There must, at some remote period, have existed
some communication between the ancestors of these Missouri Mandans and
the shores of ancient Armorica; the ancestors of these Mandans may have
then been living farther to the east; they even may have then been a
tribe of since lost Atlantis; but the analogy, not only in regard to the
word just mentioned,--_Maho-peneta_, of the Welsh and Mandan,--but in
the similarity of the pronouns of both languages, and the existence of
the idea of the counterpart of the sacred white bull of the Egyptians
being found among the Dakotas, or Sioux, all point to the fact that
these people, in common with the rest of the Americans, originally came
from the East; from whence came their languages, manners, customs,
rites, and what civilization they possessed, among which circumcision
has, through the mist of centuries, held its own in some shape or other.

That some terrible catastrophe occurred to divide the hemispheres is
evident; the Western World remaining stationary in its civilization and
retaining the customs and rites of the times as evidence of their
origin. With this view of the case, the existence of circumcision as
found among the inhabitants of the West can easily be traced to its
origin among the hills of Chaldea. The ancient traditions and
mythological relations of the Egyptians in regard to the great nation to
the West are amply verified by the deep-sea soundings of the
"Challenger," the "Dolphin," and the "Gazelle," which plainly indicate
the presence of a submarine plateau that once formed the continent of
Atlantis, whose only visible evidence above the waves of the boisterous
Atlantic is the Azores and the remains of Phoenician civilization among
the Americans.

Professor Worman, of Brooklyn, scouts the idea that circumcision was
ever connected in any way or that it originated in any of the rites
connected with phallic worship.[10] Bergmann,[11] of Strasburg,
however, not only claims circumcision to be a direct result of phallic
worship, but looks upon the rite as something that has been reached by
what may be termed a gradual evolutionary process of manners, customs,
and society, from the time of what is termed the hero-warrior period of
traditional history, when war and the clashing of shields and sword or
spear were the main delights and occupations of man. It is strange to
note what difference must have existed between these hero-warriors in
regard to their ideas of manliness; some were brutal and fiendish,
whilst others were magnanimous. McPherson, the historiographer of early
Britain, cannot help but contrast the superior manliness of the heroes
of Ossian in his graphic description of the ancient Caledonians, when
compared to the brutality of Homer's Greek heroes. The traditions upon
which Bergmann undertakes to found the origin of the rite of
circumcision are all connected with the inhuman and brutish passions
that animated our barbarous ancestry. The first incident given is the
Egyptian traditional tragedy, which was, in all probability, the initial
point of that phallic worship which, with increasing debauchery,
assisted in the final demoralization of Rome and Greece, after its
introduction into those countries.



CHAPTER II.

THEORIES AS TO THE ORIGIN OF CIRCUMCISION.


We are told that in battle man looked upon the vanquished as unfit to
bear the name of man, looking upon the weakness or want of skill which
contributed to their defeat as something effeminate. The victor then
proceeded by a very summary and effective mode, done in the most
primitive and expeditious manner, to render his victim as much like a
female as possible to all outward appearances; this was accomplished by
a removal at one sweep of _all_ the organs of generation, the phallus
being generally retained as a trophy,--a practice which was also carried
into effect with dead enemies, to show that the victor had vanquished
_men_. It has been the practice from time immemorial for a victor to
carry off some portion of the body of his victim or defeated enemy, as a
mark or testimony of his prowess; it was either a hand, head or scalp,
lower jaw, or finger. The carrying off of the phallus or virile member
was considered the most conclusive proof of the nature of the
vanquished, and, as it established the sex, it conferred a greater title
to bravery and skill than a mere collection of hands or scalps, which
would not denote the sex. In conformity with this custom, we find that
Osiris, when he returned to Egypt and found that Typhon had fomented
dissension in his absence, being vanquished by the latter in the
conflict that followed, was dismembered and cut into pieces, the
followers of Typhon each securing a piece and Typhon himself securing
the phallus or generative member. Isis, the spouse of Osiris, seems in
turn to have secured the control of government, and, having secured all
the pieces of the dissected Osiris except the phallus,--Typhon having
fled with that, and, according to some traditions, having thrown it into
the sea,--Isis ordered that statues should be constructed, each to
contain a piece of the unfortunate Osiris, who should thereafter be
worshiped as a god, and that the priesthood should choose from among the
animals some one kind which should thereafter be considered sacred. The
phallus which was missing was ordered special worship, with more marked
solemnities and mysteries; from this originated the phallic worship and
the sacredness of the white bull, Apis, among the Egyptians, which was
chosen to represent Osiris.

By gradual evolution and the progress of society, the cultivation of the
ground and the need of menials, warriors found some other use for their
prisoners taken in strife besides merely cutting off the phallus as a
trophy; these prisoners began to have some intrinsic value. From this a
change came about; the warrior instinct, however, still claimed that the
vanquished, even if a slave, should still convey or carry some sign of
servitude. The original idea of the ablation of the phallus was to
emasculate the victim; investigation developed the idea that the same
object could be accomplished by castration, an operation which also
finally reached a tolerable state of perfection through different stages
of evolution, it first being performed by a complete removal of the
whole scrotum and contents. This operation, with the ignorance of the
times in regard to stopping hæmorrhage, was, however, accompanied by a
large mortality, and it finally evolved into the simple removal of the
gland, or its obliteration by pressure or violence. Bergmann conveys the
idea that circumcision was at one time the indestructible marking and
the distinctive feature of the slave, the mind of the period not being
able to emancipate itself from the idea that the genitals must in some
manner be mutilated, not being able to conceive any other degrading mark
of manhood which barbarians felt they must inflict on slaves.

The generally accepted idea in regard to the physical mutilation of
captives taken in war, or that some token from the body of the
vanquished must be carried off by the victor, has not only the support
of tradition and monumental sculptured evidence, but its practice is
still in vogue among many races. Among the ancient Scythians, only the
warriors who returned from the battle or foray with the heads of the
enemy were entitled to a share in the spoils. Among the modern Berbers
it is still a practice for a young man, on proposing marriage, to
exhibit to his prospective father-in-law the virile members of all the
enemies he has overcome, as evidence of his manhood and right to the
title of warrior. The Abyssinians and some of the negro tribes on the
Guinea coast still follow the custom of securing the phallus of a fallen
foe. However barbarous this practice may seem, its actual performance is
only secondary, the primary motive being that the warrior wished to
prove that he had been there, engaged in actual strife, and that his
enemy had been overcome. The writer remembers that, after one of the
battles in the West during the late war, many letters arrived in his
locality with pieces of the garments or locks of the hair of the
unfortunate Confederate general, Zollikoffer, who had been slain in the
battle; a disposition in the warrior, seemingly still existing, such as
animated the old Egyptians. On an old Egyptian monument,--that of
Osymandyas,--Diodorus noticed a mural sculpture, a _bas-relief_
representing prisoners of war, either in chains or bound with cords,
being registered by a royal scribe preparatory to losing either the
right hand or the phallus, a pile of which is visible in one corner of
the foreground; from this sculpture we learn that the practice was not
only an individual performance, but that it was a national usage among
the Egyptians as well, who subjected, at times, their vanquished foes to
its ordeal in a wholesale but business-like manner.

Bergmann argues that the Israelites were given to like practices, and
cites the incident wherein David brought two hundred prepuces--as
evidence of his having slaughtered that number of Philistines--to Saul,
as a mark of his being worthy to be his son-in-law. He argues that,
whereas many have made that Old Testament passage to read "two hundred
prepuces," it should have read "two hundred virile members" which David
and his companions had cut off from the Philistines, the word _orloth_
meaning the virile member, and not the prepuce. That Israelitish
circumcision could have originated from either phallic worship or any of
the hero-warrior usages is untenable as a proposition, as regards the
living prisoners, and is contrary to the monotheistic idea which ruled
Israel, or to the benign nature of their God. The strict opposition of
the religion of Judaism to any other mutilation except that of the
covenant is also antagonistic to the views advanced by Bergmann, as it
is well known that even emasculated animals were considered imperfect
and unclean, and therefore unfit to be received or offered as a
sacrifice to their deity. No emasculated man was allowed to enter the
priesthood or assist at sacrifices. The whole idea of Judaism being
opposed to such mutilations, their observance of circumcision and its
performance can in no way have developed from either phallic or other
warlike rites or usages; but we must accept its origin as a purely
religious rite,--a covenant of the most rigid observance, coincident in
its inception with the formation of the Hebraic creed in the hills of
Chaldea.

What Herodotus or Pythagoras may have written concerning the practice
among the Egyptians was written, as already remarked, some nine
centuries after Moses had recorded his laws; Moses himself having come
some centuries after Abraham. Herodotus is quoted as representing that
the Phoenicians borrowed the practice from the Egyptians, in support of
the theory that Egypt was the central nucleus from whence the practice
started, and not that it traveled toward Egypt from Phoenicia. The
difference in the ages, already mentioned, at which the rite was
practiced--that of Phoenicia and Israel being at one time
identical--shows that the testimony of Herodotus in this one particular
was the result of faulty judgment, as we find the people who have
borrowed the practice from the Egyptians, as well as their descendants,
closely follow their practice in regard to the age at which the
operation should be performed. Another evidence of the strictly
religious nature of the rite, as far as the Hebrews are concerned, lies
in the fact that, with all their skill in surgery and medical
sciences,--they being at one time the only intelligent exponents of our
science,--they never made any alteration or improvement in the manner of
performing the operation. It is evident that even Maimonides, a
celebrated Jewish physician of the twelfth century, who furnished some
rules in regard to the operation, was held under some constraint by the
religious aspect of the rite. As a summary of this part of the subject,
it may be stated that the Old Testament furnished the only reliable and
authentic relation prior to Pythagoras and Herodotus. From its evidence,
Abraham was the first to perform the operation, which he seems to have
performed on himself, his son, and servants,--in all, numbering nearly
four hundred males; he then dwelt in Chaldea. In absence of other as
reliable evidence we must accept this testimony in regard to its origin,
causes, and antiquity.

Voltaire, in his article on circumcision in his "Philosophical
Dictionary," seems more intent on breaking down any testimony that might
favor belief in any religion than to impart any useful light or
information. He bases all his arguments on the book "Euterpe," of
Herodotus, wherein he relates that the Colchis appear to come from
Egypt, as they remembered the ancient Egyptians and their customs more
than the Egyptians remembered either the Colchis or their customs; the
Colchis claimed to be an Egyptian colony settled there by Sesostris and
resembled the Egyptians. Voltaire claims that, as the Jews were then in
a small nook of Arabia Petrea, it is hardly likely that, they being then
an insignificant people, the Egyptians would have borrowed any of their
customs. To read Voltaire's "Herodotus" is somewhat convincing, but
Voltaire's "Herodotus" and Herodotus writing himself are two different
things, and the book "Euterpe" says quite another thing from what M.
Voltaire makes it say. A perusal of Voltaire and a study of his Jewish
critics on this subject, as found in the "Jews' Letters to Voltaire,"
will convince any reader that as to circumcision M. Voltaire is an
unreliable authority.



CHAPTER III.

SPREAD OF CIRCUMCISION.


From Chaldea, then, in the mountains of Armenia and Kurdistan, the
practice of circumcision was, in all probability, first adopted by the
Phoenicians, who finally relinquished the Israelitish rite as to age of
performance and exchanged it for the Egyptian rite. From Phoenicia its
spread through the maritime enterprises of this race to foreign parts
was easy. Egypt was the next place to adopt its practice; at first the
priesthood and nobility, which included royalty, were the only ones who
availed themselves of the practice. The Egyptians connected circumcision
with hygiene and cleanliness; this was the view of Herodotus, who looked
upon the rite as a strictly hygienic measure. History relates of the
existence of circumcision among the Egyptians as far back as the reign
of Psammétich, who ruled toward the end of the sixth century B.C. The
practice must then have been of a very religious and national nature, as
we are told that Psammétich, having admitted some noted strangers, whom
he allowed to dwell in Egypt without being circumcised, brought himself
into great disfavor among his subjects, and especially by the army, who
looked upon an uncircumcised stranger as one undeserving of favors.
During the next century Pythagoras visited Egypt, and was compelled to
submit to be circumcised before being admitted to the privilege of
studying in the Egyptian temples. In the following century these
restrictions were removed, for neither Herodotus nor Diodorus, who
visited the country, were obliged to be circumcised, either to dwell
among the people or to follow their studies. There is one curious habit
that is mentioned in connection with the rite of circumcision among
these people, this being its relation to the taking of an oath or a
solemn obligation. Among the Egyptians the circumcised phallus, as well
as the rite of circumcision, seemed to be the symbol of the religious as
well as of the political community, and the circumcised member was
emblematical of civil patriotism as well as of the orthodox religion of
the nation. To the Egyptian, his circumcised phallus was the symbol of
national and religious honor; and as the Anglo-Saxon holds aloft his
right hand, with his left resting on the holy Bible, while taking an
oath, so the ancient Egyptian raised his circumcised phallus in token of
sincerity,--a practice not altogether forgotten by his descendants of
to-day. It was partly this custom of swearing, or of affirming, with the
hand under the thigh, by the early Israelites, that caused many to
believe that their circumcision was borrowed from the Egyptians,
especially by M. Voltaire, who insists that it was the phallus that the
hand was placed on, and that the translation has not the proper meaning,
as given in the Bible.

Among the Arabs it was the practice to circumcise at the age of thirteen
years, this being the age of Ishmael at his circumcision by his father,
Abraham. The Arabs practiced circumcision long before the advent of
Mohammed, who was himself circumcised. Pococke mentions a tradition
which ascribes to the prophet the words, "Circumcision is an ordinance
for men, and honorable in women." Although the rite is not a religious
imposition, it has spread wherever the crescent has carried the
Mohammedan faith. Uncircumcision and impurity are to a Mohammedan
synonymous terms. Like the Abyssinians, the Arabs also practice female
circumcision,--an operation not without considerable medical import, as
will be explained in the medical part of the work. This practice is also
common in Ethopia. Some authorities argue, from this association of
female circumcision among the Southern Arabs, Ethiopians, and
Abyssinians, that they did not derive their rite from the Israelites;
but there is not much room for doubt but that the operation came down to
the Arabians from Abraham through his son Ishmael. Considering the
occupancy of Syria, Arabia, and Egypt by the French, and the intercourse
with these countries by the British, it is surprising that the
profession in the early part of the present century had not full
information regarding the nature and objects of female circumcision as
practiced in these countries. Delpesh observes, in relation to the
Oriental practice, that his information was too vague to determine
whether it was the nymphæ or the clitoris that were removed, or whether
it was only practiced in cases of abnormal elongations of these parts.
M. Murat, however, writes at length on the subject, very intelligently,
as well as Lonyer-Villermay, who, writing in the same work with Delpesh,
thinks it is certainly the clitoris that is removed.[12] In Arabia, the
trade or profession of a _resectricis nympharum_ or she-circumciser is
as stable an occupation with some matrons as that of cock-castration or
caponizing is the sole occupation of many a matron in the south of
Europe. It is related by Abulfeda that, in the battle of Ohod, where
Mohammedanism came very near to a sudden end by the crushing defeat of
the prophet and his followers, Hamza, the uncle of the prophet, seeing
in the opposing ranks a Koreish chief, whom he knew, thus called out:
"Come on, you son of a she-circumciser!" As Hamza was among the slain,
it is most likely that he met his death from the hands of the chief,
whose mother really followed that occupation. So extensive is the
practice, that these old women sometimes go through a village crying out
their occupation, like itinerant tinkers or scissors-grinders.

The present ceremonies attending the performance of the rite among the
Arabians are well described by Dr. Delange, a surgeon of the French
army, as witnessed by him in the province of Constantine, in Algeria.

With these Arabs, circumcision is performed on a whole class, so to
speak, at the same time, regardless of the trifling differences in their
ages. It is preceded by feasting, the total length of the feast being
for eight days. For the first seven days, all the Arabs of the quarter
where the candidates for circumcision reside dress in their best. The
poor have their mantles and clothes carefully washed, and the rich deck
themselves out in their gold and silver brocaded vests and pantaloons.
During these seven days there is general rejoicing, and the Arabs spend
most of this time in the village street, racing, firing guns, or
engaging in sham battles between the different camps, during which one
carries the green, or sacred banner, which is supposed to render the
bearer invulnerable. The battle ends by the standard-bearer being fired
at by all parties, and falling, but quickly rising again and waving the
flag in token of its protecting power. The Arabs now adjourn to another
public place, where the notables and strangers are furnished seats on
carpets; here a dance to the music of tumtums and the singing of
invisible females takes place, the dancers being only males.[13] In the
evening the women sing, to which the men listen in silence, this concert
being kept up until midnight. On the seventh day, the women, decked out
in their best, and with all their personal ornaments, accompanied by all
the young men, armed with their guns and pistols, repair to the
extremity of the oasis, where they gather plates of fine sand. With this
sand they return to the village, where it is exposed overnight to the
glare of the full moon on the terraces of the house. This last day
closes with a grand banquet, given by the rich whose children are about
to be circumcised, to which all the people are invited.

The next morning all the relatives of the candidates repair to the house
where the rite is to be performed; the women going up into the second
floor, wherefrom they can look down into the court from a porch screened
with lattice-work, without themselves being seen. The men gather
together on the ground-floor, together with the operator and his
assistants and the children about to be circumcised, who are dressed in
yellow, silken gowns. The child to be operated upon is seated in a pan
of sand, while an assistant fixes his arms and holds the thighs well
separated from behind. The circumciser then examines the prepuce, the
glans, and removes any sebaceous collection. This done, a compress with
an aperture to admit of the passage of the glans is slipped over the
organ; a small piece of leather, some six centimetres in diameter, with
a small hole in the centre, is now used, the free end of the prepuce
being drawn through the aperture; a ligature of woolen cord is then tied
on to the prepuce next to the front of the leather shield, and, the
knife being applied between the thread and the leather, the prepuce is
removed at one sweep; the mucous inner layer is then lacerated with the
thumb-nails and turned back over to join the other parts. The surface is
then sprinkled with _arar_ or _genevriere_ powder and dressed with a
small cloth bandage, the subsequent dressings consisting of _arar_
powder and oil. During the operation the women in the gallery keep up an
unearthly music by means of tumtums, cymbals, and all the kettles and
saucepans of the neighborhood, which are brought into requisition for
the occasion. This music is accompanied with songs and chants, each
woman striking out with an independent song of her own, either
improvised or suggested by the occasion. This not only serves to drown
the cries of the children, but it must, in a manner, assist to draw them
away from the immediate contemplation of their sufferings. The prepuces
are now gathered together and carried to the end of the oasis, where
they are buried with ceremony and rejoicings. This circumcision only
takes place once in three or four years, and the children are from four
to eight years of age; of fifteen circumcised at the feast witnessed by
M. Delange, only two had passed their eighth year.

In a very interesting old book,[14] "The Treaties of Alberti Bobovii,"
who was attached to the court of Mohammed IV, published with annotations
by Thomas Hyde, of Oxford, in 1690, there is a description of the
Turkish performance of the rite which leads one to infer that they
circumcised the children quite young: "Et cum puer præ dolore exclamat,
imus ex duobus parentibus digitis in melle ad hoc comparato os ei
obstruit; cæteris spectatoribus acclamantibus. O Deus, O Deus, O Deus.
Interim quoque Musica perstrepit, tympana et alia crepitacula
concutiuntur, ne pueri planctus et ploratus audiatur." Bobovii says that
the age at which circumcision is performed is immaterial provided the
candidate is old enough to make a profession of faith,--which, however,
is made for him by the godfather,--in the following words: "There is no
God but God, and Mohammed is his Prophet," or, as rendered by our
author, "Non esse Deum nisi ipsum Deum, et Mohammedem esse Legatum
Dei." To which he adds that the child must not be an infant, but that he
must be at least eight years of age. Like to the Arabs, the Turks
celebrated the occasion by feasts, plays, and a general good time; the
child was kept in bed for fifteen days to allow complete cicatrization
to take place. The circumcision was performed with the boy standing.

Michel Le Feber, writing in 1681,[15] speaks of the tax levied on the
Christians by the Turks, that they, the Christians, may enjoy liberty of
conscience, and observes that, circumcision not being compulsory among
the Turks, it often led to trouble and annoyances, as many of the Turks
evaded the operation. The tax-gatherers in Turkey are very industrious,
and, as being circumcised was, as a rule, sufficient evidence of not
being a Christian, he often witnessed on the streets scenes wherein
strangers, arrested by these tax-collectors, were compelled to show
their circumcision as an indisputable sign of their exemption from the
tax. He also relates that in their zeal for converts to Mohammedanism
the Turks often resorted to presents to induce Christians to embrace
their faith. While in Aleppo, he saw a Portugese sailor, who, through
presents, had forsaken his religion, but who had repented in the most
emphatic manner when brought to face circumcision. Finding entreaties in
vain, the Cadi ordered the immediate administration of a stupefying
draught, and the sailor was then seized and circumcised without further
ceremony.

In cases where the new Mohammedan is reasonable and submits like a hero,
the ceremonies are more elaborate. Le Feber relates that if the
candidate is a man of note or wealth he is mounted on a horse and
exhibited all over the city; he is dressed in the richest of Turkish
robes and in his hand he holds an arrow with the point directed to the
sky; he is followed by a great concourse of people, some dressed in
holiday attire and others in fantastic costumes; and general feasting
and enjoyment is the rule over the course of the march, where all the
people run to swell the crowd. If the man happens to be a poor man, he
is simply hurriedly marched about on foot, with a simple arrow in his
hand pointed skyward, to distinguish him from ordinary mortals; before
him a crier proclaims in a loud voice that the new religionist has
ennobled himself by professing the faith of the prophet in this solemn
manner. A collection for his benefit is taken up among the booths and
shops, which is mostly appropriated by the conductor, circumciser, and
his assistants, after which he is circumcised without further ado.

The same author describes the operation as performed on the young Turks
and the accompanying ceremonies. They differ in some respects from those
employed in circumcising a convert. The parents of the child give a
feast in proportion to their means, to which are invited the relatives
of the family and personal friends; if of the upper ranks, he is
promenaded about the town to the music of drums and cymbals, dressed in
rich attire; two warriors lead the procession with drawn swords, and a
troop of females who sing songs of joy bring up the rear; the procession
now and then stops, when the two gladiators in the front indulge in a
fierce set-to, hacking at each other in the most determined and
murderous manner, but so studiedly shammy that neither is injured; on
the return to the house, the child, who is usually eight or ten years of
age, is bound hand and foot to prevent his causing any injury to
himself, laid on a bed, and circumcised with a razor, the operation
being performed either by a surgeon or the chief of a mosque.



CHAPTER IV.

CIRCUMCISION AMONG SAVAGE TRIBES.


E. Casalis,[16] who, in the capacity of missionary, for a very long time
resided among the Bassoutos, tells us that among that nation the
operation is performed at the age of from thirteen to fifteen years. The
ceremony is gone through once in three or four years. So important an
event is it considered by the Bassoutos that they date events from one
of these observances, as the Romans dated events from a certain
consulship, or the Greeks from an Olympiade. At the time fixed, all the
candidates go through a sham rebellion and escape to the woods; the
warriors arm and give chase, and, after a sham battle, capture the
insurgents, whom they bring back as prisoners, amidst dancing and great
rejoicings, which are the preludes to the feast. The next day the huts
of mystery (_mapato_) are erected, where, after the circumcision, the
young men are to reside for some eight months, under the tutorship of
experienced teachers, who drill them in the use of the spear, sword, and
shield, teaching them to endure hunger, thirst, blows, and all manner of
hardships; prolonged fasts and cruel flagellations being regarded as
pastimes between the exercises. The severity of the regulations may be
judged from the fact that the instructors have a right to put to death
any one who may try to escape from these ordeals. The women are
rigorously excluded from these camps, but the men are allowed to visit
them, when they have the privilege of assisting the teachers by adding
additional blows and precepts to the backs of the unlucky candidates.
After eight months of such training, the young men are oiled from head
to foot and dressed in a garment, and are now given the name which they
are to bear for the rest of their lives. The _mapato_, or mystery hut,
is now burned to the ground and the young men return to the village. The
maternal uncle of the youth here presents him with a javelin for his
defense, and a cow that is to furnish him with nourishment. Until the
time of his marriage, the newly circumcised dwell together; their duties
being of a menial character, such as gathering wood and attending to the
flocks and droves.

M. Paul Lafargue looks upon circumcision among the negro races as being
a rite commemorating their advent to manhood; Livingstone, who has also
observed the above, related incidents in relation to the performance of
_boguera_, or circumcision, among the Bassoutos, believes that with them
the rite has a purely civil significance, being in no way connected with
religion.

Among many of the African tribes the young maids have an ordeal
approaching to circumcision that they must pass when near the age of
thirteen, this rite bearing precisely the same relation regarding their
entrance into the state of womanhood that male circumcision denotes the
entrance into manhood on the part of the males among the Bassoutos. At
the appointed time the maids are gathered together and conducted to the
riverbank; they are placed under the care of expert matrons. They here
reside, after having undergone a kind of baptism; they are maltreated,
punished, and abused by the old women, with a view of making them hardy
and insensible to pain; they are also schooled in the science and art of
African household duties. Among the Gallinas of Sierra Leone, in
addition to the other observances, the clitoris of the young maid is
excised at midnight, while the moon is at its full, after which they
receive their name by which they are to be known through life. The
initiation of each sex into these mysteries is exclusively for the sex
engaged, and it would be as fatal for a man to steal into the camp of
the women during the performance of these ceremonies as it would be
fatal for a woman to enter a _mapato_ where the young men are undergoing
their ordeal. After their initiation into womanhood, the maids live by
themselves, similarly to the young men, until they marry.

Lafargue relates that among the Australians circumcision is held in such
importance that tribes at war will suspend all hostilities and meet in
peace during the observance or performance of the rite. Here, again, we
have a repetition, with a slight variation, of the practices of the
Bassoutos,--something which gives some countenance to the hero-warrior
idea of the origin of circumcision advanced by Bergmann. The Australian
warriors go through a mimic battle, and, after a series of combats,
finally capture the boys aged about from thirteen to fourteen years,
whom they bear away amidst the cries and lamentations of the mothers and
other female relatives, who, in their excess of grief, mutilate
themselves by cutting gashes into their thighs, so that they bleed
profusely. The boys are, in the meantime, carried to some out-of-the-way
place, where an old man, perched on a tree or some rising ground,
through the means of a musical instrument made of a deal-board and human
hair, announced that the rite is in process of performance, so that
neither women nor children might approach. Tufts of moss are placed in
the axilla and on the pubis, to represent puberty, and among some tribes
the skin of the penis is divided to the scrotum with a stone knife,
while others content themselves with simply making a circular incision,
which removes the prepuce, after the Jewish manner, the excised portion
being placed as a ring on the median finger of the left hand. The
circumcised then takes himself to the hills or woods, and there remains
until healed, carefully guarding himself against the approach of any
female. After this the third part of the ceremonies takes place: the
godfather of the youth opens a vein in his own arm, the circumcised
youth is placed on all-fours, and an incision is made from the neck down
as far as the lumbar region, and the blood of the godfather is made to
flow and mingle with that of the godchild; this being in reality a
bloody baptism, and a near relation to the blood-compacts of the Arabs.

The Malays, as well as the men of Borneo, are circumcised. The Battos
likewise perform the rite. Among the Islanders they sometimes ligate the
prepuce so that it drops off. Among the Battos the same object is
reached by small bamboo sticks, between which the prepuce is fastened.
In New Caledonia and Tidshi the boys are circumcised in their seventh
year. The Tonga Islanders split the prepuce on the dorsum with a piece
of bamboo or of shell. In the Marquesas and Sandwich Islands the
operation is superintended by the priests.[17]



CHAPTER V.

INFIBULATION, MUZZLING, AND OTHER CURIOUS PRACTICES.


It seems a matter of controversy as to whether the Mexicans did or did
not circumcise their children. That they had a blood-covenant is
admitted by the historians, as well as the fact that this blood was
taken from the prepuce; but that the prepuce was actually removed is
something that is not agreed upon by all authorities. Las Casas and
Mendieta state that it was practiced by the Aztecs and Totonacs, while
Brasseur de Bourbourg found traces of its practice among the Mijes. Las
Casas states that on the twenty-eighth or the twenty-ninth day the child
was presented to the temple, when the high-priest and his assistants
placed it upon a stone and cut off the prepuce, the excised part being
afterward burnt in the ashes. Girls of the same age were deflowered by
the finger of the high-priest, who ordered the operation to be repeated
at the sixth year; and once a year, at the fifth month, all the children
born during the year were scarified on the breast, stomach, or arms, to
denote their reception as servants of their god. Clavigero, on the other
hand, denies that circumcision was ever practiced. It was customary in
Mexico, according to most authorities, to take the children while
infants to the temple, where the priests made an incision in the ear of
the females, and an incision in the ear and prepuce of the males.[18]

Grotins and Arias Montan at one time advanced the idea that the western
coast of South America was peopled by some mutinous sailors from the
fleets of King Solomon, who, in their endeavor to go away far enough to
be out of reach, were driven by winds and chance to the Peruvian coast.
Others have imagined that some of the lost tribes of Israel found their
way eastward to America, by the way of China, to the Mexican coast. The
same ideal tradition has made the lost tribes the fathers of the
Iroquois Nation in the northeastern parts of the United States. An
author, who will be quoted in another part of this work, scouts the idea
that the rite, as performed in America, had any connection or common
origin with the rite performed in Asia and Africa; but, true to his
theory of the climatic causes of the origin of circumcision, he
maintains that it originated here as it did elsewhere, being a
performance born of climatic necessity. He is, however, dissatisfied
with Father Acosta for not being more explicit in relation to the _modus
operandi_ of the Mexican circumcision. The want of being explicit, and
its consequences in this particular regard, may be inferred from a
"Diatribe on Circumcision," by a Mr. Mallet, in an encyclopædic
dictionary of the last century, in which Mr. Mallet informs his readers
that Mexicans were in the habit of _cutting off the ears and prepuces_
of the newly born. Herrera and Acosta agree with Clavigero in asserting
that the Mexicans simply _bled_ the prepuce. Pierre d'Angleria and other
contemporary writers are as emphatic in asserting that in the island of
Cosumel, in Yucatan, on the sea-board of the Gulf of Mexico and on the
Florida coast, they have observed circumcision by the complete removal
of the prepuce with a stone knife. The Spanish monk, Gumilla, relates
that the Saliva Indians of the Orinoco circumcised their infants on the
eighth day. These Indians also included the females in the observance
of the rite. The same author tells us of the barbarous and bloody
performances, in relation to the rite, of the nations on the banks of
the Quilato and the Uru, as well as those dwelling along the streams
that empty into the Apure. The same is said of the Guamo and of the
Othomacos Indians; according to Gumilla, many of these Indians, in
addition to the rite of circumcision, inflicted a number of cuts on the
arms, legs, and over the body, to a degree that amounted to butchery,
the child being reserved for this inhuman treatment until the age of ten
or twelve years, that he might, by his greater powers of resistance and
of recuperation, stand some chance of escaping alive from the ordeal.
The friar mentions that in 1721 he found a child dying from this
treatment, the wounds having become gangrenous and the child dying of
pyæmia; prior to the operation the children were stupefied with some
narcotic drink, and were insensible during its performance.[19]

Besides circumcision, the Americans practiced several other operations
that bore an analogy to the operation of infibulation, a procedure
common to the Orient and to early Europe, and so ancient that, like
circumcision, its source is in the misty clouds of antiquity. It
consisted in introducing a large ring, either of gold, silver, or iron,
through an opening made into the prepuce, the free ends being then
welded together. Females were treated likewise, the ring including both
labia. In some countries an agglutination of the parts induced by some
irritant or a cutting instrument answered the purpose among females.
Dunglison mentions that the prepuce was first drawn over the glans, and
then that the ring transfixed the prepuce in that position; that the
ancients so muzzled the gladiators to prevent them from being enervated
by venereal indulgence. The ancient Germans lived a life of chastity
until their marriage, and to their observance of a chaste life can be
attributed the superior physical development of the race, as both males
and females were not only fully developed, but were not enervated by
either sexual excess or inclinations before having offspring, which were
necessarily robust and healthy. To obtain the same results in a nation
given to indolence and luxury, and lax in its morality, some physical
restraint was required, and we therefore find the practice of
infibulation coming from the warm countries to the East. The ancients
not only infibulated their gladiators to restrain them from venery, but
they also subjected their chanters and singers to the same ordeal, as it
was found to improve the voice; comedians and public dancers were also
restrained from ruining their talents by the means of infibulation. In
an old Amsterdam edition of Locke's "Essay on the Extent of the Human
Understanding," there is a quotation from the voyages of Baumgarten,
wherein he states having seen in Egypt a devout dervish seated in a
perfect state of nature among the sand-hillocks, who was regarded as a
most holy and chaste man for the reason that he did not associate with
his own kind, but only with the animals. As this was by no means an
uncommon case, it led the Greek monks, in Greece and Asia Minor, to
resort to every expedient to protect their chastity; in some of the
monasteries not only were the monks muzzled by the process of
infibulation, but they even had rules that excluded all females, either
human or animal, from within their convent,--a habit that still prevails
among many of the convents of the Orient to this day,--that on Mount
Athos especially, omitting the infibulation of the ancients.

Readers living in the climates of extreme ranges and of seasonal change
cannot understand the physical temptations that beset mortals in certain
climates, any more than they can imagine the faultless condition of the
climate itself. The subject of climatic influences will be more fully
discussed further on; but climate, as a factor of habits and usages in
one part of the world, that are incomprehensible to those living in
others, plays a part that is but little appreciated or understood;
whether it be the question of diet, dress, or custom, climate exerts its
influence in no uncertain manner. As Sulpicius Severus remarked to the
Greek monks, when they accused the Gaulish monks with voracity and
gluttony, "That which you of Greece consider as superfluous, the climate
of Gaul renders into a positive necessity." So of all physical needs and
passions,--they are subject to a similar law. Those who have read Canon
Kingsley's small work on the "Hermits of Asia, Africa, and Europe" will
appreciate the above remarks; and it may be incidentally mentioned that
his description of the climate that is common to the hilly country
bordering on the eastern half of the Mediterranean Sea gives as vivid
and as graphic a description of the physical condition of the climate
and of its effects as can well be written. It occurs in the life of the
hermit Hilarion, and the description given relates to his last home in
the ruins of an old temple, situated on a cliff in the island of Cyprus,
where the air is so invigorating that "man needs there hardly to eat,
drink, or sleep, for the act of breathing will give life enough." The
work gives the best insight also into origin and causes that led to
monachism, as well as it tells the benefit that the condition conferred
on humanity, showing a phase in the march of civilization that is but
little understood.

But, to return to the subject of infibulation, which has, in a manner,
necessitated this digression from the main topic. Thwing[20] informs us
that in ancient Germany woman was considered the moral equal of man, and
that woman might traverse the vast stretches of country unprotected and
unharmed. Woman never held such a position in the Oriental countries;
neither has man, under the sub-tropics, a like self-command as shown by
those ancient Gauls. So that, with the advent of Christianity and the
moral revolution that followed, primitive methods, either inflicted on
others or self-inflicted, were adopted to insure a chaste life.
Infibulation was known, as already stated, for centuries, and in those
rude times it seemed as the most natural and effective mode of
accomplishing the object. It was not as barbarous an operation as
emasculation on the male, as it only temporarily interfered with his
functions.

In the Old World the practice is still performed in various manners. In
Ethiopia, when a female child is born the vulva is stitched together,
allowing only the necessary passage for the needs of nature. These parts
adhere together, and the father is then possessed of a virgin which he
can sell to the highest bidder, the union being severed with a sharp
knife just before marriage. In some parts of Africa and Asia, a ring, as
before stated, transfixed the labia, which, to be removed, required
either a file or a chisel; this is worn only by virgins. Married women
wear a sort of muzzle fastened around the body, locked by means of a key
or a padlock, the key being only in the possession of the husband. The
wealthy have their seraglios and eunuchs, that take the place of the
belt and lock. Another method is a mailed belt worn about the hips, made
of brass wire, with a secret combination of fastenings, known only to
the husband. In the museum in Naples are to be seen some of these
belts, studded with sharp-pointed pikes over the abdominal part of the
instrument, which was calculated to prevent even innocent familiarity,
such as nest-hiding, to say nothing of greater evils.

In the "Les Femmes, Les Eunuchs, et Les Guerrieres du Soudan," Col. Du
Bisson mentions a very peculiar custom invented by the careful jealousy
that is inseparable from harem life. He had noticed that many of the
harem inmates, contrary to the general Oriental custom, were allowed to
go about unattended by the usual guard of eunuchs, but that they walked
in a painful, hesitating, and impeded manner. This walk was not the
conventional, short, shuffling step that peculiarity of dress and
shoe-wear imposes on the Japanese beauty, nor the willowy, swaying gait
produced in the Chinese beauty by the lack of a sufficiency of foot;
neither could it be ascribed to the presence of the ancient jingling
chain of bells which induced the mincing steps of the virgins of
Judea,--an invention which confined the lower limbs within certain
limits by being worn just below the knees, and calculated to prevent the
rupture of the hymen by any undue length of step or violent exercise;
hence a tinkling noise and a mincing step always denoted a virgin. In Du
Bisson's cases, however, virgins were out of the question; they might be
the victims of enforced continence, but a Soudanese harem contains no
virgins. On inquiry he learned that the very peculiar and unmistakably
painful gait was due to the fact that each woman carried a bamboo stick,
about eight inches in length, three inches or more being inserted in the
vagina so as to effectually fill the opening, the balance projecting
beyond, between the thighs of the person; this bamboo stick, or guardian
of female virtue, was held in place by a strap with a shield that
covered the vulva, the whole apparatus being strapped about the hips and
waist, and the whole being held in an undisplaceable position by a
padlock. This was affixed to the woman whenever she was allowed outside
the harem grounds, being placed in position by the eunuch, who carried
the key at his girdle. In such a harness virtue can be considered
perfectly safe; even safe from any mental depredation or revolution, as,
with the plug causing such uncomfortable sensations, it is perfectly
safe to infer that the imagination could not be seduced by any Don
Juanic or other Byronic unvirtuous revelry. The physical ills that this
contrivance must cause are necessarily without number, as the instrument
is not as lightly constructed as our modern stem pessaries; but to the
Oriental who can replace a woman at any time and who prizes the
virginity, continence, and chastity of his slaves, even if enforced,
more than their health or their lives, these are matters of secondary
importance. In the Soudan there are no divorce courts, hence the
probable necessity of the apparatus, and, as the woman is not obliged to
wear it unless she chooses to go out unattended, it can hardly be
considered as a compulsory barbarity. In the United States such a
practice might do away with considerable divorce proceedings.

Celsus gives a detailed description of the manner of infibulating as
practiced among the Romans. According to this authority, it was employed
by them on the youth attending the public schools, as well as upon the
actors, dancers, and choristers, who were sold to the directors of the
plays and spectacles. In the cabinet of the Roman College there are to
be seen two small statues representing two infibulated musicians, which
are remarkable for the excessive size of the ring and the leanness of
the persons to which they are attached. The mode of applying this ring
did not differ much from the usual method of preparing the ear for
pendants.[21]

Among the Greek monks mentioned, the infibulation serves a manifold
purpose; it not only is a sure badge of chastity, but its weight and
size is very often increased so as to render it an instrument of
penitence, and considerable rivalry exists at times in this regard.
Virey notices that the Hindoo bonze, or fakir, at times submits to
infibulation at the same time that he takes his vows of eternal
chastity. This ring is at times enormous, being sometimes six inches in
diameter; so that it is a burden. These saints are held in great esteem
and veneration.

Nelaton, in the sixth volume of his "Surgery," mentions the case of a
man who presented himself at Dupuytren's clinic with a tumefied,
thickened, and somewhat dilapidated and ulcerated prepuce; this prepuce
had worn a couple of golden padlocks for five years, a woman having thus
infibulated his organ.

In an elaborate work on the subject of circumcision,[22] de Vanier du
Havre relates, on the authority of M. Martin Flaccourt, that with the
Madécasses the children are circumcised on the eighth day after birth;
and that in some portions of the country the mother swallows the removed
portion of the prepuce, while in others the father loads the prepuce in
some form of fire-arm, which is afterward fired in the air. In the
neighborhood of Djezan, in Arabia, as reported by M. Fulgence Fresnel in
the _Revue de Deux Mondes_ of 1838, courtship and matrimony are not so
great social events as they are with our society beaux. The occasion is
probably considered social enough by the rest of the invited guests, but
it can hardly be called an agreeable episode in the life of the groom.
Those whose bashfulness prevents them from contracting marriage in
civilized communities can have the consolation of knowing that in
far-off Arabia, among the fierce followers of the conquerors of Spain
and of the Eastern Empire, they have sympathizing fellow-sufferers whom
the conventionalities of the country deter from rushing into matrimony.
In this region, circumcision is performed on the adult at the time of
his candidacy for matrimonial bliss. A more inauspicious occasion could
not possibly have been chosen, unless as in another Mohammedan tribe,
who circumcise the bridegroom on the day after his marriage and sprinkle
the blood that falls from the cut onto the veil of the bride. The bride
is present, and the victim is handed over to what might be called the
executioner of the holy office, who proceeds to circumcise the victim in
what might be called its utmost degree of performance and barbarity.
This attention does not stop at the pendulous and loose prepuce. He
devotes himself to the skin of the whole organ; beginning at the prepuce
he gradually works backward, removing the whole skin of the penis--a
flaying alive, and nothing more. Should the victim betray any sign of
weakness, or allow as much as a sigh or groan to escape him, or even
allow the muscles of the face to betray the fact that he is not
immensely enjoying the occasion, the bride elect at once leaves him for
good, saying that she does not wish a woman for a husband. A large
proportion of the male population annually die from this operation. So
that the Arabs of the Djezin can be likened to those spiders who lose
their life while in the act of copulation,--the female making a dinner
from off the male,--only the spider is said to die a happy death, while
that of the Arab is one of misery.

Margrave and Martyr have recorded a very peculiar practice common among
some South American tribes: A kind of a tube is fastened onto the
prepuce by means of threads of the _tacoynhaa_, the latter being the
bark of a certain kind of a tree. Cabras brought one of the natives, so
muzzled, to Lisbon, on the return from his first voyage. Some tribes
were observed to wear an apparatus like the old-fashioned
candle-extinguisher, the virile member having been forced into this
receptacle, which was strapped about the loins.

The travelers Spix and Martius found the practice of circumcision of
both sexes in the region of the upper Amazon River and among the Tuncas.
Squires mentions a curious custom of the aborigines of Nicaragua. They
wound the penis of their little sons and let some of the blood flow on
an ear of corn, which is divided among the assembled guests and eaten by
them with great ceremony.

On the fifth day after birth it is the custom among the Omaha Indians of
North America to christen the infant, the child being stripped and
spotted with a red pigment; considerable ceremony accompanies the
act.[23]

Among the cannibals of Australia, Lumholtz[24] observed a practice that
seems to have no analogue in the wide world, either as an operation or
in regard to its purposes. About ninety-five per cent. of the children
are subjected to the ordeal. This is no less than the formation of an
artificial hypospadias; this abnormality is formed through the penis
into the urethra, near its junction with the scrotum; the wound is about
an inch in length and is made with a flint knife which serves for no
other purpose; the edges of the wound are burned with a hot stone, and
the wound is subsequently kept open by the introduction of a small piece
of wood, which, on healing, leaves a permanent opening. These cannibals
undoubtedly are inspired by some Malthusian spirit which impels them
thus to functionally eunuchize themselves in one sense, as during
copulation the seminal discharge flies out backward through this
opening, being thereby a most effectual check on further procreation. By
some, this practice has been attributed to the unreliability of the
seasons in regard to food-production; but Lumholtz observes that where
the practice is most in vogue--among the tribes to the west of the
Diamantina River and west and north of the Gulf of Carpentaria--the
food-supply is not deficient, the region being full of rats, fish, and
vegetables. All the tribes are not subject to the practice of the
operation at the same time of life; in some, the hypospadias is not
produced until in adult life and after the person has married and has
become the father of one or two children, when he must submit to the
requirements of the law; the operation seems to be invested with some
civil or religious significance, as a palisade or stockade of trees is
placed around the place where it is performed. A native, aged about
twenty years, informed Lumholtz that the operation was performed because
the blacks did not like to hear the children cry about the camp, and,
further, that they were not desirous of having many children; this
native had not yet become a father and had not yet been subjected to the
operation. The natives were observed to be fat and in good physical
condition.

There is something mysterious in this operation. It can easily be
conceived how circumcision might at times have been suggested by its
spontaneous and natural performance without any assistance from man.
Cullerier reports one case of partial circumcision through the means of
an accident happening to a painter. The man was at work on a ladder,
with a small bucket of paint hooked into one of the rounds above him;
through some means the bucket lost its hold and in falling struck the
penis on its dorsum with such force that the prepuce was cut through on
a parallel with the corona of the glans for fully two-thirds of its
circumference, the glans slipping through the opening and gathering in a
fleshy bunch underneath the frenum. This man carried this abnormality
for some years, when, desiring to marry and seeing that this appendage
would be as much of an impediment as one of the huge rings worn by the
Hindoo devotee, he applied to Cullevier for advice, who promptly removed
it with the knife.[25] The writer has seen three cases, during his
practice, of spontaneous circumcision, all resulting from phymosis as a
secondary affection to venereal disease. The first case occurred when he
first entered into practice; it was in a young, stout, and full-blooded
man with a violent gonorrhoea. There was much swelling and tumefaction
of the whole organ, which seemed to be very rebellious to all treatment.
At one of his morning visits he was horrified to observe a transverse,
livid mark at what seemed to be the middle of the organ; by noon this
had gained ground to the right and left and there was no mistaking that
it meant nothing less than mortification. Never having seen a case, the
natural uncomfortable conclusion was that, through some cause or other
or the natural result of excessive congestion, the man was about to lose
one-half of his organ; and Burnside at Fredericksburg was in no greater
state of suspense and uncertainty with the fate of the Army of the
Potomac on his hands than the writer must acknowledge he was with this
man and his organ apparently liquefying under his treatment. The
surprise can be better imagined than described when, on the following
morning, the glans made its appearance safe and sound out of its
imprisonment, and at right angles with the organ there hung the prepuce,
thick and as large and as long as the penis itself, inflammatory deposit
and infiltration having brought it to that shape and consistence; the
glans became completely uncovered; the parts gathered underneath, where,
in the course of some weeks, they had shrunk to the size of a walnut,
which was afterward removed by the knife. In this case, as in the other
two cases observed, the corona was very prominent and acted as an
internal tourniquet by its upward pressure, the line of demarkation
being on the dorsum in the three cases noted.

That such cases would suggest circumcision is not only probable but
possible, as it would point out the manner of performing the operation;
but, in the cases of the Australian savages, who performed an artificial
hypospadias on themselves for a specific purpose, requiring a knowledge
of the anatomical relation of the parts as well as of their
physiological functions, it is hard to speculate how the operation was
first suggested or how it came at first to be performed. As a Malthusian
agent it is certainly an operation of the highest merit, and it should
be introduced, by all means, in the United States, where the wealth and
luxury in which the people dwell is fast drifting them toward the same
whirlpool that engulfed Rome, which was preceded by a dislike to have
children. Whenever the writer sees the poor anæmic, broken-down victim
of many miscarriages, he cannot help but feel that, if the laws of the
Damiantina River savages were enforced on their husbands, it would be a
blessing to the poor women without materially injuring the husbands,
who, in case of need of a re-establishment of the functions of
procreation, might be fitted with a vulcanite plate for the
occasion,--something like our cleft-palate patients are supplied with a
plate that enables them to articulate.

It was the custom among the Hottentots, when first discovered or known
to the whites, to remove one of their testicles. This was supposed to
enable them to run more swiftly and to be lighter-footed in the race.
The real reason, afterward found, was a mixture of pure humanitarianism
and Malthusianism boiled down to Hottentot ethics. With them a monorchid
was not supposed to beget twins; when twins are born in the family, the
mother generally smothers the female, if one happens to be such; if not,
then the feeblest of the two is sacrificed. In their migratory and
nomadic life the mother finds it impossible to either carry or care for
the two children. The male Hottentot, rather than have any avoidable
infanticide in his family, or that his wife should go through and suffer
the annoyance and pangs of an unnecessary and unprofitable pregnancy,
generously has one testicle removed; this is something that the ordinary
civilized white man would not do, even if his legitimate wife and all
his outside concubines were to have twins or triplets every nine months;
so that, even as strange as it may appear, civilization must need go to
the wild Bushmen in search of that grand old Quixotic chivalry that was
in ancient times always ready to sacrifice itself for the welfare of
woman.

The old Greek and Roman statues, representing the gods and athletes of
ancient Greece and Rome, are a puzzle to many, owing to the diminutive
and phimosed virile organ that the artists have attached to them. Galen
represents that the disuse of the organ by the athletes was the cause
of its undeveloped form, and that as the organ of these did not figure
in the worship of Venus, or participate in the festivals of Bacchus, but
was used solely and simply for micturating purposes, impotence was often
the result, citing the case of a patient who came to consult him for an
obstinate priapism resulting from venereal excess, who met, in his
anteroom, an athlete who was being treated for the opposite condition,
due to the too rigid continence to which he had been for years
subjected. Acton does not believe that continued continence has that
effect, quoting Dr. Bergeret, who had long been physician to a number of
religious societies, as saying that he had never seen serious troubles
of the organs of generation in these communities, which denotes that if
they indulged in proper fasting and prayer they were in the same
condition of flaccid impotence as the athlete in Galen's anteroom. Louis
VII, of France, tried fasting and prayer in connection with rigid
continence, and, as a result, his wife, Queen Eleonore, was divorced
from him and married Henry II, of England, who had not been continent.
Hence, we see that the old sculptors, whether wishing to represent
Jupiter or Plato, Æsculapius or Mars, a strongly knit and muscular frame
was desired, an athlete, gladiator, or soldier being used as a model;
the small, puerile, funnel-prepuced organ belonged to all these muscular
or well-trained classes, was a natural appendage, as enforced continence
and the most absolute chastity was the rule, to enforce which they even
resorted to infibulation. This enforced continence often resulted in
impotence, even before the prime of life was passed, accompanied by an
inevitable atrophy of the male organ, with the resulting prepuce in the
shape in which it is found in a boy of from eight to twelve years,
precisely as they are found on the statues. How faithful the sculptors
and artists were to nature and life in their representations can well be
imagined by a critical examination of the Apollo Belvidere, where the
difference of the scrotal position that exists between the right and
left testicles is carried out to the minutest anatomical detail. In our
age it is hard to conceive why their most masculine men should be
deified, and all their gods represented as the most perfect of bodily
development, while at the same time the finest physical specimens of
manhood were doomed to a life of the most rigorous continence. It is
also astonishing that all this should be done not from any principle or
consideration of morality or virtue, but simply as a means subservient
in producing at its maximum the highest degree of physical development
and endurance.



CHAPTER VI.

ATTEMPTS TO ABOLISH CIRCUMCISION.


Probably no rite or practice of a custom has been such a long-standing
bone of contention as circumcision; nor does the Sphynx surpass this
relic of bygone ages in mystery. From time immemorial its practice has
been the subject of disputes, and its literature finds oftentimes its
friends and foes ranged side by side. At one time a noted Israelite and
Voltaire, the scoffer of Judaism, may be consulted on the question as to
whether Israelite or Egyptian is entitled to priority as to its original
practice with a like answer; and, again, Christians are found who, after
a careful investigation, will accord this to the Israelites. In Rome,
the persecuted Hebrew was stopped on the street and compelled to show
the mark of circumcision, that he might be taxed, and in Turkish parts
the Christian was subjected to the same indignity to enable the
tax-gatherer to harvest the impost which he paid for his liberty of
conscience and not being circumcised. When the monkish missionaries of
the Catholic faith first entered Abyssinia, they were shocked to find
their converts insisting on their time-honored practice of circumcision;
and later, when the Propaganda sent its own missionaries, they were
scandalized to see Christians practicing what they looked upon as an
infidel rite; and nothing but the most earnest confession of faith, with
the assurance that the rite of circumcision was only a physical remedy,
and that in their conscience it in no wise possessed any religious
significance, and that neither did they, in any sense, hold it in any
connection with the sacrament of baptism, permitted these Abyssinians to
save themselves from excommunication. Later still, when an Abyssinian
bishop was present in Lisbon, the clergy of the city refused him the
right of celebrating the sacrifice of the holy mass in the Cathedral of
Lisbon, on the ground that he, having been circumcised, was no better
than a heretic. The Abyssinian Christians still practice the rite at the
present day.

The Turks, although very fanatical and greater proselyters than the
Christians of Rome, seem now and then to relax in favor of general
utility, as we find Bajazet II writing to the Pope, Alexander VI,
supplicating his Holiness to confer a cardinal's hat on the Archbishop
of Arles as a special favor to the Turkish emperor, as he knew that the
archbishop _had a secret leaning toward Mohammedanism_. As the clergy of
those days, from the Holy Father down, were more politicians than
followers of the humble Nazarene, the heaven of Mohammed had probably
more attractions for their taste than the ideal Christian paradise, and
it is possible that the good archbishop would have submitted to a
cardinal's hat and circumcision at the same time to secure the good
things of this world and of those in the world to come. History also
relates that his most Christian majesty, Henry III, of France, as a
relaxation to the interminable squabble between two Christian religious
factions which were rending France, and which in the end cost him his
life, actually wrote a letter to the Sultan, asking the favor to be
allowed to stand as godfather at the circumcision of his son. When it is
remembered that the godfather at a Turkish circumcision has to make a
strong profession of Moslem faith and the answers as sponsor for the
child, and must promise that the child will be faithful to the Koran and
Mohammed, it will be seen that, however much the lower levels of
humanity may quarrel over trifles, the heads of the people easily
accommodated themselves to any existing circumstances. Friar Clemens
might as well have let such a liberal-minded monarch live, as any of the
existing churches could easily have got along with him.

On the other hand, we have the remarkable tenacity to custom and habit
in this regard, as exhibited by the Moslems, who, although having
neither ordinance nor authority for its performance, either in their
law, creed, or in any order from their prophet, still no more zealous
circumciser exists than the son of Islam, who exacts from all proselytes
the excision of the prepuce. Mohammed was circumcised in his boyhood,
and, although he did not order its performance to his followers, he did
not see fit to proscribe a custom so general to the Arabians, where the
greater development of the prepuce probably renders circumcision a
necessity. From the same reason it is easy to perceive why the rite has
found such general observance among the Africans, who are as noted for
long and leathery prepuces as for their slim shanks. One author, writing
in 1772, in a work entitled "Philosophical Researches on the Americans,"
treats the subject in a very intelligent manner. His arguments are both
ingenious and plausible. This author looks upon circumcision as of
purely climatic origin in its inceptive causes. From a careful survey of
the natural history of man in his general distribution over the globe,
he finds that circumcision may be said to be restricted to within
certain boundaries of latitude, equidistant on both sides of the line.
No circumcised people have ever inhabited northern regions, and the bulk
of the circumcised races are found within certain climates. From this
reasoning it is easy to see why the rite should lose its standing under
certain climatic conditions, unless bolstered up by some religious
significance, as it is equally easy to foresee why it should flourish
elsewhere, even without any religious backing or ordinance. It is well
known that in Ethiopia and the neighboring countries, excrescences and
elongation of either the prepuce or nymphæ are as probable as the
existence of an enlarged thyroid gland or goitre among the inhabitants
of some of the valleys of Switzerland or of those of the Tyrol.
According to the author of the treatise just quoted, circumcision would
be nothing more than a remedy to repair the evils that a faulty
construction of the human body developed in certain climatic conditions.

With the Israelites it is observed as a religious rite, although they
are not strangers to the physical benefits that circumcision confers
upon them; the fact that even where no prepuce exists, as sometimes
happens, the circumciser nevertheless goes on with the rite, being
satisfied with drawing a few drops of blood from the skin near the
glans, stamps the operation essentially as being a religious rite.
Persecutions have signally failed to suppress its performance by those
of the Hebrew faith. Beginning with the decree of Antiochus, 167 B.C.,
which consigned every Hebrew mother to death who dared to circumcise her
offspring, they have not ceased to suffer in defense of their rite.
Adrian, among other repressive measures, forbade circumcision; under
Antonine this edict was still enforced, but he afterward recalled it and
gave to the Hebrews the right of observing their religious rites. Marcus
Aurelius, however, revived the edict of Adrian. Heliogabalus, who
ascended the Roman throne in the year 218 A.D., was himself circumcised.
During the reign of Constantine all the laws that interfered with
Hebraic rites were renewed, with the addition that any Hebrew who should
circumcise a slave should suffer death. Under the sway of Justinian, in
the sixth century, the persecutions against these people were so
oppressive that a Hebrew was not allowed to raise or educate his own
child in the faith of his fathers. In the seventh century, the augurs
having prophesied the ruin of the Roman Empire by a circumcised race to
the emperor Heraclius, the persecutions were renewed against these
unfortunate people. In this century, Hebrews refusing baptism suffered
banishment and confiscation of all their property; they were obliged to
renounce the Sabbath, circumcision, and all Hebraic rites if they wished
to remain. About this period the success of the Saracens induced
persecutions of the Hebrews in Spain, where their children were taken
away from them that they might be raised in the Christian religion. In
the fifteenth century they suffered the greatest persecution and
martyrdom at the hands of the Spanish Inquisition. The persecutions
above cited were national and governmental persecutions levelled
directly at the Jewish nation and creed; the persecutions that they
momentarily suffered at other times had no signification beyond the
exhibition of popular spite and fury, but those above cited were moves
calculated to extirpate the creed, if not the people, from off the face
of the globe. If repressive measures are of any avail, circumcision as
an Hebraic rite should now have no existence. Its present existence and
observance show a vitality that is simply phenomenal; its resistance and
apparent indestructibility would seem to stamp it as of divine origin.
No custom, habit, or rite has survived so many ages and so many
persecutions; other customs have died a natural death with time or want
of persecution, but circumcision, either in peace or in war, has held
its own, from the misty epochs of the stone age to the present.

There is something pathetic and soul-appealing in contemplating the
early Christians forced to worship in the catacombs of Rome, hunted like
wild animals in their subterranean burrows, and then given the choice of
making offerings to the heathen gods or being thrown into the arena as
prey to wild beasts; so are we stirred when we think of the Spanish Jew,
who had made Spain his home for centuries, being driven into exile in
such droves that no country could receive them; we see them perishing of
hunger by the thousands on the African coast, and dying of starvation on
the quays of the ports of civilized Italy. That many, through all these
trials, were forced to embrace other religions is not astonishing. In
Spain apostacy was to no purpose, as the Inquisition could not be
expected to split hairs in regard to an apostate Jew, when it sent the
best of Gothic blood, raised in the Catholic faith, to the _auto da fé_
or the scaffold,--the rack respecting neither faith nor profession that
fell into its clutches. In milder persecutions, however, he escaped by
outwardly conforming to the demands of his oppressors and history tells
us of the circumcisions secretly performed on the dead Jew, that the
spirit of the law of their fathers might be carried out.

In other cases, threatened exile, confiscation, or exorbitant taxation
drove them to adopt every possible expedient to eradicate the sign of
their Israelitism and make attempts to reform a prepuce. The first
attempts in this line were made during the reign of Antiochus, when a
number of Hebrews wished to become as the people about them who were not
persecuted--_fecerunt cibi præputia_. This is no easy operation, and in
later times by the aid of appliances, both in Rome and in Spain, they
undertook to cause the skin to recover the glans. Martial, in speaking
of the instrument used in Rome, a sort of a long funnel-shaped copper
tube in which the Hebrew carried his virile organ, terms it _Judæm
Pondum_, the weight of which, by drawing down the skin, was supposed in
time to draw it down far enough to answer the purpose. The apostle Paul,
in his epistle to the Corinthians, refers to these practices when he
says, "Was any one called being circumcised, let him not be
uncircumcised." The operation of reforming a prepuce, or of obliterating
the marks of circumcision, does not appear to have been a success.

The writer had one experience that was interesting. On one occasion he
advised circumcision for the relief of a reflex nervous disease, in a
tall, athletic Austrian sailor from the Adriatic; although the nature of
the operation was explained to the man, he evidently did not appreciate
its full nature and importance until a sweeping cut with a scalpel left
the excised prepuce in the operator's hand. Most Adriatic sailors have
sailed up the Bosphorus and are more or less familiar with both the
Greek and Turkish nations; the latter they despise with gusto, "_porchi
di Turci_" being the affectionate appellation they bestow on their
national neighbors. No sooner did he perceive the real condition of
affairs than he began to beat his head, saying that he was disgraced
forever, as he never would dare to associate with his countrymen again,
as he would be liable to be taken for a _porcho di Turco_; his frenzy
increased to such a pitch that to spare any unpleasantness it was deemed
advisable to replace the prepuce, which was done accordingly, the man
making a tolerable good recovery, as far as the grafted prepuce was
concerned. It required a secondary operation to overcome some
cicatricial contraction, and, on the whole, he had a very serviceable
prepuce; but, what was more to the point, it prevented his ever being
mistaken for a Turk.



CHAPTER VII.

MIRACLES AND THE HOLY PREPUCE.


What strange fancies have circled themselves about the subject of
generation or its organisms during the different stages of moral
civilization since the world has existed! The efforts in this regard
among different creeds have been something peculiar. Neither Mohammedans
nor Hebrews--both zealous circumcisers--ever went to the lengths reached
by Christian churches and their followers in some particulars concerning
this rite; this being especially strange when it is considered that the
new creed was the one that abolished the rite and through which the Jews
suffered such cruel and unjust persecutions. The early Christian Church
celebrated and continues to celebrate the Feast of Circumcision, and
history relates some strange events in connection with this
circumcision. Having abolished and repudiated the rite, it would seem
inconsistent that it should celebrate its performance on any occasion
and consider such an event sufficiently memorable that its occurrence
should excite the veneration of the church and be the means of exciting
the pious zeal of the faithful. The strangest events in this connection
are still more mysterious and incomprehensible, if not amusing, the only
excuse for the occurrence being the greedy thirst for relics of any and
all kinds that in the middle ages pervaded Europe.

At some remote period--in the thirteenth or fourteenth century--the
abbey church of Coulombs, in the diocese of Chartres, in France, became
possessed in some miraculous manner of the holy prepuce. This holy
relic had the power of rendering all the sterile women in the
neighborhood fruitful,--a virtue, we are told, which filled the
benevolent monks of the abbey with a pardonable amount of pride. It had
the additional virtue of inducing a subsequent easy delivery, which also
added to the reputation and pardonable vanity of the good monks. This
last virtue, however, we are told, came near causing the loss to the
abbey of this inestimable prize, for, as a French writer observes, a too
great reputation is at times an unlucky possession; at any rate, the
royal spouse of good and valiant King Henry V--he of Agincourt, whom
England waded up to its knees in the sea at Dover to meet on his return
from that campaign--had followed the example of all good dames and was
about to give England an heir. Henry then governed a good part of
France. Having heard of the wonderful efficacy of the relic of Coulombs,
he early one morning threw the good monks into consternation by the
arrival at the convent gate of a duly equipped herald and messenger from
his kingship, asking for the loan of the relic with about as much
ceremony as Mrs. Jones would ask for the loan of a flat-iron or saucepan
from her neighbor, Mrs. Smith. The queen, Catherine of France, was of
their own country and Henry was too powerful to be put off or refused;
there was no room for evasion, as the holy prepuce could not be
duplicated; so the poor monks with the greatest reluctance parted with
their precious relic, entrusting it into the hands of the royal envoy,
which wended its way to London, where it in due time, being touched by
the queen, insured a safe delivery. Honest Henry then returned the relic
to France; but so great was its reputation that royalty caused a special
sanctuary to be erected for its reception, and a full period of
twenty-five years occurred before the monks of Coulombs again regained
possession of their prize, during which period the population of the
neighborhood must have suffered from the natural increase of sterility
and the physicians must have reaped a rich harvest owing to the
increased difficulty and complications of labor induced by the absence
of the relic. On its return, the relic was found to have lost none of
its virtues, and the good people and monks were all correspondingly made
happy; in 1870, when the writer was in France, it was still working its
miracles. Balzac found ample facts to found his famous "Droll Stories"
without straining his imagination.

So great an attraction was not to go without attempted rivalry or
imitators; hence we find in the "Dictionary of Moreri," edition of 1715,
in the third volume, at page 108, that several other establishments
claim the honor of a like relic,--namely, the Cathedral of Puy, in
Velay; the collegial church of Antwerp; the Abbey of our Saviour, of
Charroux; and the Church of St. John Lateran, in Rome. All of these have
had very adventurous histories. The Abbey of Charroux was founded by
Charlemagne in 788, and among the relics with which that monarch endowed
the abbey the principal one was a fragment of the holy prepuce. This
abbey enjoyed great reputation, and indulgences were granted by Papal
bull to all those who assisted at the adoration of the relics. In the
internecine wars of the sixteenth century the abbey fell into the hands
of the godless and heretical Huguenots and the holy relic disappeared.
In 1856, while some workmen were at work demolishing an ancient wall on
the abbey site, they discovered some relic cases. The bishop was at once
notified, who immediately proceeded to investigate, when, lo and
behold! there, sure enough, was a piece of desiccated flesh, with marks
of coagulated blood; nothing more or less than the lost prepuce--long
lost, but now found. It was placed in charge of the Ursuline Sisterhood,
where it has remained ever since undisturbed, except by a controversy in
regard to the propriety of the relic, in which the good bishop ambled
about in the most ambiguous manner, the only clearly defined portion of
his dissertation being the one wherein he laments "the decadence of that
truly Christian spirit which animated the laity of the middle ages with
a radiant zeal. A piety also pervaded those gentle Christians of former
times, who were possessed of a religious instruction which determined
for them the tenets of the creed and its practices,--a happy state or
condition of affairs, which prevented the intelligence of the faithful
from wandering into the sloughs of unprofitable skepticism." This
settled the question as to the propriety of the prepuce being converted
into a miracle-working relic; at least, as far as the good bishop was
concerned.

It would be an injustice not to mention the other shrines in detail
after the prominence that has been given to the abbeys of Coulombs and
Charroux; so the history of another will be given. We are not told just
how the Church of St. John Lateran in Rome first became possessed of
_its_ holy prepuce, but it nevertheless had one; also the only authentic
one in existence, like all the others. It disappeared at one of the
periodical sackings that Rome has repeatedly suffered at the hands of
Goth, Vandal, or Christian. This time it was the soldiery of the eldest
son of the church--- Charles V--who did the sacking; it was in the year
1527, a soldier--probably some impious, heathenish mercenary--broke into
the holy sanctuary of the church and stole therefrom the box that
contained the holy relics, among them the holy prepuce. These impious
wretches, as a rule, came to grief in short order; hence we are told
that this mercenary and sacrilegious soldier was compelled to secrete
his box, when only a short distance from Rome, where the box remains and
the mercenary wretch disappears, probably carried off bodily by the
devil, as he deserved. Thirty years afterward the box is discovered by a
priest, who, ignorant of its contents, carries it to the lady on whose
domain it was found. On being opened it was found to contain a piece of
the anatomy of Saint Valentine, the lower jaw of Saint Martha, with one
tooth still in place, and a small package upon which the name of the
Saviour was inscribed. The lady picked up the package, when immediately
the most fragrant odor pervaded the apartment, being exhaled by the
miraculous packet, while the hand that held it was seen perceptibly to
swell and stiffen; investigation proved it to be the holy prepuce stolen
by the miscreant mercenary from St. John Lateran. It is related that in
1559, a canon of the church of St. John Lateran, impelled by a worldly
curiosity untempered by piety, undertook to make a critical examination
of this relic, in the process of which, to better satisfy himself, he
had the indiscretion to break off a small piece; instantly the most
dreadful tempest broke over the place, followed by crashing peals of
thunder and blinding flashes of lightning; then a sudden darkness
covered the country, and the luckless priest and his assistants fell
flat on their sacerdotal noses, feeling that their last hour had
arrived.[26]

Wonderful and miraculous cures are performed at these shrines, and some
of the cures are of a nature that would baffle the intelligence of the
most learned mind to ascertain the intricate and devious way that
nature must at times journey to accomplish some of these changes. The
writer well remembers seeing, in the Church of Corpus Christi, in
Turin,[27] a long hall, covered, from marble pavement to ceiling, with
votive tablets, after the manner inaugurated in the old temples of
Greece. Modern votaries have the advantage of being able to record their
cure, safe venture or escape from peril, by means of faithful
representation of the event in painting or drawing, as the material and
art is more common now than in the days of ancient Greece, who recorded
its cures by simple inscription in laconic terms. Modern medicine labors
under the disadvantage of presuming that the people are endowed with an
intelligence that was unknown to ancient or mediæval people, when, in
fact, the people are as credulous and as subject to imposition as they
were in the earlier centuries of the present era. With all its supposed
superior intelligence, there is no fatter pasture for quacks and
impostors than that presented by the people of the United States.
Whenever I see the poor, intelligent, broad-minded physician struggling
along, barely able to procure for himself the necessaries required to
maintain himself with proper books and appliances, while the itinerant
quack or dogmatic practitioner rolls in undeserved affluence, I question
the wisdom of our ethical code. Braddock, at the Monongahela, scorned to
have his regulars, who had fought under Marlborough and Eugene, break
ranks before a lot of breech-clouted savages, and take shelter that the
nature of the ground and the trees could afford, thinking it an unfit
action for men who had faced the veterans of Louis XIV on many a
hard-fought European field. I sometimes think that if _our_ regulars
were, for only a season, to follow the example of the provincial
militia at that battle, it would be better for the country, the people,
science, and last, but not the least, for the profession. The theory
that we should not counsel with quacks is altogether mischievous and
fallacious, although right and rigidly orthodox in its intent; were we
to counsel and meet these gentry, we should expose their ignorance and
assumption, and we should not be exposed to the charge of jealousy and
of fear to meet them in consultation. I remember on one occasion a
client went to a lawyer for advice as to how he might dispossess some
parties who had some adverse claim to some property which he owned,
after due deliberation and a protracted siege of the house, in the vain
hope of gaining admittance; the lawyer advised his client to go and nail
up all exits and fasten them in, which had the effect of driving them
out. So with our profession--we should not neglect an opportunity of
meeting a quack in consultation, regardless of the nature of the case;
it is the only way to nail them up; as it is, we have simply chained up
the shepherd-dog and given the wolves full play.

The French Guards at Fontenoy, who out of courtesy refused to fire first
on the English, may have been very ethical and chivalrous, but they were
very foolish, as the English discharge nearly swept them from the field,
and but for the Irish Brigade, who knew no ethics, Louis XV would in all
likelihood have followed the example of King John, who, after Crecy,
visited England for a season. A disregard of ethics gave Copenhagen to
Lord Nelson, who insisted on looking at Admiral Parker's signal to
withdraw from action with his sightless eye, which could not see it. A
fear of disregarding ethics lost to Grouchy the chance of assisting
Napoleon at Waterloo. In our strife against ignorance and quackery the
profession should follow the general plan of action usually adopted by
Lord Nelson--lie alongside of whom you can and sink or capture your
enemy; let each man do his duty; never mind any general plan. A reverse
to this mode of fighting invariably lost the battle to the French and
Spaniards, who were, as a rule, all tied up in ethical red tape. Our
profession is broad, intelligent, and fearless; we do not profess any
exclusive dogma, and should not, therefore, exclude persons; as a large
ship throws its grappling-irons on to its adversary, we should always
seek an opportunity to meet these gentry when practicable. As it is, we
have placed them on the vantage-ground of appearing as being persecuted;
our ethics need circumcising in this regard, and the prepuce of
exclusion should be buried in the sands of the desert.

Moreover, we often are apt to learn something from even the most
ignorant of these men. Rush investigated the nature of a cancer-cure by
not refusing to meet and talk with one of this kind;[28] Fothergill
learned from an old, unlicensed practitioner that there was a knowledge
important to the physician beyond that picked up in the pathological
laboratory or the study of microscopy; and that the practiced eye of an
otherwise unlearned man could detect that there were general physical
signs that negatived the unfavorable prognosis suggested by the presence
of tube-casts.[29] It is related of Sir Isaac Newton, that while riding
homeward one day, the weather being clear and cloudless, in passing a
herder he was warned to ride fast or the shower would wet him. Sir Isaac
looked upon the man as demented, and rode on, not, however, without
being caught in a drenching shower. Not being able to account for the
source of information through which the rustic had gained his
knowledge, he rode back, wet as he was, to learn something. "My cow,"
answered the man, "always twists her tail in a certain way just before a
rain, your Worship, and she so twisted it just before I saw you."[30]
Although twisting cow-tails do not figure in his "Principia," it is very
probable that such a lesson was not without its remote effects on a mind
like Newton's. A spider taught a lesson to one of Scotland's kings; so
that one man may learn something from another.

Professor Letenneur, of the Medical School of Nantes, in his "Causerie à
propos de la Circoncision," mentions that the Convent of Saint
Corneille, in Compiègne, claims to possess the identical instrument with
which the Holy Circumcision was performed. Such a holy relic must have
been unusually potential in performing many miracles.

In this connection it will not be amiss to notice the lapping over that
the old phallic worship and idea has made on the new religions. It is
also as interesting to observe how the human mind still leans toward
observances and ideas which are believed to belong to a solely pagan
people. Hargrave Jennings, in a chapter devoted to phallic worship among
the ancient Gauls, gives many interesting and curious examples, the
first example that he notices being that of Saint Foutin (from whom the
very expressive French word "_foutre_" is taken). Foutin was the first
Christian bishop of Lyons, and after his death, so intimately was
priapic worship intermingled with the religion or theology of the Gauls,
that somehow the memory of St. Foutin and the old, dethroned Priapus
became commingled, and finally the former was unconsciously made to take
the place of the latter. St. Foutin was immensely popular. He was
believed to have a wonderful influence in restoring fertility to barren
women and vigor and virility to impotent men. It is related that, in the
church at Varages, in Provence, to such a degree of reputation had the
shrine of this saint risen, it was customary for the afflicted to make a
wax image of their impotent and flaccid organ, which was deposited on
the shrine. On windy days the beadle and sexton were kept busy in
picking up these imitations of decrepit and penitent male members from
the floor, whither the wind wafted them, much to the annoyance and
disturbance of the female portions of the congregation, whose devotions
are said to have been sadly interfered with. At a church in Embrun there
was a large phallus, which was said to be a relic of St. Foutin. The
worshippers were in the habit of offering wine to this deity,--after the
manner of the early Pagans,--the wine being poured over the head of the
organ and caught underneath in a sacred vessel. This was then called
"holy vinegar," and was believed to be an efficacious remedy in cases of
sterility, impotence, or want of virility.

Near the city of Bourges, at Bourg Dieu, there existed, during the Roman
occupation of Gaul, an old priapic statue, which was worshipped by the
surrounding country. The veneration in which it was held and the
miracles with which it was accredited made it impolitic as well as
impossible for the early missionaries and monks to remove it; it would
have created too much opposition. It was therefore allowed to remain,
but gradually changed into a saint,--St. Guerluchon,--which, however,
did not detract any from its former merit or reputation. Sterile women
flocked to the shrine, and pilgrimages and a set number of days of
devotion to this saint were in order. Scrapings from this statue infused
in water were said to make a miraculous drink which insured conception.
Similar shrines to this same saint were erected at other places, and we
are told that the good monks, who must have had an intense and lively
interest in seeing that the population was increased, were kept busy
supplying the statues with new members, as the women scraped away so
industriously, either to prepare a drink for themselves or for their
husbands, that a phallus did not last long. At one of these shrines, so
onerous became the industry of replacing a new phallus to the saint,
that the good monks placed an apron over the organ, informing the good
women that thereafter a simple contemplation of the sacred organ would
be sufficient; and a special monk was detailed to take special charge of
this apron, which was only to be lifted in special cases of sterility.
By this innovation the good monks stole a march on their brothers in
like shrines in other localities, such as those of St. Gilles, in
Brittany, or St. Rene, in Anjou, where the old-fashioned scraping and
replacing still was in vogue. Near the seaport town of Brest, in
Brittany, at the shrine of St. Guignole, the monks adopted a new
expedient. They bored a hole through the statue, through which a phallus
was made to project horizontally; as fast as the devotees scraped away
in front the good monks as industriously pushed forward the wooden peg
that formed the phallus, so that it gave the member the miraculous
appearance of growing out as fast as scraped off, which greatly added to
its reputation and efficacy. The shrine continued in great vigor until
the middle of the last century. Delaure mentions a similar shrine at
Puy, also in France, which existed up to the outbreak of the French
Revolution. The scrapings in this case were immersed in wine, and the
guardians of the statue saw to it that no amount of paring or scraping
should remove from the saint any of that appearance of vigor or
virility which his great reputation demanded, this being done by a
similar procedure as followed at the church near Brest, one of the
attendants having been sent to investigate into the marvelous growth of
the Brest phallus.



CHAPTER VIII.

HISTORY OF EMASCULATION, CASTRATION, AND EUNUCHISM.


For the earliest records in regard to emasculation we must go back to
mythological relations. In the old legendary lore of ancient Scandinavia
or of Germany, the loves and hatreds of their semi-mythological heroes
and heroines space over many romantic incidents before reaching a
culmination. The swiftly flowing Rhine, with its precipitous banks,
eddies, and rapids; the broad and more majestic Danube or Elb; the broad
meadows and Druidical groves on its hilly slopes and stretches of dark
and gloomy forest,--all conspired to people the fancy with elfs, gnomes,
fairies, and goblins, who were more or less intermingled in all the
episodes that engaged their semi-mythological heroes. This helped to
fill in all their deeds with entertaining incidents; their halls and
castles were made necessary accessories by the rigors of the climate, as
well as were the beery feasts and carousals with the inspiration of
monotonous song also rendered necessaries by the same element; hence, we
have various incidents, either entertaining or exciting, connected with
their legendary tales, acting like periods of intermission between their
love scenes, spites, hatreds, murders, and general cremations. From such
material and such opportunities it was comparatively easy for Wagner to
construct the thrilling and interesting incidents that compose his opera
on the legend of the Nibelungenlied.

The Grecian landscape and topography does not permit of such richness of
romantic incidents or details, any more than the love-making of the
unfortunate spider who is devoured by his spidery Cleopatra at the end
of his first sexual embrace could furnish any incidents for one of
Amelie Rives's spirited novels; so that neither minstrel nor bard have
recorded the details of the first emasculating tragedy, which from all
accounts was a kind of an Olympian Donnybrook-fair sort of a
paricidal-ending tragedy.

Unfortunately, Homer was not there to describe the event, or we might
have had a Wagnerian opera with its Plutonic music to illustrate all its
incidents; or even a Virgil could have made it into interesting verses;
but, as it is, we must content ourselves with the laconic recitals that
have been handed down by tradition, and, as all the Greek performances
of those days were marked by an intense decisiveness, with an utter lack
of circumlocution, it is probable that there was not much to relate
beyond the bare facts.

In Smith's "Dictionary of Greek and Roman Biographies and Mythology" we
find it related that Uranos, or Coelus, was the progenitor of all the
Grecian gods. His first children were the Centimanes; his next progeny
were the Cyclops, who were imprisoned in Tartarus because of their great
strength. This so angered their mother, Gäa, that she incited her
next-born children, the Titans, into a rebellion against their father,
Uranos. In the general turmoil that followed Uranos was deposed, and, so
that he would be incapable of begetting any more children, Saturnus, the
youngest of his sons, with a sickle made from a bright diamond,
successfully emasculated poor old Uranos. The records are not clear
whether the operation only included the penis, or the scrotum and
contents, or whether, like the Turkish or Chinese _taillè à fleur de
ventre_, Saturnus made a clean sweep of all the genitals; it is
probable that he did, however, as the members fell into the sea, and in
the foam caused by the commotion from their contact with the element
Venus was born. Meanwhile, the blood that dripped from the wounded
surface caused the Giants, the Furies, and the Melian nymphs to spring
into life. Uranos is also represented as being the first king of
Atlantis; so that the first eunuch was a god and a king, more
unfortunate than any of Doran's heroes, in his "Monarchs Retired from
Business," because he was more effectually retired from business than
any monarch that Doran records.

After this the practice seems to have been adopted in a general way; and
the fact that the future proceedings of men and things on earth do not
much interest these unfortunate members of society in any great degree,
interest in worldly affairs and testicles seemingly having been as
intimately connected in those early and remote days as with us of the
present, it very naturally followed that this disinterestedness, as well
as the docility and pliability which emasculation engenders, first
suggested their use as servants or in position of trust, as a eunuch,
having no incentive either to run away or to embezzle, would naturally
be a valued and trusted servant. In the days of eunuchism there were no
defaulting bank, city, or county cashiers,--a circumstance which would
suggest that such a condition should form one of the qualifications for
eligibility to such offices, the very opposition to any such proposal
that the class would make showing in itself the benefits that would
follow such an innovation, as it would show that the class is not
possessed with that total spirit of abnegation requisite in the
guardians of public funds. The requirement might be extended to
bank-presidents with benefit, if some Cincinnati episodes are any
criterion. It is safe to assume that the bank that could advertise, in
connection with its attractive quarterly or semi-annual statement, that
the president and cashier were properly attested and vouched-for eunuchs
would find in the public such a recognition of the fitness of things
that the patronage it would receive would soon compel other banks to
follow the example. The procedure might, with national benefit, be
extended as an ordeal to our legislators at the national capitol, as it
would do away with the particular influential lobby so graphically
described in Mark Twain's "Gilded Age." These things or ideas are merely
thrown out as suggestions to be used by those who write those
interesting articles in the _Forum_, or the _North American_ or
_Fortnightly Reviews_, on government and social reforms, as a perusal of
the many articles written in that direction will convince any one that,
from a practical psychological view of the matter, they are sadly
deficient. To make those articles effective the reflex impressions made
by the animal on the psychological and moral nature of man should not be
neglected.

Semiramis, whose beauty and many accomplishments, assisted by the
murders of several of her husbands by the hand of the succeeding one,
had this subject in hand in a far more practical manner than it is
generally forced on the understanding; hence we see that she was the
first to introduce the use of eunuchs in the capacity of servants as
well as in official positions in and about the palace, as well as
trusting some of the positions of the highest importance to the class.
From her epoch, eunuchism has become an inseparable attendant on
Oriental despotism, and has so continued to the present day. Like yellow
fever, phthisis, and some diseases, as well as many other social
afflictions and customs, eunuchism does not seem to flourish beyond
certain degrees of north and south latitudes,--a fact that probably
assisted Montesquieu to arrive at the conclusion that climate was a
powerful factor in all things.

Bergmann, of Strasburg, quotes the ancient traditions, wherein it is
stated that man was taught the art of castration by the brute creation.
The hyena is cited as having so instructed man by the habit it exhibited
of castrating its infant males in removing the testicles with its teeth,
the habit being instigated by a jealousy, for fear of future competition
in the exercise of the procreative act on the part of the young males.
Another tradition attributes its origin to the castor. Bergmann here
traces out the etymological relation existing between the name of the
operation and that of the animal with that of a Greek verb that forms
the root of _castrum_, or camp; _casa_, or house; _castigare_, to
arrange; from whence also is traced _cosmos_, the world; _kastorio_, the
Greek for wishing to build, and the Latin _kasturio_ having the same
relative but a more imperative signification; _kastor_, signifying as
loving to build; _castitiator_, Latin for architect, and _casticheur_,
old French for constructor. The tale or tradition in regard to the
self-mutilation inflicted by the castor is traced to the Arabian
merchants who purchased the castoreum, which was imported from the
shores of the Persian Gulf and from India. It was called, also, by the
Arabs, _chuzyalu-l-bahhr_, or testicles from beyond the sea; or, in
French, _testicules d'outre mer_. These terms and the tradition that the
castor on being pursued, knowing the reason of the chase, was in the
habit of tearing out his testicles and throwing them at his pursuers,
were invented by these merchants to heighten the price and value of the
article intrinsically, as well as to make it more interesting by this
peculiar individuality of adventure. The Latins, believing and adopting
the tradition as a matter of fact, coined the word _castorare_, or doing
like the castor. Bergmann uses in this connection a number of terms in
French to denote different forms or degrees of this mutilation which
have no equivalents in English,--for instance, _chatrure_, as applied to
animals, making also a distinctive difference between the meaning of the
French words _castration_ and _chatrement_. Bergmann is a decided
evolutionist as regards circumcision being evolved from prior forms of
physical mutilation, as will be more fully explained in the next
chapter; the shaving of the head of a conquered people by the Hindoos,
or the shearing the royal locks of the ancient Frankish kings; the
blinding of one eye of their slaves by the old Scythians, or crippling
one foot by the division of a tendon in a captive by the Goths, he
considers as on the same line with the idea that led to castration, the
different forms of eunuchism, and circumcision.[31]

From a purely materialistic and utilitarian view of the subject, he
observes that what we call moral progress and civilization owe their
advancement more to material interest and cold, selfish calculation than
to any development of the humanitarian sentiments, and that neither
morality nor justice has much to do with it. The evolution of the slave
and the marks inflicted upon him by his fellow humans are the most
emphatic evidences of the justness of the above proposition. The study
of the subject is equally interesting when considered in connection with
the evolutions of the Christian Church. In its divergence from Judaism
and its beneficent laws, both social and moral, the Christian Church was
but illy fit to cope with its persecutors of Pagan tendencies, or to
enforce an unwritten law or code of morality or hygiene among an
idolatrous, barbarous, and ignorant population such as it had to
encounter. To its professors, the formation of that monachism which has
been so much misunderstood and abused was but an inevitable
condition.[32] These men had not the steady compass to guide them in the
path that was possessed by the Jewish people. The martyrdom of Christ
and many of his apostles, and the teachings of the early church, pointed
to physical denials, castigations, humiliations, and sufferings as the
only way to salvation; all pleasures were sin and all denials and pain
were looked upon as steps to heaven. The climate pointed to sexual
indulgence as the sum of all happiness, as can readily be inferred from
the Mohammedan idea of heaven; so, with the early Christians who were
born in the same climates, the denials of sexual pleasures were looked
upon as the most acceptable offering that man could make to the Deity.
Continence, celibacy, infibulation, and even castration were the
conditions looked upon by many of these men as the only means of living
a life on earth that would grant them an eternal life in the next. This
view of the situation peopled the deserts with a lot of men dwelling in
caves and in huts, living on such a scarce diet that they barely
existed. That many went insane, and in their frenzy died while roaming
in these solitudes, we have ample evidence. The tortures and impositions
of the Pagan rulers also drove many to this life or death.

Religious mania has caused many cases of self-mutilation, either to
escape continued promptings and desires, or simply from a resulting
species of insanity. Of the first, Sernin[33] reported to the Medical
Society of Paris the case of a young priest who had castrated himself
with the blade of a pair of scissors, and who nearly lost his life with
the subsequent hæmorrhage. The writer saw an analogous case on board an
American war-vessel, of which Dr. Lyon was surgeon, in the harbor of
Havre, in the spring of 1871, the subject being the ship's cobbler, a
religious fanatic, who was driven insane by self-imposed continence. We
are not surprised, from the lack of intelligence of the times, the
extreme but undefined views as to religion that then ruled men, that
self-imposed castration should have been sanely considered and carried
into effect by Origines and his monks. The Cybelian priesthood had
formerly set the example in their Pagan worship, and when we are told
that the monks of Mount Athos accused the monks of the convent of a
neighboring island with falling away from grace, because they allowed
_hens_ to be kept within the convent inclosure, we may well believe that
Origines and his monks felt that they were gradually ascending in grace
when they submitted to this sacrifice. As strange as it may sound,
self-castration is still practiced by the Skoptsy, a religious sect in
Russia. In justice to the Church, however, it must be said that she
neither asked for nor did she sanction these performances, although she
was not quick enough in asserting that she recognized the same law in
regard to her presbytery that controlled that of the Hebraic priesthood.

Eunuchism presents many contradictory conditions; eunuchs have not
always been the fat and sleek attendants on Oriental harems as tradition
and custom places them or would have us believe; neither does the loss
of virility, in a procreative sense, seem to have always robbed them of
their virility in other senses, as we find eunuchs holding the highest
offices in the State under the reigns of Alexander, the Ptolemys,
Lysimachus, Mithrades, Nero, and Arcadius. The eunuch Aristonikos, under
one of the Ptolemys, and another, Narces, under Justinian, led the
armies of their sovereigns. These are, however, exceptional cases; as a
rule, the result is as we observe in the domestic animals,--loss of
spirit, vim, and ambition. The Church recognized this result, and, while
the Hebraic law excluded eunuchs from participating in the priesthood as
being imperfect and unclean, the Church reproached Origines and his
monks and excluded eunuchs from its presbytery on the ground that such
beings lack the moral and physical energy requisite in a calling that is
supposed to guide or lead men; moreover, there are many reasons for
doubting that the ministers of state and the generals of the reigns
above mentioned were actually eunuchs in the full acceptance of the
word. Among the ancients there were several methods of performing the
operations that made the eunuchs; some were more effectual than others.
From the removal of _all_ the genitals, or the penis alone, or the
scrotum and testicles, or removing only the testicles, down to
compression or to distorting the spermatic vessels, or, as in the case
of the Scythians, who often became eunuchs from bareback riding, as
Hammond describes a eunuchism manufactured by our southwestern Indians
of New Mexico and Arizona, are performances that left many degrees of
eunuchism; as we find some eunuchs that not only contracted marriage,
but engendered children. Voltaire mentions Kislav-aga, of
Constantinople, a eunuch _à outrance_, with neither penis, scrotum, nor
anything, who owned a large and select harem. Montesquieu, in his
"Persian Letters," admits this class of marriages as being practiced,
but doubts the resulting conjugal felicity, especially on the part of
the wife. Potiphar's wife was one of these unfortunate wives; no wonder
that she tore Joseph's cloak in her desire. Juvenal mentions that some
eunuchs were held in high esteem by the Roman matrons; it possibly could
have been some of this kind of a eunuch that led armies or ruled in the
palaces. Among the sultans and Oriental potentates those who had every
exterior evidence of virility removed, so as to be obliged to micturate
through the means of a catheter, were considered the safest guards, as
well as they were the highest-priced eunuchs, for in their manufacture
fully 75 per cent. of those operated upon died as a result. It is
related that the Caribs made eunuchs of their prisoners of war on the
same principle that caponizing is resorted to for our kitchens,--the
prisoners were easier to fatten and were more tender when cooked. The
Italians allowed their children to be eunuchized for chorister purposes
in church services, their soprano voices after this treatment being
simply perfect. It was considered that, in the year prior to the papal
ordinance of Pope Clement XVI forbidding the practice or the employment
of eunuchs in choirs, four thousand boys, mostly in the neighborhood of
Rome, were castrated for chorister purposes.

In China eunuchs were in use during the reign of the Emperor Yen-Wang,
in 781 B.C. The Chinese make their eunuchs by a complete ablation of all
genitals. In India the followers of Brahma never placed their women in
charge of eunuchs. In Italy it was customary to emasculate boys that
they might grow up with the faculty of taking the female parts in
comedies, their voices thereby assimilating to that of the other sex,
this being on the same principle that the _basso-profundos_ were
infibulated that they might retain their bass.

Eunuchism resulting from an operation owing to disease has at times
given queer and unlooked-for results, as, for instance, in the case of
the old man that Sprengle mentions, in whom castration did not remove an
inordinate sexual desire. Sir Astley Cooper mentions a case in his
"Diseases of the Testes" that is somewhat unique. After castration Sir
Astley's patient showed the following results: "For nearly the first
twelve months he stated that he had emissions _in coitu_, or that he had
the sensations of emission; that then he had erections and coitus at
distant intervals, but without the sensation of emission. After two
years he had excretions very rarely and very imperfectly, and they
generally ceased immediately upon the attempt at coitus. Ten years after
the operation he said he had during the past year been only once
connected. Twenty-eight years after the operation he stated that for
years he had seldom any excretion, and then that it was imperfect." In
regard to the mortality from castration done in a professional manner
and for disease, Curling, in his work on "Diseases of the Testis,"
observes that he saw or performed some thirty operations without a
death, and that in a table of like operations performed at the Hôtel
Dieu, in Paris, it appeared that the mortality was one in four and a
quarter.

J. Royes Bell, in the sixth volume of the "International Encyclopædia of
Surgery," has the following in regard to the practice among the
Mohammedans in India: "Young boys are brought from their parents, and
the entire genitals are removed with a sharp razor. The bleeding is
treated by the application of herbs and hot poultices; hæmorrhage kills
half the victims, and at times brings the perpetrators of the vile
proceeding within the clutches of the law."

The _taillè à fleur de ventre_ of the Chinese is a somewhat primitive
procedure. According to Dr. Morache, in his account of China in the
"Dic. Ency. des Sciences Médicales," the operation is as follows: "The
patient, be he adult or child, is, previous to the operation, well fed
for some time. He is then put in a hot water bath. Pressure is exercised
on the penis and testes, in order to dull sensibility. The two organs
are compressed into one packet, the whole encircled with a silk band,
regularly applied from the extremity to the base, until the parts have
the appearance of a long sausage. The operator now takes a sharp knife,
and with one cut removes the organ from the pubis; an assistant
immediately applies to the wound a handful of styptic powder, composed
of odoriferous raisins, alum, and dried puffball powder
(boletus-powder). The assistant continues the compression till
hæmorrhage ceases, adding fresh supplies of the astringent powders; a
bandage is added and the patient left to himself. Subsequent hæmorrhage
rarely occurs, but obliteration of the canal of the urethra is to be
dreaded. If at the end of the third or fourth day the patient does not
make water, his life is despaired of. In children the operation succeeds
in two out of three cases; in adults, in one-half less. Poverty is the
cause which induces adults to allow themselves to be thus mutilated. It
is said to be difficult to distinguish these last from ordinary Chinese
men. Adult-made eunuchs are much sought after, as they present all the
attributes of virility without any of its inconvenience."

The study of the evolutionary moves or processes passed by eunuchism in
its relation to music and the drama tends to rob these otherwise
civilizing and enlightened arts of the aureoles of poetry and gentility
with which they have been surrounded. From Bergmann we learn that the
practice originated in the Orient, where female voices were held in
higher esteem in singing, and where the profane songs that accompanied
the dance were chanted by women. The Hebraic regulations permitted
neither women nor eunuchs to sing in their temples. With the
establishment of the early Christian Church in Oriental countries, more
or less of the ancient Judaic customs were retained, and in addition a
too literal interpretation of the words of St. Paul was adhered to,
which said that women should not be _heard_ in the Church. The Oriental
Church from these reasons long remained in a quandary; according to the
ceremonials, it was deemed requisite to imitate as near as possible the
voices of the angelic seraphims, and this could not be done by the
rasping bass voices of the well-fed monks; women were out of the
question in the then social stage of church evolution; so that at last a
compromise was effected by admitting the eunuch, who could chant in a
most seraphic soprano, as his prototype, the mendicant priests of
Cybele, had done before him.

Constantinople became the centre of learning for Greek music, and the
fine soprano solos which now form the attraction of many of our modern
churches were sung by the eunuchs. Eunuchs were not only the chief
singers, but they cultivated the art into a science, and Constantinople
furnished through this class the music-teachers for the world, as we
learn that in 1137 the eunuch Manuel and two other singers of his order
established a school of music and singing in Smolensk, Russia. There is
no doubt but that in a moral sense, considering that women are generally
the pupils, this was a most meet and an appropriate arrangement; for,
as St. Alphonsus M. Liquori observed, man was a fool to allow his
daughters or female wards to be taught letters by a man, even if that
man were a saint, and, as real saints were not to be found outside of
heaven, it can well be imagined how much more dangerous it might be to
have them taught music and singing by a man not a eunuch,--elements
which have a recognized special aphrodisiac virtue, as was well known to
the ancient Greeks, who only allowed their wives to listen to a certain
form of music when they (the husbands) were absent from home.

There is not much room for doubt but that both morality and medicine
have too much neglected the study and contemplation of the natural
history of man, and relied altogether too much on the efficacy of church
regulations and castor-oil and rhubarb. There are other things to be
done besides simply framing moral codes and pouring down mandrake into
the stomach; the old conjoined service of priest and doctor should never
have been discontinued, as, by dividing duties that are inseparable,
much harm has resulted. Herein dwelt the great benefit of the early
practice of medicine among the Greeks, and to the physical understanding
and supervision of human nature by the Hebraic law may be said that the
creed owes its greatness and stability, and the Hebrew race its sturdy
stamina. The wisdom of the Mosaic laws is something that always
challenges admiration, the secret being that it did not separate the
moral from the physical nature of man. Bain, Maudsley, Spencer, Haeckle,
Buckle, Draper, and all our leading sociologists base all their
arguments on the intimate relations that exist between the physical
surrounding and the physical condition of man and his morality. Churches
foolishly ignore all this.

From Constantinople the fashion or custom gradually invaded Italy; and
as Rome was the centre of the new religion, so it also became the centre
of music, and Rome and Naples were soon the home of the eunuch devoted
or immolated to the science of music. The eunuchs reached the height of
their renown in music, as well as what might be termed their golden era,
with the establishment of the Italian opera, in the seventeenth century.
At this period all the stages of Italy were the scenes of the lyric
triumphs of this otherwise unfortunate class, some of whom accumulated
vast fortunes. In the following century, as has been seen, Clement XVI
abolished the practice as far as the church was concerned, and in the
present century the first Napoleon abolished the practice secularly and
socially. Mankind cannot sufficiently appreciate the benefits it
received from the results of the French Revolution; we are too apt to
look at that event simply from the unavoidable means which an uneducated
class--rendered desperate by long suffering and brutalization under an
organized system of oppressive misrule--had adopted to remedy existing
evils. After the dissolution of the Directory France cannot be said to
have been in a state of anarchy, and the long and bloody wars with which
Napoleon is usually blamed should rather be charged to that government
and imbecile ministerial policy that lost to England the American
colonies. The series of battles from Marengo to Waterloo are as much the
creation of the cabinet of George III as those from Concord to Yorktown.
Waterloo involved more than the simple defeat of Napoleon; it meant the
defeat of moral and intellectual progress, as well as the suppression of
the rights of man. The suppression of the Inquisition in Spain, and of
eunuchism in Italy; the Code Napoleon; the Imperial highways of France;
the construction of its harbors,--notably that of Havre; and the
political and social emancipation of the Jews in France, Italy, and
Germany are monuments to this great man that have not their equals to
crown the acts of any other French monarch. Like the Phrygian monk who
leaped into the arena in Rome to separate the maddened gladiators, and
who was stoned to death by the angry and brutal mob of spectators whose
amusement he stopped, Napoleon's work has had its results, in spite of
Waterloo and St. Helena. The martyrdom of the poor monk caused an
abolishment of the brutal sports of the Colosseum, which henceforth
crumbled to pieces. Little did the people look for this result who
trampled the monk under foot. Neither did Blucher, debouching on the
English left with Bulow's battalions on the evening of Waterloo,
foresee, some fifty years later, Prussia extending its hand to make a
united Italy, which with Napoleon--who was by blood, nature, instinct,
and education an Italian--had been the dream and ambition of his life.

Eunuchism as a punishment is an old practice, as the ancient Egyptians
inflicted it at times upon their prisoners of war; so it formed part of
their penal code, and we are told that rape was punished by the loss of
the virile organ; a like punishment for the same offense was in vogue
with the Spaniards and Britons; with the Romans at different times and
with the Poles the punishment was castration. The difficulty of proving
the crime, as well as the ease with which the crime could be charged
through motives of revenge, spite, or cupidity on innocent persons,
should never have allowed this form of punishment to be so generally
used as history relates that it was; rape being one of the most complex
and intricate of medico-legal subjects, unless we take M. Voltaire's
summary and Solomonic judgment, who relates that a queen, who did not
wish to listen to a charge of rape made by one person against another,
took the scabbard of a sword and, while she kept the open end in motion,
asked the accuser to sheath the sword.

Count Raoul Du Bisson, _Dedjaz de l'Abyssinie_, gives some very
interesting information in regard to eunuchism in his work entitled "The
Women, the Eunuchs, and the Warriors of the Soudan." Count Bisson has
looked on the question from its moral, physical, and demographic
stand-points, and, having seen eunuchism in its different aspects, from
his landing at Alexandria and Cairo, down through his different
expeditions into Arabia, the Soudan, and Abyssinia, his observations are
well worth repeating.

From a demographic and statistical view of the subject, its truly
Malthusian results become at once shockingly and persistently
prominent,--not alone in the interference that the condition induces in
arresting any further procreation on the part of the unfortunate victim,
but in the unparalleled mortality that, in the gross, is made necessary
by the results of the operative procedures. The Soudan alone furnished,
according to reliable statistics, some 3800 eunuchs annually, the
material coming from Abyssinia and the neighboring countries, it being
gathered by war and kidnapping parties, or by purchase, from among the
young male population of those regions. These children are brought to
the Soudan frontier and custom duties are there paid for their passage
across the border, the duty being about two dollars per head. At
Karthoum they are purchased by pharmacists, apothecaries, and others
engaged in the manufacture of eunuchs, who generally perform simple
castration; the mortality among these amounts to about 33 per cent.
These simply castrated eunuchs bring about $200 apiece. The great eunuch
factory of the country, however, is to be found on Mount Ghebel-Eter, at
Abou-Gerghè; here a large Coptic monastery exists, where the unfortunate
little African children are gathered. The building is a large, square
structure, resembling an ancient fortress; on the ground-floor the
operating-room is situated, with all the appliances required to perform
these horrible operations. The Coptic monks do a thriving business, and
furnish Constantinople, Arabia, and Asia Minor with many of their
complete, much-sought-for, and expensive eunuchs. They here manufacture
both grades,--those who are simply castrated and those on whom complete
ablation of all organs has been performed, the latter bringing from $750
to $1000 per head, as only the most robust are taken for this operation,
which nevertheless, even at the monastery, has a mortality of 90 per
cent.

The manner of performing the operation is as barbarous and revolting as
the nature of the operation itself, and the cruel and ignorant
after-treatment is as fully in keeping with the whole. The little,
helpless, and unfortunate prisoner or slave is stretched out on an
operating-table; his neck is made fast in a collar fastened to the
table, and his legs spread apart and the ankles made fast to iron rings;
his arms are each held by an assistant. The operator then seizes the
little penis and scrotum and with one sweep of a sharp razor removes all
the appendages. The resulting wound necessarily bares the pubic bones
and leaves a large, gaping sore that does not heal kindly. A short
bamboo cannula or catheter is then introduced into the urethra, from
which it is allowed to project for about two inches, and no attention
is paid to any arterial hæmorrhage; the whole wound is simply plastered
up with some hæmostatic compound and the little victim is then buried in
the warm sand up to his neck, being exposed to the hot, scorching rays
of the sun; the sand and soil is tightly packed about his little body so
as to prevent any possibility of any movement on the part of the child,
perfect immobility being considered by the monks as the main element
required to promote a successful result. _It is estimated that 35,000
little Africans are annually sacrificed to produce the Soudanese average
quota of its 3800 eunuchs._

When this immense sacrifice of life, the useless barbarity, and the
really unnecessary needs of such mutilated humanity existing are fully
considered, it would seem as if Christian nations might, with some
reason, interfere in this horrible traffic, by the side of which
ordinary slavery seems but a trifle. When we further consider that, in
some instances, the child is also made mute by the excision of part of
the tongue,--as mute or dumb eunuchs are less apt to enter into
intrigues, and are therefore higher prized,--the barbarity, cruelty, and
extremes of inhumanity that these poor children have to suffer cannot be
overestimated. Neither must we be astonished at the stolid indifference
that is exhibited by the eunuchs in after life to any or all sentiments
of humanity, or that they should hold the rest of humanity in continual
execration.

Often-occurring accidents in harems make _complete_ eunuchs a
desideratum. Bisson mentions that on one occasion he saw the chief
eunuch of the Grand Cherif of Mecca--a large, finely-proportioned,
powerful black--on his way to Stamboul for trial and sentence; he was
heavily chained and well guarded. It appears that the eunuch had only
been partly castrated, and that the operation had been performed during
infancy; his testicles had not fully descended, so that in the operation
the sac was simply obliterated, which gave him the appearance of a
eunuch. In this condition he seemed to have kept a perfect control of
himself and passions until made chief eunuch of the Cherif, who
possessed a well-assorted harem of choice Circassian, Georgian, and
European beauties. The _négligé_ toilet of the harem bath and the
seductive influence of this terrestrial Koranic seventh heaven was too
much for the warm Soudanese blood of the chief; his forays were not
suspected until a blonde Circassian houri presented her lord and master,
the Cherif, with a suspiciously mulatto-looking son and heir. A
consultation of the Koran failed to explain this discrepancy, and
suspicion pointed to the chief eunuch, who was accordingly watched; it
was found that he had not only corrupted the fair Circassian, but every
inmate of the harem as well. The harem was promptly sacked and drowned
and the false eunuch shipped to the Sultan for sentence, the Cherif
having the right to sentence and drown the harem, but having no such
rights over such a high personage as the chief eunuch.

There are physiological facts and pathological conditions brought forth
for our contemplation, while investigating the subject of eunuchism in
all its details, that cause us to feel that, after all, the old
Hippocratic principle of inductive philosophy, upon which our study and
practice of medicine is founded, with rational experience and
observation for its corner-stone, is, even if commonplace, the only
proper avenue of knowledge. To exemplify this proposition we have in
this particular subject the practical observations and experience of M.
Mondat, of Montpellier; in his interesting work on "De la Stérilité de
l'Homme et de la Femme," published in 1840, he details some instructive
information on the subject of eunuchs, giving some explanation as to why
many simply castrated eunuchs are, like the much-prized eunuchs of the
Roman matrons, still able to acquit themselves of the copulative
function. He mentions that while in Turkey he studied the subject in its
details, and, having found some of these copulating eunuchs, he secured
some of the ejaculated fluid and subjected it to a careful examination.
The discharge was lacking the characteristic seminal odor; it was in
other respects, to the palpation especially, very much like the seminal
fluid. He found that these eunuchs were much given to venereal
enjoyment, but that either legitimate intercourse or masturbation, to
which many were addicted, was apt to be followed by a marasmus ending in
galloping consumption. Mondat personally knew the opera-singer Velutti,
who died in London; Velutti was, when a child, castrated by his parents,
having both testicles removed, being intended by his father, who had
himself performed the operation, for the choir of the Papal Chapel at
Rome. Velutti was as much of a favorite in his day as our present tenors
and handsome actors. The admiration of the opposite sex was fatal to
him; he formed a _liaison_ with a young English lady residing in London,
and the resulting excesses in which he indulged quickly brought him to
his grave. He was passionately fond of women and was able to acquit
himself perfectly; at least, as far as the copulative act--barring
fecundation--was concerned.

In a previous part of this chapter I have alluded to the very
appropriate arrangement which formerly existed when music-teachers were
eunuchs, and that our higher circles of society would do well to employ
eunuchized coachmen, especially if possessed of susceptible and elopable
daughters; but, from the accounts given by Mondat, it would seem that
they are not as safe as might at first be imagined. However, they could
not be as dangerous as the chief eunuch of the Grand Cherif of Mecca and
increase the population to the same extent; but I should judge that they
might be a very demoralizing moral element if introduced into modern
society. If eunuchs must be employed, it can easily be understood why
the Turk and Chinese prefer the real, clean-cut article. The New York
"Four Hundred" should make a note of this, as in their present thirst
for European aristocratic notions, coats of arms and titles, there is no
telling how soon they may cross over into Oriental customs and run a
harem, in which case it would be sad to have them make any mistakes in
the quality and ability of the eunuch.

Dr. Gardner W. Allen has furnished the American profession with a
faithful translation of the valuable work of Professor Ultzmann on
"Sterility and Impotence." In this, we have a clear and intelligent
dissertation that explains the above conditions, and I am only surprised
that the observations of Mondat have not developed such explanations
before, as the principle was fully explained in practice fifty years ago
by the Montpellier physician. According to Ultzmann, there is a form of
fecundating impotence in persons otherwise well provided with an
apparent complete apparatus, an impotence which he terms _potentia
generandi_. He states, however, that this form of impotence was not
recognized until a few years ago, citing the fact that females have had,
as a rule, to bear all of the blame for the unfruitfulness of the
family, and that they have been accordingly subjected to all manner of
operations, general and local treatment, even to being sent to watering
places and sanatoria where red-headed male attendants are employed, to
say nothing of the prayers, intercessions, pilgrimages, and novenas to
the holy shrines, as mentioned in the chapter on the holy prepuce.
Ultzmann observes that a man may be perfectly able to go through the
procreative or, rather, the copulative act, even to the great
satisfaction of all parties concerned, and yet be perfectly impotent; he
even goes further, by observing that there are cases in which copulation
may take place without any fluid whatever being ejaculated. He mentions
two such cases at pages 87 and 116 of his book. In the first instance
the ejaculated fluid is precisely as that observed in such cases as
those of the eunuchs and of Velutti, mentioned by Mondat, and consisted
of an azoöspermic discharge, made up mainly from the secretion of the
seminal vesicles, the accessory glands of the urethra, the prostate, and
Cowper's glands, as well as the discharge from the secretory glands
distributed along the course of the urethral mucous membrane. Some of
the cases of this form of impotence have exhibited wonderful copulating
desire and power of endurance, and, even if unfecundating, they must be
said to be better off than the victims of that other form of male
impotence, the _potentia coeundi_ of Ultzmann, where, with a normal
semen, either the power of erection or that of ejaculation may be
entirely absent.



CHAPTER IX.

PHILOSOPHICAL CONSIDERATIONS RELATING TO EUNUCHISM AND MEDICINE.


Eunuchism does not always subdue the animal passions; this is the view
that the church took in connection with the emasculation of Origenes and
his monks; the church here held that not only was it possible for them
to still sin in heart or imagination, but that, even were the complete
eradication of the sexual idea possible, they had by their act lost the
main glory of a Christian,--that of successfully striving against
temptation, and by a force born of triumphant virtue overcome all the
wiles of the devil. It is related that among the eunuchs at Rome there
were some who, having been made so late in life, still retained the
power of copulation, although the final act of the performance was
absent. Montfalcon relates that Cabral reported dissecting a soldier who
was hanged for committing a rape, but who on dissection showed not the
least trace of testicles, either in the scrotum or abdomen, although the
seminal vesicles were filled with some fluid.[34] Sprengle, in his
"History of Medicine," relates of the complete removal of both testicles
from an old man of seventy years of age, on account of inordinate sexual
desire, the operation having no perceptible effect in subduing the
disease.[35] These cases are analogous to those exceptionable cases in
which, after extirpation of the ovaries, both menstruation and
fecundation have still taken place.

Modern civilization and its unnatural mode of dressing inflict great
harm on men by keeping these parts too warm and constricted. Much of
the irritability of these organs, as well as their _decadence_ at an age
some generation or two before the time when they should still possess
all their virile attributes, can be directly attributed to this cause. A
more intelligent way of dressing would result in less moral and physical
wreckage, and require less galvanic belts and aphrodisiacs in men under
fifty. If those who habitually swath their scrotums in the heavy folds
of their flannel shirts, to which are superadded the cotton shirts,
drawers, and outer clothes in which civilized man incases himself, would
cast a backward eye into the dim and misty past, and see the priest of
some of the old Pagan gods soaking the scrotum in hot water, and then
gradually rubbing the testicles within, by gentle but firm friction, _to
make the testicles disappear_, a process by which many of the heathen
priests prepared themselves for the discharge of their sacerdotal duties
and the strict observance of those rules of chastity and celibacy which
they were henceforth to live up to, they would find _one_ explanation of
why civilized man does not possess that vigor and retain that
procreative power into advanced age that was one of the characteristics
of our ancient progenitors in the days that breeches were as abbreviated
as those now worn by the Sioux Indians. These are really but leggins,
which run only to the perineum and are simply tied by outer points to a
strap from each hip. Finely and comfortably cushioned chairs may be a
luxury to sit on, but they will have, on the man who uses them in youth
and in his prime, a wonderful sedative and moral influence later on,
about as effectual as the miniature warm baths for the scrotum and
gentle pressure to the testicles that were used by the heathen priests
of old, who preferred a gradual disappearance of the glands to the too
sudden and summary methods of the Cybelian clergy, who used a piece of
shell and an elaborately-performed castration. According to Paulus
Ægineta, this was a common practice of making eunuchs out of young boys
in the Orient, the mortality being hardly any; whereas the _taillè à
fleur de ventre_, the favorite method for making eunuchs for harem
guards and attendants, and more suited to the jealous disposition of the
Turk, has a mortality of three out of every four, according to Chardin,
and of two out of every three, according to Clot Bey, the chief
physician of the Pasha,[36] and of nine out of ten, according to Bisson.
So prone to reach high offices were intelligent eunuchs that it is
related that parents were at times induced to treat their boys in the
manner above stated, that they might be on the highway to royal favor,
honor, and rank; such is the ennobling tendency of Oriental despotism,
polygamy, and harem life. On the same principle Europeans subjected
their boys to a like operation to fit them for a chorister life or the
stage, where fame and honor and wealth were to be found.

Medicine has been the butt of wits and philosophers, as well as of the
men who, from the profession, have gone into the ranks of literature.
Smollet, himself a physician, gives us an insight into our wandering and
erratic misapplication of our knowledge on therapeutics in "Peregrine
Pickle," where the poor painter, Pallet, is believed to be a victim of
hydrophobia. The learned opinion of the doctor, who explains the many
and various reasons by which he arrives at his diagnosis, the various
physical signs exhibited by the patient as being pathognomonic of the
disease, and his final venture with the contents of the _pot de
chambre_, as a diagnosis verifier, which he dashes in the patient's face
in preference to ordinary water on account of the medicinal virtues
contained in urine, which in the case seemed to him to have a peculiar
therapeutic value, is something worth reading, however ludicrous it all
sounds. There are few intelligent physicians but who have seen as
ridiculous performances, in what might be called medical gymnasts, that
equal, if not surpass, those of Smollet's doctor. Rabelais was also a
professional brother, who, equally with Smollet, attempted to waken up
the profession by his satires. Smollet was not only a physician, but in
his early life had seen some very active and practical work, having
participated in and been a witness to the ills and misfortunes that
follow any attempts to "lock horns" with nature through ignorance of
physical laws and preventive medicine,--having been a surgeon's mate in
the fleet which assisted the land forces in the murderous and ill-fated
Carthagena expedition which cost England so many lives, ignorantly and
needlessly sacrificed to ministerial disregard of physical laws and its
consequences,--lessons which, unfortunately, seem to have but little
effect on cabinets, owing to their shifting _personelle_, England
following up the disasters of Carthagena with the still greater blunder
of the Walcheren expedition, where, out of England's small available
physical war material, nearly forty thousand men were either left to
fatten the swamps of Walcheren, or to wander through England in after
years on the pension-list, physical wrecks and in bodily and financial
misery.[37] Again, the same disregard, born of ignorance and red tape,
crippled the British army in the Crimea, causing in its ranks the
greatest mortality. It has seemed as if it would be of advantage if all
the blunders, either philosophical or of statesmanship, committed by a
cabinet, should be written in large letters of gold, to be hung in the
council-halls of the nations, that similar blunders at least might not
occur again.

Dumas, in his "History of the Two Centuries" and his "History of the
Century of Louis the XIV," gives some very interesting medical touches.
Le Sage, in his "Adventures of Gil Blas," gives us food for speculating
on medical philosophy in connection with the interesting subject of how
to make the profession remunerative. Dickens's ideas of the doctor, as
given in his works, are life touches. Witness his description of the
little doctor who superintended little David Copperfield's advent into
the world, or of Dr. Slammer of the army; they represent his view of the
professional character. Fontenelle, probably, was right in ascribing the
fact of his becoming a centenarian, and maintaining a stomach with the
force and resistance that are the peculiar characteristics and
attributes of a chemical retort, to the fact that when sick it was his
practice to throw the doctor's physic out of the window as the doctor
went out of the door, as in his day a man required the constitution of a
rhinoceros and the stomach of an ostrich, with the external
insensibility of a crocodile, to withstand the ordinary doctor of the
period and his medications. Napoleon believed that Baron Larrey was the
most virtuous, intelligent, useful, and unselfish man in existence; in
fact, it is doubtful if any man of his time commanded from this truly
great man so much admiration or respect, either for bravery, courage,
intelligence, or activity, as the great and simple-minded Larrey. As
observed by Napoleon of his bravest general,--poor Marshal Ney, the
bravest of the brave, the rear guard of the grand army, the last man to
leave Russian soil,--Ney was a lion in action, but a fool in the closet.
All his generals had some great distinguishing characteristic, beyond
which was a barren waste, a vacuity, but too apparent to a man of
Napoleon's discernment. But the cool, unflinching bravery of Larrey,
that did not require the stimulus of the fight or the phrenzy of strife
to bring it to the surface and keep it alive; bravery and intelligence
alike active under showers of shot and shell or in the thunders of
charging squadrons; in the face of infective epidemics or
contagiousness, walking about in these scenes in which his own life was
as much at stake as that of the meanest soldier, with the same cool
exercise of his intelligence that he exhibited in the organization and
superintendence of his hospitals in the time of peace; always the same,
untiring, unmurmuring, brave, studious, observing, unflinching in his
duties, unselfish; whether in the burning sands of Egypt or in the snowy
steppes of Russia, in the marshy plains of Italy or in the highlands of
Spain, he always found him the same, and his notes and observations,
from his first government service on the Newfoundland coast to his last,
always showed him the same laborer and student in the field of medicine.
And yet at St. Helena we find Napoleon refusing to take remedies for
internal disease whose real nature was unknown, and only toward the end
did he consent to take anything, and then only when seeing that the end
was approaching, and more from a kindly desire to express his
appreciation of the services of his attendants, and not to wound their
feelings, than from any hope of assistance. Napoleon had not neglected
the study of medicine any more than he had the study of every other
science. This is evident from the instance related as taking place
during the march of the grand army from the confines of Poland into
Russia, in 1812, when dysentery became very prevalent, of his inviting
several of his favorite guard to his own table, where he experimented
on each particular grenadier with a specific form of diet, so as to
determine its cause and possible remedy. He did not look upon our
knowledge of pathology and our skill in diagnosis as being sufficiently
advanced or perfect to make him feel but that a treatment for an obscure
disease like his own would be pretty much a matter of guess-work.
Charles Reade, in his "Man and Wife," shows an intimate knowledge of
medical science where he philosophizes on the effects of an irregular
life and of over-physical training. His logic is sound science. Defoe
and Cervantes show a like intelligent insight as to medicine; and it was
not without reason that Sydenham, the English Hippocrates, advised a
student of medicine who entered his office as a student to begin the
study of medicine by the careful study of "Don Quixote," remarking that
he found it a work of great value, which he still often read. The works
of Bacon and of Adam Smith on "Moral Sentiments;" the famous treatise on
the "Natural History of Man," by the Rev. John Adams; the later works of
Buckle, Spencer, Darwin, Draper, Lecky, and other robust wielders of the
Anglo-Saxon pen, as well as the works of Montaigne, Montesquieu, La
Fontaine, and Voltaire, are all works that the medical man could
probably read with more profit than loss of time. In fact, either Hume,
Macaulay, or any philosophical work on history will furnish to the
physician additional knowledge of use in his profession. No physician
can afford to neglect any study that in any manner adds to his knowledge
of the natural history of man, as therein is to be found the foundation
of our knowledge as to what constitutes health, and as to what are the
causes that lead humanity to diverge from the paths of health into those
of physical degeneracy and mental and bodily disease.

We have in medicine many sayings which pass for truisms, which are,
after all, misleading. We say, for instance, keep the feet warm and the
head cool; this will not always either keep you comfortable or well, as
we know that in neuralgias it is absolutely necessary, either for
comfort or to get well, to keep the head warm. While so much stress is
laid on the necessity of keeping the head cool, a thing a person is sure
to look after whenever the head becomes uncomfortably warm, and to which
can be ascribed but few ailments or deaths, we hear comparatively
nothing about the thermometric condition of the perineum, which, from
the varying temperatures in which it is at times plunged, produces more
beginnings for diseases in the future, during youth and our prime, as
well as it quite often causes the sudden ending of life in more advanced
periods. People who carefully observe the rule of keeping their heads
cool and their feet warm will stand with outspread legs and uplifted
coat-tails with their backs to a blazing grate, and then, going outside,
incontinently sit down on a stone or iron door-step, or, stepping into a
carriage or other vehicle, they sit down on a cold oil-cloth or leather
cushion, without the least knowledge of the harm or danger that they are
liable to incur. They little dream of the prostatic troubles that lie in
wait for the unwary sitter on cold places, ready to pounce upon him like
the treacherous Indian lying in ambush,--troubles that carry in their
train all the battalions of urethral, bladder, kidney disease and
derangments, and subsequent blood disorganization, which often begin in
a chilled perineum, and, in conjunction with the local disease that may
result, end in handing us over to Father Charon for ferriage across the
gloomy Styx long before our life's journey is half over. It is true,
neither the savage of Africa or America nor the nomads of Asia are
subject to any of these troubles; but with us, hampered with all the
benefits of the dress, diet, habits, and luxuries of civilization, and
with a civilized prostatic gland, it is quite otherwise. Herein, again,
comes that connection between religion, morality, and medicine, that
existed with so much benefit to mankind, but from which we of later days
have, in our greater wisdom, seen fit to separate; although,
inconsistently as it may seem, the present age has done more than any
previous epoch in practically demonstrating the intimate and inseparable
relation existing between the physical and moral nature of man. The
persistent priapism which oftentimes results from riding with a wet seat
and the inordinate morbid sensibility of the sexual organs that may
result from the same cause or from spinal irritation are not to be
allayed by any homily on morality or on the sanctifying attempts at
keeping the animal passions under subjection, any more than will prayers
or offerings to all the gods of Olympus restore the eunuchized, either
through foolish civilized dress and customs or through excessive
indulgence. We must mix medicine with our religion and make the clergy
into physicians, or ordain our physicians into full-fledged clergymen.

The science of medicine, or what might be called the natural ways of
nature through its physical laws, is true to itself; the fault lies in
our interpretation of its phenomena, which we fail to study with
sufficient discriminative precision and nicety. We have repeatedly
mistaken causes and results from this want of close observance and of
precision, attributing results to causes which did not exist. As an
example, when the early disciples of homoeopathy in ancient Palestine
undertook to revive poor, old, withered King David, by putting him to
bed with a young and caloric-generating Sunamite maid, when it was by
like incontinent practices that he had brought himself to that state of
decrepitude, it is plain that they misunderstood the principle.
Boerhaave--who, as a true eclectic practitioner, followed these ancient
and Biblical homoeopaths in their practice in a similar case, the
subject being an old Dutch burgomaster, whom he sandwiched between a
couple of rosy Netherland maids--also failed to grasp the true condition
of the nature of things, or the true philosophical explanation. The
exhalations from the aged are by no means an elixir of health or life to
the young, and the fact that the young were apt to lose health by
sleeping with the aged was wrongly attributed to their loss being the
others' gain, and the result of its passing into the bodies of their
aged companions, and not to its true cause,--the deteriorating influence
to which they were subjected; and, further, when we analyze the subject
still more, we can understand how a full-blooded and active,
lithe-bodied, thin, and active-skinned Sunamite maid might and would
impart caloric to King David; but, from our knowledge (not altogether
practical) of the difference that exists between differently
constitutioned and differently built maids in imparting caloric, and
from our knowledge of the physique of the Netherland maids, who are cold
and impassive, with a layer of adipose tissue that answers the same
purpose as that of the blubber in the whale,--that of retaining heat and
resisting cold,--we can well believe that the poor, shriveled
burgomaster could receive but little heat, even when sandwiched between
the two; but, on the contrary, he was, in fact, more liable to lose the
little he had, unless we look at the subject in another light, and
consider that sentiment that is common to both animals and men of
spirit, a sentiment that has furnished the subject for more than one
canvas in the hands of the true and sympathetic artist, as seen on the
awakening and alert attitude of the worn-out and old decrepit war-horse,
browsing in an inclosed pasture, as he hears from afar the familiar
bugle-notes of his early youth, or some cavalry regiment with prancing
steeds and jingling accoutrements, with bright colors and shining arms,
going past the pasture, restoring for a time to the stiffening joints
and dim eyes the suppleness and fire of bygone times, with visions of
gallant charges and prancing reviews; or, how the same sentiment erects
once more the bowed and withering frame of the old veteran, and once
again fires his soul with the martial zeal of his prime as he sees the
passing colors and active-stepping regiment which he followed in the
bright sunshine and flush of his youth. Aside from these sentiments,
which might possibly have inspired David and the Dutch burgomaster with
an infusion of a new and transient good feeling, it is unquestionable
but that some heated brickbats or stove-lids, curocoa jugs or old stone
Burton ale-bottles filled with hot-water, would have been more effectual
in imparting warmth than either Sunamite or Netherland maids.

It is hard to reconcile the beliefs of some people or nations with their
manners and customs. For instance, there is the Turk; when a Jew becomes
a Mohammedan he is made to acknowledge that Jesus Christ, the son of
Mary, is the expected Messiah, and that none other is to be expected;
they know of Christ's speech on the cross, made to the repentant thief;
they believe in a heaven full of houris, with large black eyes and faces
like the moon at its full, in which all good Moslems are to have
continual rejoicings, and yet they go on performing the most barbarous
and inhuman forms of castration imaginable, which not only deprives its
victims of their virility, but subject more than three-fourths of those
operated upon to a painful death, and the remaining to a life of
continual misery. Have these poor subjects no right to future bliss, or
in what shape will they reach there? If the heavens of these eunuchisers
were like the heaven of Buddhism, or, as the Chinese call it, the
Paradise of the West, where, although all forms of sensual
gratifications are to be enjoyed, no houris are to be supplied to the
saints of Buddhism,--as even the women who enter this paradise must
first change their sex,--we might understand that, the genitals not
being needed in the eternal world, it might be considered a matter of
small moment to compel a man to go through this short and transient life
without them; but where a robust condition of the sexual organs is
suggested as one of the heavenly requisites, it would seem as if the
Turk would look upon the suffering, misery, and death that they cause,
in connection with the inhuman mutilation they inflict, with horror.
Doctrinal theology, whether in the East or West, is something
incomprehensible.



CHAPTER X.

HERMAPHRODISM AND HYPOSPADIAS.


There exists a class of human beings whose description is connected with
the subject of this work. They date back to mythological times, and the
confusion incident to the misapplication of names and the want of proper
observation on the part of the narrators has tended to carry the
uncertainty of their real existence to the present day. One reason that
this part of the subject would be incomplete without their description
is on account of the origin of their existence being intimately
connected with eunuchism, being, in fact, an outgrowth of this
condition; and any history of eunuchism would be but half told, without
the additional information concerning these persons.

Hermaphrodites, as stated, date back to mythology. Tradition tells us
that Hermaphroditus, a son of Venus and Mercury, was educated by the
Naiades dwelling on Mount Ida. At the age of fifteen years, he began his
travels; while resting in the cool shades on the woody banks of a
fountain and spring near Caira, he was approached by the presiding nymph
of the fountain, Talmacis, who, becoming enamored of him, attempted to
seduce him. Hermaphroditus, like Joseph, was the pattern and mirror of
continence, and would not be seduced. Talmacis then, like Potiphar's
wife, seized on the unlucky pattern of virtue, and prayed to the gods
that they should so amalgamate poor Hermaphroditus to her body as to
make them one. The prayer was heard on Olympus, and forthwith the two
became one, but with the distinctive characteristics of each sex
unchanged. Thus began that fabled race of the _androgynes_ of the
ancients. Another tradition, which is probably correct, affirms that
ancient Carnia, or Halicarnassus, was in those days the Baden-Baden of
Asia Minor; that thither repaired all the victims of gluttony,
debauchery, and general physical bankruptcy. Its name in ancient Caria
denotes its seaside-resort location, Hali-Karnas-Sos meaning literally
"Karnassus-by-the-sea," like Boulogne-sur-mer. The city was under the
protection of Hermes and Aphrodite, whose temples were near each other.
Human nature in the days of Halicarnassus did not much differ from human
nature at Monte Carlo or Baden-Baden. The baths had a number of young
and handsome eunuchs who waited on the old, debauched, and nervous
wrecks, and the nymph who presided over the whole was Talmakis, a name
derived from the salty nature of the springs which fed the baths; this
nymph was worshiped as Aphrodite. Pederasty was one of the practices at
these baths. From these conjoined conditions the place was said to be
peopled with hermaphrodites,--meaning, at first, simply that they were
under the protection of Hermes and Aphrodite; and latterly the name was
attached to the passive agent in the pederastic art,--a name that has
followed the class and crossed the ocean into the interior wilds of
America, as in Powell's history of the manners and customs of the
Omahas, an Indian tribe of the Missouri, we find that they at times
practiced pederasty, the passive agent being called by the Indians an
hermaphrodite, or double sexed.[38]

The relations that from eunuchism led to pederasty are very easy of
explanation. Eunuchism induces an effeminate form, softer body, and
prevents the growth of the beard; the voice is softer and more
melodious; and their timidity renders them also more effeminate,
obedient, and dependent. The peculiar commingling of the female form
with that of the male furnished to the sculptors the models for those
wonderfully well-made forms which are yet to be seen, representing in
statuary the forms of Androgynes and Hermaphrodites; that of the
favorite eunuch of the emperor Adrian being remarkable for the symmetry
of its form and grace of pose.

Europe must have been astonished at the tales that were carried back by
the early explorers and voyagers, in relation to the New World. The
story of the immensity of the quantity of gold and silver, of great
stores of hidden treasures, of the quantities of precious gems and
priceless crystals was fully discounted when, from the Florida coast and
the explorers of the Lower Mississippi, men returned with the tale that
in the everglades and in the trackless forests, intersected by navigable
sloughs, there dwelt a people half of whom were hermaphrodites. Neither
the explorers nor their European historiographers seem able to have
grasped the true state of affairs. Many believed in the actual existence
of such numbers of these monstrosities, while others, arguing from what
was then known regarding the extraordinary development of the nymphæ and
clitoris, as well as of the great labia, of the women in the African
regions, concluded that these supposed _androgynes_, or hermaphrodites,
must be women, the dress assumed by these and the menial labors to which
they were consigned assisting to favor this opinion. The early
Franciscan missionaries to California found the men who were used for
pederasty dressed as women.[39] Hammond mentions the practice as in
vogue among the Indians of the southwest, which in a measure greatly
resembled that of the ancient Scythians in its operation, the men being
dressed as women, associating with women, and used for pederastic
purposes during the orgies of their festivals. These men had previously
been eunuchised by a process of continued and persistent onanism, which
caused at the end a complete atrophization of the testicle.

In regard to the great number of hermaphrodites observed in Florida and
on the Mississippi, the accounts are only reliable as far as they were
present in female garb and in an apparent state of slavery, being
compelled to do all the menial labor of the villages and camps, besides
being used for pederasty, no examination having been made by any
traveler. Their lot was different from those described by Hammond in his
work on "Male Impotence," where the whole transaction seems to have some
sort of religious and civil significance. In Florida, however, they
tilled the ground, extricated and carried off the dead during a battle,
and did all the work generally, being used for beasts of burden and not
allowed to cut their hair; but all authorities are silent or in complete
ignorance as to whether they had suffered castration. Pere Lafiteau,
however, gives an explanation which was in the last century considered
ridiculous, but which, in the light that has been thrown on the
existence of a former continent, and of the undisputable relation that
must, some ages in the past, have existed between Phoenicia and Central
America, seems a strongly probable solution of these customs. The Father
accounts for the presence of these American _androgynes_ in the
following manner: The Carribeans, or Caribs, were originally a colony
from Carnia; with these colonists was brought over the worship of their
Pagan gods of Caria and Phrygia; these two localities were the homes of
the Cybelian priesthood, who dressed in female garb, as did the
sacrificial priests of the Temple of Venus Urania. It is true that the
Java or Floridian priest had nothing in common with the priests of
Cybele or of Venus Urania; but, still, Lafiteau gave as lucid an
explanation for the existence of these conditions as any of his
contemporaries. Charlevoix observed the same practices among the
Illinois, which he attributed as being due to some principle of
religion. The Baron de la Hontan insists that the missionary,
Charlevoix, was mistaken; that the persons whom he saw in female attire,
whom he took to be men, were not men. Hontan asserts that they were
veritable hermaphrodites. The missionaries were, however, correct, as
what has since been observed confirms their opinion. M. du Mont, who
ascended the Mississippi for a distance of nine hundred leagues, also
reported meeting Indians at different places attended by these
petticoated androgynes.[40]

As strange as it may seem, many intelligent men were loth to part with
their belief in the existence of these double-sexed individuals; the
logic used by many of these insisters of hermaphrodism, although now
very ridiculous, was no doubt sensible logic one hundred and fifty years
ago. As a matter of curiosity, some of this reasoning will bear
repeating. It is taken from a Latin edition of an ancient description of
Florida, originally in the English, but translated into the Latin by the
geographer, Mercator. In this book we find the roots of some of the
myths that led Ponce de Leon and his steel-clad warriors to wander
through Florida in a vain search of that spring or fountain of the
waters of perpetual youth and of everlasting life which they were never
to find. We there learn that, in the days of the good old Spanish
knight, the inhabitants of Florida lived to a very old age, and that
they did not marry until very late in life, as before that period it was
very difficult to determine the sex of the individual.

From what has since been seen among the Indians, the probability is that
these were really eunuchs, and probably in slavery, as the result of the
fortunes of war, as their great number and servile condition will hardly
admit of the belief that they belonged to the same tribe as their
masters and oppressors. Pederasty was an old, very old practice, being
mentioned before circumcision; it prevailed among many of the Orientals,
and among the many peoples by whom the early Jews were surrounded, who
were, according to the Old Testament, about as an immoral, dissolute,
and bestial a set as one could well imagine. Their religions were
nothing but a gross mixture of stupid superstition and blind idolatry,
pederasty, fornication, and general cussedness. In the then state of the
Jewish nation, to have allowed them to mingle freely with these people
would have ended in having the Jews adopt all their customs and habits.
The aim of the Jewish leaders was to prevent any too free intercourse of
their people with these nations, that they might remain uncontaminated
even while dwelling near them. To accomplish this it was necessary to
raise a barrier that would be the distinguishing mark of the Jewish
nation. Jahns, in his learned work on the "History of the Hebrew
Commonwealths,"[41] lays down the idea that circumcision, as well as
many articles in their laws,--which to us appear trivial,--were in
reality intended to separate the Jews farther and farther from their
idolatrous, bestial, and heathenish neighbors, while at the same time
these same ordinances were intended to preserve a constant knowledge of
the true and only God, and maintain their moral and physical health.

Although hermaphrodism on a large scale, as an existing condition, was a
matter of serious belief at the end of the eighteenth century, it has
occupied no little attention in this. Courts have been called to decide
on cases to invalidate marriages, or to decide the sex, more than once;
and physicians are often asked the question, Do hermaphrodites really
exist? Dr. Debierre, of Lyons, published in 1886 a valuable paper,
entitled "Hermaphrodism Before the Civil Code: its Nature, Origin, and
Social Consequences," which was published in the _Archives of Criminal
Anthropology_ of Lyons, France. In this short but very concise treatise,
Debierre gives us a complete review of the subject from mythological
times to 1886. It must be quite evident to all that there exists no
logical reasons why the sexual or generative organs should be exempt
from, at times, being subject to variations from the normal, either
through the commingling of two conceptions or of faulty development
affecting other parts of the body,--conditions that go to form
monstrosities. Debierre gives one peculiar case of a duplication of
vagina and uterus in a girl of nineteen, the appearance of the parts and
the septum between the vaginæ giving to the whole an appearance
precisely similar to that of a double-barreled shot-gun. These
monstrosities are as likely to happen as the different forms that
affect--either by arrested development or some abnormality of excessive
development--the head, which is a very prolific subject of anomalies.

Hermaphrodism is a common attribute in the vegetable kingdom, where
fixed habitation or position makes such a condition necessary; it is
also common to many of our lower forms of animal life, and even in the
human foetus the presence of the Wolfian bodies and the canal of Müller
in the same individual attest a primitive case or condition of
hermaphrodism. In other words, humanity begins its existence in a state
of hermaphrodism. This condition is found up to the end of the second
month of foetal life in the human being, in common with all mammals, as
well as all the vertebrates, where, however, it is subject to variations
as to time of development and limit of existence in the normal
condition. In the chick, it is only after the fourth day that the
genital gland begins to determine whether it will turn into an ovary or
a testicle; in the rabbit it is on the fifteenth day, and in the human
embryo on the thirtieth day. Hermaphrodism does not occur, however, from
this at first uncertain state of affairs, but rather from subsequent
developments of the external organs that by their abnormality of
formation simulate one or the other sex, while the internal organs may
belong without any equivocation of structure to its definite sex; as it
has often happened that some of these cases, having been the subject of
differences of opinion among experts during life, were, after death,
unanimously assigned to one sex by all of the same experts, the organs
readily defining the sex being completely of the one sex. As observed by
Debierre, where the subject is really a female, even where the vagina or
uterus is unperceived, the presence of the menstrual function or some
physical disturbance at its stated periods are sufficient evidences, as
a rule, by which to determine the sex. The case of Marzo Joseph, or
Josephine, reported by Crecchio in 1865, had rudiments of an hypospadic
penis ten centimetres in length and a prostate of the male sex, with a
vagina 6 centimetres in length and 4 in circumference, ovaries,
oviducts, and uterus of the female; it was not until her death, at the
age of fifty-six, that her sex was fully determined. The case reported
by Sippel in 1880, supposed to be a male from external evidences, was at
death found to be a female. Guttmann reported a like case in 1882. The
celebrated case of Michel-Ann Dronart is remarkable; this case was
declared a male by Morand Pere and a female by Burghart, as well as by
Ferrein; declared asexual or neutral by the Danish surgeon, Kruger; of
doubtful sex by Mertrud. The case of Marie-Madeleine Lefort, to which
Debierre devotes four figures, is full of interest. One of the figures
is her portrait at the age of sixteen, and another is from her
photograph at the age of sixty-five. She has a man's head in every
particular of physiognomy and expression, having in the latter figure a
full beard and the peculiar intellectual development of a male sage; she
has the hairy breast of the man, with the mammary development of the
female, and an abnormally-enlarged clitoris, which was often mistaken
for the male organ. The vagina at its lower end was narrow, and the
urethral aperture opened into it some distance from its outer opening;
otherwise she was sexually a perfect woman, and menstruated regularly.
Debierre quotes the case which Duval gives in his work on
hermaphrodites, wherein a man asked for a dissolution of marriage,
claiming that his wife had a male organ, which, although she was a woman
in every other sense, prevented by its interference the consummation of
the marriage act. The court had the case examined, when it was found
that the erection of the clitoris, which was large, was enough to
interfere as the husband had stated. It decreed that the young woman
should have the objectionable and interfering member amputated, and on
the refusal to have this done the marriage should be dissolved. She
refused, and the divorce was consequently granted to the man.

From the history of Marie Lefort, it can well be conceived how the
popular mind, in ignorant times, could easily be imposed upon. Montaigne
relates the history of a Hungarian soldier who was confined of a
well-developed infant while in camp, and of a monk brought to a
successful accouchement in the cell of a convent; while Duval reports
the case of a priest in Paris who was found to be pregnant with child,
who was in consequence imprisoned in the prison of the ecclesiastical
court. These cases were strongly females in every sense, but with some
male characteristic sufficiently developed, like in the case of Marie
Lefort, to allow them to believe themselves men and to pass for such.

On the other hand, males have had some female characteristics so well
pronounced that they have passed for females. Debierre mentions a number
of cases, to wit: Ambroise Paré reported such a case in his time;
Ladowsky, of Reims, reports the case of Marie Goulich, who, up to the
age of thirty-three, was believed to be a female, at which time the
descent of the testicles removed all doubts as to sex. Sheghelner and
Cheselden have reported analogous cases, and Girand's case--who was
happily married to a man with whom he lived until the death of the
husband, in which the only female attribute was a blind vagina, which,
in his case, seems to have answered all purposes--was a most remarkable
case. As a rule, the cases of males who have been mistaken for
hermaphrodites have been cases of hypospadic urethræ in a greater or
lesser sense of deformity.

Debierre, however, mentions some cases of true hermaphrodism. He quotes
a number of cases, the earliest being from the writings of Coelius
Rhodigin, who claimed to have seen in Lombardy a case in which the
organs of the two sexes were side by side; Ambroise Paré records that in
1426 a pair of twins were born, joined back to back, wherein both were
hermaphrodites. Among the many reporters that he quotes, he mentions
Rokitansky, who reported a case in 1869, at Vienna, this being the
autopsy of Hohmann, who had two ovaries and oviducts, a rudimentary
uterus, and a testicle, with a sperm-duct containing spermatozoa. This
individual menstruated regularly, and it is an interesting question as
to what the result would have been had some of the spermatic fluid come
in contact with some of the ovules that were periodically discharged.
Hohmann had an imperforate penis and a bifide scrotum. Ceccherelli, who
gives a more minute description of this interesting case, relates that
Hohmann, who died at the age of forty, had menstruated regularly to the
age of thirty-eight. The penis was imperforate but hypospadic, from
whence came the urinary and spermatic discharges, and Hohmann could in
turn copulate as either male or female. Odin is also quoted in relation
to the case seen at the Hôtel-Dieu-de-Lyon, during the service of M.
Bondet. The subject was aged sixty-three, and named Mathieu Perret. The
case greatly resembled that of Hohmann, at the autopsy being found to be
double sexed. So that, while most of the cases mentioned are fictitious
and only apparent, the fact remains that the existence of true
hermaphrodites is indisputable.[42]

If the subject of either apparently or true hermaphrodism is one of
unhappiness, and oftentimes of discomfort and misery, history relates
that this unfortunate class has suffered additionally, from the laws and
action of ignorant and barbarian times, as such freaks of nature must
of necessity have occurred at all times; only in the then ignorant state
of medicine and anatomy they must have been considered as occurring much
oftener--every deviation from the normal being considered as
hermaphroditic. Opmeyer relates that in excavating in the neighborhood
of the capitol in Rome, the laborers discovered the bronze tables on
which were inscribed the twenty-two laws of Romulus, termed by many
historians "The Double Decalogue of Romulus." Article XV of this law, as
well as Articles IX and X, seem to be directed against the life of these
androgynes. In Roman history, however, we have an event which would seem
to contradict that there existed any laws in actual force against this
unfortunate class. It happened during the existence of the Punic wars,
when the people were more or less laboring under fear and excitement,
which would readily prepare them to accept any superstitious notion. It
was during these times that three of these androgynes were known to
exist in Italy. Titus Livius mentions that the existence of one of these
was denounced during the consulships of C. Claudius Nero and of Marcus
Livius. Etruscan soothsayers and seers were summoned to Rome, that they
might consult the signs and the conditions of the constellations that
accompanied the nativity of this hermaphrodite, or androgyne. These
impostors, after a careful consultation of all attending circumstances,
gave it as their opinion that the occurrence was an unfortunate
impurity, and that it could only result to the disadvantage of Rome,
unless she at once took steps to purify herself of such a monstrosity,
with the conclusion that the androgyne should be first exiled from Roman
soil, and then drowned in the depths of the sea. The unfortunate being
was accordingly inclosed in a chest and put on board a galley, which
put immediately to sea; when the vessel was out of sight of land the
chest was thrown into the Mediterranean.[43]

A hermaphrodite born in Umbria during the consulship of Messalus and C.
Lucinius was condemned to death, as well as was the one born at Luna
during the consulship of L. Matellus and Q. Fabius Maximus. Debierre
states that in the reign of Nero this barbarous custom was discontinued,
as this emperor admired these freaks of nature from their novelty, as it
is related that his chariot was drawn by four hermaphroditic horses.[44]

In connection with hermaphrodism it has been shown that the males who
have been supposed to be so malformed were really, in most instances,
but cases of hypospadias. It may not be uninteresting to observe that,
while during nearly four thousand years circumcision has been practiced
without the habit or condition ever having become transmissible or
hereditary, hypospadias has shown a decided tendency to being
transmitted. In Virchow's _Archives_, Lesser reports having treated
eight subjects during one generation in a family.[45] Fodéré records the
case of hypospadias reported by Schweikard, in a person of forty-nine
years of age, whose urethral orifice was near the junction of the penis
and scrotum, but who, nevertheless, had three fine children. The same
author records the remarkable case reported by Hunter to the Royal
Society of London, also so deformed, who successfully impregnated his
wife by receiving the spermatic fluid in a warm spoon and immediately
injecting it into the vagina.[46] Another interesting case is taken from
_L'Union Médicale_ of August 26, 1856. It instances both the heredity
connected with hypospadias and the peculiar circumstances under which
impregnation at times takes place; it is reported by Dr. Trexel, of
Kremsier, and is as follows: "On April 1, 1856, a newborn infant was
brought to Dr. Trexel, that he might determine its sex. The father and
mother were servants of a peasant. On an examination of the alleged
father, he was found to have all the external characters of a male; the
urethra, which was rather shorter than ordinary, but of large size, was
imperforate; the scrotum was divided into two pouches, each containing a
testicle. The apposed surfaces of the scrotal pouches were covered with
a red skin, and the division extended through their entire length. At
the root of the penis, in the anterior angle of these pouches, was an
opening of the size of a lentil; this was the orifice of the urethra.
The lower surface of the penis was grooved from the above-mentioned
orifice to the end of the glans. There was no prepuce. Almost in a line
behind the corona of the glans, and in the groove, were two elliptical
openings, which readily admitted a large hog-bristle; there was a third
smaller opening two lines from the orifice of the urethra. This man had
always passed for a woman. He lay in the same room with the mother of
the child; and they acknowledged having had frequent connection. The
woman declared that she had had no commerce with any other man for three
years, and the man did not deny this assertion. The idea of cohabitation
with another man was further negatived by the circumstance that the
infant had the same conformation of the genital organs as the father.
How did fecundation take place? The three openings in the penis were
probably the orifices of the excretory ducts of Cowper's glands. But
might not these have been the openings of the ejaculatory ducts? It is
to be regretted that Dr. Trexel did not examine these canals; their
length and direction would have thrown light on the subject. The fact
of fecundation may also be explained by supposing that during coition
the posterior wall of the vagina supplied the place of the absent floor
of the urethra, thus forming a complete canal. This is the most probable
explanation."[47]

The above case, as stated, had passed for a woman; these cases are by no
means such rarities. The case of Marie Dorothee, mentioned by Debierre
in his work, was as peculiar. Hufeland and Marsina had pronounced Marie
a woman, while Stark and Martens pronounced her a man, and Metzger could
not determine on the sex. The case of Valmont, noticed by Bouillaud and
Manee, is on a par with that of Giraud, in which the party was married
as belonging to one sex and where it was not until after death
ascertained that the person belonged to the other sex. Valmont had a
hypospadic urethra and penis; a scrotum without testicles; ovaries with
the Fallopian tubes; a uterus opened into a vagina of two inches in
length, which, gradually narrowing, ended in the male urethra, to which
was attached a prostate gland. Valmont contracted marriage as a man and
was not discovered to have been a female until the autopsy revealed her
to be a woman. The relation does not state anything in regard to
menstruation; so that her condition in that regard is unknown.[48]

There has also been reported a number of cases in the male analogous to
the double organed female mentioned by Debierre. Geoffrey St. Hilare
reports a case where the penis was double, one being above the other,
urine and semen flowing through both urethras. Gorè mentioned a like
case to the Academy in 1844. Dr. Vanier (Du Havre) records the case
reported by Huguier to the Academy, where the organs in the anatomical
preparation which he exhibited were so anomalous that it was impossible
to decide the sex. Aside from the medico-legal aspects that these cases
present, there is an interesting Jewish theological question connected
with them. The law is explicit as to circumcision; the cases presenting,
if males, should be circumcised, but how to determine the sex where an
autopsy alone will decide the question is not defined. It has been
decided, in such cases where the presumption is that the child is of the
male sex, that, like in cases of absence of prepuce, a suppositious
circumcision should be performed, so that the covenant should be
observed; this being in keeping with the sentiment shown by the Jews
when persecuted by the Romans, or, later, by the Spaniards, who often
were not able to circumcise until after death; but they never fail to
comply with the covenant as far as it is possible.

Cases are liable to occur, however, which, without leaving the question
as to sex in doubt, if reasoned by exclusion, would not furnish any
possible opportunity for circumcision. Such a case is reported in
Virchow's _Archives_, vol. cxxi, No. 3; also in the _British Medical
Journal_ of December 6, 1890, and in the _Satellite_ for January, 1891.
It is one of congenital absence of penis. "Dr. Rauber records very
briefly the case of a shoe-maker, aged 38, who complained of pain and
trouble in the anus. On examining him, Rauber found a well-formed
scrotum containing two testicles, each with a vas deferens and spermatic
cord, but no trace of a penis. The urethra opened apparently into the
anterior wall of the rectum. The man occasionally experienced sexual
excitement, followed by an emission into the rectum. The burning pain
complained of in the rectum and about the anus was due to the irritation
caused by the urine. The man would not allow an ocular inspection of
the interior of the rectum. Unfortunately, the details of this very rare
condition are incomplete."

It would be interesting to know where the seat of his sexual desire is
situated, unless an aching testicle is such. I once knew a Spiritualist
who claimed to feel the pains suffered by any friends with whom he was
in sympathy; he once tried to argue with me that a certain lady
patient--a warm personal friend of my questioner and a Spiritualist--had
ovaritis, because he felt an intense burning pain in his _right ovarian
region_ whenever he went near to her. I tried to reason with him that
that pain should be in his right testicle, but he would insist on having
the sympathetic pain in _his_ ovarian region.



CHAPTER XI.

RELIGIO MEDICI.


Sir Thomas Browne, in his "Religio Medici,"[49] alludes to the scandal
that is generally attached to our profession, we being accused of
professing no religion. That this opinion is still prevalent at the
present day is undeniable,--philosophers and physicians are believed to
be atheists and non-religionists,--while, at the same time, by that
strange contradiction that is so common, philosophers and physicians are
the known and recognized sources of religions, such is the intimate
relation existing between physical and moral hygiene. Confucius, the
contemporary of Pythagoras, whose religion was said to be nothing more
than the observance of a certain moral and political ethical code, and
he who first formulated the text "that one should do unto others as one
wishes others to do unto him," the founder of the Confucian religion,
the orthodox religion of China, was a philosopher. Buddha, the founder
of the second creed recognized in China, and which forms the religion of
a great part of eastern Asia, was also a philosopher who was endeavoring
to reduce the Brahminical religion to the simple principles of
philosophical religion, based on morality. Moses not only was the
greatest philosopher of his time, but also had an insight into medicine
that to us of the present day is simply incomprehensible. The Great
Master was both a philosopher and a physician, his disputes with the
learned and his attention to the sick having given him the titles of
Great Master and Divine Healer.

To use the words of the "Religio Medici," the great body of the medical
profession can, without usurpation, assume the name of Christians; for
no monk of the desert convents of Asia Minor or religious knight of the
middle ages, either in their care of the sick, or giving food and
shelter to the weary, or protection of sword and shield to the oppressed
pilgrim plodding his way to the Holy Land, were more deserving of the
name of Christian than the medical man unwearily and unselfishly
practicing his profession. To the true student of his art there is that
in medicine which makes of the physician a practical Christian. Nor is
there aught in medicine, either in its traditions, history, study, or
practice, that in the lover of his art should ever make him anything but
a philosophical and practical religionist. The physician, such as is
actively engaged in the daily practice of his profession, instead of
having no religion, is really a practical religionist, and, although he
may subscribe to no outer ceremonial form or dogma, his life is such
that a Confucian, a Buddhist, a Christian, or a Hebrew can behold in him
the practitioner of the essence of either of their religions,--a
conception carried out by Lessing, in his play of "Nathan the Wise,"
where the Jew, the Saracen, and Crusader teach the impressive lesson
that nobleness is bound by no confession of faith or religion; showing
the principle that should guide true religion.

The Rev. Dr. Townsend, of Boston University, has given a very
interesting and intelligent relation of the connections that exist
between medicine and the Old Testament, in the light of
nineteenth-century science.[50] The article in question is interesting
in its logical reasons as to why the Bible was inspired by a superior
power, as well as in the comparisons it lays before us of the medicine
of the Pagans and that of the Bible, during the early history of the
world. After reviewing the false, crude, and senseless vagaries and
superstitious notions that passed for medicine from the period of the
Trojan war, in 1184 B.C., to the dissolution of the Pythagorean Society,
500 B.C.--periods which existed after the writing of the books of
Moses,--and the period between 500 B.C. and 320 B.C., or the philosophic
era of medicine, during which flourished the father of our present
system of medicine, an era of advancement, but which in our eyes is
still full of errors and unscientific conclusions. From these two
periods we span over centuries of darkness for science and medicine to
the ages of Ambroise Paré and the more modern fathers of our art, who by
perseverance finally extricated medicine from the mass of magical and
superstitious rubbish which, like barnacles, had clung to it during its
passage through the dark and ignorant ages. After this review our author
turns to the Bible and discourses in this wise:--

"Turning our attention to the Bible, we take the position that, though
it was not designed to teach the science of medicine, still, whenever by
hint, explicit statement, or commandment there is found in it anything
relating to medicine, disease, or sanitary regulation, there must be no
error; that is, provided the Bible, in an exceptional sense, is God's
book. Now, what are the facts in this case? They are these: though the
Bible often speaks of disease and remedy, yet the illusions, deceptions,
and gross errors of anatomy, physiology, and pathology, as formerly
taught, nowhere appear upon its pages. This, it must be acknowledged, is
at least singular. But more than this: the various hints and directions
of the Bible, its sanitary regulations, the isolation of the sick, the
washing, the sprinkling, the external applications, and the various
moral and religious injunctions in their bearing upon health are
confessed to be in harmony with what is most recent and approved. To be
sure, the average old-school physician of a century ago would have
blandly smiled at our simplicity, had it been suggested to him that his
methods would be improved by following Bible hints. 'What did Moses know
about medical science?' would have been his reply. But Moses, judged by
recent standards, seems to have known much, or, at least, to have
written well."

The above statement is a truthful relation of facts, from which it can
well be conceived that even in the Bible the physician finds something
to inspire him with the idea of its divine inspiration, as the very
history of medicine, with which it is connected, and with which he is
familiar, only lends him further support in that direction. Most
intelligent physicians are also lovers of philosophical history. None is
more entertaining than Rawlinson, either in his "Seven Great Monarchies"
or his "Ancient Egypt." In his "Ancient Religions," in his concluding
remarks, he observes as follows, in regard to the Hebraic religion: "It
seems impossible to trace back to any one fundamental conception, to any
innate idea, or to any common experience or observation, the various
religions which we have been considering. The veiled monotheism of
Egypt, the dualism of Persia, the shamanism of Etruria, the pronounced
polytheism of India are too contrariant to admit of any one explanation,
or to be derivative of one single source.... It is clear that from none
of the religions here treated of could the religion of the ancient
Hebrews have originated. The Israelite people, at different periods of
its history, came and remained for a considerable time under Egyptian,
Babylonian, and Persian influence, and there have not been wanting
persons of ability who have regarded Judaism as a mere offshoot of the
religion of one or the other of these three peoples. But, with the
knowledge that we have now obtained of the religions in question, such
views have been regarded as untenable, if not henceforth impossible.
Judaism stands out from all other ancient religions as a thing _sui
generis_, offering the sharpest contrast to the systems prevalent in the
rest of the East, and so entirely different from them in its essence
that its origin could not but have been distinct and separate.... The
sacred books of the Hebrews cannot possibly have been derived from the
sacred writings of any of these nations. No contrast can be greater than
that between the Pentateuch and the 'Ritual of the Dead,' unless it be
that between the Pentateuch and the Zendavesta, or between the same work
and the Vedas.... In most religions the monotheistic idea is most
prominent _at the first_, and gradually becomes obscured, and gives way
before a polytheistic corruption.... Altogether, the theory to which the
facts appear on the whole to point is the existence of a primitive
religion, communicated to man from without, whereof monotheism and
expiatory sacrifice were parts, and the gradual clouding over of this
principle everywhere, unless it were among the Hebrews."[51]

Medicine is indebted for its advancement to the Hebraic religion to a
greater extent than is generally believed. In the early Christian
centuries there existed three great creeds: the Christian, Hebraic, and
Mohammedan. The Christian Church was in a perplexing condition. As
observed by Draper,[52] it was impossible to disentangle her from the
principles which had, at the beginning, entered into her political
organization. For good or evil, right or wrong, her necessity required
that she should put herself forth as the possessor of all knowledge
within the reach of the human intellect. But the monk and priest were
prohibited from studying medicine,[53] as by so doing the church saw
that she would have to relinquish the spiritual control of disease were
medicine a matter of scientific research; she preferred to hold on to
her spiritual dominion, and let science slumber in darkness. On the
other hand, the Mohammedans, recognizing the principle of fatalism in
their religion, it was not to be expected that they should cultivate an
art entirely opposed to that principle. In this state of affairs the
Jewish physician, led by the teachings of his religion, alone presented
the study of medicine in a scientific manner, and its practice and its
result taught the Moslems that medical science placed it within the
power of man to keep himself out of the grave, when either assailed by
disease or laid low by the wounds of war. The Arabs were not slow to
avail themselves of this discovery; and to the learning and skill of the
Jewish physician, guided by the light of an intelligent Deity and a
liberal religion, does medicine owe the existence of those able and
learned Arabian physicians that flourished during the eleventh and
twelfth centuries.

There has been more or less of fault-finding in regard to certain rules
and ordinances being sacramental, which, from the nature of things,
should have been merely advisory or suggestive, as they pertained
more to the hygienic welfare of the people than to the spiritual. Thus
to reason, is neither philosophical nor in concert with our knowledge
of the structure of man, and of the intimate relations that exist
between mind and body, or of good health and good morals. The writer
has seen violent catharsis produced by bread pills, after podophyllin,
castor-oil, and phosphate of soda in the most generousdoses--administered
as one would drop a letter in a mail-box--had completely failed; it is
all in the manner and way we give a medicine or treat a disease. Certain
narcotic and irritant poisons or powerful sedative agents have a
physical action uninfluenced by the mind, but an intelligent physician
is hardly supposed to drive at the small tack of disease with such
powerful sledge-hammers. Charcot, recognizing the power of and availing
himself of such a remedial agent as the pilgrimages to the Notre Dame de
Lourdes, is an evidence of the intelligent and enlightened practitioner,
who has learned, what the Bible taught, long, long ago, that human
nature must be taken as it is found, and that, like the homely saying of
Mohammed, as the mountain would not come to him, he must go to the
mountain. Moses and all the Scriptural writers were well aware of this
state of affairs, and their manner of using their knowledge was adapted
and timed to the general intellectual development of the times.

There is one point in connection with the above that should not escape
our attention, this being that, while the Hebraic creed and the people
still subscribed to the theological doctrine of the origin of disease,
in common with the religions then in vogue, here the connection stopped.
All other creeds--not excepting Christianity--looked forward to a
theological doctrine of the cure of disease. With the Hebrew, disease
was looked upon as the result of some infraction on his part of some of
the laws, and the consequent expression of displeasure on the part of
the Deity. He was taught, however, that the observance of certain
ordinances were both conducive to health and to the prevention of
disease, and acceptable to God, as well as to rely upon his study and
skill to cure disease. This was equivalent to teaching them that
diseases arose from physical causes, and that physical means were to be
used to combat them. From this arose the practice of exposing the sick
in public places, that they might receive the benefit of the advice of
such who might have had experience in a like case. It is from their
religion that Hebraic medicine has received its foundation of
intelligent philosophy that carried it in its purity through all ages,
free from magic, superstition, and imposture. With other creeds and
religions, medicine, disease, as well as the physical phenomena
affecting nature, were believed to be the arbitrary expression of anger
of their gods, and that the cure of disease, or alterations in physical
phenomena, were to be as arbitrarily effected, regardless of the
existence or action of physical laws. It is to be regretted that one of
the sects which has sprung from the Hebraic creed, and which worships
the same God, has been unable to emancipate itself or its people from
the idea of an arbitrary theological doctrine of the origin and control
of disease. It is this creation of a narrow-minded theology of a
vaccilating, unintelligent, unphilosophical, and arbitrary God, who
would neither respect nor regard the laws of his own creation, that has
led the great body of physicians out of the modern churches. They do not
deny the existence of the Deity, but the god of their conception is a
higher and nobler god,--the Deity of Religio Medici.

When the prize for the best essay on "_the power, wisdom, and goodness
of God, as manifested in creation_"--a series of publications known as
the Bridgewater Treatises--has been nearly every other time won by
physicians, among whom we may mention Sir Charles Bell, Dr. John Kidd,
Dr. Peter M. Roget, and Dr. William Prout,--not only won on their own
merit, but in competition with learned theologians and noted
divines,--we may truly say that physicians are by no means atheists or
agnostics, but that, on the contrary, they are the real exponents of a
practical and intelligent religion, which they not only practice, but
fully and intelligently comprehend.



CHAPTER XII.

HEBRAIC CIRCUMCISION.


The first mention that we meet concerning circumcision is in Genesis. It
is the command of God to Abraham; in establishing the covenant with him,
He said to him: "This is my covenant, which ye shall keep between me and
you, and thy seed after thee: every man-child among you shall be
circumcised. And ye shall circumcise the flesh of your foreskin; and it
shall be a token of the covenant betwixt me and you" (Gen. xvii, 10,
11). It was also ordained that this should be extended to servants
belonging to Abraham and his seed, as well as to their own children; and
that in case of children it should be done on the eighth day after
birth.[54] This was appointed as an ordinance of perpetual obligation on
the Hebraic family, and its neglect or omission entailed being cut off
from the people (12, 14). In compliance with this ordinance, Abraham,
although in his ninety-ninth year, circumcised himself and all his
slaves, as well as his son Ishmael. Slaves by purchase were
circumcised,[55] as were any strangers, who were also circumcised before
being allowed to partake of the passover or to become Jewish citizens.
It was to be observed by all heathens who became converted to the Jewish
faith. During the wanderings in the wilderness circumcision was not
practiced, but Joshua caused all to be circumcised before they entered
the promised land.[56]

The old Hebrews strictly followed the injunction to circumcise on the
eighth day, and of such importance in a religious sense was this rite
in their estimation that even when the eighth day fell on the Sabbath
the eighth day ordinance was observed. The ordinance, however, was not
blindly arbitrary, as rules were laid down for exception. For instance,
whenever a family had lost two children through circumcision it did not
become obligatory on that family to circumcise the third child, who was
however considered as entitled to all the benefits of the congregation
or of the Hebraic religion, just the same as if he had been circumcised.
Again, Maimonides, or Moussa Ben Maimon, a celebrated physician and
rabbi, born in Cordova in the year 1135 A.D., among his works on
medicine, has left directions in regard to circumcision which have been
the guides of the _mohels_. Among the Hebraic physicians it was
considered that the child partook of the constitutional strength or
feebleness of the mother; hence the rule above mentioned, in regard to
exemption to circumcision, only was in operation when the two who had
formerly died belonged to the same mother as the third one, who would
thereby be exempt; but if the two children had belonged to another
woman, and this third child of the father was not from the same mother,
the rule did not exempt. The third child of the mother who had
previously lost two infants at the rite was, however, to be circumcised
when arrived at adult age, provided no further counter-indication
occurred. The opinion that the mother gave the constitution to the child
was promulgated by Maimonides and became general.

The eighth day is believed to refer to the eighth day after full term;
thus, a child born prematurely is not supposed to be circumcised until
eight days after it would have reached its full term, and only then if
its general good condition is settled. Maimonides looked upon infantile
jaundice, general debility, and marasmus as contra-indications to the
performance of the rite; any erysipelatous inflammation, ophthalmia,
anæmia, eruption of any kind, fever, tendency to convulsive
movements--in fact, any observable departure from normal health should
be allowed to pass before performing the rite. Aside from these general
conditions that denoted that the operation was contra-indicated, the
local condition of the organ itself also was to be examined, and if
certain conditions existed the operation was to be put off. These
conditions consisted in any irritation or red appearance of the prepuce,
due to either inflammation or to the irritative action of the sebaceous
matter underneath the prepuce, the acrid nature of these secretions
being at times sufficiently virulent to produce an ulceration, even in
the newborn.[57]

Among the Hebrews themselves there are those who do not look upon
circumcision in a favorable light, but on something that has served its
time in its own day, and within the past year a proselyte has been
accepted into one of the New York synagogues without previous or
subsequent circumcision, these reformed Jews looking upon adult
circumcision as too painful an operation to be gone through, as they
claim, unnecessarily. It must be said, however, that these persons look
upon circumcision purely in a sacramental light, and simply as an
arbitrary ordinance of God in the remote ages of antiquity, but which in
the present century has not enough practical significance to warrant its
performance on the occasion of an adult joining the congregation. These
persons look upon it, as has been said, in a purely theological light,
and ignore any and all considerations of hygiene in connection with it,
claiming that if it is a simple matter of hygiene, then it is not a
sacrament, and that, if it is sacramental, then the subject of hygiene
has nothing whatever to do with it. The force of their reasoning and
logic is very obscure and clouded, to say the least. The covenant either
exists or it does not; to do away with one ordinance in any arbitrary
manner is to gradually begin to crumble down the whole fabric of
Judaism; for when exceptions are begun, one tenet as well as another is
liable to topple over. If the rite is a sacrament, then it should be
performed on all, and a proselyte should not be admitted without being
circumcised, and, if a hygienic measure only, the same rule holds. These
Jews evidently ignore the rationalism that governed the promulgation of
the Mosaic law, and its recognition of the inseparability of the moral
from the physical nature of man.

Montaigne has left us a description of the performance of the rite, as
witnessed by him in the city of Rome in the sixteenth century. He
relates it as follows: "On the thirtieth of January was witnessed one of
the most ancient ceremonies of religion practiced by mankind, this being
the circumcision of the Jews. This is performed at the dwelling, the
most commodious chamber being chosen for the occasion. At this
particular time, by reason of the incommodity of the house, the rite was
performed at the door of the domicile. The godfather sat himself on a
table, with a pillow on his lap. The godmother then brought the child,
after which she retired. The godfather then undressed the child's lower
part so as to expose his person, while the operator and his assistant
began to chant hymns. This operation lasts at least a quarter of an
hour. The operator may or may not be a rabbi, as it is considered a
great blessing to perform this operation; so that it follows that many
are found who are anxious to exercise their faculty in this regard,
there being a tradition that those who have circumcised a certain number
do not suffer putrefaction in their mouth, nor does their mouth become
food for worms after death; so that it often happens that they make
presents of value to the child for the privilege of operating upon it.
On the same table on which the godfather is seated all the required
instruments and apparatus are placed, while an assistant stands by with
a flask of wine and a glass. A warming-pan full of coals is on the
floor, at which the operator warms his hands. The child being now ready,
with its head toward the godfather, the operator, seizing the member,
draws the foreskin toward him with one hand, while with the fingers of
the other he pushes back the glans; he then places a silver instrument,
which fixes the skin, and which at the same time holds back the glans so
that the knife may not cut it. The foreskin is then cut off and buried
in the little basin of soil that forms one of the appurtenances to the
operation. The operator then tears with his nails the skin which lies on
the glans, which he turns back over the body of the member. This seems
the hardest and most painful part of the operation, which, however, does
not seem dangerous, as in four or five days the wound has healed. The
crying of the child resembles that of an infant undergoing baptism. No
sooner is the glans uncovered than the operator takes a mouthful of
wine; he then places the glans in his mouth and sucks the blood out of
it; this he repeats three times. This done, he applies a powder of
dragons' blood, with which he covers up all the wound, the parts being
then done up in expressly-cut bandages. He is then given a glass of
wine, over which he says some prayers; of this he takes a mouthful, and,
after moistening his fingers in the same, he applies the wine three
times to the child's mouth. The wine is then sent to the mother and the
women, who are in some other apartment, who all take a sip. An assistant
then takes a silver instrument, pierced with little holes like a small
strainer, which he first applies to the nose of the officiating
minister, then to that of the child, and afterward to the nose of the
godfather."[58] The above description of the performance of the rite in
the sixteenth century answers to the method of its performance as was
witnessed some years ago in France.

In the "Biblical, Theological, and Ecclesiastical Cyclopædia" of Drs.
McClintock and Strong the following description of the rite, as taking
place in our modern synagogues, is given:--

"The ceremony of circumcision, as practiced by the Jews in our own
times, is thus: If the eighth day happens to be on the Sabbath, the
ceremony must be performed on that day, notwithstanding its sanctity.
When a male child is born the godfather is chosen from amongst his
relatives or near friends; and if the party is not in circumstances to
bear the expenses, which are considerable (for after the ceremony is
performed a breakfast is provided, even amongst the poor, in a luxurious
manner), it is usual for the poor to get one amongst the richer, who
accepts the office, and becomes a godfather. There are also societies
formed amongst them for the purpose of defraying the expenses, and every
Jew receives the benefit if his child is born in wedlock.

"The ceremony is performed in the following manner, in general: The
circumciser being provided with a very sharp instrument called the
circumcising-knife, plasters, cummin-seeds to dress the wound, proper
bandages, etc., the child is brought to the door of the synagogue by the
godmother, when the godfather receives it from her and carries it into
the synagogue, where a large chair with two seats is placed; the one is
for the godfather to sit upon, the other is called the seat of Elijah
the Prophet, who is called the angel or messenger of the covenant. As
soon as the godfather enters with the child, the congregation say,
'Blessed is he that cometh to be circumcised, and enter into the
covenant on the eighth day.' The godfather being seated, and the child
placed on a cushion in his lap, the circumciser performs the operation,
and, holding the child in his arms, takes a glass of wine into his right
hand, and says as follows: 'Blessed be Thou, O Lord our God, King of the
Universe, Creator of the fruit of the vine! Blessed art Thou, O Lord our
God! who hath sanctified His beloved from the womb, and ordained an
ordinance for His kindred, and sealed His descendants with the mark of
His holy covenant; therefore, for the merits of this, O living God! our
rock and inheritance, command the deliverance of the beloved of our
kindred from the pit, for the sake of the covenant which He hath put in
our flesh. Blessed art Thou, O Lord, the Maker of the Covenant! our God,
and the God of our fathers! Preserve this child to his father and
mother, and his name shall be called in Israel, A, the son of B. Let the
father rejoice in those that go forth from his loins, and let his mother
be glad in the fruit of her womb, as it is written: "Thy father and
mother shall rejoice, and they that begat thee shall be glad."' The
father of the child then says the following grace: 'Blessed art Thou, O
Lord our God, King of the Universe! who hath sanctified us with His
commandments, and commanded us to enter into the covenant of our holy
father, Abraham.' The congregation answer: 'As he hath entered into the
law, the canopy, and the good and virtuous deeds.'"[59]



CHAPTER XIII.

MEZIZAH, THE FOURTH OR OBJECTIONABLE ACT OF SUCTION.


Biblical and rabbinical traditions throw no light on the origin of the
details of the operation as now performed. That it was anciently
performed with a knife of stone is certain; an event common in its
general observance, and which seems to have pervaded all nations or
races, howsoever remote or scattered, that it has induced Tylor[60] to
ascribe the origin of the rite to the stone age. We are told that when
Moses was returning to the land of Egypt he had neglected circumcising
his son, and that because of that neglect he nearly lost his son's life;
his wife, Zipporah, the daughter of the Midian king and priest, Jethro,
seeing the danger and knowing its cause, took her little son Gershom and
circumcised him with a stone knife, and offered the foreskin to God as a
peace-offering. Just where the wine was first used we are not told.
Wine, however, was an emblem of thanksgiving, and, being one of the
fruits of the earth, was considered an acceptable offering to God. It
has since, in some form or other, either as wine or as the
representative of either divine or human blood, been used in both the
Catholic and Protestant Churches in their ceremonials or vicarious
sacrifices, or imitations of old customs. Circumcision was by many
connected with a blood sacrifice; it was so suggested by the words of
Zipporah at the circumcision of Gershom: "And Zipporah, his Midianitish
wife, took up a sharp stone and cut off the foreskin of her son, and
cast it at his feet and said, 'Surely a _Khathan_ of blood art thou to
me.'" Much speculation has followed the use of this word _Khathan_,
which, in the ordinary Arabian, may mean either husband or son-in-law;
it also means a newly-admitted member of a family; a similar word means
"to provide a wedding feast," and one other word from the same root and
branch means "to give or receive a daughter in marriage." In our own
day, the _mohel_, or ministerial circumciser, makes it a practice to
draw a little blood from the skin of such as are presented for the rite,
but whom nature has not furnished with sufficient foreskin for the
operation. The application, thrice repeated, of the blood and wine to
the lips of the child, is probably used as a sign of the sealing of the
compact. Wine is mentioned in connection with the High-Priest
Melchisedeck as the wine of thanksgiving at his meeting with Abraham;
wine was presented to Aaron by the angel, who, giving him a crystal
glassful of good wine, said to him: "Aaron, drink of this wine which the
Lord sends you as a pledge of good news." Originally, circumcision must
have consisted of the simple removal of the foreskin, and the
elaboration of the ceremonial details must have been a subsequent
occurrence; persons wounding their fingers will instinctively carry them
to their mouth, and it may be that the suction practiced by the Hebrews
had its origin in this natural hæmostatic suggestion. Wine as a
hæmostatic and as an emblem of thanksgiving and an acceptable offering
naturally came in as an accessory.

This practice--which, in the old, patriarchal days of the simple
shepherds, when men only lived on the flesh of their own flocks, their
diet, however, consisting mostly of cakes of flour, milk, honey, a few
herbs, or the flesh of the goat or sheep--could not have been as
objectionable as it is at the present day, with blood and secretions in
a continued ferment through diet and habits. Man, living in the open air
of Armenia, Palestine, or Arabia, sleeping in the open tents of our
Biblical forefathers, living on the simple diet of a shepherd's camp,
with the abstemiousness that those climates naturally induce in man,
could not help but be healthy. In those early days, when neither
passion, anxiety, nor worry disturbed either digestion or sleep, man had
no vitiated secretions, wine was then a rarity, and water was the drink.
One of the early patriarchs on such diet would have furnished a dainty
and savory dish to the most fastidious cannibal, who is now tormented by
the _komerborg kawan_, this being a term used by the Australian
cannibals to designate the peculiar nausea that is induced in them when
they recklessly eat of white man,[61]--something which they do not
experience from feasting on the savages who live on the simple diet of a
pastoral tribe. This primitive gastronomic science in regard to
cannibalism even reached such a pitch of refinement that, as has been
previously mentioned, some tribes even resorted to emasculation to
improve the flavor of the animal juices, which by this procedure became
less acrid. The Arabian and Oriental traditions bring us down tales of
how, on the same principles, human beings intended to grace the festive
platter were fed exclusively on rice. The salivary and buccal
secretions, under such a simple diet as that indulged in by our Biblical
forefathers, become bland and harmless; not only harmless, but even
antiseptic and positively beneficial, acting on the same principle as
local applications of pepsin. So that the practice, at the time of the
patriarchs and in their own family, of this part of the rite could not
have offered the same objection that it does at the present day. The
modern house-dweller, living on a mixed diet and in a climate that
induces him to eat grossly, both as to quality and quantity, partaking
more or less of vinous, spirituous, or fermented liquors, as well as
indulging in tobacco, is quite another being from the Arabian or
Armenian shepherd of former days. Business anxieties and worry also have
a very pronounced effect; so that, with the change in the conditions of
man and the inception and multiplication of diseased conditions, as well
as the creation of constitutional and transmissible diseases, this
practice of suction should have been stopped.

Intelligent rabbis, devoted to their religion, are necessarily prone to
defend any of the details in its ceremonials that age and practice have
sanctioned, and even some of the later writings of Israelism seem to
make the mezizah, or suction, a necessary and ceremonial detail. In the
"Guimara," composed in the fifth century, Rabbi Rav Popè uses these
words: "All operators who fail to use suction, and thereby cause the
infant to run any risk, should be destituted of the right to perform the
ceremony." In the "Mishna" it says, "It is permitted on the Sabbath to
do all that is necessary to perform circumcision, excision, denudation,
and suction." The "Mishna" was composed during the second century. The
celebrated Maimonides lent it his sanction, as in his work on
circumcision he advises suction, to avoid any subsequent danger. Our
modern Israelites are supposed, as a rule, to have taken their
authority, aside from previous usage and custom, from the "Beth Yosef,"
which was written by Joseph Karo, and subsequently annotated by the
Rabbi Israel Isserth. In all of these sanctions, however, there is no
reason expressed why it should be performed.[62] Maimonides undoubtedly
looked upon this act as having a decided tendency or action in depleting
the immediate vessels in the vicinity of the cut surface, and that the
consequent constriction in their calibre would prevent any future
hæmorrhage. That this is the natural result of suction is a fact readily
understood by any modern physician. The depletion of the vessel for some
distance in its length, with the contraction in the coat that follows,
is certainly a better preventive to consequent hæmorrhage than the
simple application of any styptic preparation that can only be placed at
the mouth of the vessel, but which leaves its calibre intact. Hot water,
or an extreme degree of cold, will answer to produce this contraction
and depletion, but there is here a local physical reaction that is more
liable to occur than when the contraction has taken place naturally, as
when induced by depletion, instead of by the stimulus of either heat or
cold. So that if, in the light of modern civilization and changed
conditions of mankind, and the existence of diseases which formerly did
not exist, we are now convinced that suction is dangerous, we should not
judge the ancients too hastily or rashly for having adopted the custom,
as it is certainly not without some scientific merit; although,
authorities are not wanting who hold that suction or depletion increases
the danger of hæmorrhage.

It can be understood that the results of suction would be in some
measure analogous to those left by the application of an Esmarch bandage
on a limb. The ancients, performing the operation with rude implements
and having no hæmostatic remedies or appliances, naturally followed the
best means at their command; they evidently feared hæmorrhage, and their
rule in regard to exemption shows us that they recognized the existence
of hæmorrhagic diathesis or other transmissible peculiarities of
constitution. This same fear of hæmorrhage probably suggested the second
step of the operation being performed, as it is by laceration instead of
by cutting instruments, showing in this an evident desire to limit the
cutting part of the operation to as small a limit as possible. Against
an infant who has decided hæmorrhagic tendency, we are about as helpless
as were the ancient Hebrews, and, while the Turkish or some of the
Arabian methods of performing the operation may be said in ordinary
cases--by the application of cord and the consequent constriction--to
limit the danger from subsequent hæmorrhage, still, in the hæmorrhagic
diathesis this would not be of any avail; so, as already observed, we
must not too rashly judge those old shepherds of the Armenian plains for
adopting a practice which to them was calculated to avert subsequent
dangers, or their descendants following in their footsteps, until having
learned better, even if that practice is to us disgusting, primitive,
and useless.

Cases occur,--happily not frequently,--of alarming and uncontrollable
hæmorrhage. The following case is suggestive of the alarming extent and
persistence that may attend one of those hæmorrhagic cases, even when
recovery eventually takes place. It is reported by Dr. Sannanel in the
_Gazetta Toscana delle science medicale e fisiche_ of 1844. The case was
that of a Jewish infant circumcised on the eighth day. Some hours after
the operation the child was observed to be bleeding; the hæmmorrhage
would only cease for a few moments, and then come on with increased
force, and which proved rebellious to ordinary remedies. Dr. Sannanel
was called during the night of the third day after the operation. A
number of physicians had been in attendance, and neither ice,
astringents, pressure, nor any usual hæmostatic means had had the least
effect; cautery with nitrate of silver, sulphuric acid, and the actual
cautery by means of heated iron were tried in succession, without any
good results. Ten days passed in this manner, the hæmmorrhage only
ceasing for a few moments at a time, and the child was nearly
exsanguinated from the continued serous seepage and the paroxysmal
hæmorrhages, when a lucky application of caustic potassa almost
immediately stopped the hæmorrhage. This case was seen by nearly all the
leading medical men of Leghorn, who lent their aid and counsel to save
the little life. The case is interesting from the length of time it
persisted, and that even after all the loss of blood and suffering that
the little fellow endured he survived.[63]

Dr. Epstein, of Cincinnati, in a letter of March 29, 1872, to the
_Israelite_ of that city, mentions a nearly fatal case from hæmorrage
after the rite of "_Milah_," and gives the result of his experience in
such cases. He argues that _Hitouch_ or _Hitooch_ alone, or the first
step or cutting off of the prepuce, performed with ordinary care, could
hardly be followed up with any more serious results than can be
controlled with the application of a little acidulated water. The second
act, or _Periah_, the act of laceration, he looks upon as one that calls
for coolness, judgment, and skill, as the membrane should only be torn
so far and no farther, the thin, inner fold of the prepuce being
vascular only in the sulcus back of the corona and at its lower
attachment, where it forms the frenum, or bridle; any carelessness or
over-anxiety on the part of the operator in tearing this membrane too
far back results in danger of hæmorrhage; especially is this part of the
operation liable to be badly done if the inner preputial fold is thick
and resisting, as in that case undue force may carry the laceration back
into the vascular tissue. The means suggested by Dr. Epstein to arrest
hæmorrhage are those ordinarily used in hæmorrhagic cases, such as will
be given presently. The doctor regrets that the operators are not as
they should be, physicians, and that, when _mohels_ are employed,
persons are not sufficiently exacting as to their qualifications.[64]

In France the government has managed to secure more safety in the
operation. By a royal decree of date of May 25, 1845, in compliance with
a desire expressed by the Hebrew Consistory, it was ordered that no one
should exercise the functions of a _mohel_ or of _schohet_, without
being duly authorized to perform said functions by the Consistory of the
Circonscription; and that all _mohels_ and _schohets_ shall be governed
in the exercise of their functions by the Departmental Consistory and
the General Consistory. By virtue of this decree a regulation was passed
by the Consistories on the 12th of July, 1854, ordering that thereafter
circumcision should only be performed in a rational manner, and by a
properly qualified person. Suction was likewise abolished, and the wound
directed to be sponged with wine and water. This decree and the
resulting regulations have been of the greatest benefit to the French
Israelites, and some attention to the matter would not be amiss in the
United States.

This reformation has met with the approval of the leading French Jews,
whose General Consistory decided that suction was not necessarily a part
of the religious rite, and that, as it was undoubtedly introduced into
the rite on the days of primitive surgery, it was perfectly rational to
suppress this operative accessory, now that that same science, in its
enlightenment, pronounced it unsafe. The whole body of the Congregation
did not tamely submit to what they considered an innovation, and from
some of the mohels all possible resistance was opposed to prevent the
abolishment of this part of the operation from becoming a law. So
determined was this opposition in some instances that the Consistory of
Paris found it necessary to impose on all the mohels an obligation,
bound by an oath, that they would respect the law. Those who refused to
take the obligation gave up their vocation.

The Grand Rabbi of Paris, at the time of this reformation, M. Ennery,
was one of the most zealous supporters of the new departure. The
influence of the French pervaded northward, and the _mezizah_ was
abolished in Brunswick, Dr. Solomon, a learned Hebrew of that State,
being instrumental in having it done legally. The discussion of this
subject, in 1845, had one very happy effect,--the supporters of the
reformed idea of the rite issued a circular letter to all the leading
continental surgeons and medical men asking for their opinion on several
points in relation thereto, especially, however, on this part of the
rite. The opinions of many of these will be referred to in the medical
part of this work.

The after-treatment of the circumcised infant is governed more or less
by local habits and the individual intelligence of the mohel and his
experience. After turning back the inner fold of the prepuce, the parts
are covered with a small, square bandage, with an aperture to admit the
passage of the glans. This, and the subsequent small bandage of old
linen, which is calculated to hold it in place, are slightly coated with
a powder composed of lycopodium, with the slight addition, at times, of
Monsel's salts, alum-powder, or some vegetable astringent. Over these
another compress is placed, to prevent the friction of the clothes of
the infant or of the bedding. The infant then receives a final
benediction, and the godmother then receives the child in her arms and
carries it to its cot or crib. The operator generally visits the infant
in the afternoon of the operation, and carefully inspects the dressings,
to see that no hæmorrhage has supervened.

It is customary to place the child in a bath, either the same evening or
on the following morning, the object of this being to remove and to
facilitate the removal of the dressings, which are more or less
saturated and clotted with blood. After the removal of these, the wound
is redressed, as previously, except that some cerate--ointment of roses
or some other mild ointment--is used. Some prefer the simple water
dressing from beginning to end. Since the introduction of creasote, acid
phénique, and carbolic acid, many mohels are in the practice of washing
the parts with water impregnated with one of these before performing the
operation, and using subsequently the same form of lotion at every
dressing. In case of hæmorrhage there is an hæmostatic water or lotion,
which has been long used by the German and Polish mohels with
considerable success, and which, in ordinary cases, has been found to be
all that was required. This water, called by the French "Mixture
d'arguesbusade," "Eau vulneraire spiriteuse de Theden," and by the
Germans as "Spritzwasser" and "Schusswasser," is composed as follows:--

  Acetic acid,                  10     grammes.
  Rectified spirits of wine,     5        "
  Diluted sulphuric acid,        2½       "
  Clarified honey,               8        "

This mixture is well mixed and filtered, and is then kept in a
tightly-stoppered vial.

Dr. Bergson uses a mixture composed of diluted sulphuric acid, 1 part;
alcohol, 3 parts; honey, 2 parts; and 6 parts of wine vinegar.

Hæmostatic powders are also used by the Hebrews, being more conveniently
kept or carried than the hæmostatic waters. In Russia and in Poland they
are composed of decomposed or decayed hawthorn-wood powder and
lycopodium. That of Berlin is composed of Armenian bole, red clay,
dragons' blood, powdered rose-leaves, powdered galls, and powdered
subcarbonate of lead. In France a hæmostatic fluid, composed of dragons'
blood digested in turpentine, is in vogue. The Eau de Pagliari is also
used; it is composed of a mixture of tincture of benzoin, 8 ounces;
powdered alum, 1 pound; and 10 pounds of water, boiled together for six
hours, and is considered a powerful styptic. In addition to these, burnt
linen, spiders' webs, starch-powder, powdered alum, and plaster-of-Paris
powder are used by different mohels. Touching the bleeding points with a
pointed pencil of nitrate of silver is also a practice understood by the
Jewish circumcisers.



CHAPTER XIV.

WHAT ARE THE BENEFITS OF CIRCUMCISION?


There are those, even among the Hebrews, who are so imbued with the
purely theological idea of the origin, performance, and causes of
circumcision, that they cannot see any moral nor hygienic value in the
operation. Among many Christians the idea still prevails that
circumcision is the relic of some barbarous rite, practiced in some
epoch away in the remote ages of the world, grafted on to the Jewish
religion by some accident or other; but that beyond the clinging of the
Jews to this custom, as being a remnant of their old religion, they
neither see in the rite any other significance, moral results, nor
hygienic precaution; and the fact of a Jew being circumcised is too
often made a subject of merriment among the unthinking portion of the
Christian world. Neither are physicians all of one accord on the subject
as to whether circumcision is a benefit, or, being useless, a dangerous
and an unnecessary operation. The writer is most emphatically in favor
of circumcision, and has the fullest faith in the positive moral and
physical benefits that mankind gains from the operation.

It may well be asked: What does the Jew receive in return for all the
suffering that he inflicts through circumcision on himself and his
little children? What is there to repay him or his for all the risks and
annoyances, besides branding himself and his with an indestructible
mark, which has been more than once the sign by which they have suffered
persecution, spoliation, expatriation, and death? Are there any
benefits enjoyed by the Jew that the uncircumcised does not enjoy in
equal proportion?

The relative longevity between the Hebrew race and the Christian nations
that dwell together under like climatic and political conditions
indicates a stronger tenacity on the part of the Jewish part of the
nations to life, a greatly less liability to disease, and a stronger
resistance to epidemic, endemic, and accidental diseases. By some
authorities it has been held that the occupations followed by the Jew
are such as do not compel him to risk his life, as he neither follows
any labor requiring any great and continued exertion, nor any that
subjects him to any great exposure; that, as a rule, when in business,
by some intuition he follows some branch that has neither anxiety, care,
nor great chance of loss connected with it; that he does not follow any
occupation that is attended with any risk of accident for either life or
limb. Besides all these, it is also urged that in cities the careful
inspection of their meat, and the peculiar social fabric of the family,
the love and veneration for their aged, as well as their proverbial
charity to their own poor and sick, and their provident habits and
hygienic regulations imposed upon them by the Mosaic law, are all
conditions that conspire to induce longevity.

That the Hebrew is generally found in such conditions as above described
is undisputed; but it is questionable if all these conditions are
necessarily such as are favorable to health and long life, and that,
therefore, the longevity of the Jewish race cannot altogether be
ascribed to the above conditions. Looking at the subject of occupation,
if we consult Lombard, Thackrah, and the later works on the effects of
occupation on life, we must admit that the Jew has no visible advantage
in that regard, as he follows hardly any out-of-door occupation, being
often in-doors in a confined and foul atmosphere. To those who have
closely observed the race in this country,--coming as they do from the
cold-wintered climates of Germany, Austria, or Poland, bringing with
them the habit of living in small, close rooms, for the sake of economy
and comfort,--it must be admitted that among the lower classes and the
poorer of the race, their shops being connected, as they usually are,
with their living-rooms, the _toute ensemble_ is anything but conducive
to a long life. Their anæmic and undeveloped physical condition and weak
muscular organization are sufficient evidence that their surroundings
are not calculated to improve health. In England, statistics
sufficiently prove that the fisherman on the coast, exposed to all kinds
of weather, is not as prone to disease as is his brother Englishman who
deals out the groceries in his snug shop. Exercise has been held an
important element in the factory of the long-lived. From the time of
Hippocrates down to Cheyne, Rush, Hufeland, Tissot, Charcot, Humphry,
and all authorities on the factors of old age, exercise has been looked
upon as favoring long life. Exercise cannot be said to enter in any way
as a factor in the longevity of the Jew; but, on the contrary, his
in-door life is known to be very productive of phthisis in other races.
His recreations are, as a rule, of the home social order. They visit and
spend the time allotted to recreation in social intercourse, which their
hospitality always insists on accompanying with a generous lunch, which,
to say the least, is not an element that is conducive to either health
or long life; for no people excel the Jew in home hospitality, and even
among the poorer classes a stranger is never allowed to depart without
some refreshment being offered him. Among the class better able to
extend hospitality, social reunions and card parties, with lunches of
fruits, cakes, cold meats and coffee, or wines, are among their regular
occurrences. Their great affection for the family and for their youth
and aged suggests these means of recreation, as then they are enjoyed by
all alike; but, as observed, the hygiene of all this is very doubtful;
it produces too much irregularity.

It is related that after the Roman conquest of Palestine many of the
Jews, becoming more or less accustomed to Roman manners and customs,
often joined in the games which the Romans held in imitation of the old
Olympic games of the Grecians. Not to be ridiculed, many resorted to the
practices described in a previous chapter, to efface all the marks of
their circumcision, that they might enter the games with as much freedom
as the Romans or other uncircumcised nations; so that the present
aversion to out-of-door sports evinced by the Jew is not necessarily a
racial trait; the persecutions and political inequality that until
lately he has been made to suffer have driven him into retirement and
seclusion. Although seeking neither converts nor political power and
influence, he has been hunted down, massacred, and chased about as a
dangerous beast. As the children of the great Rabbi Moses Mendelssohn
asked of their father: "Is it a disgrace to be a Jew? Why do people
throw stones at us and call us names?" It may well be asked, why? These
actions have forced them into the social and retired habits for which
they are noted; although it cannot be said that it is from a lack of
spirit, as one of the Rothschilds is well known to have been present at
the battle of Waterloo, where from a spot in the vicinity of the
British right-centre he observed the events of the battle; and when,
with the failure of Ney's last desperate charge with the formidable
battalions of the Old Guard, he saw the advance of the Prussians closing
in on the French right, he galloped to the sea-shore, and, crossing the
Channel in a frail boat, reached London twenty-four hours in advance of
the news of the battle,[65] but long enough for him to clear several
millions from off the panicky state of the money market. Marshal
Massena, one of Napoleon's bravest generals, the defender of Genoa and
the hero of Wagram, was of Jewish origin.

Athletic sports are not of necessity conducive to long life, even if
they are to temporary robust health; but there is no mistaking the fact
that the sedentary and in-door life of the average Jew is a deteriorator
to health and life, and especially among that class of families who are
poor and keep no servant; from heredity and home education having
adopted unhygienic customs, in which they have grown up,--in these a
total disregard for all ventilation forms a part. Were an uncircumcised
race so to live, scrofula and phthisis would be the inevitable result.
This difference of results I have witnessed more than once as existing
among the two races coming from the same European nationality, where
their disregard to ordinary rules of hygiene, induced by climatic
causes, especially ventilation, were alike in both the Semitic and
European descendants of the one nation, the purely European being more
prone to consumption and scrofula. It is interesting to note the
difference in the moral, mental, and physical conditions induced by
creeds; it would seem as if it should not make any difference. The
generally accepted idea of religion is that it should raise the moral
standard of all those nations who practice religion; but the results
are very peculiar, as we are forced to admit that reformation in
religion has not always been a reformation in morals. Take Great Britain
for example; if illegitimacy is any criterion of the moral state of
those professing creeds, we find the least among the Jew; next among the
Catholic; next comes the Episcopalian; then last the Presbyterian,--the
oldest creed showing the greatest moral tendency, and that of poor Knox,
which is the youngest, showing the least. This has certainly its
physical effects, that are not without its influence in producing a
greater or lesser length of life. The evolution of religion has here
induced a lower moral tone and a resulting physical degeneracy.

As observed by alienists, religions of different creeds have different
tendencies in inducing insanity, both as to ratio of population and as
to manifestations;[66] the Protestant, when unbalanced by religious
cause, is generally controlled with some idea that shows itself in wild
and erratic attempts at scriptural interpretation, caused by want of
fixed dogmas and the unending splittings that are forever taking place
in the new faith, and the persistent, intrusive, and belligerent spirit
of proselytism that controls each new branch as it buds into existence.
The Catholic has a fixed dogma, which the church attends to, and he
neither feels called upon to make his neighbors miserable or himself
insane in hunting up new interpretations. When he does go insane on the
subject of religion, the cause, as a rule, can be traced to some real or
imagined moral delinquency, which has brought all the terrors of the
punishment of the damned forcibly and persistently to his disordered
imagination. In the insane-asylums of Cork, in Ireland, with its
overwhelming Catholic population, the ratio of inmates in regard to
creeds is as that of one Catholic to ten of the Reformed religion,
showing in the most conclusive manner the influence exerted by religion
in this direction. On the other hand, the Jew has the simplest of
religious creeds; he neither wastes useful time, robs himself of sleep,
nor becomes dyspeptic in hunting for hidden meanings in some ambiguous
scriptural phrase; he is satisfied with his creed, his dogmas are firmly
anchored, and the nature of his religion being a sort of family
congregation, he is not called upon to go out in search of proselytes,
any more than the father of an already large family feels called upon to
go out and hunt up the homeless, that he may convert his home into a
promiscuous orphan-asylum. As before remarked, his creed is of the
simplest, and there exists a complete and explicit understanding between
his God and himself. There are no mystical, hidden meanings in Scripture
for the Jew; nor does he dread any eternal, unheard-of, and inexplicable
torments. His laws are very clear, and the punishments for their
infraction very explicit. To the Jew it is a straight and well-lighted
road, as far as religion is concerned. The writer has always felt that
it took a mind that was incapable of appreciating simple truths, but
that loved to hover on that mystical border-land on the confines of
gloomy insanity that would allow its owner to seriously wander through
and behold any theological beauties in Bunyan. To the Jew there is none
of the gloomy, weird, mystical, mind-racking, ungodly theology that some
of our creeds torture the poor brains of their professors with. As the
wild Indian of the plains runs sticks through his anatomy and capers
wildly about to torture his body, so some of the creeds delight in
torturing their devotees. The Jewish religion is the one best suited to
tranquilize the mind; it is very philosophical and rational. Were he to
acknowledge Christ, he would not have to change his course of life to
become a most exemplary Christian. The celebrated letter of Moses
Mendelssohn to the Swiss clergyman, Lavater, in answer to a dedication
of the latter to Mendelssohn, is probably the best exposition of the
essence of the Jewish faith that can be found. Therein he says: "We
believe that all other nations of the earth have been commanded by God
to adhere to the laws of nature. Those who regulate their conduct
according to this religion of nature and of reason are called _virtuous
men of other nations_, and are the children of eternal salvation." Such
a religion does not unsettle man's mind.

These apparent digressions are made to show what additional factors
exist, besides circumcision, to induce longevity in the Jewish race, and
that the subject may be better understood; for these reasons the above
comparisons have been made. Students of demographic science are well
aware that form of government, religion, climate, diet, habit, and
custom,--all have an important bearing on the mental and physical as
well as on the moral nature of man. To the true student of his art all
these conditions are but factors in the physical scale, and should so be
considered without fear or favor; to him the whole world is but a unit,
and the people upon its surface are but as one people, alike subject to
the leveling laws of nature, which recognize neither royalty nor
vagrant, nationality nor creed, color, condition, nor station in life or
society.

Professor Bernoulli, of Bale, found the Israelite less prolific than the
Christian;[67] subject to less mortality, greater longevity, less
still-born, less illegitimacy, less crime against the person, and less
insanity and suicide, when compared with his Christian brother--all of
which he attributes not to a superior physique or organism, but solely
to the observance of the laws of their religion and to the nature of the
same, which exercises a beneficial influence on the mind.

B. W. Richardson, in his "Diseases of Modern Life," in speaking of the
relation of race to disease, says: "Through the valuable labors of MM.
Legoyt, Hoffmann, Neufville, and Mayer, we have obtained, however, some
curious facts relative to the most widely disseminated of all races on
the earth, the Jewish. These facts show that, from some cause or causes,
this race presents an endurance against disease that does not belong to
other portions of the civilized communities amongst which its members
dwell. The distinctness of the Jews in the midst of other and mixed
races singles them out specially for observation, and the history they
present of vitality, or, in other words, of the resistance to those
influences which tend to shorten the natural cycle of life, is
singularly instructive.

"The resistance dates from the first to the last periods of life.
Hoffmann finds that in Germany, from 1823 to 1840, the number of
still-born among the Jews was as 1 in 39, while with other races it was
1 in 40. Mayer finds that in Furth children from one to five years of
age die in the proportion of 10 per cent. among the Jewish, and 14 per
cent. among the Christian population. M. Neufville, dealing with the
same subject, from the statistics of Frankfurt, gives even a more
favorable proportion of vitality to the Jewish child population.
Continuing his estimates from the ages named into riper years, the value
of life is still in favor of the Jews, the average duration of the life
of the Jew being forty years and nine months and that of the Christian
being thirty-six years and eleven months. In the total of all ages, the
half of the Jews born reach the age of fifty-three years and one month,
whilst half of the Christians born only reach the age of thirty-six
years. A quarter of the Jewish population born is found living beyond
seventy-one years, but a quarter of the Christian population is found
living beyond fifty-nine years and ten months only. The Civil State
extracts of Prussia give to the Jews a mortality of 1.61 per cent.; to
the whole kingdom, 2.62 per cent. To the Jews they give an annual
increase of 1.73 per cent.; to the Christian, 1.36 per cent. The
effective of the Jews require a period of forty-one years and a half to
double themselves; those of other races, fifty-one years. In 1849,
Prussia returned one death for every forty-one of the Jews and one for
every thirty-two of the remaining population.

"The Jews escaped the great epidemics more readily than the other races
with whom they lived. Thus, the mortality from cholera amongst them is
so small that the very fact of its occurrence has been disputed. Lastly,
that element of mortality, suicide, which we may look upon
philosophically as a phenomenon of disease, is computed by Glatter, from
a proportion of one million of inhabitants of Prussia, Bavaria,
Würtemburg, Austria, Hungary, and Transylvania, to have been committed
by rather less than one of the Jewish race to four of the members of the
mixed races of the Christian population. Different causes have been
assigned for this higher vitality of the Jewish race, and it were indeed
wise to seek for the causes, since that race which presents the
strongest vitality, the greatest increase of life, and the longest
resistance to death must in course of time become, under the influences
of civilization, dominant. We see this truth, indeed, actually
exemplified in the Jews; for no other known race has ever endured so
much or resisted so much. Persecuted, oppressed by every imaginable form
of tyranny, they have held together and lived, carrying on intact their
customs, their beliefs, their faith, for centuries, until, set free at
last, they flourish as if endowed with new force. They rule more
potently than ever, far more potently than when Solomon in all his glory
reigned in Jerusalem. They rule, and neither fight nor waste."[68]

Richardson attributes the great benefits enjoyed in this regard by the
Jewish race to the soberness of their lives. This position is, however,
not altogether tenable, if by that we mean abstemiousness; they are
extremely temperate, but not abstemious. Tissot, Cornaro, Lessius,
Hufeland, Humphry, Sir Henry Thompson, as well as the older Greek and
Roman authorities, all are agreed that an abstemious life is the one
that is most conducive to long life. There is no race that is more
proverbial for their good cheer and indulgence in the good things of the
table than the Jewish; no race enjoys feasting any more than they, and
from childhood they are accustomed to a generous and nutritious diet, as
well as to their share of the wines with which their tables are
supplied. Their greater thrift and application to business, their habits
of economy and carefulness in business affairs enable them to better
supply their tables. In California there is no class that lives better
or whose tables are supplied so well either as to quality or quantity as
those of the Jews, and yet no class is more exempt than they from the
class of diseases that originate in too good living. As before remarked,
in relation to the poor of that faith, who are unable to keep a servant,
and who live in a combination of shop and home in the most unhygienic
condition, disregarding ventilation and every other sanitary needs, but
who, nevertheless, escape the evil results that would and do attend such
social conditions among those of other races, so in this instance of
good living: the better class of Jews do not suffer in anything near a
like proportion to the better class Christians from diseases incident to
too full habits and an inactive life. Richardson observes that he drinks
less and that he eats better food than his Christian brother. In regard
to the drinking habit, overindulgence is not a Jewish failing; they do
not drink to excess, but total abstinence is not in their vocabulary. It
is inconsistent with their idea of wine as being a gift of God, and
something that is symbolical of good faith and thanksgiving. Nor is
total abstinence consistent with their idea of generous hospitality. On
the eighth day after birth the Jew tastes wine, and from the time he is
able to sit at table he becomes familiar with its use. To him wine is
not symbolical of either moral depravity, mental or physical
deterioration, or of death. Their females are all accustomed to its use
from childhood, but it does not cause them to become either immoral or
unchaste; so that in neither sex does wine produce that moral and mental
wreckage which abbreviates the length of human existence among those of
other creeds. Radical fanaticism, that drives a tack with a maul and a
twenty-penny spike with a tack-hammer, cannot be expected to study this
or any other question in any rational manner; but to the sociologist,
the question as to what produces this remarkable soberness, in the midst
of the habitual and continued use of wine in the race from the time of
its earliest history, is something worthy of calm and careful
consideration. How much circumcision may have to do with this will be
discussed in the medical part of the volume.

In London, according to Dr. Stallard, the mortality among Jewish
children from one to five years is only ten per cent., while among the
children of the Christians it is fourteen per cent., the rate being
analogous to that observed by Mayer among those of these ages in Furth.
Among the London adults the average duration of life among the Jews is
forty-seven years, while among the Christians it is only thirty-seven.

Dr. Hough[69] has gathered some interesting historical and statistical
matter bearing on the subject of Jewish resistance to disease and the
benefit possessed by the race in relation to the immunity enjoyed by
them in prevailing epidemics. The plague of 1346 did not affect them;
according to Fracastor they escaped the typhus of 1505; Rau remarks
their immunity to the typhus of 1824; Ramazzini noticed their exemption
to the fatal intermittents of Rome, in 1691; and Degner says that they
escaped the epidemic dysentery at Nimegue, in 1736. Richardson truly
observes that "from epidemics the Jews have often escaped, as if they
possessed a charmed life." This racial difference and benefit, when
compared to other races, has more than once cost them dear. In the dark
and ignorant ages, when men reasoned nothing from a physical basis, but
attributed all and every phenomena to some supernatural agency, either
heavenly or diabolical, it was but natural for such minds to associate
this exemption with some purchased compact made with the devil, who was
often also held accountable for the existence of the epidemics. The
rational and law-of-nature observing Jew supposed to be in league with
his satanic majesty could neither be seen nor heard in his own defense;
consequently, massacres, pillaging, and such other barbarities that an
insane popular fury could suggest, were the humane manifestations with
which a Christian people visited their Jewish brothers, whose only sin
consisted in worshiping the God of their fathers, and in strictly
observing His laws and commandments.

In France, Dr. Neufville found that, of one hundred children in the
first five years of life, among the Jewish population, 12.9 die; while
from the same number of the same aged class of Christians 24.1 die.
One-half of all the Christians die at thirty-six years, and one-half of
all the Jews at fifty-three years and one month.

Dr. John S. Billings has gathered statistics relating to 10,618 Jewish
families, consisting of 60,630 persons,[70] living in the United States
in December, 1889, mostly descendants of Jews from the northern or
middle nations of Europe. For our purpose only the deductions as to
death-rate and tendency to longevity will be given. In this valuable
paper Dr. Billings says: "When we come to examine the reports of deaths
for five years furnished by these Jewish families, we find that they
give an average annual death-rate of only 7.1 per 1000, which would be
about one-half of the annual death-rate among other persons of the same
average social class and condition living in this country." To this he
adds that, provided the deaths at different ages among the Jews have
been correctly reported, this race will, on comparison with those of
other races, show a greater tendency to longevity, as the Jewish
expectation of life is at each age markedly greater than that of the
class of people who insure their lives, the average excess being a
little over twenty per cent.

In speaking of the death-rate among children, Dr. Billings makes the
following comparisons: "The low death-rate among the Jews is especially
marked among the children, and this corresponds to European
experience. Thus in Prussia, in 1887, the death-rate of the Jews under
fifteen years of age was 5.63 for 1000, while among the remainder of the
people it was 10.46 per 1000." This result he accounts for partly to the
fact that among the Jews illegitimacy is comparatively rare and to the
high rate of mortality among the illegitimate born, which raises the
average of the other classes.

In regard to the immunity of the race from consumption or tubercular
disease, the statistics of the above Jewish families gives to the Jews
less than one-third of the number of deaths from these diseases than
what occurs among the others as to the male population, and less than
one-fourth as to the female population. These statistics coincide with
the observations of the writer on this part of the subject, and are even
more than corroborated by the French War-Office Reports from Algeria,
where the deaths from consumption among the Christians amount to 1 for
each 9.3 deaths, and among the Jews to 1 in 36.9, while among the
Mohammedans it is only 1 in 40.7 deaths. In Algeria the relative
mortality from all causes is only about three-fifths of that of the
Christian, and the Turk, although seeming to enjoy a greater exemption
from phthisical or tubercular diseases than the Jew, falls below the Jew
in exemption from deaths due to general causes, as his mortality is
one-eighth greater than that of the Jew. Dr. Billings gives us some
interesting food for thought in the course of his article and some more
particularly bearing on the subject of immunity from consumption. He
asks: "Are these differences due to race characteristics, properly
so-called, to original and inherited differences in bodily organization,
or are they, rather, to be attributed to the customs, habits, and modes
of life of the two classes of people?"

Some years ago, Henry I. Bowditch, of Boston, put on foot an extended
system of inquiry in regard to ascertaining the causes or antecedents of
consumption in the State of Massachusetts. In answer to some of the
questions of the circular, Rabbi Dr. Guinzburg, of Boston, answered as
follows, under date of October 29, 1872:--

1st. The number of Jews living in Boston is about 5000.

2d. There certainly have not died of consumption, during the last five
years, more than eight or ten Jews in the various congregations.

To this Dr. Bowditch adds, as follows:--

"If Dr. Guinzburg's data be correct, they show a very great immunity
from consumption on the part of the Jews, compared with the citizens
generally, as will be seen by the following comparison between these
numbers and those procured from the Registration Reports, published by
the State. In the report published in 1869, page 64, we find that for
the five years preceding 1869 the annual average of deaths by
consumption was 338 for every 100,000 living. These data from Dr.
Guinzburg and the State Report give the following table:--

                              Proportion of Deaths to
                                 100,000 of Living.
  All religions,                        338
  Jews,                                  40

"These statements from Dr. Guinzburg are confirmed by the following
letter from Dr. A. Haskins, of this city. Dr. Haskins is connected with
one of the Jewish benevolent associations for the benefit of the sick. I
sent to him similar questions and make the following extracts from his
reply:--

"'I am generally employed in about sixty families (Jewish). I have had
these families under my care for two and a half years. During this time
I have seen but one case of consumption. I have averaged among these
sixty families about two visits daily. In my other Jewish practice,
which is not inconsiderable, I have in this time (two and a half years)
seen two cases of consumption.... I am sorry I have no statistics
whereby I could compare the two peoples, viz., Jews and Christians. I
can, therefore, give you only my impressions. I should say that I find
consumption less frequent among the Jews than among Christians. This
would be my own impression without any data to fortify it.'

"Dr. Waterman also sustains the same idea. The following extract will
give some idea of his opportunities for observation and the sources of
his deductions:--

"'BOSTON, November 2, 1872. Dear Sir,-- ... First, I have attended four
charitable associations; number about forty, fifty, sixty, and one
hundred families. At present I only attend one, containing one hundred
families, and on which I average a fraction over one visit a day. I
have, besides, many private families among the Jews. I have attended but
few cases of consumption, and I think the disease is not so prevalent as
among Christians.'"

The same report of Dr. Bowditch quotes from Stallard's "London Pauperism
Amongst Jews and Christians," as saying that there is no hereditary
syphilis, and scarcely any scrofula to augment the mortality in the
Jewish families.

In relation to the liability of the Hebrew race to phthisis, Richardson
has the following at page 22 of his "Diseases of Modern Life": "The
special inroads on vitality made on other races by disease are not
easily determined, because of the difficulties arising from temporary
admixture of race. I tried once to elicit some facts from a large
experience of a particular disease, phthisis pulmonalis, and, as the
results of this attempt may be useful, I put them briefly on record.

"At a public institution at which large numbers of persons afflicted
with chest diseases applied for medical assistance, and at which I was
for many years one of the physicians, I made notes during a short
portion of the time of the connection that existed between race and the
particular disease I have instanced--phthisis pulmonalis, or pulmonary
consumption. The number of persons observed under the disease was three
hundred, and no person was put on the record who was not suffering from
a malady pure and simple; I mean without complication with any other
malady. They who were thus studied were of four classes: (_a_) those who
were by race distinctly Saxon; (_b_) those who were of mixed race, or
whose race could not be determined; (_c_) those who were distinctly
Celtic; (_d_) those who were distinctly Jewish.

"The results were, that of the three hundred patients, one hundred and
thirty-three, 44.33 per cent., were Saxon; one hundred and eighteen,
39.33 per cent., were of mixed or undetermined race; thirty-one, 10.33
per cent., were Celtic; and eighteen, 6 per cent., were Jewish."

Although Dr. Richardson admits it would be unfair to accept the above
figures as a basis for general application, he argues that they are, on
the average, sufficiently suggestive, as among the Saxons it was noticed
that there were more cases in whom the disease was hereditary, while
among the others it was generally acquired.

In going over the subject of this question in regard to phthisis, we
must admit that, although the Jew in his own home, synagogue, or in his
social reunions, is not exposed to tubercular emanations, and that he
has less chance of contracting the disease from tuberculous meats, he
is, after all, a theatre-goer; a pretty constant inhabitant of the
sleeping-car and hotel, as a commercial traveler and general merchant;
and that, on the whole, he eats the same food, breathes the air and dust
of the same streets, and drinks the same milk and water as the
Christian, and, as observed by Dr. Billings, cooking destroys the
bacillus in meats. So that the comparative exposure in this
country--where the practice is not as prevalent as in Germany of eating
raw minced-meat sandwiches--existing between the Jew and the Christian
to tubercular infection from meat are about equal. The records of the
Jewish Hospital of New York gives, out of 28,750 persons admitted, only
44.17 per 1000 of its admissions as being due to consumption; while
those of the Roosevelt Hospital, out of 25,583 admissions, gives a per
1000 of 67.93.

From what is known of the relation of syphilis to consumption, not only
as affecting the primary individual, but the subsequent generations of
the same, and the known greater exemption of the Jew to syphilitic
infection, owing to the protecting influence of circumcision, it is safe
to assert that therein is to be found one of the main reasons of the
exemption of that race to consumption. If we but look at the
geographical distribution of phthisis and the history of its progress,
we shall find that it has had syphilis as its _avant courrier_ on more
than one occasion. Lancereaux, in his "Distribution of Pulmonary
Phthisis," points to the fact that where consumption has made its
greatest ravages, and where it has nearly depopulated one of the great
divisions of the globe,--namely, the groups of islands in the Pacific
Ocean,--the disease had no existence at the beginning of the present
century. Syphilis, scrofula, and a quick, galloping consumption have,
since the last ninety years, taken off the greater part of the
population. The same course of transition from the best of physical
conditions to racial deterioration and extinction from the same relative
condition of causes--syphilis, scrofula, and phthisis--has been observed
among the open-air dwellers of the New Mexican Plains, in the mountains
of Arizona, and on the arid wastes of the Colorado Desert, where the
appearance of consumption cannot be attributed to housing or incipient
civilization, as it is attributed to housing among the Chippeways,
Sioux, or Mandans in the regions that formerly formed the Northwest
Territory. The question is very plainly answered as to how consumption
was introduced or whence it sprung that has so ravaged the Oceanic
Islands. The sailors who first visited those islands were not, as a
rule, a batch of consumptive tourists on a voyage in search of health or
recreation; but we can well understand that the proverbially improvident
mariner has not always had his health looked after by an Anson or a
Cook, and that many a festive tar who induced the unsophisticated Indian
maid to join him in worship at the shrine of Venus Porcina carried in
the innermost recesses of the folds of his pendulous and sea-beaten
prepuce the remnants of former Bacchanalian festivities performed in the
questionable temples of Venus and Bacchus in Portsmouth or London.
Consumption, as such, was neither imported nor propagated by Europeans
into those islands, its original entry being in the shape of syphilis.
Had it been the ancient mariners of old Phoenicia in the days of its
circumcision, or the circumcised marines of the ancient Atlantean fleets
from the sunken continent of Plato, instead of the uncircumcised
sailors of modern England, that first and since visited those islands,
it is safe to say that consumption would not now exist there. From this,
it may be well to inquire what would be the relation between the Jewish
race and consumption; were circumcision among them to be done away with,
would it not be greatly on the increase?

The weight of testimony is evidently convincing that the Jew has a
greater longevity and stronger resistance to disease, as well as a less
liability to physical ills, than other races; that all these exemptions
or benefits are not altogether due to social customs is evident; how
much circumcision may have to do in inducing these favorable conditions
can be better appreciated by a consideration of how circumcision affects
those of other races, and more particularly how its performance works
changes in the individual in his general health and condition, and in
doing away with many physical ailments that the individual was
previously subjected to. So that the Jew cannot be said to be a loser by
his observance of this rite, and he and his race have been well repaid
for all the sufferings and persecutions that its observance has
subjected them to. As observed by John Bell, "The preservation of health
and the attainment of long life are objects of desire to every man, no
matter in what age or country his lot is cast, nor by what arbitrary
tenure he holds his life. They are the wish of the master and the slave,
of the illiterate and the learned, of the timid Hindoo and the warlike
Arab, of the natives of New Zealand not less than of the inhabitants of
New England,--an indispensable condition for the greatest and longest
enjoyment of the senses and propensities; for the widest range and
exercise of intellect and gratification of the sentiments, whether these
be lofty or ignoble, health, in any special degree, has ever been a fit
subject of contemplation and instruction by the philosopher and
legislator. Their advice and edicts on the means of preserving it have
frequently been enforced as a part of religious duty, and, at all times,
civilization, even in its elementary forms, has been marked by laws on
this head. With the numerous and minute hygienic enactments of the great
Jewish lawgiver for the guidance of the people of Israel we are all
familiar. Prompted, we may suppose, in part by the example of Moses, and
also by considerations growing out of the nature of the climate in which
he lived, Mohammed incorporated with the mingled reveries, ethics, and
blasphemies, which composed his Koran, dietetic rules and observances of
regimen that are to this day implicitly obeyed by his zealous
followers."[71]

If circumcision is not a factor in the difference that exists between
the Jewish race and other races, if it goes for nothing as an exemptor
of disease and the promoter of longevity, then there must exist some
other factor or cause that induces these conditions. What this factor
is, the legislator, the sociologist, and the physician should make it
their business to find out.



CHAPTER XV.

PREDISPOSITION TO AND EXEMPTION AND IMMUNITY FROM DISEASE.


The peculiar differences that exist between different animals in regard
to their susceptibility to the action of drugs is even more remarkable
than the differences that exist in their susceptibility to certain forms
of disease. We can understand and appreciate what Koch tells us in
regard to the different susceptibilities exhibited by the house-mice and
the field-mice to the anthrax bacillus, or why a nursing child should
offer different results, when exposed to the diphtheria bacillus or the
contagious poison of any of the exanthemata, from those witnessed in the
meat or promiscuously dieted child. We can also appreciate that
different individuals have different susceptibilities to disease, as
well as we understand that the same degree is not always in an unvarying
point of resistance or susceptibility in the same individual. The
investigation and study of these conditions teach us, however, that
there is a cause, or that there are causes that induce and modify this
susceptibility. But there are conditions that are as yet beyond our
comprehension. Take, for instance, two animals, both vertebrates,
mammals, and dwelling together, eating the same food, and even having a
mutual understanding or sympathy of mind and affections, having a like
circulation, a like brain and nervous system, it would naturally be
supposed that these two would exhibit a like susceptibility to the
actions of narcotic poisons; but when we are told that one dog has
taken 21 grains of atropia with impunity we are staggered. Atropia may
not affect rabbits (as it does not), but the rabbit does not approach
man in the same close relationship as the dog. Richardson administered
to a healthy young cat 7 drachms of Battley's solution of opium, then 10
grains of morphia, and a little later 20 grains more of morphia without
rendering the cat unconscious. The same experimenter gave to a pigeon
21, 30, and 40, then 50 grains of powdered opium on succeeding days with
no bad effect. S. Weir Mitchell gave to three pigeons, respectively, 272
drops of black drop, 21 grains of powdered opium, and 3 grains of
morphia without any effect.[72] On the other hand, horses show a like
susceptibility to man to the action of drugs. In the island of Ceylon, a
sloth can take 10 grains of strychnia with safety,--chickens presenting
a like immunity to the poisonous effects of this alkaloid. While the dog
offers such a contrast to the action of drugs as compared to man, he is
as subject to goitre, and they have been seen in a true state of
cretinism.[73]

An Apache, or Colorado Indian, will prefer a dessert of decomposed
gophers to one composed of the best canned peaches or Bartlett pears; he
will devour the mass without any resulting evil, while a German--after
many generations of training on all forms of sausages in every degree of
age and ripeness, and on every form of cheese, from the refreshing
cottage cheese from curdled milk and the delicious cream cheese, down
through to all and every grade as far as Limburgher, or maggoty, common
cheese--has not, in every case overcome the tendency of the civilized
intestine and constitution to the action of sausage poison, something
that has no effect on the ordinary Indian, or on the uncivilized
dweller north of the arctic circle. Even the house-dog, that faithful
companion of man, in many cases living on exactly the same fare as his
master, is insensible to the action of this poison. An Indian will gorge
and gormandize, after a prolonged fast, on such quantities and qualities
of food that, if the ordinary white man were to indulge in a like feast,
he would be in imminent danger of literal rupture or explosion, or
liable to end in sudden apoplectic seizures, or, in case of a too
healthy and active digestion, liable, owing to a lack of a
correspondingly active condition of the excretory organs, to go off in
uræmic coma. This sporadic and fitful feasting has no perceptible effect
on the Indian, who either simply works it off in exercise, or sleeps it
off in a long and prolonged period of sleep, during which his lungs work
with the deep and steady pull and persistence that a tug-boat exhibits
when towing in a large ship against the tide and a head wind,--working
in and out more air in one respiration than the ordinary white man will
in a dozen. All these different conditions are more or less plain to us
and as easy of explanation,--just as plain as to how and why some birds
eat gravel to improve their digestion. In the cases of different
susceptibility to the action of strychnia or of narcotics, the
explanation must of necessity, for the present, be more or less
speculative. But how are we to account, even in the way of speculation,
for the peculiar immunity, lack of predisposition and hereditary
tendencies to disease exhibited by the Hebrew, who, since the history of
the world, has been a civilized and rational being,--even for decades of
centuries before the civilization of Europe? Living under the same forms
of government, climate, and shelter, practically using the same
varieties of food and drink, he exhibits an entirely different vitality
and resistance to disease, decay, and death,--being, in fact, a puzzle
to the demographic student. The only really marked difference that
exists between this race and the others lies in the fact that the Hebrew
is circumcised, other differences not being sufficiently constant to be
accounted as factors. Circumcision is, in the opinion of the writer, the
real cause of the differences in longevity and faculty for the enjoyment
of life that the Hebrew enjoys in contrast to his Christian brother.
Christian and uncircumcised races may individually, or in classes,
develop some peculiar immunity or exemption, as, for instance, the
tolerance to arsenic exhibited by some German mountaineers, or the
peculiar safety enjoyed by the butcher class from attacks of continued
fever;[74] but these exemptions are purchased at the expense of the
future, the effects of arsenic, long continued, finally having its
morbid effects, and the very plethora which is the bulwark of resistance
in the butcher, this plethora being in the end a treacherous foe,
diseases result from it which make a sudden ending to this class when it
is least expected.

For an all around long-liver the Hebrew holds a pre-eminence, and, as
the factor in this pre-eminence, circumcision has no counter-claimant.
Circumcision is like a substantial and well-secured life-annuity; every
year of life you draw the benefit, and it has not any drawbacks or
after-claps. Parents cannot make a better paying investment for their
little boys, as it insures them better health, greater capacity for
labor, longer life, less nervousness, sickness, loss of time, and less
doctor-bills, as well as it increases their chances for an euthanasian
death.



CHAPTER XVI.

THE PREPUCE, SYPHILIS, AND PHTHISIS.


It is not alone the tight-constricted, glans-deforming,
onanism-producing, cancer-generating prepuce that is the particular
variety of prepuce that is at the bottom of the ills and ailments, local
or constitutional, that may affect man through its presence. The loose,
pendulous prepuce, or even the prepuce in the evolutionary stage of
disappearance, that only loosely covers one-half of the glans, is as
dangerous as his long and constricted counterpart. If we look over the
world's history, since in the latter years of the fifteenth century
syphilis came down like a plague, walking with democratic tread through
all walks and stations in life, laying out alike royalty or the vagrant,
the curled-haired and slashed-doubleted knight, or the tonsured monk, we
must conclude that syphilis has caused more families to become extinct
than any ordinary plague, black death, or cholera epidemic. Without
wishing to enter into a history of syphilis, it is not outside of the
province of this book to allude to its frequency and spread.

Syphilis is not restricted to classes by any means; it is not those of
the lower class alone who are its victims. Dr. Fr. J. Behrend, in his
work, "Die Prostitution in Berlin," observes that abolition of the
brothels in that city in 1845, '46, '47 and '48, trebled the number of
cases of syphilis treated at the Der Charité; in the year 1848 the cases
of syphilis treated at that hospital numbered over 1800. It was also
remarked during this period of legally-enforced virtue, that, as
inconsistently as it might appear, the disease invaded the best of
families. From Dr. Neumann, in his brochure entitled "Die Berliner
Syphilisfrage," published in 1852, we learn that, in the Trades and
Mechanics' Benevolent Union of Berlin, in 1849, 13.51 per cent. of the
sick were so from syphilis.

In the thirteenth volume of the _British and Foreign Medico-Chirurgical
Review_, we find, in a review of the control of prostitution, an
estimate in regard to the syphilization of a nation. The estimates are
made on the most conservative figures, as, in the desire of the reviewer
not to overestimate, he starts by figuring out the actual number of
prostitutes in England, Wales, and Scotland to be only 50,000, when they
were estimated, by those who had carefully studied the subject, as being
more than double that number; the conservative estimate is, however,
suitable for our purpose; so that we cannot be accused of overestimating
the results. The portion of the review to which we wish to call
attention is as follows:--

"Though the result of the evidence contained in the first report of the
commissioners on the constabulary force of England and Wales was that at
that time about 2 per cent. of the prostitutes of London were suffering
under some form of venereal disease, yet we will descend even lower, and
presume that of one hundred healthy prostitutes, taken promiscuously
from England and Scotland, if each submits to one indiscriminate sexual
act in twenty-four hours, not more than one would become infected with
syphilis, an estimate which is without doubt far too low; yet, if
admitted to be correct, the necessary consequence will be, _that of the
fifty thousand prostitutes five hundred are diseased within the
aforesaid twenty-four hours_.

"If we next admit that a fifth of these five hundred diseased women are
admitted to hospital on the day on which the disease appears, it follows
_that there are every day on the streets four hundred diseased women_.
Let it be supposed that the power of these four hundred to infect be
limited to twelve days, and that of every six persons who, at the rate
of one each night, have connection with these women, five become
infected, it will follow _that there will be four thousand men infected
every night, and consequently one million four hundred and sixty
thousand in the year_. Further, as there are every night four hundred
women diseased by these men, one hundred and eighty-two thousand five
hundred _public prostitutes will be syphilized during the year; hence,
one million six hundred and fifty-two thousand five hundred cases of
syphilis in both sexes occur every twelve months_.

"If, then, the entire population had intercourse with prostitutes in an
equal ratio, _the gross population of Great Britain, of all ages and
sexes, would, during eighteen years, have been affected with primary
syphilis_. Be it remembered, we do not assert that more than a million
and a half of _persons_ are attacked every year, but that that number of
_cases_ occurs annually in England, Wales, and Scotland, though the same
individual may be attacked more than once. Although it is evident that
all the estimates used for these calculations are (we know no other word
that expresses it) ridiculously low, yet we find that more than a
million and a half of cases of syphilis occur every year,--an amount
which is probably not half the actual number. How enormous, then, must
be the number of children born with secondary disease! How immense the
mortality among them! How vast an amount of public and private money
expended on the cure of this disease!"

The same reviewer (P. S. Holland), in another article on the "Control of
Prostitution," observes that among the British troops syphilis is one of
the most frequent of diseases, about one hundred and eighty cases
occurring annually among every one thousand soldiers.

The effect of syphilis in depopulating the islands of the Pacific has
been pointed out in a former chapter; the nature and origin of the
disease that takes them off is unmistakable. Scrofula and rapid phthisis
are taking off the inhabitants at a rate that, in those islands most
affected, the native population will soon become extinct. According to
Lancereaux, in the Marquesas group the women do not live beyond the age
of thirty to thirty-five years, three or four months being the duration
of the disease. Ellis, in his "Polynesian Researches," published in
1836, remarks that at that date the disease, as above described, had but
recently appeared. In the nineteenth volume of the "Archives de Médecine
Navale," Rey mentions that at the Easter Island pulmonary phthisis is
the dominant affection with the adults, and that scrofula is very
prevalent with the children.[75]

The effect of syphilization in inducing a scrofulous taint and the
appearance of a rapidly-marching consumption among savage races has been
well observed among the Indians in the southwestern parts of the United
States, where the appearance of these fatal diseases can easily be
traced to that as a cause. There is something peculiar about the
Anglo-Saxon race that is fatal to the Indian; wherever they come in
contact, the savage race begins physically and morally to crumble; the
habits of the Anglo-Saxon in the matter of intemperance and his lust
soon end the poor Indian; while, on the other hand, the Latin races mix
with them without any physical detriment to the Indian. In what was
formerly the Northwest Territory the French and Indian intermarried, and
syphilis did not begin to tell on the Indian until the Americans settled
the country. From these observations it is very evident that in the
Polynesian Archipelago syphilis must have been the precursor of the
phthisis and scrofula, as we know it to have been that which induced
those diseases among the Indians of the Mississippi or Missouri Valleys,
or of the Colorado and Mojave Deserts, or in the mountains and valleys
of Arizona.

On the other hand, circumcised races, whose women have not carried a
syphilitic taint into the race, are as a class free from any syphilitic
taint. Neither their teeth, physiognomy, skin, nor general condition
denote any syphilitic inheritance. This is true of the Jewish
descendants of Abraham, who have more strictly adhered to the
non-intercourse or marriage with other races, and whose women have
abstained from vice; the Arabian descendants of Ishmael have, in a great
measure, also retained their marked family individuality, except it be a
few tribes, who, by contact with the soldiery of European nations, have
had their women corrupted and syphilis introduced into the tribe through
this channel.

Richardson, in his "Preventive Medicine," observing on the effects of
syphilis in inducing deterioration of the organs of circulation and
their degenerative changes, says that, in his opinion, syphilis is the
progenitor of various diseases, and that those who give this opinion the
greatest range are, unfortunately, nearest the truth. The breathing
organs, he remarks, are distinctly susceptible to injury from this
hereditary cause.

In 1854, at the Metropolitan Free Hospital, situated in the Jews'
quarter in London, Hutchinson observed that the proportion of Jews to
Christians among the out-patients was as one to three; at the same time
the proportion of cases of syphilis in the former to the latter was one
to fifteen. Now, this result was not due to any extra morality on the
part of the Jews, as fully one-half of the gonorrhoea cases occurred
among those of that faith. J. Royes Bell also observes the less
syphilization among circumcised races.[76]

The absence of the prepuce and the non-absorbing character of the skin
of the glans penis, made so by constant exposure, with the necessary and
unavoidably less tendency that these conditions give to favor syphilitic
inoculation, are not evidently without their resulting good effects. Now
and then syphilitic primary sores are found on the glans, or even in the
urethra or on the outside skin of the penis, or outer parts of the
prepuce; but the majority are, as a rule, situated either back of the
corona or on the reflected inner fold of the prepuce immediately
adjoining the corona, or they may be in the loose folds in the
neighborhood of the frenum, the retention of the virus seemingly being
assisted by the topographical condition and relation of the parts, and
its absorption facilitated by the thinness of the mucous membrane, as
well as by the active circulation and moisture and heat of the parts. It
must be evident that but for these favoring conditions the inoculation
or infection would and could not be either as sure or as frequent. Any
protecting mechanical aid that interferes with these favoring conditions
grants an immunity to the individual, even when he is freely exposed;
this protection has often been obtained by applying to the glans and
penis a substantial coat of some tenacious oil like castor-oil, which
was afterward gently washed off, first in a shower of tepid water and
afterward in a tepid bath of warm water and borax.

Horner, formerly of the navy, in his interesting little work on "Naval
Practice,"[77] relates that it was customary, in the older navy of the
United States, to allow public women to come on board at some of the
ports and to go down to the men between decks, the Department of the
Navy being probably actuated by the same humane principle that used to
induce some of the West Indian cannibals to lend their wives to their
prisoners of war who were intended, in the shape of roast or
_fricandeau_, to grace the festive board, as it was deemed inhuman by
these philanthropists to deprive a man of his necessary sexual
intercourse, even if they were soon to roast him and pick his bones.
They may, however, have been selfish in the matter, as by some
authorities it is represented that this was done to improve the flavor
of the prisoner, who was said to offer a more savory dish through this
considerate treatment, the strong flavor that the semen gives to flesh
being well eradicated by free fornication. Whether it was through these
motives of humanitarianism, or the feeling that an American tar was the
equal of the British tar, whose praises and equality Sir Joseph Porter,
K.C.B., writes a song about in "Pinafore," who had as much right to
contract a left-handed marriage as any Prince of Wales or any other
prince or crowned head of Europe, the women were, nevertheless, allowed
to go down between decks in preference to giving the men indiscriminate
liberty on shore, the government further providing for their welfare by
causing the assistant surgeon to examine the women at the gangway or
hatchway, to see that they were not diseased. Horner relates the
ludicrous appearance presented by a near-sighted assistant at one of
the hatchways while making this professional examination, surrounded by
the sailors and marines, who were greatly-interested spectators. Had the
government provided a pot of castor-oil wherein the tar could dip his
penile organ, as bridge piles are dipped into a creasoting mixture,
these humiliations to our professional brother could have been avoided.

In the conclusion to be reached, circumcision is not put forward as the
only exempting element or preventive measure that deserves all the
credit for the immunity that the Jews enjoy from syphilis, or to the
absence of hereditary diseases that are secondary or due to the presence
of that disease in the parents, as considerable credit is to be given to
the well-known chastity of their females. This chastity is, in a great
measure, due to the inseparable conditions of their religion,--moral and
social fabrics which are welded into one. Their charity assumes the most
practical form, so that it is not possible for one of their females to
have to resort to a life of prostitution to save herself or her children
from starvation, as, unfortunately, is too often the case in Christian
communities, where religion is put on and off with Sunday clothes. The
temperance and sobriety, as well as the economy and industry of the
father, are not without a good moral as well as a hereditary effect on
the daughters, who are neither rendered brutal nor demoralized through
the example and instigation of drunken fathers. They have, therefore, a
better average homelife, to which they cling and which protects them.
The aid and benevolent associations of the Jews are among the most
efficacious of charitable institutions, and no class gives more freely
or generously for this purpose. The Home for Aged Hebrews in New York is
an example of the character with which they dispense charity. We need
not, therefore, be surprised to find, in statistics of illegitimacy by
religious denominations taken in Prussia, that the Jewish women are
three times as chaste as the Catholics and more than four times as
chaste as the Evangelists.[78] The Jew has, therefore, two avenues of
infection from syphilis cut off,--the lesser liability due to his
circumcision and the chastity of the women.

Richardson mentions the immunity of the Jewish race from tubercular
disease, and notices the well-known relation existing between a
syphilitic taint and a phthisical tendency. The comparative statistics
offered by the Mohammedans, Jews, and Christians in regard to deaths
from consumption have already been mentioned in a former chapter, they
being as four Christians to one Jew, while the Mohammedan, from his
greater abstemiousness and temperance to assist him, shows a still lower
percentage than the Jew. There can be but little doubt that to this
particular and well-marked less syphilization the Hebrew race owes much
of its exemption from many other diseases and its greater resistance to
ordinary ailments and epidemic diseases.

The relative less frequency of syphilis among all circumcised people is
noticed by Dr. Bernheim, in his brochure "De la Circoncision," he being
the surgeon of the Israelitish Consistory of Paris. His utterances on
this subject are worthy of attention, he having not only paid particular
attention to this, but having had unusual opportunities for the basis of
his opinions. Dr. Bernheim looks upon coition as a frequent source of
tubercular infection, and the sensitive and absorbing covering of the
uncircumcised glans as a ready medium of transmission of the virus from
one system to the other. He calls attention to the frequent granular
condition of the uterine os, in confirmed cases of tuberculosis, as
something that is too much overlooked. This view of the case, from Dr.
Bernheim's stand-point, is worthy of greater consideration than it has
generally received at the hands of the profession.

The great number of examples that have recently come to light in
connection with the direct inoculability of tubercular consumption, both
in the later works on phthisis and in the medical press, are not without
interest or without a lesson. The case recorded within the past year of
a healthy chambermaid, who was immediately inoculated with tubercular
matter with rapidly-following constitutional effects through a scratch
on the hand, received from the sharp edge of a broken china cuspidor
that a consumptive was using, is one of these cases that are to the
point; so it is evident that the uncircumcised need not always wait for
the degeneration of syphilis into syphilitic phthisis or syphilitic
scrofula to become a consumptive, but it is within the greatest range of
possibility and probability that he may become at once a consumptive
through an excoriation or abrasion received during coition with a
tubercular woman. So many tubercular prostitutes ply their trade, or, to
be more definite, so many prostitutes become tubercular, and in its
different stages follow their occupation as the only means of keeping
out of the poor-house, that man runs as much if not more risk, in
consorting with the class, of contracting tuberculosis than that of
contracting syphilis.

There is something about syphilis that is not generally noticed; we are
all well acquainted with the dire results that usually follow syphilitic
infection, its course through every stage of suffering and misery, its
transmission and effects in tubercular meningitis or in syphilitic
affections of the mesentery through heredity in children, and of the
many horrible cases of destruction of tissue, in skin, mucous membrane,
cartilage, or bone, with their attending mutilations and disfigurations;
but there is no record of the great number of cases, and very few
physicians of any extended practice but who can recall some such cases,
where, after undoubted syphilitic infection, with the usual course of
primary sores and secondary eruption, the patient has suddenly blossomed
out into a state of robust health that his system was an entire stranger
to before the infection. The writer has, in the course of a long
practice, seen a number of such results follow both the infection
attended with a miliary eruption and that followed by the large
small-pox-appearing eruption, both kinds being preceded by the primary
sore; and these results have been observed in cases of both what are
called the soft and multiple and the hard or Hunterial initial sore.
Some of these cases rapidly gained in flesh, with an evident increase in
the redness of their blood, increasing in vigor and strength with a very
perceptibly less tendency to attacks from accidental or previously
subject-to diseases.

The same result has been observed to follow an attack of small-pox with
some individuals, and the writer well remembers a similar result
following a very extraordinary event. The subject was a man well known
among his old comrades of the First Minnesota Infantry as "Duke," and to
many of the older practitioners of Wabashaw County, of that State, as
"Old Duke." In early life he was sickly and weakly, never having fully
recovered from a malarial fever contracted in the Mexican war. Coming to
Minnesota, he adopted the life of a raftsman, with all the
irregularities that accompanied such a life. On one occasion, after a
protracted spree, feeling the need of stimulation and not having the
wherewith to procure it, he secured a jar in which a snake and several
other reptiles were preserved in spirits, and drank the fluid contents.
He was, some days afterward, taken violently ill with a high fever and
racking pains, ending in an eruption of boils that covered him from head
to foot; he made a slow and tedious recovery; but when recovered he
seemed to have become imbued with a constitution resembling
_lignum-vitæ_, for a more stubborn-twisted constitution never existed
than that of "Old Duke." The power of resistance that this man developed
was something wonderful. Dr. C. P. Adams, of Hastings, Minnesota, and
the St. Paul physicians who were connected with the regiment well
remember, though, wiry, precise, and soldierly "Duke," who, even in the
old Army of the Potomac, immersed up to his ears like the rest of the
army in the mud and dirt of the encampment of Falmouth, above
Fredericksburg, came out on general inspection as prim as if he had just
stepped out of a bandbox, for which he received a medal for soldierly
conduct and bearing.

These apparent digressions are not made either to be tedious or to weary
the reader, nor without an object. They are made to show that, whereas
syphilis is looked upon as such a deadly disease, and it may be said to
be the sole cause of fear to the assiduous worshiper at the shrine of
Venus Porcina, there is another still more fatal danger awaiting him,
ambushed in the folds of the vaginal mucous membrane, or coming along
silently out of the cervical canal,--like the legions of Cyrus stealing
along the dry bed of the Euphrates into ancient Babylon, to fall
unawares on the feasting Nebuchadnezzar on that fatal night. So, in like
manner, the virus of tuberculosis, either extruding from a granular os
or from its neighborhood, gradually moves down on the unsuspecting,
uncircumcised, and easily inoculable-surfaced glans penis, to infect the
system with a tubercular poison that has no such exceptions as those
above noted, as at times are the followers of syphilis. It is not alone
the individual himself that may be the sufferer from this poison, but
his progeny for several generations may have to suffer for the infection
thus received, just as much as they would were that infection to have
been syphilitic. As before remarked, this has heretofore not
sufficiently occupied the consideration of the profession, and, as it
cannot certainly be denied that such a source of tubercular infection is
both possible and probable, the subject is entitled to more serious and
deliberate consideration than that which has heretofore been paid to it.

Tuberculosis certainly has these two channels of entrance: either
through direct infection or through an evolutionary process resulting
from syphilis. The appearance and vital statistics offered by the French
War Office in regard to the Algierine provinces, the report of the
United States Census, the opinion of Dr. Billings deduced from the
census reports, the opinions of Hutchinson, Richardson, Bernheim, and
many other observers, as well as the personal but unrecorded
observations of many practitioners, all tend to bear testimony to the
remarkable difference that exists between circumcised and uncircumcised
races in regard to the ravages of consumption. Is circumcision a factor
in this difference, or is it not? If it is, then circumcision should
receive more attention than it has; if it is not, then we should not be
idle in hunting up the cause of difference, for an ounce of prevention
is certainly worth in this regard a whole pound of Koch's lymph as a
curative agent.



CHAPTER XVII.

SOME REASONS FOR BEING CIRCUMCISED.


The surgical and medical history of circumcision is intimately connected
with the remotest ages, this being, in fact, the earliest surgical
procedure of which we have any record. From the same records we obtain
hints as to two conditions for which circumcision probably was
suggested, either as a preventive or as a remedy.

Jahn, in speaking of the people by whom the early Hebrews were
surrounded, mentions their idolatrous practices, and that their peculiar
forms of Pagan worship were accompanied by indulgence in fornication,
lascivious songs, and unnatural lust. Others of their neighbors
worshiped the "_hairy he-goat_," with which they also practiced all
manner of abominations. Sodomy, or pederasty, seemed a sort of religious
ceremony with some of these heathen nations; from a religion it
necessarily became a social practice; this, in connection with the
phallic practices and worship, necessitated frequent exposure of the
male member. The evil results, to say nothing of the disgusting and
demoralizing tendency of these practices of the Pagan, were evidently
well known to the Jews. The contrast between the physique and health of
the pastoral habits, out-of-door life and simple diet of the Jews, and
the necessary opposite condition of health and physique due to luxury
and to these practices among their neighbors, could not have escaped
their attention. How much onanism had to do with the establishment of
circumcision may well be conjectured. Again, the other hint is in
reference to procreation, as some stress is laid to the connection
between the conception of Sarah and the circumcision of Abraham. Here we
have suggestions of a preventive to onanism, and a cure to male
impotence when due to preputial interference.[79]

Strange as it may seem, these two important results, due to
circumcision, seem to have been lost sight of for some thousands of
years, as even the able works of the physicians of the latter part of
the last century have nothing to say connecting onanism and
circumcision. Neither the works of Tissot on male onanism nor the
pioneer work of Bienville on nymphomania speak of the presence of the
prepuce in the male, or of the nymphar or clitorian prepuce in the
female, as being causative of, or their removal curative of, either
masturbation, satyriasis, or nymphomania; moral, hygienic, and internal
medication being by both these authors considered to be all that our
science could offer or do to alleviate or cure this unfortunate class.
It is only of late years that circumcision, in its true relations to
onanism, has received full consideration. In regard to its being a cure
of impotence, its recognition has been of longer duration.

It is related by Leonard, in his "Memoires,"--who, in his capacity of
hair-dresser in ordinary to her Majesty, the unfortunate
Marie-Antoinette, had ample opportunity for picking up all the domestic
small talk of the royal family and their affairs,--that Louis XVI, in
addition to all his troubles and the indignities which he suffered,
besides finally being beheaded, was afflicted with a congenital phimosis
which prevented the flow of semen from properly discharging itself. It
appears that his Majesty was no little annoyed at not being able to
procure an heir to his throne. His royal sister-in-law, the Countess
d'Artois, had given birth to a prince, the Duke of Angouleme, who was
the heir presumptive to the throne in case of the non-issue from Louis;
another sister-in-law had been brought to bed with a royal princess, and
here was the king himself without any prospective possibility of any
heir. Like all kings, he was more or less unreasonable; so he blamed his
first surgeon in ordinary for all these short-comings,--as if it were
the duty of these court surgeons, among their many other tribulations,
to furnish heirs to thrones. The surgeon finally informed his Majesty
that if he wished to become a father it would be necessary for him to
submit to the slight operation that was the subject of the church
festival of the first day of January, namely, the Feast of the
Circumcision. His most Christian Majesty entered a protest to this
acknowledgment that there was anything in Judaism worth imitating. The
surgeon insisted that the operation celebrated on the first of January
would put him in a way to have the much-desired heir. The king finally
waived all objections from any religious scruples, but could not be
brought to look at the prospective operation with any sentiments of
agreeable expectation.

The king finally became good-natured, and a touch of that plebeian
jollity which at times made him quite agreeable spread over his features
as he imagined the ludicrousness of the spectacle that would be
presented by a king of France in the hands of these handlers of the
scalpel, treating him like an African savage. He took some days to
consider the matter. On the next day he informed M. Louis, his first
surgeon in ordinary, that he had decided on submitting to the operation,
and the day and hour were fixed. The royal circumcision, however, never
took place, as it is most likely that in the privacy of his chamber his
Majesty worked, like many a plebeian or man of low degree had done
before him and has done since, to bring a refractory prepuce to terms.
The king was somewhat of a mechanic, as his skill as a locksmith has
passed into history; so that it is not unlikely that, with what little
information he had on the subject, he managed to sufficiently dilate, by
scarification and stretching, the preputial opening, as from the year
1778 the queen had three children.

Cases of attempted self-circumcision are not rarities, as people have
some inexplicable idea that a self-inflicted cut is not as painful as
one that is done by others. The writer well remembers being called to
assist one of these domestic surgeons who had undertaken to circumcise
himself with his wife's great scissors. The man had a very long but thin
and narrow prepuce that had always been an annoyance to him. The writer
had circumcised two of his children for the same malformation, and the
father, seeing the benefit to these two, determined to share in the
general benefit; but at the same time he arranged to do it all by
himself, and give the family and the surgeon a sample of his courage and
a simultaneous surprise party. Securing the scissors, he wended his way
unperceived into the recesses of his wood-shed. The mental and physical
anguish the poor man underwent, and what soliloquies he must have
addressed to the rafters of the wood-shed while making up his mind and
screwing up his physical courage for the last fell act with the
scissors, can hardly be described, as, in all probability, they were of
the most rambling and inconsistent order. At any rate, he must have
reached a climax in time and grasped the fated prepuce with a revengeful
glee, and, with all his powers concentrated in his good right hand, he
must have closed the remorseless blades of the scissors on the unlucky
prepuce. When the surgeon arrived at the scene of carnage, he was
directed to the wood-shed, on the outskirts of which hovered the family,
frantic with fear and apprehension; within, in the darkest corner, with
wildly dilated eyes, and performing a fantastic _pas seul_, was a man
with a huge pair of scissors dangling between his legs, warning all
hands as they valued his life not to approach or lay a hand on him. He
had shut the scissors down so that it clinched the thin prepuce, and
there his courage and determination had forsaken him; he lost his
presence of mind, and was not even able to take off the scissors; he had
simply given one wild, blood-curdling yell--like the last winding notes
from Roland's horn at Roncevalles--that had brought his family to the
wood-shed-door, and they had then sent for a surgeon. New terrors here
awaited the unlucky victim for self-circumcision. He dreaded lest the
surgeon should accidentally have it enter his mind to finish the
operation with the scissors, and in that case he would be helpless, as
the surgeon would, undoubtedly, have a sure and tender hold of it. After
executing a number of _pas à deux_ on the Magilton step, while the
surgeon endeavored to reassure him and gain his confidence, promising to
remove the scissors without inflicting any further harm, he was finally
allowed to approach, and, while the patient assumed a Taglioni attitude
on one foot, the other leg being extended at right angles with the body
and his hands clawing the air, the scissors was removed. The patient,
through the aid of lead lotions and a week's rest, made a good recovery
with a whole prepuce, chagrined at his failure, but happy to have
escaped immediate pain.[80]

There is not much doubt but that the operation could have been
suggested by its, at times, spontaneous performance, a case of which, by
Cullerier, and some other additional cases have been mentioned in a
former chapter. Cases occur at times, also, wherein the person having a
previously normal and uninterfering prepuce has, through either herpetic
inflammations or through impure connection, spurious gonorrhoea, or the
use of some venereal-disease preventing-wash after connection, produced
some irritation resulting in the abnormal thickening of the inner fold,
or an interstitial deposit at the junction of the skin and mucous
membrane, with consequent constriction, this deposit finally forming a
hard, inelastic ring, which prevented a free exposure of the glans and
interfered in sexual connection. In such cases,--like in stricture of
the meatus,--any mechanical interference short of cutting with a knife
only aggravates the existing difficulty, and it is not uncommon to have
such cases apply for assistance after they have in vain tried to dilate
the constricting preputial orifice. In the early writings of the Greeks,
it is mentioned that among the Egyptians circumcision exempted them from
a certain form of disease that affected the penis. Philon mentions
particularly the immunity that the operation conferred against a species
of affection which Michel Levy asserts to have been a gangrenous
disease. So that, outside of any religious significance, there is no
doubt that, in individual cases, circumcision has more than once been
suggested, although it cannot be said that such individual cases would
ever, or could, lead to its becoming a national or racial, much less a
sectarian, rite.



CHAPTER XVIII.

THE PREPUCE AS AN OUTLAW, AND ITS EFFECTS ON THE GLANS.


Ricord has well termed this appendage to civilized man "a useless bit of
flesh." Times were, however, when--man living in a wild state, and when
in imitation of some of our near relatives with tails and hairy bodies;
when he still found locomotion on all-fours handier than on his two
feet; when in pursuit of either the juicy grasshopper or other small
game, or of the female of his own species to gratify his lust, or in the
frantic rush to escape the clutches, fangs, or claws of a pursuing
enemy, he was obliged to fly and leap over thorny briars and
bramble-bushes or hornets' nests, or plunge through swamps alive with
blood-sucking insects and leeches--Ricord's definition would certainly
have been inapplicable. In those days, but for the protecting double
fold of the preputial envelope that protected it from the thorns and
cutting grasses, the coarse bark of trees, or the stings and bites of
insects, the glans penis of primitive man would have often looked like
the head of the proverbially duel-disfigured German university student,
or the Bacchus-worshiping nose of a jolly British Boniface. So that in
those days, unless primitive man was intended to have an organ that
resembled a battle-scarred Roman legionary, a prepuce was an absolute
necessity.

With improvement in man's condition and his gradual evolution into a
higher sphere, the assumption of the erect posture, and the great stride
in civilization that originated the invention of the manufacture of the
perineal band, which not only protected the glans in its thorny passage
through life, but also acted like a protecting ægis to the scrotum and
its contents, the prepuce became a superfluity; not only a superfluity,
but, now that its natural office had been replaced by the perineal
cloth, it actually began to be a nuisance, as its former free contact
with the air had retained it in a state of vigorous and
disease-resisting health which was now fast departing. As Montesquieu
observes, in the causes that led to the decline and fall of the Roman
Empire, those seasons of trials, tribulations, and struggle for
existence are those of health and progress and healthy life, and the
periods of luxury and idleness are those of degeneracy and decay. So
with the prepuce, the luxury and idleness, voluptuousness and consequent
feasting incident to its being supplanted in its original functions by
the perineal cloth, which left it thenceforth unemployed, led it in the
pathway of disease and death. This first innovation in civilization was
to the prepuce the beginning of its decay and fall. Like Belshazzar in
his great banquet-hall in ancient Babylon, the prepuce might have read
the hand-writing on the wall, "_Mene, Mene, Tekel, Upharsin_," and
foreseen the gory end that awaited it. Like to other human affairs,
however, even in his fallen estate a kind word can be said for the
prepuce. Puzey, of Liverpool, has found it of extreme value, and even
unequaled by any other part of the body, for furnishing skin-grafts,[81]
these grafts showing a vitality that is simply phenomenal, considering
the laxity of its tissues and its seemingly adipose character. There is
no doubt, however, that for skin-transplanting there is nothing superior
to the plants offered by the prepuce of a boy, and where any large
surface is to be covered this should undoubtedly be chosen, as offering
the greatest and quickest success and the least chances of failure.
This is really the only disadvantage that can be charged against
circumcision, as in a strictly circumcised community they would be
debarred from this great advantage. An uncircumcised individual could be
procured, however, to supply the deficiency. It is related that in the
latter part of 1890, a Knight Templar, in Cincinnati, required a great
supply of grafts or skin-plants to cover a largely-denuded surface, and
that the whole of his Commandery chivalrously and generously supplied
the needed skin-plants in a body. A few healthy prepuces would have been
more efficacious. In advising the use of the prepuce for these purposes
it must not be overlooked that in case of a white man it would not do to
use skin of any other color besides his own. We have no data to base any
assertion as to the relative action of skin-grafts taken from Mongolians
or Indians, but we have very reliable data in relation to the
proliferating action of those of the negro,[82] which induces a growth
of epidermis of its own kind; so that preputial grafts from the negro,
combining the extra vitality and proliferation of the preputial tissue
with the strong animal vitality of the negro, if applied to a white man,
might not produce the most desirable cosmetic effects, especially if on
one side of the countenance.

But, taken as a whole, when considered in its relation to onanism,
nocturnal enuresis, preputial calculus, syphilis, cancer, and a lot of
nervous and other ailments, or induced abnormal physical conditions, we
can really conclude that the days of the prepuce are past and gone, that
it has outlived its usefulness, and that those whom a religious or civil
ordinance or custom happily makes them rid of it are people to be
greatly envied. As Sancho Panza remarked, "God bless the man who
invented sleep," so we may well join in blessing the inventor of
circumcision, as an event that has saved some parts of the human family
from much ill and suffering.

Phimosis is an ancient attendant on our inheritance of the prepuce, we
being, in fact, born with it; this is the rule. There are, however,
exceptions to this rule, which, singularly enough, are found to be
hereditary. The writer has met with a number of such instances, and they
have always been found to have been family traits. Within the past year,
after attending a confinement, his attention was called to the child by
the nurse, who thought that the child was deformed; the nurse,
singularly enough, never having seen a natural-looking glans penis in
all her life, was astonished at the size and appearance of the member.
On examination, the organ showed a complete absence of prepuce. On
inquiry, the father and another son, born more than twenty years
previously,--this comprising every male member of the family,--were
found to have been thus born, with the glans fully exposed. The family
is now residing in San Diego, and is naturally one of more than superior
physical health and intelligence. I saw another family similarly
affected in the north of France, and of individual cases, without
knowing the history of the rest of the family, I have seen a large
number. As the prepuce can be observed in every stage of disappearance
among mixed races, it would seem that in time it would disappear
altogether. Its effectual absence in so many cases evidently belongs to
some evolutionary process, and shows beyond question that nature does
not insist on its presence either as a necessity or as an ornament.

The word or term "phimosis" is derived from two Greek roots, signifying
"string" and "to tighten," or "to tie with a string." Galen, from its
signification, accepted the word, and from him it has been transmitted
through the different epochs of medicine down to our own times. In
virtue of its etymological significance, it was formerly applied to any
stenosis or closure of duct or aperture, but at present the term is used
simply to denote that constriction that affects the prepuce, and which
prevents the glans from being passed through the preputial orifice.
Phimosis is said to be congenital or natural and acquired. The first of
these is the common lot of all, as a rule, and with some it remains so
throughout life. As babyhood advances in boyhood and boyhood into youth,
the prepuce gradually becomes lax and distensible, and in proportion to
the existence of these conditions it also loses in its length. Where,
however, the distal end persists in its constricted condition it is
drawn forward as the penis increases in bulk.

In many cases its tightness prevents the escape of the sebaceous matter
that collects in the sulcus back of the corona, and the resulting
irritation on the surface of the glans and the inner mucous fold of the
prepuce ends in an inflammatory thickening of the latter, its inner
surface becoming thick, undilatable, hard, and unyielding, all the
natural elasticity that should be present having departed, with more or
less inflammatory thickening and adhesions between the two layers of
skin that form the prepuce. In this unyielding tube the glans is
imprisoned and compressed, often suffering the tortures that the
"maiden" of the dungeons of the Inquisition inflicted on the unhappy
heretics. It becomes elongated, cyanosed, and hyperæsthetic; the meatus
of the urethra is congested and hypertrophied, the corona is undeveloped
and often absent, the glans having, on the whole, the long-nosed,
conical appearance of the head of a field-mouse. There are hardly five
per cent. of the uncircumcised but who suffer in some degree from this
constricting result of the prepuce, to a greater or less extent.

On the other hand, the unconstricted glans penis assumes the shape and
appearance that is seen in the circumcised. The head is shorter, the
face flat and abrupt, and the meatus, instead of being at the end of a
conical point, is situated on the smooth, rounded front of the glans,
and does not differ in color from the covering of the glans itself. From
the superior commissure of the meatus to the sulcus in the rear of the
corona its topographical outline may be said to describe two opposite
segments of a circle, as seen in the cuts representing the glans in its
natural shape. The corona is prominent and well developed.

The opponents of circumcision base much of their opposition to the fact
that circumcision interferes with the natural condition of the parts.
The question may well be asked, which of these two shaped glans is the
natural product as nature intended it should be? It is a well-known fact
that the most forlorn and mouse-headed, long-nosed glans penis will,
within a week or two after its liberation from its fetters of preputial
bands, assume its true shape. We may naturally inquire if nature made
the glans of a certain shape, which seems to be the proper shape for
copulative purposes, only to have the condition most effectually
abolished by a constricting, unnatural band? How much the shape of this
glans, from meatus to corona, may have to do with retaining the urethra
to a healthy and normal calibre and condition has not been inquired
into, but, as far as the writer has observed, a normal glans seems to
have less abnormalities of the urethra, and in treating such cases he
has always found that when the urethra of one of these normal-glans
subjects was affected it was far easier to manage; on the other hand,
secondary and even a tertiary recurrence to an operation is often the
fate of a long, narrow, conical-pointed penis.

Phimosis is known to have been a cause of male impotence by its direct
interference with the outward flow of the seminal fluid; but, although
we have cases where impregnation has taken place by the aid of a warm
spoon and a warm syringe, as in the case related in a former chapter, it
must be admitted that the corona is not without some functional office
in the act of procreation. Its shape indicates a valve action like that
of the valve in a syringe-piston, and if we examine the two extremes of
these conditions of glans--one devoid of corona, as many are, and the
other with the corona in its most pronounced form, when in a state of
erection--the difference, either in the appearance of the two organs or
in the different philosophical action and results that must necessarily
follow the use of these two differently shaped glans, will at once be
apparent. Unfortunately--or, as many may consider it, most
fortunate--the female organs are not always so shaped as to be in
themselves wholly favorable to impregnation. The wearing of corsets, the
habitual constipation of females, the relaxed and unnatural condition of
the uterine ligaments and vagina in civilized women, all favor uterine
displacement, with any or all forms of uterine ailments. To this we may
add the effect of repeated miscarriages, application of astringent
washes, irregular menstruation, etc., all of which conditions often
result in an elongation of the neck, constriction of the cervical canal,
with the external os placed on the depended point of the sharply pointed
cervix, which is liable to point in any direction. Just imagine one of
these conditioned females and one of the mouse-headed, corona-deficient,
long-pointed glans males in the act of copulation! The conical penis
finds its way in the reflected fold of the vagina, while the point of
the uterus may be two or three inches in some other direction, making
impregnation wholly impossible; besides, in the normal-shaped penis, the
corona acting as a valve, behind which the circular muscular fibres of
the vagina close themselves, tends to retain the seminal fluid in front,
while the very shape of the organ assists in straightening out the
vaginal canal and to bring the uterus in proper position. In the long,
thin, narrow and pointed glans, devoid of corona, there is no mechanical
means to retain the seminal discharge. Some years ago some one
introduced the idea of postural copulation, to be tried in cases of
sterility, and it has been found that impregnation would take place in
some cases where it had formerly appeared impossible, this position
having the effect of righting malpositions during the act, which were
the cause of the sterility; but it stands to reason that, where the
shape of the organ is such that it further favors malpositions, as well
as where it offers no obstacle to the vagina immediately expressing or
dropping out all the seminal fluid, impregnation is more difficult, and
that, where the uterine deformity is coincident with this condition of
penis to assist, it becomes well nigh impossible. Foderè mentions a
penis about the size of a porcupine-quill on an adult male, and Hammond
mentions one of the size of a lead-pencil in diameter and two inches in
length. From total absence of the penis, either through disease or
accident, to the diminutive organs mentioned by Foderè and Hammond, and
on up to the full-sized and normal-shaped organ, we have every degree of
sizes and shapes, and with these go every conceivable degree of ability
or faculty for impregnation.

Aside from the foregoing considerations, there are others equally
important. Although Greece was involved for years in war and ancient
Troy was destroyed and all its inhabitants slaughtered because of the
seduction of one woman; and Semiramis, through her beauty, got all her
successive husbands in chancery; and poor, susceptible Samson, from
firing Philistine vineyards and killing lions bare-handed, and the
Philistines by the thousands with the jaw-bone of an ass, was reduced
through Delilah to bitter repentance and turning Philistine mill-stones;
and we know that the familiar infatuation of Antony for Cleopatra ruined
Antony; and we are familiar with the well-known maxim of the French
police-minister, that to catch a criminal it was but necessary to first
locate _the woman_ and the man would soon be found,--society has
determined to ignore the influence of the animal passions as factors in
our every-day life, or factors in the estrangements, coldness, and the
bickerings that end in divorces. Not to shock the reader with detailed
accounts as to what an important factor the shape of the penis may be in
the domestic economy, I will refer the reader to Brantome's works.

Although the councils of the older church were not above giving these
conditions their calm and deliberate consideration, which resulted in
the foundation of the present physical considerations in relation to
divorce laws, such studies or considerations are at present only touched
upon gingerly and with apologies for doing so, as if the "study of man"
was of any less importance to-day from what it was in the days of Moses,
the elder church, or when Pope formulated his oft-quoted but
little-followed maxim, that "the proper study of mankind is man." The
present miscalled "delicacy of sentiment" is about as misplaced a
condition of disastrous and misleading morality as was the out-of-place
and untimely bravery of poor old Braddock when refusing Washington's
advice at the Monongahela. The success and beauty of the Mosaic law is
its squarely facing the conditions of actual life, and its absence from
nonsense or nauseating sentimentality. Were our present churches to
observe more of this plain talk, for which the good old Anglo-Saxon is
as fully expressive and convincing as the old Hebrew, and deal less in
rhetorical flourishes and figurative mean-nothings to tickle the ears of
our modern Pharisees, mankind as well as womankind would be infinitely
so much the better off, mentally, morally, and physically, and there
would be less of the conflict between science and religion. Luther's
dream of restoring religion to its primitive purity has come to but as
poor realization at the hands of his so-called followers, which leads
one to think that if the martyrs of the Reformation could come back and
see the fruits of their martyrdom--suffered that pure religion might
live--they would conclude that, for all the resulting good accomplished,
they might as well have kept a whole skin and a whole set of bones.

In cases of pronounced phimosis the aperture in the prepuce may not be
in a line with the meatus, and the resulting discharge of urine or the
ejaculations of seminal fluid may from this cause be unable to find an
egress. The fluid escaping from the urethra will, in case the opening is
at the side or upper part of the prepuce, cause it to balloon out until
a sufficient quantity is thrown out so as to distend, the opening as
well as the prepuce, before it can find its way out; in such cases
impotency is liable to be as complete as in those cases of stricture
wherein the seminal fluid is forced backward into the bladder. Having
given this general view of the effects of phimosis as it may affect man
in the shape of his organ, which may have a serious result in his
domestic relations or in becoming a father, we will proceed to the
consideration of diseases and conditions that phimosis encourages and to
which it renders man more liable. In the consideration of these cases it
must not be forgotten that the sexual relations are much more to man or
woman than is generally acknowledged. The days for the establishment of
the Utopian republic of Plato are not yet with us. That Platonic love
does exist is true, as it has in the past and will in the future.
Scipio, refusing to accept the beautiful betrothed bride of an enemy as
a present, or Joseph leaving his coat-tail in the hands of the amorous
bride of the eunuch Potiphar, with the suicide of Lucretia, in the past,
are events which virtue and modern continence probably duplicate every
day; but these are exceptions to the rule. Physicians daily see
evidences of the most devoted Platonic affection in either sex, but they
also see enough of the opposite side of the question to convince them
that in the majority of cases the sexual relations are the bond of
union, as well as the mainspring of love. As observed by Montesquieu,
the bride of a first-class Turkish eunuch has but a sorry time, and a
woman of the same calibre of mind as that possessed by the ordinary
Circassian or Armenian bride cannot be in a much happier condition with
a husband partly eunuchised by a constricted prepuce.



CHAPTER XIX.

IS THE PREPUCE A NATURAL PHYSIOLOGICAL APPENDAGE?


By many surgeons the idea of circumcision, unless connected with an
immediate demand for interference,--such as a phimosis unmanageable by
any other means, an induced phimosis from gonorrhoea or other
irritation, syphilis in its initiatory sore, cancer or some such
cause,--is looked upon as an unwarrantable operation, a procedure not
only barbarous, painful, and dangerous, but one that directly interferes
with the intentions of nature. The prepuce is by many looked upon as a
physiological necessity to health and the enjoyment of life, which, if
removed, is liable to induce masturbation, excessive venereal desire,
and a train of other evils. The question then resolves itself, What is
the real physiological status of this appendage, if it has any, and, if
it is a physiological appendage, when does it merge into a pathological
appendage? As by some it is held that the prepuce enjoys the same right
to live and exist as the nose, ear, or a limb, which are only subject to
amputation in case of a serious disease, they should be reminded that
they are not taking into consideration that the nose and ear are
calculated to warn us of danger, and that our legs are very useful; as
even the great orator Demosthenes, by the timely and rapid use of his
legs, was enabled to escape from a battle, where his oratory was of no
avail against the illiterate javelins of the unscholarly Macedonians. If
the prepuce only was endowed with an olfactory sense,--as, for instance,
if a nervous filament from the first pair of nerves had been sent down
alongside of the pneumogastric and then, by following the track of the
mammary and epigastric arteries, had at last reached the prepuce, where
the olfactory sense could have been turned on at will, like an
incandescent lamp,--it might have been a very useful organ, as in that
sense it could have scented danger from afar, if not from near, and
enabled man to avoid any of the many dangers into which he unconsciously
drops. But, seeing that the prepuce, to say nothing of being neither
nose, eye, nor ear to warn one away from danger, or a leg to run away on
after once in it, having not even the precautionary sensitiveness of a
cat's moustachios, it cannot, in any way that we can see, be compared to
any other useful part of the body.

All attempts to find reasons for its existence that are of real benefit
to man have so far proved unsatisfactory, and, unlike the reasons for
its removal, are, as a rule, founded on speculation. To further reason
out the why and wherefore of its existence or of its summary surgical
execution, we must consider its shifting positions as to the effects it
produces, as well as to its conditions at different ages, sitting on its
case like an impartial jury in the case of some unconvicted but
diabolically-inclined criminal.

As before remarked, we are, as a rule, born with this appendage, just as
much as we are with the appendix vermiformis, which rises up, like
Banquo's ghost, whenever we eat tomatoes or any small-seeded fruit. This
prepuce is then long, and the penis is found at the end of an
undilatable canal, which is formed by the constricted prepuce; at this
early stage of our existence it is often additionally bound down to the
glans by a greater or less number of adhesions. We are then in what many
term a state of physiological phimosis, that being a perfectly natural
condition, and one consistent with health; at least, we imagine it is
normal.

Phimosis in childhood is generally considered a physiological state,
only to be taken as a pathological condition under certain
circumstances. Preputial adhesions may, according to many observers,
also be classed as physiological at an early period of life, as it is by
them considered as congenital, and common enough to warrant its being
classed as normal. As to the first, or phimosis, it undoubtedly is a
physiological condition during infancy; but why, we do not know; and it
is also a fact that from birth to puberty it remains so in fully over
one-half of the cases. Out of 98 children, from one week to sixteen
years of age, examined by Dr. Packard, the prepuce was entirely
unretractable in 54, partly so in 3, and wholly so in 36; while in 1 it
only half-covered the glans and in 4 the glans was wholly uncovered, 1
of these 4 being an infant only five weeks old.

Dr. Packard also gives the result of 172 examinations by himself, of
from twelve to seventy-three years of age, and 106 examinations by Dr.
Maury, a total of 278, in whom 100 had a long prepuce, 97 a
partly-covered glans, and 81 (of whom 2 had been circumcised) in whom
the glans was exposed.[83] As to adhesions, there is an unaccountable
diversity of opinion as to their constancy as a natural condition, being
frequent enough to class them as physiological occurrences. Dr. A. B.
Arnold, of Baltimore, states that his experience in reference to
preputial adhesions leads him to conclude that the frequency of its
occurrence has been much overstated. In the number of children that he
has circumcised, which exceeds 1000, he has met with it in less than
four per cent. of the cases. He also mentions that in the adult the
adhesions show greater firmness.[84]

On the other hand, Dr. Bernheim, of the Paris Israelitish Consistory,
observes that, of over 3000 newborn whom he has examined, with but few
exceptions he found the presence of preputial adhesions. He remarks,
however, that in the majority these are detached or broken by the first
attempt at erection.[85]

Bokai, out of 100 children, found 8 who were over seven years of age,
who were perfectly free; while of the remaining 92 under that age 6 more
showed no adhesions and 86 had various degrees of adhesions.[86]

Dr. Holgate, of the out-door department of Bellevue, considered that all
phimosic cases have adhesions; while Dr. Moses, of New York, out of some
fifty circumcisions performed at the eighth day, found only adhesions
three times.[87]

These observations are, however, in perfect accord. If we connect the
statement of Dr. Arnold, in regard to the increasing character of the
firmness in the adhesions of the adult, with the statement of Dr.
Bernheim, that the first erection is often sufficient to break up the
existing adhesions in the infant, we must conclude that they are nothing
more at first than a slight agglutination, which the slight manipulation
required to properly locate the position of the glans, and to space out
the prepuce preparatory to the operation of circumcision, must, in the
majority of cases, be sufficient to liberate the prepuce from the glans;
this is evident also from the statement of Dr. Moses, who only found six
per cent. of the cases operated upon by him as being so affected.

The writer has been present at a large number of Hebrew circumcisions
performed on the eighth day, and from that up to the sixth month (as in
many communities they wait until a number of children are collected, so
to speak, before sending for the mohel, who may reside at quite a
distance), and in all of those witnessed he has never seen any
complications from adhesions; but cases of adhesion have been often
encountered from the second to the eighth year, and it has always been
the case, as a rule, that the older the child the greater the firmness
of the adhesion. In these cases the practice generally advised of using
a probe is not practicable, as the person is more apt to wound the sound
prepuce than to tear the adhesions; the practice most effectual is to
hold the glans firmly but gently with the thumb and forefinger of the
right hand, and then to draw the prepuce as firmly back with its fold
held in the forefinger and thumb of the other. It is a more expeditious
mode, and the least painful; by this method extensive adhesions can
readily be broken up; vaselin and a piece of fine lint should then be
interposed for a couple of days to prevent a re-adherence.

Another co-existing condition with phimosis, very often found, is a
shortening of the frenum. Dr. Jansen, out of 3700 soldiers of the
Belgian army, found 12.3 per cent. with this pathological condition and
2.5 per cent. with a narrow prepuce.[88]

Take the three conditions above enumerated,--phimosis, preputial
adhesions, and short frenum,--all are but a departure from a normal, in
a greater or less degree; and whether the resulting discomfort consists
in mere mechanical impediment to urination, erection, or as a factor in
nocturnal enuresis, dysuria, impotence, either through reflex action or
interference with emission, malposition of the urethral orifice during
copulation owing to any of these conditions, or in any of the nervous
derangements that may accompany this condition, or in the more serious
results, ending in positive deformity of body or limb, or in the
warping of moral sentiments, or, even further, in inducing insanity, it
cannot well be seen how the conditions that will certainly produce these
results, in a more or less degree, can ever, in any logical sense, be
considered a physiological condition.

There are certain conditions to life, up to the time of birth, which,
unless they then cease at once to exist, immediately become from a
physiological into very serious pathological conditions. These are well
understood, and have their reasons for existing during our pre-natal
existence; but the prepuce has no known function during uterine life or
subsequently; and there being no valid reason for its existence, there
are certainly no logical grounds for its being considered a
physiological condition, especially when the serious results attending
the most accentuated form of the above three conditions are considered,
and as its necessity, in cases of its entire absence, has not yet been
demonstrated.

It can well be said that about two-thirds of mankind are affected in a
greater or less degree with these pathological conditions, causing them
more or less annoyance. Of these, a certain percentage suffer a life of
continued misery, as a direct or indirect result of these conditions.

As to the actual necessity of a prepuce existing, or as to what
annoyances or diseases persons are subjected to who are born without it,
there is a most singular and expressive silence in medical literature.
It stands to reason that, if it is a necessity, some one person should
have found it out long ago, and there should then be some evidence to
present in relation thereto. There are cases reported in some of the
older surgeries wherein an attempt has been made, in the absence of a
prepuce, to restore or manufacture one by means of a plastic operation.
Vidal describes such an operation,[89] but there is no reason given as
to why the operation was undertaken; there is no record of any diseased
condition which it was intended either to cure or to alleviate; so that
we are left to infer that the person simply submitted to the operation
from purely cosmetic reasons. The Hebrews of Palestine, after the Roman
conquest, or those in Italy or Spain, attempted a like operation, but
not from any reason of lessened health or to restore any lacking
physiological action, their aim having simply been to hide their
identity, for the purpose of escaping persecutions, exactions, or
annoyances, either from their rulers or their fellow-citizens.

Dr. A. B. Arnold, in a paper on circumcision, read before the Academy of
Medicine of Baltimore, argues that it is not difficult to divine the
purposes of the prepuce, holding that it is necessary to protect the
tactile sensibility of the glans, due to the presence of the Pacinian
bodies which Schweigger Seidel discovered in the nerves, and that a
better provision than the anatomy of the prepuce cannot be conceived for
shielding the very vascular and sensitive structure of the glans from
external sources of irritation and friction, that might rouse the
sensibility of this organ, which, on physiological grounds, may cause
early masturbation; further arguing that, the corona being undoubtedly
the most excitable part of the glans, its denudation by circumcision
leaves it more apt to be affected by chance titillations.[90] In this
latter view of the case the preponderance of views is, however, in the
opposite direction. J. Royes Bell states that, owing to the induration
of the glans through the means of circumcision, masturbation and
syphilis are less rife amongst the circumcised than amongst the
uncircumcised.[91] M. Lallemand, whose experience in the treatment of
seminal emissions is of the greatest value, looked upon circumcision as
one of the means of curing those diseases, looking on the diminished
irritability of the glans resulting from the operation as the curative
element.[92] Dr. Cahen, in a "Dissertation sur la Circoncision," in
1816, before the Faculty of Medicine of Paris, called the attention to
the diminished sensibility of the glans induced by circumcision. Dr.
Vanier, of Havre, looks upon the prepuce as the most frequent cause of
onanism. "If the prepuce is lax, its mobility produces an irritation to
the highly irritable and sensitive nervous system of the child by the
titillation in its movements on the glans; if too tight and constricted,
then it compresses the glans, and by its irritation it leads the child
to seize the organ."[93] So that in either case he looks upon the
prepuce, through the sensitiveness it retains and induces in the glans,
as the principle cause of masturbation. M. Debreyne, the Trappist monk
and physician of La Trappe, who has paid considerable attention to
medicine as applied to morality, practically makes the same
observations. In children who have not yet the suggestions of sexual
desire imparted by the presence of the spermatic fluid, the presence of
the prepuce seems to anticipate those promptings. Circumcised boys may,
in individual cases, either through precept or example, physical or
mental imperfection, be found to practice onanism, but in general the
practice can be asserted as being very rare among the children of
circumcised races, showing the less irritability of the organs in the
class; neither in infancy are they as liable to priapism during sleep as
those that are uncircumcised.

Dr. Bernheim says that "the prepuce may be said in general to be an
appendage to man, if not positively harmful in some cases, at least
useless, requiring constant care, the neglect of which is liable to
entail disease and suffering; the irritation it produces through the
sebaceous secretion is a frequent cause of masturbation which nothing
short of circumcision will remedy."

Through middle life, unless the prepuce be the subject of some vicious
conformation, little inconvenience may result from its presence, except
it be from the dangers to infections already pointed out during this
period of life; an ordinarily movable and retractable prepuce will not
acquire the condition of phimosis, unless it be through disease or
accident; but with our entrance into old age, or after having passed our
vigorous prime, the torment of the days of our infancy and childhood
come to harass us again. Persons given to corpulency, with a long
prepuce, are apt to become affected with phimosis in their latter years,
as such persons are more subject to loss of their sexual vigor and power
of erection than lean and spare people; in these, the gradual diminution
of the size of the erectile tissues of the organ and its retraction
allows of the reconstriction of the preputial opening, which, in the
end, will not allow the prepuce to be drawn back over the gland. These
conditions are followed by the irritating affections incident to
phimosis of our earlier life, with the modification that age has induced
in making us subject to more serious and fatal ailments, both locally
and generally.



CHAPTER XX.

THE PREPUCE, PHIMOSIS, AND CANCER.


In the _British Medical Journal_ of January 7, 1882, there is an
interesting article by Jonathan Hutchinson on the "Pre-cancerous Stage
of Cancer." In this article he states that, whereas, twenty years
previously, his suggestion had been to treat all suspicious sores as
being due to syphilis until a clearer diagnosis could be made out, he
"had more recently often explained and enforced the doctrine of a
pre-cancerous stage of cancer. According to this doctrine, in most cases
of cancer, either of penis, lips, tongue, or skin, there is a
stage--often a long one--during which a condition of chronic
inflammation only is present, and upon this the cancerous process
becomes ingrafted. Phimosis and the consequent balanitis lead to cancer
of the penis.... A general acceptance of the belief that cancer usually
has a pre-cancerous stage, and that this stage is the one in which
operations ought to be performed, would save many hundreds of lives
every year.... Instead of looking on whilst the fire smouldered, and
waiting till it blazed up, we should stamp it out on the first
suspicion.... What is a man the worse if you have cut away a warty sore
from his lip; and, when all is done, a zealous pathologist demonstrates
to you that the ulcer is not cancerous, need your conscience be
troubled? You have operated in a pre-cancerous stage, and you have
probably effected a permanent cure of what would soon have become an
incurable disease. I do not wish to offer any apology for carelessness,
but I have not in this matter any fear for it."

In view of the great frequency of the occurrence of cancer of the penis,
and the facts pointed out by Roux, that, after the removal of the
cancerous prepuce or a portion of the penis for cancer, in case of a
recurrence the disease does not do so in the penis, but that it attacks
the inguinal glands, showing conclusively that the prepuce is the
inciting cause as well as the initial point of attack, the sentiments in
the foregoing paragraph, taken from the words of Hutchinson, are worthy
of our most careful consideration.

M. Roux, Surgeon to the Charité, during the second decade of the present
century, first called the attention of the French profession to the
intimate relation or dependence that cancer of the penis bears to
phimosis. In England he was preceded in this field of surgical
investigation by William Hey, whom Roux met in London in 1814. Hey had
then operated by amputation of the penis on twelve cases of cancer, nine
of whom had had phimosis at the time of the development of the cancer.
Wadd at this time also published a work on the subject, but, although he
noticed that phimosis was a cause of cancer, he did not fully grasp the
subject as Hey and Roux had done, as he believed a cancerous diathesis a
primary necessity, and did not then recognize that the primary cause was
fully to be found in the prepuce itself.

Roux was probably the first to point out the peculiarly local character
of penile cancer, as there is no locality wherein a timely operation is
less apt to be followed by a recurrence. He records a number of cases
where the prepuce alone was affected when first seen, but none wherein
the glans was attacked and where the prepuce was exempt, giving ample
evidence of the original starting-point of the disease.[94]

Erichsen also remarks on the little liability to recurrence of cancer of
the penis after a timely operation; he divides the cancer to which the
penis is subject to as being of two distinct kinds,--scirrhus and
epithelioma. The latter variety commences as a tubercle in the prepuce,
and, according to Erichsen, does not occur in the body of the penis
except as a secondary infiltration or deposit.[95] Travers states that
Jews who are circumcised are not subject to either form of cancer.[96]

Repeated attacks of herpes preputialis and some consequent point of
induration are looked upon by Petit-Radel, Chauvin, and Bernard as
frequent starting-points for the cancerous affection of the prepuce. The
aged or persons of lax fibre being more subject to these inflammatory
attacks, are also the most frequent victims of cancer in this situation.
The celebrated Lallemand, in regard to the tendency to cancer induced by
the presence of the prepuce, observes as follows:--

"Besides simple balanitis ... there also result various indurations,
which are proportionate in their degree to the length or time and
intensity with which the inciting inflammatory conditions have existed.
I have repeatedly found the mucous lining of the prepuce thickened,
hardened, ulcerated, and nodulated; at other times converted into a
fibrous or even into cartilaginous tissue of excessive thickness; in
others, still, in which it had assumed a scirrhous and cancerous nature.
I have repeatedly operated on such cases, wherein the prolongation of
the prepuce was the only recognized primary cause, the subjects being
often countrymen of from fifty to sixty years of age, who had never
known any women except their own, but who had, nevertheless, been long
sufferers from balanitic attacks, accompanied by abundant acrid
discharges, swellings of the prepuce, with more or less consequent
excoriations and narrowing of the preputial orifice."[97]

Claparède sums up the inconveniences and dangers to which the possessor
of a prepuce is liable to suffer from, as follows: "The retention of the
sebaceous secretion is liable to alter its character, converting it into
an acrid, irritating discharge, which induces more or less burning,
smarting, itching, excoriations, and swelling, which, affecting the
little glands situated about the corona and sulcus, induces them to
secrete an altered and vicious secretion. In this manner a simple
elongation of the prepuce will produce an inflammation of the surface of
the glans (balanitis), or that of the prepuce itself (posthitis), or the
two conjoined (balano-posthitis), complicated possibly with phimosis. By
an extension to the mucous membrane of the urethra of the same condition
of the inflammatory process, we have blennorrhagia; blennorrhagia is
liable to be followed by inguinal swellings or tenderness, orchitis,
stricture, and prostatic disease; the formation of preputial calculus,
from retention of the urine in the prepuce; and cancer is apt to be the
end of any of these conditions."[98]

J. Royes Bell, in Ashhurst's "International Encyclopædia of Surgery,"
observes as follows: "Carcinoma attacking the genital organs usually
assumes the form of epithelioma; the other kinds are rarely met with.
Epithelioma may invade the prepuce, or the whole penis, or any part of
it. The most common age for it is fifty years or over. In the great
majority of cases there has existed a congenital or acquired phimosis. A
contusion or a urinary fistula may be the exciting cause. With a
phimosis the parts are not kept clean, but the gland is macerated and
rendered tender and excoriated by retained secretions, and the
irritation causes an epithelioma to grow in those predisposed to the
disease, as is found to be the case when the tongue is irritated by a
broken tooth, or the scrotum by the presence of soot in its folds.
Syphilis has no direct influence in inducing the disease, but a
syphilitic chap or ulcer may be the starting-point of an epithelioma.
Two kinds of epithelioma affect the penis,--the indurated and the
vegetating, or cauliflower growth.... The nature of the disease, in
either the prepuce or the glans, is masked by a phimosis.... The
prognosis in these cases is much more hopeful than in epithelioma, in
other situations.... Sir William Lawrence operated on a patient who was
quite well years afterward, and Sir William Ferguson amputated the penis
of a man of note in the political world, who lived many years after the
operation, and died at an advanced age."

Agnew, of Philadelphia, describes an epithelioma of the prepuce
occurring in persons past middle life, beginning as a tubercle, crack,
or wart, for which he advises an early circumcision; he admits, however,
to not having sufficient data to determine whether Jews and circumcised
persons are exempt from carcinoma of the penis; but as its usual
starting-point he evidently admits to be in the prepuce, circumcision
must certainly be a preventive to its appearance. Gross gives
substantially the same opinion as Agnew in this regard. Dr. John S.
Billings, in his article on the "Vital Statistics of the Jews," in the
January _North American Review_, of 1891, on the subject of cancer,
observes as follows:--

"As regards cancer and malignant tumors, we find that the deaths from
these causes among the Hebrews occur in about the same proportion to
deaths from other diseases as they do in the average population. But as
the ratio of deaths to population is less among the Jews, so the ratio
of deaths from malignant diseases to population is also less. Among the
living population the proportion found affected with cancer among the
Jews was 6.48 per 1000, while of those reported sick by the United
States census of 1880, for the general population, the proportion was
10.01 per 1000."

There are no convenient data as to the prevalence or percentage of cases
of cancer among the Arabian or Mohammedan population of Asia and Africa,
but the above comparison of 6.48 per 1000 among the Jews of the United
States, against 10.01 per 1000 of the general population, shows that the
circumcised race does, in the instance of cancer, certainly enjoy a
certain amount of immunity, having in this regard not quite such an
exemption as they enjoy from consumption, but still sufficient to assist
in making them longer-lived and more able to enjoy life and die a less
lingering and painful death.

It is surprising that, in view of the fact that carcinoma of the penis,
starting with such frequency in the prepuce, should have left any doubt
but that with the absence of this appendage there would follow less
liability to cancer. Cullerier informs us that he had several times
amputated the penis for cancerous diseases, but that he is unable to
tell us whether the persons were affected with phimosis, remarking that
on the last case he had observed the indurated remains of the prepuce;
he had, however, recognized the necessity of freely exposing the gland
in cases where, from continued irritation and inflammation, there was
danger of cancer formation.

Nelaton describes two varieties of cancer that affect the penis,--that
which attacks the integument and that which attacks the glans. The
first of these varieties he observes as generally beginning as a
hardened nodule in the prepuce, which becomes at once more or less
thickened and indurated. He gives Lisfranc the credit of pointing out
the fact, that, even in the most hopeless-looking case, the glans and
body of the penis may be simply pushed back and compressed, but
otherwise sound, and that before resorting to an amputation of the whole
organ it is better to make a careful exploratory dissection in search of
the penis, as it oftentimes happens that the prepuce and integument can
be dissected off, leaving the organ intact. He also mentions that
elephantiasis of the penile integument generally begins in the prepuce.

Baron Boyer believed that the vitiated preputial secretion allowed to
remain beneath the prepuce was one of the causes of cancer of the penis,
observing that it would be interesting to know whether cancer of the
penis was a rarity among circumcised people, such as the Jews and
Mohammedans.[99]

It is easy to perceive why or how Agnew, Gross, Cullerier, and many of
those who have written on the subject, have failed to appreciate the
existence of the prepuce as an exciting cause, or as being, in the
majority of instances, the part primarily attacked. The nodule,
excoriation, or abrasion that develops into a cancer generally produces
more or less local disturbance; in many it produces a phimosis that is
only relieved by the ulcerative process that exposes the gland, which
may by that time itself be attacked or even destroyed. They are then
seen by either the rural practitioner or the family physician, but
before submitting to an operation they run the gauntlet of many
physicians, and, when it comes to operating, they generally apply to
some one of great skill and reputation. By this time there is little
left of the organ, and, as a rule, the party is unable to tell where the
disease originated, whether in the prepuce or glans, to them the swollen
prepuce seeming to be the whole organ. Of late years, however, it has
been pretty well established that it generally begins in the prepuce,
and the great number of amputations of the penis on record for this
disease does not lead one to believe that it is as rare a disease as was
formerly believed. In Langenbeck's _Archiv_, Bd. xii, 1870, Dr.
Zielewicz reports fifty cases of amputation of the penis by the
galvano-cautery loop, mostly for carcinoma, one of the fifty being for
gangrene and one other for a large papillary tumor. That one surgeon was
able to report forty-eight cases of carcinoma or cancer that were
treated by one special system of operating tells us plainly enough that
the unfortunate possessor of a prepuce, no matter how normal or
unobjectionable it may seem to be in the prime of man's existence, or
however physiologically necessary it may be deemed, runs too many risks
in holding on to his possessions.

The views set forth by Hutchinson in the beginning of this chapter are
precisely those that are held by the writer, who would even go further,
by advising all such as have, in their youth or since, suffered with
balano-posthitis in any degree or form, or whose prepuce shows a
tendency to elongation with age, to have the same removed at once; where
the prepuce is not redundant, but only tight, a slight operation, such
as slitting, will at once remove the possibility of any future danger,
without keeping a man from his business a single day.

It may here be remarked that, although always favorably impressed with
the great benefits arising out of circumcision, nothing ever resulted in
such a serious consideration of the subject as seeing a professional
brother dying with a cancerous affection of the penis. The disease had
originated in the mucous lining of the prepuce, and when seen in
consultation with his attending physicians the gland had already
disappeared and the inguinal glands were affected. The man was in the
prime of life, and, aside from the local trouble, a specimen of perfect
health and physique. He informed us that while a youth he had suffered
from repeated attacks of herpes preputialis; that he had suggested
circumcision more than once to his father, who also was a physician, but
who, unfortunately for the son, could not see any merit in circumcision.
To his eyes there was nothing that circumcision could do but what could
be accomplished by washing and personal attention to cleanliness. When
older, the prepuce gave him less trouble, and for a long time after his
marriage it ceased to trouble him altogether. The idea of the necessity
of circumcision did not occur to him again until the appearance of the
cancerous disease; even then, not appreciating the danger, and looking
upon the trouble as a simple transient result of some inflammatory
action, he waited until the parts would be in a better state or
condition of health before resorting to an operation,--that time never
came.

Although to Roux, Wadd, and Hey the credit must be given for bringing
the subject of cancer of this organ so prominently before the
profession, the knowledge of the existence of the disease has long been
a matter of record. Patissier, in the fortieth volume of the "Dict. des
Sciences Médicales," quotes from the third volume of the "Mémoires de
l'Académie Royale de Chirurgie," that in 1724 an officer, aged fifty,
was attacked by a cancerous affection originating underneath the
prepuce; at the time he consulted MM. Chicoineau and Sonlier the
disease had existed for two years, the inguinal glands were implicated,
and even the suspensory ligament was affected. These surgeons,
nevertheless, determined upon an operation, and, after a long chapter of
hæmorrhagic accidents, the patient finally made a recovery. Another
case, quoted by Patissier, was operated upon by M. Ceyrac de la Coste,
the patient a man of sixty, the disease originating, like the preceding
case, underneath the prepuce.

Warren, in his "Surgical Observations on Tumors," observes that cancer
of the penis begins by a warty excrescence on the glans or prepuce.
Walshe, in his work on the "Nature and Treatment of Cancer," says: "The
disease may commence in almost all parts of the organ, but the glans and
prepuce are by far its most common primary seats. It may originate
either from a warty excrescence or a pimple, or it may infiltrate the
glans, or appear as a complication of venereal ulceration. Phimosis,
either congenital or acquired, is an exceedingly common accompaniment,
and it appears probable that the irritation occasioned by this condition
of the parts may act as an exciting cause of the disease in persons
predisposed to cancer. Circumcision is, therefore, an advisable
prophylactic measure, where the constitutional taint is known to
exist."



CHAPTER XXI.

THE PREPUCE AND GANGRENE OF THE PENIS.


Another accompaniment of that preputial appendage is gangrene of the
penis, which, like carcinoma, starting in at the prepuce, may invade the
pubes and scrotum. This disease is not so rare as to merit the little
attention it has received from our text-books. M. Demarquay has
collected the history of twenty-five cases; from him we learn that the
prepuce is the most frequent seat of the start of the affection, from
whence, according to Astruc, it rapidly spreads to the skin of the whole
organ, and then attacks the corpora cavernosa; it may even extend as
high as the umbilicus. This disease spares no age; it attacks young and
old alike.

There is not a case recorded of this disease that particularized any
other starting-point than the swelling, tension, active or passive
congestion that takes place in the integument of the penis. By this it
must not be understood that the initial disease or inflammatory action
that produces the gangrene must necessarily have its seat in the
integument, but that it is the integument of the penis (and especially
that of the prepuce) in which, through the laxity of its tissues,
passive congestion is favored that the gangrenous action begins. That
this is the actual case there can be but little doubt about, as, even
where the gangrene invades the body of the penis itself, even where the
inflammatory action may have started from a violent urethritis, that
condition of blood which favors gangrenous results will be found to
have begun during its state of stasis, where it has parted with much of
its watery element, as well as considerable of its vitality, while in
its slow, tedious, and obstructed passage through the prepuce. Some of
this dark, thickish blood, finding its way from the integumentary return
circulation to that of the deeper structure, becomes there a mechanical
as well as a pathological cause for that impediment to the free
circulation of the parts, through its altered physiological condition.
The deeper structures of the penis, besides their own blood-supply,
carry back into the deeper or systemic circulation a large supply from
the integumentary tissues, when in the latter, owing to the greater
supply due to any inflammatory action, the blood-current is delayed and
impeded in its lax and easily-dilatable tissues, and blood-changes occur
favoring the gangrene in the deeper tissues, so that, whether the
gangrene first takes place in the body of the penis or in the scrotum,
it will be in the prepuce or adjoining integument that its real
originating causes will be found.

Baron Boyer, in speaking of the inflammation of the penis, observes that
the intensity of the swelling, great pain, and difficulty of urination
that follow have led many to believe that the inflammation of the deeper
structures really always formed a part of the disease. In otherwise
healthy and vigorous subjects it does not, however, extend beyond the
skin, as has been demonstrated where the resulting gangrene from excess
of inflammatory action has ended in resolution, the deeper tissues not
having been found to be injured. It is only where the tone of the
general system is lowered, through disease, age, or other deteriorating
conditions, that the whole organ is liable to become affected or to
break down.

Boyer, in the tenth volume of his "Treatise on Surgical Affections,"
gives several examples of this affection not due to age: one case was a
person, simultaneously attacked by an adynamic fever and a
blennorrhagia, who suffered from gangrene of the penis; the local and
constitutional disturbance was not high, however, and the patient
escaped with the simple loss of the prepuce.

Another case admitted to the Charité, aged thirty-six, was afflicted
with a blennorrhagia, upon which an attack of low fever supervened. The
penis inflamed, became engorged and livid, and soon gangrenous symptoms
presented themselves, making rapid progress; at first the integument
alone was affected, but later all the structures became implicated and
the penis was completely destroyed, the sloughs detaching themselves in
shreds, leaving a conical stump that healed but slowly.

One case, a young man of twenty, also at the Charité, was admitted with
adynamic fever; a few days after admission the prepuce was observed to
be somewhat inflamed; in spite of all treatment this progressed so
rapidly that the purple discoloration presaged a gangrene, which was not
slow in following; the focus seemed to be at the superior and back
portion of the prepuce; an incision evacuated a quantity of purulent,
serous fluid; the disease, however, extended up the organ as far as its
middle before its actions ceased; the sloughs were then cast off, when
it was found that part of the gland and a portion of the cavernous body
had followed the integument in the general wreck, subjecting the patient
to intolerable pain during micturition. After the recovery from the
fever, the remaining portion of the gland and the mutilated parts of the
cavernous body were amputated to remedy this condition; the patient
subsequently admitted to have had a blennorrhagia at the time of his
admission to the hospital.

The gangrenous action may, in proportion to the low condition of the
patient, be as proportionately rapid. Another case from Boyer, quoted
from the works of Forestus, relates how the whole organ underwent such
speedy disorganization that its liquefied remains were found in a
poultice, which had been applied with a view of relieving the
congestion,--a very dear price to pay for retaining the prepuce, that
the exquisite sensitiveness of the tactile faculty for enjoyment,
resident in the corona of the gland, might not be interfered with.

Gross does not mention this affection in his work on surgery, but Agnew
devotes considerable space to its description, dividing the disease into
two forms: the inflammatory, such as may follow venereal primary sores
or operations on the penis, not excepting circumcision; and the
obstructive variety, such as may follow embolism or any mechanical
obstruction, either purposely or accidentally applied. Of the latter he
gives a number of quoted instances; he only admits seeing one case, that
of an aged man in the Pennsylvania Hospital, in whom the disease was
caused by embolism of the dorsal artery.

J. Royes Bell, in the "International Encyclopædia of Surgery," pays more
attention to it than any of our American authors; mentioning, among the
causes which may give rise to it, the exanthemata, especially small-pox,
and the poisoning by ergot of rye and erysipelas. Among the local causes
lie mentions phimosis, paraphimosis, and balano-posthitis.

Bell quotes the case reported by Mr. Partridge, in the sixteenth volume
of the "Transactions of the Pathological Society of London," wherein a
sober man, aged forty, lost the whole of his penis up to the root,
during the course of a typhus fever. Also the case reported by Mr. Gay,
in the thirtieth volume of the same "Transactions," wherein a
cabinet-maker, aged thirty-one, lost his penis through the probable
results of rheumatic phlebitis, and due to the presence of a plug in the
internal iliac vein. In the twelfth volume of the "Transactions" of the
same society he finds the record of the case of a soldier who lost his
penis through gangrene induced by syphilitic phagedena.

In the consideration of the subject of the prepuce as connected with
penile gangrene, it must not be overlooked that the presence of a
prepuce may be the inciting cause of some rheumatic affection (the
writer has repeatedly seen such), just as such cases are often the
result of stricture; as cases of rheumatism that have resisted all
remedial means, but that have readily given way to the dilatation of a
stricture, are by no means uncommon; not a mere muscular reflex
rheumatic pain, but even when accompanied by a rheumatic blood
condition. So that even in such a case as above reported as being due to
rheumatic phlebitis, or the case reported in the fortieth volume of the
"Dictionaire des Sciences Médicales" by Patissier, wherein a man lost
penis and scrotum through gangrene, induced by urinous infiltration, may
all in the origin be due, if not to the immediate, to the remote effects
of the presence of the prepuce.

In the first volume of the _Journal of Venereal and Cutaneous Diseases_
the writer reported a case of the complete loss of penis in a young man
as a result of phagedena due to syphilis. The man had had a long and
pendulous prepuce; in his case, had circumcision been performed in early
childhood, it would have lessened the chances of primary infection, and
had it been performed after his infection, it would have removed one
cause--if not the principal cause--of the ease with which the phagedenic
action was inaugurated. The case already mentioned as an example of
spontaneous and natural circumcision belongs to the gangrenous results
following phimosis, ending with the loss of the prepuce. In Maclise's
"Surgical Anatomy" several specimens of deformity are figured, showing
the results of this mildest of the effects of a phagedenic action. The
beginning of the interference in the return preputial circulation
undoubtedly always takes place over the superior aspect of the corona,
where the pressure of the glans is most sharply defined against the
inner fold of the prepuce.

There are milder conditions, wherein the circulation of the prepuce is
materially interfered with, both through the lax tissues of the parts
and the peculiar anatomical construction and shape of the neighboring
parts, wherein, without going as far as gangrenous breakdown, the person
suffers considerably nevertheless, and is placed in danger of losing his
penis; for, as observed by Patissier, whenever a person affected with a
gonorrhoea is attacked by a putrid or any low-grade fever, he runs the
greatest danger of losing his virile member through gangrene.

Even where phimosis does not exist, but only the long, lax, and
retractable prepuce, that is considered a perfectly physiological
condition, the prepuce is liable to cause very distressing and
complicating annoyances during the progress of other diseases. The
writer has noticed that cases with a thick, leathery, and redundant
prepuce, even when perfectly retractable, are more liable to require the
use of the catheter during the course of a continued fever. Such a
condition is also a very frequent accompaniment of prostatic
obstruction. So often has this been noticed that its association with
prostatic trouble or disease tends to the belief that the irritation
produced by this condition of prepuce often lays the foundation for
prostatic disease in not a few cases.[100] In elderly people, with the
atrophied penis and elongating prepuce, the constant moisture from the
urine on the inner fold and glans adds greatly to the irritation as well
as to the discomfort of the patient.

A number of affections are accompanied by oedema, especially toward the
latter stages of the disease; such, for instance, as the ending of cases
of mitral insufficiency. In these, the distension of the prepuce and the
resulting balano-posthitis is at times a source of great distress, and
at times the resulting engorgement produces a retention of urine. It was
after an attendance on one such case that required daily and frequent
puncturings for its relief, but which, in spite of all care, finally
became gangrenous, that a fellow practitioner cheerfully submitted to
circumcision, to avoid the possibility of any such complication
occurring to embitter his closing illness.[101]

The prepuce is the starting-point of many of the cases of penitis and
retention of urine that often accompany attacks of gonorroea; especially
can this result be anticipated where the prepuce is long, pendulous, and
with its veins in a varicose condition. Why it should be so is
self-evident. Anything that will add to the interference of the return
circulation only exaggerates the tendency to penis engorgement; this
increases the difficulty of urination, which, by the retention that
results, in turn increases the constriction at the root of the penis,
and adds to the already difficult return circulation. The bladder by its
urine, and the penis by its blood, actually form, by their mutual
pressures, an impassable dam at the root of the organ. That this is the
true condition has been more than once verified from the instant relief
given to the whole condition by the prompt employment of the supra-pubic
puncture or aspiration, as catheterization in such cases is altogether
out of the question, and should never be attempted or employed unless a
soft catheter can be inserted.

A person laboring under a continued fever has his blood in a condition
to favor sphacelus; with the slow-moving current of vitiated blood and
its retention in such lax tissues as those of the prepuce, through the
medium of the enlarged preputial veins, coupled with the lessened
sensibilities of the bladder and his perhaps semi-conscious or
unconscious condition, and an equally unconscious bladder, he is, to say
the least of it,--if in possession of a prepuce,--also the unconscious
possessor of a certain degree of percentage, no matter how small or
fractional that may be, of recovering from his fever without his penis.
Dr. W. W. McKay, of the U. S. Marine Hospital Service of San Diego,
attended a case of typho-malarial fever in consultation with me, where,
but for the persistent, intelligent, but delicate use of the catheter
for nearly three weeks the penis would have become gangrenous. The
subject was an uræmic, irritable, nervous, leathery-prepuced individual;
the organ was unusually large, the skin of the penis thick, and it was
only by keeping the bladder empty that prevented a state of engorgement
that would have effectually interfered with further catheterization. As
it was, the penis was often dank, livid, and discolored from the passive
engorgement.

The writer saw a similar case with the late Dr. F. H. Milligan, of
Minnesota. The congestion in this case was due to a gonorrhoeal
inflammation involving the skin of the whole penis, retention having
followed painful micturition, and the swelling of the penis following
the retention; the prepuce was enormously distended, and the penis
seemed in a state of erection as far as dimension and rigidity were
concerned. The man, a steam-boat cook, informed us that it was fully
twice as large as when rigidly erect in health. All efforts to reduce
the swelling were unavailing; neither punctures, leeches, nor
scarifications were of any avail; catheterization was impossible, but,
after relieving the bladder by the supra-pubic aspiration, the patient
experienced some relief. He, nevertheless, lost the whole skin of the
penis, with that of the pubis and on the front of the scrotum. The man
ran into a low form of fever, with uræmic symptoms; the stench was so
great that it was almost impossible to remain in the same room with him;
but he finally made a slow and very tedious recovery. In healing there
was considerable downward curvature of the penis, which, however, did
not prevent him from following his old, dissolute course of life.[102]

A calm, unprejudiced consideration of the subject of the liability of
the uncircumcised races dwelling in the temperate and semi-tropical
countries to cancer, gangrene, and elephantiasis might well lead one to
ask: Why are we afflicted with a prepuce? We can understand how a man
may become gouty, and become a subject in the end for a gangrene of the
extremities; or how senile gangrene may, through a series of
pathological processes and blood changes, with the aid of age, finally
be reached; or how, by a like course of diseased processes, we reach the
apoplectic stage. These conditions, however, can be put off, or partly,
if not wholly avoided, by a proper course of life, and, at the worst,
it is only after the fires of our youth and prime have completely burned
out, that these conditions are liable to claim us as their lawful
victim. Not so, however, with some of these conditions that may end in
penile gangrene; that are liable to pounce upon us unawares, like an
Apache in an Arizona cañon; or as the hired mercenaries of old Canon
Fulbert did upon poor Abelard in his study, and, without further ado or
ceremony emasculate man as effectually as the most exacting Turk could
demand, with a veritable _taillè à fleur de ventre_ operation.

Nature has her own ways of protecting what there is of any utility;
there is a law of the survival of the fittest that we all appreciate.
If, then, this penile appendage is of any utility, why is it that,
unlike the rest of the body, it falls such an easy victim to gangrene?
The procreative function seems to be, in a sense, one of the main cares
of nature in its relation to the animal as well as the vegetable
kingdom; but here is a useless bit of skin, adipose tissue, mucous
membrane, and some connective tissue, that on the least provocation is
liable to go off into a gangrene and drag one of the main generative, or
even all the procreative, apparatus into the general wreck. Nature
certainly never intended anything of the kind. To be generous, and not
libel nature, we must conclude that the prepuce is a near relative to
the fast-disappearing climbing-muscle; very useful in our primitive,
arboreal days, when we needed such a muscle to reach our perch for the
night, and a prepuce or something of the kind, in default of a
breech-cloth, to protect the glans penis from being scratched by the
briars or thorny and rough bark of the trees in our ascent. The prepuce
was well enough in our primitive and arboreal days,--ages and ages ahead
of our cave and lake dwellings,--when the notch in a tree and its rough
bark formed our couch; but in these days of plush-cushioned pews and
opera-seats, cosy office-chairs, car-seats, and upholstered furniture or
polished-oak seats, it serves no intelligent purpose.

Emasculation has never been looked upon with favor by its victim, and it
would be but natural to suppose that man would take every precaution
against the accidental occurrence of such an undesired condition. The
writer well remembers that, in his "Tom Sawyer" days on the banks of the
upper Mississippi, in the happy days of the crack rafting crews, before
the introduction of the towage steamer, when the river towns were more
or less terrorized by wild gangs of these men, some of whom were always
fighting and quarreling and drinking when not at work. In the lot there
was one man with a great reputation at a rough-and-tumble fight. His
main hold was that he generally tried to emasculate his adversary by
destroying the physiological condition of the testicle. The man was not
a large or powerful man, nor was he a great boxer or wrestler, but this
reputation made him feared by all the bullies on the river. The report
that not a few who had tackled him had subsequently been of no value,
either as fornicators or fecundators, or had to be castrated on account
of the resulting testicular degeneration, seemed in no way to encourage
any one to wish to meet him in a personal encounter. It would seem as if
the desire to avoid such an accident--provided persons knew the dangers
that lurk in a prepuce--would induce many to submit to circumcision.
That many more do not do so can only be attributed to the general human
wish to escape a less present evil for a greater unknown one, being
evidently deterred by the prospective pain that must be suffered
immediately.

There is a question that should interest man above that of the simple
loss of penis. It appears that there is a powerful moral effect that
follows this loss, as might, in the majority, be anticipated. According
to the experience of Civiale, many who have lost the penis, through
amputation for disease or through disease itself, end in suicide. He
mentions particularly a patient at the Charité who had lost his penis,
who, finding no other means to take himself off, saved up sufficient
opium, from that given him to calm his pains, to take all at one dose
and commit suicide. In the London _Lancet_ for March 27, 1886, there is
reported a discussion on this subject, to which the reader is referred,
as it fully covers the moral and physical effects of castration and
penis amputation for disease. M. Roux, who amputated the penis of a
brother of Buffon, in 1810, reported that, in that case, M. Buffon lost
none of his customary gayety.



CHAPTER XXII.

THE PREPUCE, CALCULI, AND OTHER ANNOYANCES.


From an article published in the New York _Medical Times_ of March,
1872, from the pen of Dr. J. G. Kerr, of Canton, China, we learn that
phimosis is not an uncommon occurrence among the Chinese. As has been
demonstrated by C. H. Mastin, of Mobile, climate is a great factor of
calculus. ("Transactions International Medical Congress" of 1876, page
609.) That of China seems a most favorable climate in this regard; so
that, between the prevalence of phimosis among the Chinese and the
calculus-producing tendency of the climate, China may be said to be the
classic land of preputial calculi, as England is that of the gout, or
the United States that of delirium tremens. From Dr. Kerr we learn that
the occurrence of these concretions were, as a rule, multiple, and that
in two cases that fell under his observation the number of stones from
each individual exceeded one hundred. In one case there were forty, and
in three cases there were between twenty and thirty. These were of
different sizes and weight, some being an inch and five-eighths in
diameter, and from that size down to where one hundred and sixteen taken
from one individual case only weighed one ounce. The tendency to
calculous disease in that climate may well be imagined, when the same
observer relates a case of urinary infiltration into the skin on the
under side of the penis that gave rise to the formation of a collection
of calculi in that locality, four of which were the size of pigeons'
eggs; and another case in which a urinary fistula induced the formation
of a calculus in the groin, near the scrotum, the calculus weighing two
and a half drachms and measuring one and a half inches by three-quarters
of an inch in diameter.

Claparède mentions a case in the practice of M. Dumèril, in which the
stone extracted from the prepuce weighed two hundred and twenty-five
grammes, or about eight ounces. Civiale speaks of a young man of twenty
with phimosis, who, after practicing sexual connection for the first
time, experienced pain and a purulent discharge, from whom, on
examination, he removed five stones as large as prunes. The patient had
felt them in their position, but had imagined the condition to be a
natural one.

E. L. Keyes gives their composition as being of calcified smegma, urate
of ammonium, triple and earthy phosphates and mucus, and as symptoms and
results: pain, purulent discharges, interference with urination and the
sexual act, involuntary emission, ulceration of the preputial cavity,
and impotence.

Enoch mentions a child of two years in the Charité, who, being operated
upon for phimosis, was found to have a preputial calculus occluding the
urethral meatus. At the autopsy a calculus as large as an egg was found
in the bladder.

The presence of these formations, although not necessarily dangerous in
themselves, may, by their effects and in the irritation they induce, be
the means of producing serious mischief. The only preventive or remedy
for this condition is circumcision.

Acquired phimosis has been mentioned as a result of inflammatory lotion,
such as is connected with balano-posthitis; it sometimes happens that,
the act of coitus being done forcibly, especially with public women, who
are apt to use very astringent and constricting washes, the prepuce
becomes injured, with the result of producing a phimosis. One man will
produce the same results through the means of some vaunted wash or dip
which is supposed to act as a prophylactic to any venereal infection.
One patient had developed a chronic herpetic affection by the constant
use of an iodized ointment which he regarded as an infallible
prophylactic. Many cases of phimosis result from the attending
inflammation that follows on the liberal domestic application of nitrate
of silver to an abrasion after connection, in the mistaken idea that the
party labors under, that he is destroying some venereal virus.

By the irritation that all these applications and accidents induce,
warts and vegetations are the but too frequent results. These I have
never seen in a circumcised individual, and their occurrence and
frequency, as well as persistency, are directly proportionate with the
degree of tightness, thickness, or redundancy of the prepuce and the
irritability of the gland. As remarked by Lallemand, in reference to the
victim of nocturnal enuresis becoming a future victim of nocturnal
emissions, so it may be said of the person subject in early life to
either warts, excoriations or vegetations on the penis, that it is this
class that furnishes in after life the subjects for cancerous disease as
well as furnishing the easiest victims for venereal infection. These
warts, although easily removed, have a tendency to recurrence,
especially as long as the moist bed that has once grown them there is
still vegetating.

The prepuce is liable to indurations and hypertrophy. Of the first
anomaly, the London _Lancet_ of 1846 has a record of two cases in which
paraphimosis was induced in elderly subjects, and of one in which it
induced phimosis. Since then a number of cases of thickening and
induration have been reported. Hypertrophy may take place in any degree,
varying from the mere leathery and overpendulous but unobstructive
prepuce to the case recorded by Vidal, in the fifth volume of his
"Pathologie Externe et Médecine Operatoire," which happened in the
practice of M. Rigal, de Gaillae. The hypertrophied prepuce was
something enormous, and hung down to below the patient's knees; it was
pear-shaped, with the base hanging downward; this base was as large as a
man's head. This prepuce was successfully removed by M. Rigal, who
presented the specimen before the Paris Surgical Society, who were then
discussing a somewhat similar but not so extensive a case, presented by
M. Lenoire. Vidal mentions having operated on a number of cases of this
deformity of the prepuce in various degrees of growth.

As a rule, simple hypertrophic disease of the penile integument does not
interfere with the sexual functions of the male organ after its removal;
it being susceptible of complete removal in exaggerated cases, even
without touching the body of the organ. There are exceptions to this
rule, however, when even this otherwise non-malignant disease may entail
the loss of all the genitals. In the London _Lancet_ of July 11, 1846,
at page 46, there is a record of a remarkable case of this nature
reported by F. H. Brett, Esq., F.R.C.S. The case was that of a locksmith
of forty years of age, who was naturally much phimosed. The penis was
enormously enlarged, as well as the scrotum, which was more or less
ulcerated and full of sinuses filled with a serous pus; some six months
prior to the final operation, a part of the prepuce was removed to
facilitate urination, but the whole mass had to be subsequently removed,
including the whole of the skin of the penis and the scrotum, the
testicles having been carefully dissected out and recovered with some
skin flap.

In this case the disease was believed to have originated from a perineal
fistula. The pathological investigation in the case, however, by Mr.
Quekett, who submitted the mass to a microscopical examination,
confirmed Mr. Brett in his original opinion that the disease had the
same pathological conditions as the similar disease found in India,
where it originates from local inflammatory causes. In this case the
preputial irritation was, in all probability, the precursor of the
conditions that led to the perineal fistula, the patient having had a
stricture for some twelve years. Mr. Brett states that the man had been
abandoned by his wife on account of his previous sexual disability, and
on account, as well, of his having been incapacitated from following any
vocation. After the operation all his functions were restored and his
organs were sound.

Nelaton records a case reported by Wadd, in 1817, of an African negro so
affected, whose penis measured fourteen inches in length and twelve and
a half inches in circumference; also the case reported by Gibert, of
Hospital St. Louis, of a subject "with a penis the size of a mule's."

Mr. Brett attributes the recovery of his case as being due in a great
measure to the moral support given to the patient from the knowledge
that his procreative organs were not interfered with, and on the same
grounds he attributes the great fatality previously attending the
operation to the fact that it previously had been the custom in many
cases to make a clean general _taillè à fleur de ventre_, sacrificing
all the genital organs. In simple hypertrophy, he considers that the
body of the penis and the testicles will always be found to be in a
normal condition; a careful dissection of the parts will invariably save
not only the man's sexual functions, but his moral stamina, which he
sadly needs in such an emergency. In the discussion on this subject
heretofore mentioned as taking place in the London Medical Society, Mr.
Pye, Mr. John A. Morgan, and others insisted on the necessity of
retaining the testicles, whenever possible, in all these sweeping
operations upon the genitals, they being actually necessary for the
moral and physical support of man, Mr. Morgan observing that their
removal would depress parts controlled by the sympathetic system.



CHAPTER XXIII.

REFLEX NEUROSES AND THE PREPUCE.


We have seen in the previous chapters what the immediate effects of the
prepuce may lead to; we have followed its local effects in childhood to
youth, thence into what it does in our prime, and we have seen how, when
we are on the down grade, owing to the increase of years, then, like the
minute-men of Concord, wakened up by Paul Revere's classic ride, hanging
on to the rear of the retreating and disheartened British, it harasses,
worries, and downs a man here and there, striking down the man as if it
had some undying, irremediable spite, which nothing but his misery and
death could alleviate. Some authorities will argue that all that is
required is cleanliness; that all men need do is to be like a true
American, with the old Continental watchword of "eternal vigilance is
the price of liberty" in continued active practice. A bowlful of some
antiseptic wash and a small sponge should always be at hand, and he
should be as industrious as if haltered in a tread-mill; he should make
this a part of his toilet, and his daily and hourly care. This will, we
are told, lessen his chances of becoming a victim to the many ills that
lie in wait for him, all on account of the glory, honor, and comfort of
wearing a prepuce, which is a perfectly physiological appendage.

From these visible and apparently easily understood conditions and
results we are now to enter a broad field, wherein the prepuce seems to
exercise a malign influence in the most distant and apparently
unconnected manner; where, like some of the evil genii or sprites in
the Arabian tales, it can reach from afar the object of its malignity,
striking him down unawares in the most unaccountable manner; making him
a victim to all manner of ills, sufferings, and tribulations; unfitting
him for marriage or the cares of business; making him miserable and an
object of continual scolding and punishment in childhood, through its
worriments and nocturnal enuresis; later on, beginning to affect him
with all kinds of physical distortions and ailments, nocturnal
pollutions, and other conditions calculated to weaken him physically,
mentally, and morally; to land him, perchance, in the jail, or even in a
lunatic asylum. Man's whole life is subject to the capricious
dispensations and whims of this Job's-comforts-dispensing enemy of man.

As strange as it may seem, this field of knowledge, this field of misery
and suffering, disease and distortion, of physical and mental obliquity,
presided over by this preputial Afrit of malignant disposition, was an
unknown, undiscovered, and therefore unexplored region for some
thousands of years, and it remained for an American to discover and
describe this vast territorial acquisition, and to annex it to the
domain of medicine, which, through its skill, could modify the influence
of the evil genius that there presided and spare humanity much of the
ills to which it had been subjected.

In this regard, Louis A. Sayre was to medicine what Columbus was to
geography. Neither Strabo nor Herodotus had anything to say regarding
what existed beyond the pillars of Hercules, and neither Hippocrates nor
Galen had anything in regard to this preputial Merlin, which in their
day, even, had its existence. Neither did Tissot nor Bienville, the two
pioneers in the field of our knowledge regarding onanism and
nymphomania, dream of the existence of this one cause of the diseases
to which they gave so much time and study. It is only some twenty years
since Louis A. Sayre read his paper, entitled "Partial Paralysis from
Reflex Irritation Caused by Congenital Phimosis and Adherent Prepuce,"
before the American Medical Association. This was the starting-point
from whence the profession entered into what had previously been a
veritable "Darkest Africa."

When we read that only some fifty years before the times of Columbus
Christian Europe had no lunatic asylum,--not that there was a lack of
lunatics or that the existence of lunacy was entirely ignored, but that
the then state of medicine and the general intelligence was not
emancipated from the idea of demoniacs,--and we are told that the
lunatics were in many instances hung, quartered and burned, hooted and
chased about the streets, or chained in gloomy dungeons; until, as
related by Lecky, a Spanish monk named Juan Gilaberto Joffe, filled with
compassion at the sight of the maniacs who were hooted by crowds through
the streets of Valencia, founded an asylum in that city. His movement in
this direction called the attention of the Church and people to this
class in a practical light, and from Spain a more enlightened idea in
regard to this class swept onward throughout Europe. As observed, it
seems strange to us of the present day that such ignorance in these
matters should, or could, have so long existed. It seems impossible for
us to conceive how these conditions of incoherent action and of mental
derangements could have existed and their causes have not been fully
appreciated; and yet we were not above, some twenty years ago only,
subjecting children to punishment and scoldings for being addicted to
nocturnal enuresis, or of accusing cases of nocturnal and involuntary
emissions as being due to masturbation. The child was allowed then to
grow up paralytic, or with a deformed limb, or continually punished to
correct what was imagined to be a condition of willful carelessness,
irritability, or willful moral perversion. Perversion, stupidity, and
irritability of the mind or temper were not known to depend, in many
instances, on preputial irritation; children were, accordingly, worried
and punished for something over which they had no earthly control or the
least volition. Humanity cannot, at present, sufficiently appreciate
what Louis A. Sayre has done in its behalf. It is here that we realize
the hidden wisdom of the Mosaic law and the truth of the assertion of
the late Dr. Edward Clarke, that, "The instructors, the houses and
schools of our country's daughters, would profit by reading the old
Levitical law. The race has not yet outgrown the physiology of Moses."

These irritations from the preputial irritability are not always so slow
moving as to span over either months or years in their fell work.
Instances of their sudden action have been sufficiently recorded as to
warrant them as being classed as causative agents in acute affections
that instantly threaten life. In the London _Lancet_ of May 16, 1846,
there is a record of a very peculiar case reported to the London Medical
Society by Dr. Golding Bird: "The case was that of a child seven or
eight weeks old only, an out-patient of Guy's Hospital. The child had
become almost lifeless immediately after nursing, and to all appearances
looked as if under the influence of some narcotic. It had not, however,
had anything of the kind given to it, nor had it sustained a fall, nor
was the head so large as to lead to suspicion of congenital
hydrocephalus. On inquiring if the child passed water, the answer led to
an examination of the prepuce, which was found to be elongated, and had
an aperture only of the size of a pin-hole, like a puncture in the
intestines. The urine was dribbling out; it was evident that the child
had never completely emptied its bladder. Mr. Hilton slit up the
prepuce, and all the symptoms were immediately relieved and soon
entirely removed." Dr. Bird referred to a case which he had related to
the Society some years before, which was reported in the _Lancet_ at the
time, of a child who fell a victim to a malformation of this kind, and
after death the bladder and ureter were found like those of a man who
had long suffered from stricture. Mr. Hilton has seen many cases similar
to the one mentioned by Dr. Bird. The greatest benefit resulted from
slitting up the prepuce. In this case the benefit was very remarkable, a
partial paralysis of the left side, under which the little patient
labored, being quite removed in twenty-four hours.

In this case the difficulty was evidently both the result of mechanical
pressure and reflex irritation. A somewhat similar case as to its
results is given by Dr. Sayre, to whom the case was reported by Dr. A.
R. Mott, Jr., of Randall's Island, in January of 1880: "John English,
aged 46, native of England, widower, clerk; admitted to workhouse
hospital. Patient had been at work for a week as a prisoner; on the 23d
of December was noticed to be restless and uneasy, and finally, in the
evening, he fell from his bunk in a fit. During the next forty-eight
hours he had several convulsions, and during the intervals lay in a
semi-comatose condition, showing no consciousness except to stir a limb
when pinched. Pulse, 120; temperature, 101½°; respiration, 18.
Swallowed nothing, and passed fæces in bed. Continued in this condition
until December 25th (temperature having fallen to 100°), when a string
was discovered passed twice around the penis behind corona and tied, the
long prepuce serving to conceal it from observation. While not
sufficiently tight to occlude the urethral canal, still a firm,
indurated band remained after the string was cut, and did not disappear
for four or five days.

"Within one hour after the removal of the string the man sat up and
asked for milk, and from this time remained perfectly well (was under
observation for three months). He declared that he remembered nothing
that had taken place during the past three days; had never had fits,
denied venereal diseases, was moderately addicted to drink, but had led
a 'virtuous life since the death of his wife, two years before.'"

The following case in the practice of Dr. F. J. Wirthington, of
Livermore, Pa., was also reported to Dr. Sayre: "When the child was
born, he was considered the biggest and finest boy that had been born in
the community for a long time, until, when he was about two and a-half
years old, and being sick, a doctor was called in, who told them that
their child was paralyzed, the paralysis being in his lower extremities,
and who treated him with the usual nerve-tonic and with electricity.
Notwithstanding all this, the boy went steadily down, and the paralysis
continued until he was seen by Dr. Wirthington. The child was then
unable to walk; on examination, the prepuce was found to be adherent
almost all the way around the glans penis. Behind the corona was a solid
cake of sebaceous matter. The case was promptly operated upon, and,
although the previous attendant had not found any cause to account for
the paralysis, a rapid recovery took place, the boy being able to walk
even before the complete cicatrization of the wound, and was soon the
picture of health."

Dr. T. F. Leech, of Attica, Fountain County, Ind., reports a case of a
fourteen-month-old child, who had been the terror of all that part of
the town for over six months, as he cried constantly. Except when asleep
or nursed by his mother, he would lie perfectly still and squall, not
showing any disposition to sit up; nor did he like to be raised up. He
was very nervous, and would have times when his limbs would be rigid.
This state of things grew worse, until the child was accidentally seen
by Dr. Leech, who, on examination, found a contracted and adherent
prepuce, the child being at the time in a high fever and suffering great
nervous excitement. An operation by slitting and breaking up the
adhesion afforded immediate relief; the spinal irritation, partial
paralysis of the lower extremities, spasms during urination, and all
trouble disappeared as if by magic.

Prof. J. H. Pooley, of Columbus, Ohio, reported the case of a fine,
healthy boy who, up to three months before being seen professionally,
had always been well and in perfect health. His condition was found by
Professor Pooley to be one of localized chorea, manifesting itself in
constant convulsive movements of the head. They were nodding or
antero-posterior movements, alternating with lateral or shaking and
twisting motions; these movements had become almost constant during the
waking hours of the child. There was no distortion of the features nor
any choreic movements of the extremities; indeed, the whole affection
consisted in the nodding and shaking movements of the head referred to.
These were almost incessant, sometimes slow and almost rhythmical, then
for a minute or two rapid and irregular, seeming to fatigue the little
fellow, and accompanied by a fretful, whimpering cry. The child had been
subjected to a variety of treatment, but without any benefit or effect
of any kind. Upon the most careful examination of the patient and his
history, Professor Pooley could not discover anything that seemed to
throw any light upon the case, except a condition of well-marked
phimosis. Acting upon this, the Professor immediately circumcised the
child, and from the very day of the operation the spasmodic action began
to diminish, and in two weeks he was entirely well, without any other
treatment of any kind.

Dr. W. R. McMahon, of Huntington, Indiana, has reported three cases of
epilepsy in children caused by congenital phimosis that were entirely
relieved by an operation without any subsequent return of the
difficulty. One of the cases was in a boy ten years old, with very firm
preputial adhesions and a high grade of inflammation of the parts.

Dr. J. D. Griffith, of Kansas City, Mo., operated on a case of phimosis
on a child nearly three years of age, who was afflicted with repeated
attacks of convulsions and paralysis of the hips and lower extremities;
the little fellow had as many as fifteen convulsions in a day; the
patient was greatly troubled with painful urination and priapism. On
examination at the operation, a firmly adherent prepuce and a large roll
of caseous matter was found just back of the corona. A complete recovery
followed the removal of these conditions.

The above cases are taken from the paper read before the Section of
Diseases of Children at the International Medical Congress of 1887, by
Dr. Sayre. It contains a number of additional cases of an analogous
character to the above, reported to him by physicians in different parts
of the country. They show the variety, extent, and far-reaching
character of the diseases induced by any preputial irritation. Dr. G. L.
Magruder, of Washington, D. C., in the same paper, has a record of
twenty-five cases of various nervous disturbances which he had entirely
relieved by circumcision or dilatation, without any medication whatever.
Dr. Magruder, in concluding his report, in which he quotes the authority
of Brown-Séquard, Charcot, and Leyden, as having noticed serious nervous
disturbances resulting from reflex irritation due to affections of the
genito-urinary organs, observes as follows:--

"From the foregoing, I think that we are justified in the conclusion
that phimosis and adherent prepuce give rise to varied troubles of more
or less gravity, manifesting themselves either in the muscular, osseous,
or nervous systems; and that the removal of these abnormal conditions of
the penis frequently affords marked relief, and, at times, perfect and
permanent cure."

In the discussion that followed the reading of Dr. Sayre's paper, Dr. De
Forest Willard, of Philadelphia, remarked that he had operated by simply
stripping back the prepuce and that he did not circumcise, but that he
looked upon the subsequent cleanliness of the parts as the greatest
safeguard, not only as against reflex irritation, but also against
masturbation. Retained filth and smegma are far more likely to call a
boy's attention to his penis by their unrecognized irritative effects
than washing can possibly do. His practice is in accordance with the
belief that young children can be relieved by the simpler methods, such
as dilatation; but he also observes that when a child has reached eight
or ten years of age, and has never been able to expose the glans,
contraction is almost certain to be present, and circumcision must be
performed. In adults there is rarely any escape when the prepuce is
tight.

Dr. I. N. Love, of St. Louis, said: "It has been my judgment and my
practice for many years, in these reflex irritations, to pursue the
radical course of circumcision. I believe thoroughly in the Mosaic law,
not only from a moral but also from a sanitary stand-point. All genital
irritation should be thoroughly removed. It is all very well to instruct
the mother or the nurse to keep the parts within the prepuce clean, but
they can not or will not do it. Complete and proper removal of the
covering to the glans takes away all the cause of disturbance. Dr. Sayre
takes a more pronounced position on this subject than the majority of
those who have discussed his paper. An improper performance of a
surgical procedure is no argument against the operation, but rather
against the operator. For the reasons I have given, I am in favor of the
radical application of the Mosaic rite of circumcision."

Dr. J. Lewis Smith, the president of the Section, believed in the evil
results of the reflex irritation due to abnormality of the prepuce. In
many instances the causative relation of the preputial disease to the
symptoms which it produces is not so apparent as it may be in others,
but after correct treatment of the prepuce they disappear. There was one
result of phimosis which, he observed, neither Professor Sayre nor those
who contributed to his paper noticed. The expulsive efforts accompanying
urination sometimes cause prolapsus of the rectum, and frequently
produce inguinal hernia. In a lecture before the Harveian Society
(_British Medical Journal_, February 28, 1880), Edmund Owen, Surgeon to
St. Mary's Hospital and to the Hospital for Sick Children, says:
"Perhaps the commonest cause of hernia in childhood is a small preputial
or urethral orifice, and next to that I would put the smegma-hiding or
adherent prepuce." Arthur Kemp (London _Lancet_, July 27, 1878), Senior
House-Surgeon to the Children's Hospital, says: "Phimosis is a common
occurrence, and numerous ill effects can undoubtedly be attributed to
it;" and he alludes to the observation of Mr. Bryant, as published in
his book on the "Surgical Diseases of Children": "In fifty consecutive
cases of congenital phimosis, thirty-one had hernia, five had double
inguinal hernia, and many had umbilical hernia besides. In no one was
the hernia congenital, its earliest occurrence being at three weeks.
Circumcision was performed in these cases, and all were much
benefited."[103]

During the session of the Ninth International Congress, where the above
paper was read and remarks made, which appear in the third volume of its
"Transactions," another paper was also presented by Dr. Saint-Germain,
of Paris. The Doctor fully recognized the dangers from a narrow or
adherent prepuce, but did not think that more than one case in three
hundred really required circumcision; he believed in dilatation, as
employed by Nelaton, with the exception that, whereas Nelaton employs
three branches to his dilator, Saint-Germain preferred only a two-branch
dilator.

Dr. Lewis, the president of the Section, related a number of cases where
the use of uncleanly instruments had resulted disastrously. But, for
that matter, the same objection can be offered against dilatation, as a
filthy instrument is as liable to infect the patient as a knife. There
is no earthly excuse why a knife that has been used on a case of
diphtheritic croup should be used some hours afterward to circumcise a
child. As to the operation of dilatation practiced by Dr. Holgate, it
can really be said to answer the _immediate_ demands, but how far its
utility is efficient as to _permanent_ results Dr. Holgate has not
given the profession any information.[104]

One of the most interesting and instructive papers that it was ever the
fortune of the writer to listen to, touching on the subject of reflex
nervous diseases or neuroses due to preputial adhesions, was one
prepared by Dr. M. F. Price, of Colton, California, and read at the
semi-annual meeting of the Southern California Medical Society, at its
Pasadena meeting in December, 1889. In the course of the paper he gives
a considerable number of examples, of which some extracts are herewith
given: One case was a boy aged seven, who for two years had had frequent
attacks of palpitation of the heart; when seen by Dr. Price the little
heart was laboring hard, beating at a furious rate (far beyond
counting), with a loud blowing or splashing sound, and the pulse at the
wrist a mere flutter. The breath was inspired in a series of jerks, the
face flushed and somewhat swollen. The chest-wall was visibly moved at
every thump of the heart. The doctor attended the child for a month
without the little patient making any appreciable improvement. Some time
during this period of observation the father happened to mention that
the boy sometimes complained of his penis hurting him at the time of an
erection. This led the doctor to examine the parts, when he found a long
prepuce, with a mucous membrane adherent to the glans, about a line
beyond the corona, the whole circumference of the organ. With the use of
cocaine and a blunt instrument the adhesions were removed, with an
immediate amelioration of all the reflex symptoms. The very next
paroxysm was lighter and less exhausting; the improvement was
continuous. The child soon went to school and had no further trouble;
but, in the doctor's opinion, the two years' hard struggle have not
been without its evil results on the constitution and organism of the
child.

The next case was born November 2, 1888; a large, healthy boy at birth.
By June of the following year the child was afflicted with what the
mother called "jerky spells;" up to this time the boy seemed listless,
did not care to sit up, and seemed from some cause to be in more or less
pain, with his eyes turned to the left. The parents dreaded that the
child, their only one, would turn out idiotic. The spasmodic spells
alluded to were of a tetanic nature, the body being thrown backward; his
head and eyes continued to be turned to the left, and nothing could
attract the child's attention. The boy cried night and day, but he was
in good flesh, had all the teeth he should have, bowels were regular,
and the appetite good. Whatever the doctor did in the medical way seemed
to be of no avail. One day, however, he thought of examining the
prepuce, thinking, perhaps, that it might be contracted and that the
convulsive movements might be reflexes from the parts. On examination
the prepuce was found elongated and distended, with a very minute
opening; this was dilated with difficulty, when the inner fold was found
adhering almost the whole extent of the glans; the dilatation and
breaking down of these adhesions was slowly persevered in, until
sufficient dilatation was obtained and the glans was freed. From the
very first operation the convulsions commenced to diminish, both in
force and frequency, and a constant and rapid improvement of the child
took place. Six months afterward the boy was perfectly normal, stood by
himself, played with play-things, and was an interested member of the
family circle.

Case No. 3 was a repetition of Case No. 2, except that, with the
experience of the latter case, the doctor wasted no time with
medication, but proceeded at once to examine the prepuce, which was
found to be very long, and with a pin-hole opening. The dilatation of
this and the breaking up of the adhesions gave immediate relief. During
the course of the paper he quoted the case related by Brown-Séquard, and
recorded in the New York _Medical Record_, vol. xxxiv, p. 314, where he
"related a very interesting case that presented all the rational signs
of advanced cerebral disease, a case that he considered quite hopeless,
that was relieved by an operation for phimosis and the treatment of an
inflammatory condition of the glans penis." To use Brown-Séquard's own
words, "So rapid was the recovery that within six weeks from the day of
the operation he presented himself at my office perfectly well in every
respect."

In the early part of this book, in speaking of female circumcision, it
was mentioned that when the medical part of the volume should be reached
some medical reasons for its necessity would be given. Dr. Price, in his
paper, gives some information on this subject, which is of the greatest
interest. In the course of the paper he says as follows: "Nor do I think
these reflex neuroses from adherent prepuce wholly confined to the male
sex. The preputium-clitoridis may be adherent and produce in the female
similar reflexes. During the session of the American Medical
Association, held in Chicago in 1874, I think, I attended one afternoon
a clinical lecture by Dr. Sayre. A little girl, fourteen years of age,
but about the size of a seven-year-old child, was brought in, who had
never walked nor spoken, but with quite an intelligent countenance, who
was in constant motion, and who presented very many nervous symptoms.
Dr. Sayre examined her, and found the prepuce adherent the whole extent
of the clitoris. He gave it as his opinion that here was the primary and
sole cause of the symptoms, and that appropriate treatment shortly after
birth would have prevented all the serious consequences so painfully
apparent, and which was then too late to remedy.

"I once had occasion to pass a catheter into the bladder of a lady who
presented an innumerable train of nervous symptoms, often bordering on
insanity, but was unable to do so without exposing the parts. Although
the meatus could be distinctly felt, the catheter would not enter. On
exposure to view, an opening was seen in the clitoris, which was firmly
bound down by preputial adhesions near the extremity of the organ.
Entering the catheter at this point, it readily passed through the
clitoris, then down through a passage under the mucous membrane to the
natural site of the meatus, on into the urethra, and through into the
bladder. In the light of recent experience, my opinion now is, that here
was the cause of all the nervous symptoms in this case."

The relative disposition in regard to the irritability of the external
sexual organs as existing in the female, when contrasted with the male,
is, for some reason, not sufficiently considered or understood. The idea
of masturbation or of irritation from the genitals ending in reflex
neuroses is always, as a rule, associated with the male, and that it has
not been more associated with the female has deprived her of the same
benefit that the prosecution of the study in this regard has been to the
male sex. Masturbation among the feeble-minded, which is so common,
must, of necessity, have for its determining cause a foundation of
morbid irritability of the sexual organs. This is well known to be so
among the males, whose hands seem instinctively to be drawn to those
parts. Dr. C. F. Taylor, of New York, in an article on the "Effect of
Imperfect Hygiene of the Sexual Function," published in the _American
Journal of Obstetrics_ for January, 1882, gives us an account of his
investigations in this regard, with the following results: "In an asylum
for the feeble-minded of both sexes, it was found that the habit was
about equal in the two sexes, there being only this difference: that the
females began to masturbate one or two years earlier than the males, and
that the habit, once established, was found to be more persistent than
in the males. It was, further, ascertained that the habit came
naturally, without the aid of precept or example to either sex."

It may well be a question as to whether the feeble-mindedness be not a
reflex condition from this excessive morbid irritability of the sexual
organs. There is not much doubt but that, if one of the cases reported
by Dr. Price had not been circumcised, the expressionless, listless
infant would have grown, in time, into a masturbating, feeble-minded,
idiotic creature, as many others, so situated, have done before it. Now,
would it have been logical to have laid the morbid irritability of its
generative organs to its feeble-mindedness, when its feeble-mindedness
was fully demonstrated to have been wholly dependent on the sexual
irritation? From these premises we might take another step forward, and
ask whether, under a proper hygienic prophylaxis,--which would involve a
thorough inspection of the genitals of _all_ children reported to be
either physically or mentally deficient,--such a course would not
greatly diminish the number of paralytics, feeble-minded, and generally
deficient of both sexes? If the results in private practice are any
criterion, it is safe to assert that a strict adherence to the Mosaic
law for the males and to some of the African customs for the females
would most assuredly relieve all these cases that might come under the
caption of results of reflex neuroses. Twenty years ago this subject
was, to the body of the profession, a _terra incognita_ in regard to the
male, and, as the female is similarly subject to the same morbid
influence, it is to be hoped that in the present decade she will receive
the same attention which the profession is now beginning to pay to the
male sex.[105]

In the foregoing parts of this chapter, examples of reflex neuroses have
been given to show the different effects that genital irritation will
produce. The cases given were chosen for the diversity of variety of
symptoms, and as cases representing the affection, without any other
complication. Many more could have been added, but they are unnecessary.
In the writer's practice there has been a number of cases in the adult
that have exemplified that this form of ailment is by no means
restricted to children, as has been shown in the case reported by Dr.
Mott to Dr. Sayre, in regard to the middle-aged man with a string about
his penis. One of these cases was that of a young man, six feet in
stature, broad-shouldered, and well built. He applied for relief for a
dyspepsia that affected his stomach and also his heart. The man had an
apparently feeble and irritable heart; cold, clammy skin; disturbed
digestion, and uneasy sleep; was constipated and flatulent. No treatment
seemed to make any impression upon his case. At last he began to
emaciate and look haggard. His mind was also becoming visibly weaker,
was attacked by dizziness, and on several occasions he fell in a fit.
With this condition he at last began to have frequent nocturnal
emissions. On account of the latter his genital organs were examined,
and the penis was found smaller than the average, with a long and narrow
prepuce. The glans could easily be uncovered, but the tightness of the
prepuce and its unyielding qualities made paraphimosis a possibility; so
that the young man, having once or twice had considerable difficulty in
returning the prepuce to its place, never attempted its retraction
again. There were no adhesions, but the inner fold of the prepuce had
been thickened by balanitis. Seeing the need of circumcision _for the
local benefit_, the operation was suggested with a view of relieving the
pressure on the glans, which was looked upon as the probable cause, in
his broken-down condition, of the advent of the nocturnal emissions. He
gladly submitted, and, to the surprise of both physician and patient,
_all_ his troubles disappeared, and he at once became a changed man. So
impressed was he with the result, that, on his return to his home, he
examined his younger brother, and, finding him with a like long, narrow
prepuce, he immediately brought him in and had him circumcised, as a
prophylactic against his being subjected to the risk of lost health as
he himself had suffered.

Another case, a man of forty-five, also a farmer, was afflicted with
dyspepsia, palpitation of the heart, general debility, constipation,
constant headache, etc. He could not cut up an armful of wood without
bringing on palpitations and gaseous eructations, or being upset for the
day; and after having connection with his wife he generally had a
terrific headache, lasting for two or three days;[106] he could stand no
protracted mental effort, even such as is required to make an addition
of a long line of figures, or the least business worry, without the
supervening headache. All treatment against these conditions was
useless; the colon was kept empty, the diet was changed; pepsin and
bismuth, tonics, frictions, Turkish baths, and all hygienic observances
and moral treatment were all of no avail. One day, on consulting the
writer, he complained of a pruritus at the head of the penis. On
examination it was found that he had a narrow, long prepuce, a
congenitally-contracted meatus, and was then suffering with a slight
balanitis. He was very careful to keep the parts clean, but, he informed
me, that in spite of all precautions, these attacks would come on. The
mucous covering of the inner fold of the prepuce and glans was so
irritable that connection often brought it about. The glans was small
and elongated, with the meatus red, and with lips oedematous and
congested. To free him from this tormenter, circumcision was advised.
The party could not, however, remain away from home for the time
required for the operation; so that a compromise operation was
performed,--one that would not keep him from business, and, at the same
time, relieve the contracting pressure on the glans. This was by
Clouquet's operation and bandaging back the prepuce over the penis, back
of the corona,--an operation that, in my hands, has often filled all the
desired purpose. The meatus was also incised. After the operation _all_
of his troubles disappeared, as they had done in the preceding case, and
he was soon a hearty and well man, able to chop wood, attend to
business, and, in case of need, do family duty for a Turkish harem
without recurrence of his old tormenting, dyspeptic palpitation or
sick-headache.

The writer has resorted to circumcision in many cases to improve the
temper and disposition of children, with the best of results, and in one
case, in association with another physician, performed the operation on
a lunatic, whose lunacy ran to women and girls, with whom he would fall
desperately in love, without any encouragement or provocation, or even
acquaintance; finally reaching spells of such incoherence of action and
speech that confinement would be required. The peculiarity of his
hallucinations called attention to the genital organs. This man had
never masturbated, and was, when well, a compactly-built, active, and
intelligent man. By occupation he was a contractor, and a man of more
than usual executive ability besides. On examination it was found that
he was a subject of congenital phimosis, never having been able to
uncover the glans. He had been in the habit of washing out the preputial
cavity by the aid of a flat-nozzled syringe. The prepuce was long, but
not thick; nevertheless, it was inelastic and very firm. The examination
seemed to have a good mental effect upon the man, as it made him quite
rational for the moment. He entered into the idea that this condition
had some connection with his derangement very intelligently, even
suggesting many symptoms and attacks that he had suffered from childhood
up as probably gradual-stepping processes through which his present
condition had been reached. He cheerfully submitted to a thorough
circumcision, which had the effect of ameliorating his condition. He was
subsequently sent to an asylum, where, after a short time, he was
discharged well. Some years afterward, conscious of feeling a return of
the mental derangement, he voluntarily applied for admission to the same
institution and remained until better.

This case is very instructive. The patient readily connected his
mental trouble, by a retrospective view through a series of
gradually-increasing troubles, that originated in the preputial
condition, to the phimosed condition of that appendage, and he was
certain that this prepuce had been at the bottom of all the physical and
mental trouble he had experienced. The reflex nervous train of
affections had undoubtedly produced some localized lesion in the
brain-structure. The natural sound, healthy organism of that organ, and
the bright, active nature of his mind, however, prevented a total
wreckage of the mental faculties. It is safe to assume that, had he had
the ordinary listless, unresisting mind, disposed to brood, and easily
cast down, he would, from the first derangement, have become a hopeless
and demented lunatic. The circumcision could not undo all the mischief
that had been accomplished, some of which had certainly left a permanent
taint, but the mildness of his future attacks and the better exercise of
his volition were the undoubted results of the operation.



CHAPTER XXIV.

DYSURIA, ENURESIS, AND RETENTION OF URINE.


Any dissertation on circumcision and its many uses, either prophylactic
or curative, would be incomplete without a reference to enuresis;
another reason for making a somewhat full reference to the subject would
be the undecided position that this morbid condition seems to occupy in
medical literature, as well as the meagre and unsatisfactory treatment
it has received by the majority of those who have mentioned it. It is
anomalous, to say the least, to find, in general or special literature,
enuresis mentioned as a diseased condition peculiar from babyhood to
puberty; to find it fully described and to have it stated that it is a
widely-prevalent distemper, affecting both sexes alike; to know that it
is an annoying, intractable, persistent condition, wearing to the child
in every sense, subjecting it to a demoralizing mortification as well as
to unmerited scoldings, humiliations, and punishments, and that its
habit, in badly-ventilated quarters, will breed other diseases,[107] as
well as that its continued action tends to the development of onanism,
with its long and widely-ramifying trains of physical and social ills;
and to find works especially devoted to children's diseases silent on
the subject. Knowing all these things, and also that Ultzmann,
Lallemand, and others who have treated this affection, mention it as a
children's disease, it is unaccountable to reason out why most of our
text-books and treatises on children's diseases should be so remarkably
and unreasonably silent. It certainly cannot be laid to its lacking in
study material, as the author of "Quain's Dictionary of Medicine" says:
"It is one relative to which much might be written without exhausting
the subject, the pathology of which has wide and manifold relations....
There appears to be something analogous between this condition and that
which determines in after life the seminal emissions under similar
circumstances." Our American works are notably deficient in this regard;
although Stewart, of New York, in his "Diseases of Children," published
over fifty years ago, devotes a chapter to dysuria and one to retention
of urine, treating the subject quite fully, even down to the description
of preputial calculi; he, however, failed to notice that the irritation
of preputial constriction or adhesions will produce both conditions,
and, following many of the authors of the time, as has been done since,
he adopted the urino-digestion theory of acid and irritating urine, due
to faulty digestion, of Prout and Magendie, who looked to regulating the
digestion of the child, or the mother who nursed it, as the only method
of cure; the lithic-acid diathesis being, in their opinion, the main
thing to be guarded from.

Other works that mention these conditions are equally on the wide sea of
speculation, as they all, more or less, look upon the treatment that
they advise as indefinite and unsatisfactory, showing an equal want of
sound anchorage-grounds for their etiological reasonings. Dillnberger,
of Vienna, in his hand-book of children's diseases, mentions enuresis,
but has nothing better to offer for its relief than that advised by
Bednar, who followed a systematically-timed period of awakening,
gradually lengthened out, from the time of putting the child to bed. In
addition, he advises internal medication, and, like Ultzmann, he
recognizes the possibility of a local cause in little girls, in whom he
advises the local application of nitrate of silver. Edward Ellis
mentions dysuria, and a long prepuce is noticed among its numerous
causes. The works that give the subject the most intelligent treatment
(the word "intelligent" is here used advisedly, and is in reference to
the results obtained) are those of West, of London, and Henoch, of
Berlin. West, in his "Diseases of Children," says: "In the child,
however, we sometimes find the symptoms produced by difficulty in making
water owing to the length of the prepuce and the extreme narrowness of
its orifice, which may even be scarcely large enough to admit the head
of a pin. This congenital phimosis is, I may add, not an infrequent
occasion of incontinence of urine in children, and is also an exciting
cause of the habit of masturbation, owing to the discomfort and
irritation which it constantly keeps up. In every case, therefore, where
any difficulty attends the passing or the retention of the urine, or
where the practice of masturbation is suspected, the penis ought to be
examined, and circumcision performed if the preputial opening is too
small. This little operation, too, ought never to be delayed, since, if
put off, adhesions are very likely to form between the glans and the
foreskin, which render the necessary surgical proceeding less easy and
more severe."

In the "Lectures on Diseases of Children," Henoch, of Berlin, says: "I
need scarcely add that an examination of the external genitals should
never be omitted in any case of dysuria during childhood. You will not
infrequently discover a phimosis which interferes more or less with the
discharge of urine and retains portions of the latter behind the
foreskin, where it may decompose and give rise to an inflammatory
condition of the prepuce, with painful dysuria.... This is also true of
the occasional adhesion of the labia minora in little girls, like the
similar adhesion of the foreskin in boys. It is almost constant in the
first period of life, but sometimes persists to the end of the first
year; can usually be torn by the handle of the scalpel, and rarely
requires an incision. In a few cases this adhesion appeared to me to be
the cause of the dysuria, which disappeared after the separation of the
labia from one another."

Henoch, however, does not seem to have grasped the full relation that
the natural phimosis of young children bears to dysuria, as he here
follows the prevailing opinion, that where by dint, push, hauling, and
hard work the prepuce can be pushed back phimosis does not exist, as
well as the general apathy to the fact that a prepuce can exert a very
injurious influence by its pressure, even when not adherent and very
retractable; such a prepuce is often attended by balanitis and
posthitis, with an accompanying difficult, frequent, and painful
urination. In a case which will be related farther on, in the discussion
of the systemic effects of a long, contracted prepuce, as it induces
diseased action by continuity of tissues, there is an account of a death
of a two-year-old child which we can assume to have had its original
starting-point in a condition of phimosis. Henoch, however, rather
attributes the death in that case to what may well be considered the
result of a cause, leaving the original cause more to appear as a final
accessory condition.

My reasons for this view of the subject are simply owing to the fact
that I do not believe that a child can long be afflicted with the
_ischuria phimosica_ of Sauvages without having the urinary organs
beyond more or less seriously affected from the mere retention alone,
irrespective of any reflex irritation from the pressure on the glans or
of any from the irritation of the peripheral nerves; the dilatation of
the adjacent cavities or channels and the deposit of calcareous matter
being facilitated by the retention of urine and its naturally altered
condition owing to that retention. So that dysuria in young children,
beginning in a slightly phimosed condition, or in the irritability of
the glans and meatus, due to its preputial covering, it is safe to
assume, may produce a train of symptoms ending in permanently-injured
health, or even death. The irritating urine of a slight access of fever
may, by its passage over the irritable mucous lining of the prepuce, be
the initial starting-point of a serious or fatally-ending disease. In
all of these, it must be admitted, the presence of the prepuce is either
actively or passively the cause of the most serious disease processes
that may follow.

Ultzmann, of Vienna, in his work on the "Neuroses of the Genito-Urinary
Organs," gives the subject of enuresis considerable attention. It is not
a work on diseases of children, but it, nevertheless, goes into the
subject as if it were, and furnishes the profession with considerable
information. He defines enuresis to be the passage of urine of a normal
quality in a child who, with the exception of this involuntary
urination, is healthy. In the first periods of life, a slight vesical or
intestinal expulsive effort is sufficient to overcome the guarding
sphincter muscles at their outlet; the child first obtains a voluntary
control of the rectal sphincter; and, generally, with the second year it
gains control of the vesical. Those who pass their second year without
obtaining this control, but in whom the organs and urine are normal, may
be said to be afflicted with enuresis. He divides enuresis into three
varieties; that involuntary urination which takes place at night during
sleep he terms the _nocturnal_; that which takes place while climbing,
laughing, coughing, or in the course of any violent muscular exercise is
the _diurnal_; and that wherein the involuntary evacuation takes place
day and night alike he terms as the _continued_. This last is again
subdivided into the continuous and periodical. As a cause, he cites
anæmia, scrofula, rachitis; but adds that physical debility is not
necessary for its presence, as well-developed, vigorous, puffy children
are as liable to be affected as thin and scrawny ones; while not all
scrofulous or rachitic children are so affected, only a small portion
being enuretic. Sex has no influence on the liability that tends to
being attacked, the proportion between the sexes being about equal. As
to age, he finds the greatest proportion to be between three and ten
years, but he has often treated those of either sex even at the age of
fourteen and up to seventeen years. It is absolutely necessary to
examine the external genitals and the urine of those affected by this
disease, as phlegmasiæ of the vagina, of the vestibule or urethra in
girls, or the practice of onanism, or lithiasis, cystitis, or pyelitis
may be the cause of the disease. Girls are apt to be found affected with
polypoid excrescences at the meatus, which when removed will cause the
enuresis to disappear.

From the above it will be observed that Ultzmann has paid much attention
to these neuroses; but it will also be remarked that neither the
balanitis, collection of infantile smegma, preputial adhesions nor
irritations are taken into any account as possible factors of either
dysuria or enuresis; he has followed more or less an electrical form of
treatment for genito-urinary neuroses, the rectal rheophore being one of
his favorite modes of treating enuresis; in his etiological views of
these disturbances he has adhered more or less to the views of
Trousseau, Bretonneau, and Dessault, who looked upon a debilitated or
anomalous condition of the vesical neck as the cause of the majority of
neuroses in that region.

It may be asked why these celebrated and observing physicians have
neglected the preputial condition, if, as it is claimed, it is, in
itself, so important and sure a factor of the derangements at the
vesical neck? To answer this, or to explain any marked discrepancy that
may occur in medicine between minds equally as acute and observing, it
is but necessary to observe that there is, in medicine, to a certain
extent, a like rule of inheritance, education, with fashion or custom of
habit of thought and practice, as we find in religion. Canon Kingsley
and Froude are equally as acute and discerning as the late Cardinal
Newman, but that did not necessitate their following that prelate into
the foremost ranks of the Catholic Church; and Pere Hyacynthe was
equally as intelligent as Cardinal Newman, but that did not prevent him
from leaving the fold into which the Cardinal had entered from out of
the Reformed Church. Some are born Catholics or Protestants, and are so
with vehemence; others are born in these religions, but are only
lukewarm in their doctrinal observance; while others reason and jump the
traces in either direction. The followers of the destructive theories of
Bronssais could not see the errors of their ways, and neither could they
be made to see the merits of a less interfering form of medical
practice. Trousseau was himself at one time tainted with Bronssaisism,
but, like Paul of Tarsus, he was made to see the error of his way, as he
relates, through a case of gout that he nearly laid out in trying to lay
out the disease antiphlogistically.

I do not assume that preputial irritation is at the bottom of _all_
cases of dysuria or enuresis, any more than it would be rational to deny
that cases of circumcision performed in some cases of diabetic enuresis
have proved fatal as a result of the operative interference; but it is
safe to assume that, in the great number of cases in whom some
irritating conditions were found and removed, the enuresis or dysuria
was due to such preputial irritation. It is also logical to assume, with
West and Henoch, that the organ should in all cases be examined, and its
condition rendered as harmless as possible. That the condition of
preputial irritation has not been fully recognized by all parties as a
cause of enuresis does not do away with the fact that it does exist, any
more than the refusal of the prelates and doctors of Salamanca to listen
to Columbus did away with the fact of the existence of the American
continents.

A. L. Ranney, in his "Lectures on Nervous Diseases," pages 174, 175,
speaks of enuresis in children as being a reflex cachexia, "excessive
stimulation of the centripetal nerves connected with the so-called
'vesical centres' of the spinal cord,"--a condition which may be
produced by either worms in the intestines or by preputial irritation.
Ranney advises a careful exploration of the urethra and rectum in these
cases, and the elimination of all local causes of the conditions.

Probably the most remarkable case of the immediate continuous effects
resulting from phimosis is the one recorded by Vidal, in the fifth
volume of the third edition of his "Surgery." This was a young man with
a congenital phimosis, having but a very small aperture; on an operation
to relieve the phimosis there was a gush of water, but this only fell at
the feet of the patient, without being ejected at any distance; the
urethra was found to have undergone precisely the same dilatation back
of this preputial orifice that it usually undergoes back of a stricture;
the whole urethra from the meatus backward was found to have exceeded
the calibre of that of the vesical neck; the bladder was greatly
dilated.



CHAPTER XXV.

GENERAL SYSTEMIC DISEASES INDUCED BY THE PREPUCE.


Aside from all the local affections or reflex neuroses, either mental or
physical, that a prepuce may induce, there are an innumerable train of
diseases that may originate in this one cause that at first sight would
seem to have no connecting-link with any preputial condition.

It has already been suggested that the prepuce does not at all ages bear
the same analogous relation to man. In childhood, especially during our
earliest years, it is out of all proportion in size when compared to the
rest of the organ, or to any use it may have placed to its credit. Man
does not, then, certainly need that refinement of nervous sensitiveness
in the corona that is useful in after life in inducing the flow or
ejaculation of the seminal fluid; neither is there at that age much of a
corona to protect. In middle life, or what might be called the
procreative period of man, when the corona would seem to require all its
excitability or sensitiveness, seems to be the very season in life when
the glans is most apt to remain uncovered; so that nature and this
hypothetical idea of the use of the prepuce are evidently at variance.
So we go through childhood with this long funnel-shaped appendage into
manhood, when the increasing size of the body of the penis restores a
sort of equilibrium between the size and bulk of the organ and its
integumentary covering. At this period, as we have seen, although it
does not, from the equilibrium restored, and the more or less use to
which it is subjected, induce any great immediate or uncomplicated
troubles, it nevertheless endangers the existence of the penis through
the accidental course of some putrid or continued fever, or it subjects
man to the manifold dangers of venereal or tubercular infections.

In advanced age, owing to the diminution in size of the organ, the
prepuce resumes the proportionate bulky dimensions of childhood, and as
the organ recedes and becomes more and more diminutive, the prepuce
again, like in childhood, begins to tend to phimosis; the urine of the
aged is also more irritating and prone to decomposition or putrefaction,
and the constant state of moisture that the preputial canal of the aged
is necessarily kept in, either by frequent urination or the incomplete
emptying of the urethra that is peculiar to old age, and which results
in more or less dribbling, is a powerful factor in inducing the many
attacks of posthitis and balanitis, as well as those attacks of
excoriation and eczema which are so annoying to the aged. I have often
seen such cases happening to men past fifty, who, being widowers, and
never having had anything of the kind, as well as being in the most
complete ignorance of the nature of the disease, have, from delicacy and
fear that the disease might induce some suspicions as to their conduct
in the minds of those whose good opinions they value above all else,
gone on suffering untold miseries, especially if the urine were in the
least diabetic.

One such case that fell under my observation not only produced such
misery as to entail a loss of rest and of appetite, but even induced
such a disturbance of assimilation and nutrition that the resulting
hypochondriacal condition that developed from these enervating causes
ran the patient into a low condition, ending in complete prostration of
all vital powers and death, without the intervention of any other
disease. The subject was a timid, retiring man of about fifty-five
years, and this was the first and only time that the prepuce had ever
caused him any annoyance,--a circumstance which greatly preyed upon his
mind, as he could not disconnect it with the idea that it must be
suspected as venereal, although he had always led a most continent life
since the death of his wife. This is, of course, an extreme case; but as
it is a result beginning in a certain condition, be it an extreme,
erratic, or infrequent occurrence, it is, nevertheless, an example of
what may happen in advanced life, even where the prepuce has never
before been a source of the least disturbance or annoyance. Persons who,
with the increase of years, are also liable to an increase of adipose
tissue, are more subject to this dwindling down of the penis and
consequent elongation of the prepuce, with all the attendant annoyances,
than thin or spare people.

In this irritation that the prepuce is liable to cause, we have not only
to encounter the dangers that its thickenings or indurations may bring
on in their train, in the shape of cancer, gangrene, or hypertrophies,
but other and no less serious results are liable to follow a herpetic
attack, or in consequence of an attack of balanitis or posthitis. The
dysuria attending any of these conditions may be the initial move for
such a serious complication that life may be brought to a sudden end,
even in infancy, to say nothing of the ease with which life is taken off
in after years and in old age; with debilitated and imperfect kidney
action, it takes very little to hustle us off from life's foot-bridge.

A case as occurring in Henoch's clinic, already mentioned or referred to
in a previous chapter, shows what a simple phimosis is capable of
inducing. In the history of the case the phimosis and the resulting
retention in the preputial cavity no doubt were the causes of the
calculus found there; and the succeeding calculi and abnormal condition
of the urinary organs, we can safely assume, were a subsequent creation
to that in the prepuce. The case is taken from Henoch's "Lectures on
Diseases of Children," Wood Library edition, page 256, and is as
follows:--

"A. L., aged two, admitted November 28, 1877. Quite well nourished, but
pale. Complete retention of urine for two days; slight redness and
marked oedema of penis, scrotum, and perineum. The foreskin cannot be
retracted, on account of phimosis. Abdomen distended, hard, and
sensitive, the dilated bladder extending a few fingers' breadth above
the symphysis. In order to introduce the catheter, it was first
necessary to operate upon the phimosis, during which a calculus, which
completely occluded the meatus, was removed. The catheter, when
introduced into the bladder, removed a quantity of cloudy urine. The
oedema, rapidly disappeared under applications of lead-wash, but on
November 29th vomiting and diarrhoea occurred during the night, with
rapid collapse; December 1st, death. Autopsy: In the bladder, a
sulphur-yellow stone, as large as a hen's egg, completely filling the
organ; similar calculi, from the size of a pea to that of a bean, in the
pelvis of the left kidney; right kidney normal."

In the above case, the oedema of the penis, scrotum, and perineum was as
much a result of the distension of the bladder by the retained urine
interfering with the return circulation from the oedematous parts as the
different appearances of diseased conditions were a result of the
primary phimosis; yet this case, if seen during its early infancy, when
probably the contraction of the preputial orifice was as yet not so
well marked, would have been pronounced one in which it would be
needless and barbarous to perform circumcision upon. We would most
assuredly have to wander aimlessly and unprofitably in the region of
speculation to build up the etiology of the above-related case and reach
the culmination there found, unless we accept the one that it was all,
from first to last, the result of the phimosis.

Jonah, pitched overboard at sea to appease the tempest and swallowed by
the whale, became convinced finally that he had better return to Nineveh
to preach reform; while Pharaoh would not let the children of Israel
depart even after Moses had so frightened him--as it is related in the
rabbinical traditions compiled by the Rev. T. Baring-Gould, M.A.--that
the royal bowels were completely relaxed at the sight of the snakes
turned loose about the royal throne,--a circumstance which nearly lost
him his claim to divinity, which was based on the fact that his bowels
moved only once a week, as in this case they not only moved out of time
and in the most unkingly manner, so that the noble king hid underneath
the throne, but before even Pharaoh could disengage himself from the
royal robes, which event could hardly have raised him in the estimation
of the gentlemen eunuchs of the bed-chamber. Those who unwound the mummy
of Pharaoh tell us that he had the appearance of a self-willed,
despotic, but intelligent, old gentleman; but the above rabbinical
relation, from Baring-Gould's "Legends of the Patriarchs and Prophets,"
seems to have had no convincing effect on Pharaoh; so we must not be
surprised if even a case like the one from Henoch's clinic would, with
many, carry no conviction.

In the second volume of Otis on "Genito-Urinary Diseases," of the
Birmingham edition, at page 380, there is an interesting account of a
physician who, in youth, was troubled with an annoying prepuce, which,
from frequent attacks of balanitis, had finally become more or less
adherent to the glans penis; up to the age of nineteen he had been
unable to completely uncover the glans. By six months of hard and
persistent labor he had finally broken up these adhesions. At the age of
twenty-two he married, and he then ruptured the frenum, which bled
profusely and left him sore for some days. Then for twenty-seven years
he had no further trouble, but at the end of that time he began to
experience what he believed were attacks of dumb ague, and the scrotum
began to swell and felt sore on firm pressure. Heavy, aching pains then
followed. This condition of things lasted for over five years, varied by
the appearance of carbuncles on the nose and elsewhere, to relieve the
monotony of the thing. From this time on, abscesses began to form in the
scrotum and into the integument of the penis, burrowing forward into the
prepuce, which was much swollen and painful. A gangrenous opening
effected itself in the dorsal surface, which relieved him somewhat. The
patient was finally examined by Dr. Otis, who found a badly strictured
urethra, the strictures beginning at the meatus, and at intervals
extended down as far as two and three-fourths inches. The case had no
venereal history, the patient never having had any disease or anything
of the kind. The strictures were plainly the result of the
balano-posthitic attacks as much as they were the cause of the
degeneration of the mucous membrane in the lower urethra, that allowed
of the infiltration of urine into the tissues, which caused all the
systemic disturbances, abscesses, misery, and agony of the patient,
depriving him of comfort, sleep, or ability for labor, and which sent
him here and there in search of health and relief.

It would seem really as if a prepuce was a dangerous appendage at any
time, and life-insurance companies should class the wearer of a prepuce
under the head of hazardous risks, for a circumcised laborer in a
powder-mill or a circumcised brakeman or locomotive engineer runs
actually less risk than an uncircumcised tailor or watchmaker. They
recognize the danger that lurks in a stricture, but what a prepuce can
and does do, they entirely ignore. I have not had any opportunities for
comparison, but it would be interesting to know, from the statistics of
some of these companies, how much more the Hebrew is, as a
premium-payer, of value to the company than his uncircumcised brother.
Were they to offer some inducement, in the shape of lower rates, to the
circumcised, as they should do, they would not only benefit the
companies by insuring a longer number of years, on which the insured
would pay premiums, but they would be instrumental in decreasing the
death-rate and extending longevity.

I have seen so many cases of stricture whose origin could be traced to
balanitis that it can almost with confidence be assumed that, wherever
there is a long prepuce with a red and inflamed meatus in a child, that
unfortunate child will be a victim of fossal strictures when arrived to
manhood, and that, moreover, he will be a surer victim to the reflex
neuroses which so often accompany strictures, and which have been so
ably described by Otis, than the victim of uncomplicated strictures
acquired in the worship of Venus. There is no end to the misery that
these poor fellows have to suffer, besides the habitual hypochondriacal
condition into which the accompanying physical depression, throws them;
it unfits them for business, any undertaking, or even for social
enjoyment or entertainment; they keep themselves and their families in
continued hot water. These subjects are, also, more prone to gouty and
rheumatic affections, asthma, and other neuroses.

Among the many cases of nervous disorders simulating other diseases that
I have seen relieved were two Jewish lads with an imperfection of the
meatus. They were two brothers, and from the history of the cases, and
that given me by the mother of the lads in regard to the father, the
malformation must have been hereditary and congenital. It consisted of a
partial occlusion of the meatus by a false membrane, which divided the
meatus in two, horizontally, but which was closed at the posterior end
of the lower passage, which readily admitted a probe from the front as
far as the occlusion, about a third of an inch to the rear. The
restoration, or rather the making the anterior urethra and meatus to
their normal condition, relieved both boys of asthma, under which they
had labored for years.

The many cases simulating the general disturbances that accompany many
kidney disorders, that are simply the result, in their primary causes,
of preputial irritation and the disturbances to the kidney function due
to the same cause, have long induced me to look upon the prepuce as a
great and avoidable factor to some of the many forms of kidney diseases,
prostatic enlargements, vesical diseases, and many other diseases of the
urinary organs, which we know full well can result from strictures, as
the latter need not always act in a purely mechanical mode to do its
full extent of mischief.

One result of these preputial irritations not generally or particularly
mentioned in any of our text-books--a condition far-reaching as regards
its own results, and more annoying and serious than it appears at first
sight--usually begins with a reflex irritability of the anal sphincter
muscle, or a rectal irritation of the same order, which in time produces
such organic change that an hypertrophied and irritable, indurated,
unyielding muscle is the result. Agnew, of Philadelphia, describes the
condition, but does not mention this frequent cause under the name of
sphincterismus; once this is established, the train of resulting
pathological or diseased conditions that may follow are without
end.[108] This is no fancy sketch, nor will the student of the pedigree
and origin of diseases feel that the case is exaggerated or imaginative.
These are some of those cases that are always ailing, never well and
really never sick, but who are, nevertheless, gradually breaking down
and finally die of what is termed "a complication of diseases," before
living out half their term of life.

How this happens is simple enough--the straining required to produce an
evacuation is out of all proportion with the character of the discharge;
such patients often complain of being constipated when the evacuations
are semi-fluid; this straining is followed by a dilatation and
consequent loss of power of the rectum, which becomes pouched and its
mucous membrane thickened; the whole intestinal tract sympathizes and
digestion is interfered with, and the forcible expulsive efforts affect
all the abdominal and thoracic organs in a more or less degree, laying
the foundation for serious organic diseases. Now, this condition, which
may be said to be no more than one of obstinate constipation, is a far
more reaching condition and a far more injurious state than can be
imagined at a first glance. Constipation is not, as a rule, always
accompanied by the indigestion, either stomachic or intestinal, that
goes with this condition; the contents of the intestines in simple
constipation may simply lack fluidity without undergoing putrefactive
fermentation, but in this condition the undigested and retained
intestinal contents do undergo that change, resulting in the generation
of material whose re-absorption produces a toxic condition of the blood,
from whence begins a series of serious organic changes in the blood, and
from this in the organs.

To the practical physician these changes are evident and their cause
just as plain, and it is just here where the laity lack the proper
education, and where they should understand that the intelligent
physician generalizes the disease and only individualizes the patient;
and it is this ignorance on the part of the laity that gives to
empiricism and quackery that advantage over them, as they look upon all
disease as a distinct individual ailment, that should have an equally
distinct and individual therapeutic agent to cope singly with. The laity
know very little of these things, and in their happy ignorance care
still less for the finer definitions of or of the clinical importance of
toxæmia, or the processes of abnormal conditions that lead up to such a
state, or the results that may follow when that condition is once
reached. To them, dyspepsia is an indigestion ascribable to the stomach,
and a sick-headache is ascribed to something wrong about the stomach or
liver.

The laity have never been called upon to answer the questioning of the
late Prof. Robley Dunglison: "What do you mean, sir, by biliousness? Do
you mean, sir, that the liver does not secrete or manufacture a
sufficiency of bile, or not enough? Do you mean that the bile-material
is left in the blood, or too much poured in? Do you mean that there is
an excess in the alimentary canal, and a deficiency elsewhere? Please,
sir, explain what you really mean by the term 'bilious!'" The Professor
had a way about him that at least made one stop and seriously inquire,
before adopting any random notion in regard to medicine. It is to be
regretted that, in the humdrum tread-mill work of many physicians, they
even have to drop into the commonplace way of treating dyspepsias and
such ailments without any further inquiry. A farmer knows better than to
drive a dishing wheel, or with merely having a nail clinched in the
loose shoe of a valuable horse; but he is fully satisfied to do so in a
metaphorical sense, as regards his own constitution, and the mere hint
from his physician that he had better lay up for repairs, or that there
is something wrong about him that will require investigation, and that
there is an ulterior cause to his feeling tired, headachy, or dyspeptic,
or an allusion that there is something systemic, as a cause, to his
momentary attacks of disordered vision or amaurosis, will generally make
him look on the doctor with mistrust.

The merchant, banker, and mechanic are not up to Professor von Jaksch's
ideas of toxæmia,--that toxæmia may be exogenous or endogenous, or that
the latter is further subdivided into three more varieties,--and, what
is worse, he cares still less. The above three classes of humanity, when
sick, simply would want to know if Professor von Jaksch was good on
dyspepsia, the measles, or typhoid fever. They care very little that he
divides endogenous or auto-toxæmia into that produced by the normal
products of tissue-interchange, abnormally retained in the body, giving
rise to uræmia, toxæmia from acute intestinal obstruction, etc., the
above being the first division. The second depends on the outcome of
pathological processes, which change the normal course of assimilation
of food and tissue-interchange; so that, instead of non-toxic, toxic
matter is formed. The second group he names noso-toxicoses, which he
subdivides into two principal divisions:--

(_a_) The carbohydrates, fats, or albuminous matter, which may be
decomposed abnormally and give rise to toxic products, _e.g._, diabetic
intoxication, coma carcinomatosum.

(_b_) A _contagium vivum_ enters the body through the skin, or the
respiratory or digestive tract, and develops toxic agents in the tissues
on which it feeds, as in infectious diseases.

In the third group the toxic substance results from pathological
non-toxic products, which again produce a toxic agent, only under
certain conditions. This group he calls auto-toxicoses, and includes in
it poisonous substances, resulting from decomposition of the urine in
the bladder, under certain pathological conditions, and giving rise to
the condition called ammoniæmia. (_Medical News_ of January 7, 1891;
from _Wiener klinische Wochenschrift_ of December 25, 1890.)

As observed above, unfortunately the patients know nothing, nor can they
be made to understand these conditions, that are only reached through
labyrinthic pathological processes, and, what is still worse, this way
of looking at disease is incompatible with the idea of specific-disease
treatment, which to them looks more practicable and quick, and which is
also more to their liking. They cannot see any sense in such reasoning,
which to them is something eminently impracticable; neither can they see
a reasonable being in the doctor who practices on such, as they call
them, _theories_.

The practical physician, however, sees in Professor von Jaksch's
summary the turning-point of many a poor fellow's career,--from one of
comparative health into one of organic disintegration, decay, and
dissolution,--all the required processes starting visibly from the very
smallest of beginnings; any obstruction in the urinary tract or
intestinal canal being sufficient to start any of the conditions which
end in toxæmia; and, from a careful observation running over several
years, I do not think that I am assuming too much in saying that a
balanitis is often the tiny match that lights the train that later
explodes in an apoplectic attack or sudden heart-failure due to toxæmia;
the organic and vascular systems being gradually undermined until,
unannounced and unawares, the ground gives way and the final catastrophe
occurs,--unfortunately, an occurrence or ending looked upon as
unavoidable by the friends of the victim. They cannot see any danger;
the idea that diseases have the road paved, not only for an easy
entrance but an easy conquest, by the action of these toxic agents on
the tissues, is something that they cannot grasp. These blood changes or
blood conditions are things too intricate, and the physician who
understands them is, to them, a visionary and unpractical man. These
conditions are, however, neither new nor unknown, and there is really no
excuse for the ignorance exhibited in these matters by the general
public, as it is through the blood that this mischief takes place. They
can reason in their impotent way, that they should drench themselves
with "blood tonics" and all manner of nauseous compounds to "purify"
their blood, but the simple, scientific truth is something beyond their
understanding, as well as something that they steel themselves against.

Sir Lionel Beale, in observing the immense importance he attaches to
blood composition and blood change in diseases of various organs, truly
remarks that "blood change is the starting-point, and may be looked upon
as the cause, of what follows," the other factor being the "'tendency'
or inherent weakness or developmental defect of the organ which is the
subject of attack;" to which he adds that he feels convinced that, if
only the blood could be kept right, thousands of serious cases of
illness would not occur; while the persistence of a healthy state of the
blood is the explanation of the fact that many get through a long life
without a single attack of illness, although they may have several weak
organs; and that an altered state of the blood, a departure from the
normal physiological condition, often explains the first step in many
forms of acute or chronic disease. Sir Lionel has been a pioneer in the
field of thought that looks for the cause of the disease, which, however
remote it may be, should not be overlooked as a really primary
affection. His extensive labor in the microscopic field has fully
convinced him that many of the pathological changes in the different
organs are due to what might be called some intercellular substance that
is deposited from the blood. (Beale: "Urinary and Renal Disorders.")

Toxic elements in the blood affect the kidneys in a greater or less
degree, and there produce changes at first unnoticed,--at least, as long
as the kidney can perform its function,--but the day arrives when, as
described by Fothergill, blood depuration is imperfect, and we get many
diseases which are distinctly uræmic in character, and ending in any of
the so-called kidney diseases, Bright's disease being one of the most
common. As observed by Fothergill, however, the kidney is not the
starting-point, the new departure only taking place when the structural
change on the kidney has reached that point that it is no longer equal
to its function--the "renal inadequacy" of Sir Andrew Clarke. (J. Milner
Fothergill, in the _Satellite_, February, 1889.)

During the Bradshawe lecture, Dr. William Carter made the following
remarks: "According to Bonchard, one-fifth of the total toxicity of
normal urines is due to the poisonous products re-absorbed into the
blood from the intestines, and resulting from putrefactive changes which
the residue of the food undergoes there." In the course of the lecture,
Dr. Carter fully explains that one of the benefits derived from milk
diet in Bright's disease is the small residuum deficient in toxic
properties, and lays great stress on the employment of intestinal
disinfectants or antiseptics that exercise their influence throughout
the whole tract, suggesting naphthalin as peculiarly efficacious,
thereby cutting off one source of blood contamination at its source.
Although these are recent developments in medicine, Bonchard mentions
that in the practice of M. Tapret cases treated on this principle did
well. (Braithwaite's _Retrospect_, January, 1889.)

Persons laboring under this toxic condition of the blood, with a
consequent deterioration in the texture and the physiological function
of the vital organs, are of that class that easily succumb to injuries
or serious sickness, and of that class to whom a surgical operation of
even medium magnitude is equal to a death-warrant.

The above conditions are an almost constant attendant on that condition
of the sphincter described by Agnew as sphincterismus, which also is
productive of hæmorrhoids and fissure, and often of fistula. That
sphincterismus is caused in many cases by preputial irritation is as
evident as that the same affection, or hæmorrhoids or any other rectal
or anal affection, will, in its turn, produce vesical and urethral
reflex actions, and primarily functional and secondarily organic changes
in those parts. Besides, the great number of cases wherein the gradual
and progressive march of each pathological event could be traced with
accuracy has convinced me of the true cause of the difficulty being the
result of reflex irritation.

Delafield, in his "Studies in Pathological Anatomy," gives, as the first
form of pneumonia, that from heart disease; in the days of Broussais
this would have sounded absurd, but, to-day, some forms of heart disease
are known to be the regular sequences of some particular form of kidney
disease, just as some form of pneumonia attends an affected heart and
that some forms of pneumonia degenerate into phthisis. When the blood
change is an established fact, it is only a question as to which is the
weak organ, and the organism of the individual will decide whether it
will be a simple sick-headache or the beginning of a pneumonia ending in
phthisis.

I have purposely dwelt on this part of this subject, owing to the recent
origin and publication of many of the views connected with it; also on
account of the greater ease of making the subject plain by fully
discussing each step of the process; and if the views of Sir Lionel will
be recalled, that a toxic element in the blood is the starting-point,
and that an irritable or weakened organ invites destruction,--the
induction of serious and fatal kidney disorder by the transmitted
irritability and consequent injury to the kidney produced by preputial
irritation in the first instance, and the supplemental blood-poisoning
by intestinal absorption of septic matter, which soon brings about Sir
Andrew Clarke's "inadequacy of kidney,"--all will be readily understood.
When this point is reached, a too hearty meal, exposure to variable
weather, or a little extra care or anxiety, are sufficient, as
determining causes, to bring life into danger.

As pointed out, many cases of Bright's disease or other renal difficulty
have their origin in this distant but visible source, and, although
malarial poisoning and a great number of other causes will produce the
same particular organic changes and diseases, this condition must be
admitted as one of the frequent causes. The influence of the
genito-urinary tract on the rest of the economy, and the importance of
the sympathy it excites, or how quickly, by its being irritated, some
apparently dormant pathological condition will be awakened to life and
activity, is not sufficiently appreciated. As observed by Hutchinson, a
patient who has once been the subject of intermittent fever is more
prone, on catheterization, to have a urethral chill and fever than one
who had never had the fever. (Hutchinson: "Pedigree of Diseases.")

Ralfe observes, in his "Kidney Diseases," that long-standing disease of
the genito-urinary passages must be reckoned as among the chief
etiological factors of chronic interstitial nephritis (page 227). The
condition of the kidneys in cases of strictures of long standing is
known not to be a reliable one, and any incentive to dysuria or to
retention, no matter how slight, is apt to lead, eventually--and that
even in very young subjects--to that toxic condition mentioned in a
former part of this chapter as one of von Jaksch's subdivisions of
toxæmia, the ammoniæmia of Frerichs; this condition being the fatal
ending of the case of the two-year-old child mentioned by Henoch, who
died after the relief of a retention due to phimosis and calculi
resulting from the phimotic occlusion. Having seen so many cases wherein
the conditions described in this chapter were so apparently--whether
from ammoniæmia due to infection, or toxæmia from the urinary tract, or
uræmic toxæmia from the intestinal tract--all due to some preputial
interference or irritation, I cannot help but feel that in these
conditions--which, singularly, are not so prevalent with the Hebrews as
with Christians--we have one factor in the cause of the shorter and more
precarious vitality of the latter.

Morel, in his "Traité des Dégénérescences Phisiques," ably discusses the
degenerative and morbific influences and results of toxæmia, as well as
he clearly defines their sources. The connection between toxæmia and
mental affections has already been shown, and Prof. Hobart A. Hare, in
his instructive and interesting prize essay on "La Pathogénie et la
Thérapeutique de l'Épilepsie (Bruxelles, 1890)", mentions that
convulsive disorders resulting from the presence of some toxic substance
are of frequent occurrence. How much this may enter as a partial factor
into many of the cases of epilepsy which are classed in the order of
"reflex" may well challenge our consideration. Hare lays great stress on
the necessity of circumcision wherever there is an indication of
preputial local irritation. "If practicable, circumcision should be
performed; it is an operation with but small risk or danger, and easy of
performance. In such circumstances it is always permissible to
circumcise, were it for no other end than an acknowledged attempt to
reach a cure."



CHAPTER XXVI.

SURGICAL OPERATIONS PERFORMED ON THE PREPUCE.


In operative interference there is one point which should not be lost
sight of, this being that the length and bulk of the prepuce in a great
measure depends on the constriction at its orifice; if the orifice is
small, the prepuce tight and inelastic, every erection, by putting the
penis-integument on the stretch, adds to its bulk,--nature naturally
trying to make up the deficiency,--the two points of resistance being
where the glans pushes it ahead, having the constricting orifice for a
hold or purchase, and the skin at the pubes, which is called upon to
furnish the extra tissue for the time being needed during erection,
which should be supplied by the prepuce--this being the only office
which I have been able to assign to this otherwise useless but very
mischievous appendage. In cases where preputial irritation produces more
or less priapism, the continued stretching of this integument causes a
marked increase in its growth, which is mostly added forward. It was on
this principle or its recognition, that Celsus devised his operations,
and on which the persecuted Jews undertook to recover their glans by
manufacturing a prepuce; and, although the trial was not reported as
being very successful, I do not doubt but that, if the skin could have
been drawn sufficiently over so as to constrict it anteriorly so as to
give the glans a purchase, as in the case of phimosis with an inelastic
prepuce, the operation could be more of a success; all that is required
is the continued extension and the prepuce might be made to rival in
length the labia majoræ of the females of some African tribes, or the
pendulous buttocks of the Hottentot Venus.

I have employed the knowledge of this elasticity and source of supply of
the penis-integument, on more than one occasion, in recovering the
denuded organ with skin. A number of cases are on record where, owing to
the want of that artistic and mechanical knowledge without which no
surgeon is perfect, the operator has drawn forward the skin too tight in
circumcising, after which, owing to the natural elasticity of the skin,
the integument has retracted, leaving the penis like a skinned eel or
sausage. This accident is even liable to occur where the skin has not
been tightly drawn, but where subsequent erections have torn through the
sutures, and where the natural retraction of the skin has laid the organ
bare for some distance. I have seen a number so recorded, but do not
remember seeing any remedy suggested, it seemingly being accepted that
the recovery must take place by gradual granulation,--a necessarily very
slow process, owing to the constant interference by--the always present
in such cases--unavoidable erections.

Several years ago I advised circumcision to a gentleman owing to a
contracted condition of the muscles of one hip and thigh, which was
threatening to render him a deformed cripple; he had a congenital
phimosis and a very irritable glans penis. The operation was performed
in a proper manner by a surgical friend, but this friend, unfortunately,
was a great believer in antiseptic and wet dressings. A few days after
the operation he called upon me to ask me to go and see the patient, as
they were both in a pickle, the patient being exceedingly angry, being
in constant misery, and the penis so denuded by the giving way of the
sutures--owing to the erections--that it looked to the patient as if he
never could have a whole penis again, and the doctor saw no way out of
the difficulty; the penis was, in reality, a dilapidated and
sorrowful-looking appendage, and anything else but a thing of beauty or
pride; it was raw, angry-looking, and bleeding at every move; the first
wink of sleep was followed by an attempt at erection that raised the
patient as effectually as an Indian would in scalping him; so that,
taken altogether, the penis, anxious countenance, and the flexed
position of the whole body to relieve the tension on the organ, the man
looked about as battered, cast down, and sorrowful as Don Quixote did in
the garret of the old Spanish inn, with his plastered ribs and
demolished lantern-jaw.

Luckily, the patient was seen before the retracted portion of the penile
integument had had a chance to condense and indurate. The bed was
slopping wet with the drenchings of carbolized water that the penis had
undergone, the man's clothing was necessarily damp, and the whole
bedding and clothes were steamy,--all of which greatly added to his
discomfort and tendency to erections. The man was washed, placed in a
new, clean, and dry bed, and his clothing changed. The organ was then
forced backward until the preputial frill or edge was approximated to
the cut end of the penis-skin, where it was made fast by an
uninterrupted suture around the whole of the circumference. A short
catheter, about three inches in length,--the catheter being as full size
as the urethra would comfortably hold, and of the best and thickest of
the red, stiff variety,--was introduced into the urethra. This protruded
about half an inch beyond the meatus. A stiff, square piece of
card-board was pierced and slipped over this, and then adhesive rubber
straps were brought from the integument to this little platform, the
first being from the median line of the scrotum, lifting the sac forward
and upward. The pubes were shaved and the next four straps started from
the root of the penis, each strap being split at the glans-end so as to
encircle the protruding end of the catheter. By these means the skin was
brought back and firmly supported over the penis, toward the glans; and,
in case of any erection, the act would only assist in drawing the
covering farther over the penis as the pasteboard platform and adhesive
straps formed the distal end of an artificial phimosis. The catheter
allowed of free urination, and the scrotum was further held up in
position by a flat suspensory bandage passed underneath the scrotum and
fastened over the abdomen near each hip. The penis wound was then
dressed with a very little benzoated oxide-of-zinc ointment passed
between the adhesive straps; a bridge-support placed over the hips to
support the bed-clothes, and all was finished, and full doses of bromide
of sodium and chloral were ordered at bed-time. When the dressings were
removed, five days afterward, all was healed, the sutures removed, and
the suspensory alone replaced. The patient had not been troubled with
any more erections or annoyances of any kind. These are the points which
often do more or less mischief: wet dressings are uncomfortable and
favor erections, while the effect of the weight and action of the
scrotum in drawing backward on the integument should not be overlooked;
in addition, it should not be overlooked that we have it in our power to
produce, so to speak, an artificial phimotic action, which has the same
traction on the penis-integument that the natural phimosis induces.

The foregoing method, to be used in these cases, has proved very
serviceable in my hands, and it is here given that it may assist others;
as there is no need of waiting for granulations or of allowing the
patient to undergo so much misery, which, besides the local injury,
cannot help but affect the general health very injuriously. The penis
can stand any amount of forcing backward; it stands this in cancer or
hypertrophy of the prepuce, or in the inflammatory thickenings that
precede gangrene of the prepuce, in any extended degree; becoming, for
the time being, more or less atrophied. As has been shown by Lisfranc,
the penis can be made nearly to disappear into the pubes; so that we are
not as helpless in these cases as our text-books would have us believe.

In infants, and in young children below the age of ten or twelve, the
Jewish operation, as modified and done in accordance with the dictates
of modern surgery, will be found the most expedient. By this method we
avoid the need of any anæsthetic agents, which are more or less
dangerous with children, as well as the need of sutures, which are
painful of adjustment and very annoying to remove in those little
fellows who dread new harm; there is also much less risk of
hæmmorrhages, as the frenal artery is not wounded. In children of a year
or over, a very good result will be found often to follow Cloquet's
operation, care being taken to carry the slitting well back, as well as
care in taking it on one side of the frenum, so as to avoid any wound of
that artery, the subsequent dressing being a small Maltese-cross
bandage, pierced so as to admit the glans to pass through; the prepuce
is retracted and the tails folded over each other and held there by a
small strip of rubber adhesive plaster; a little vaselin prevents the
soiling by urine underneath. This last operation is short and very
easy, is not painful, nor does it require much manipulation; it is only
one quick cut on the grooved director and it is over; by the retraction
of the prepuce, the longitudinal cut becomes a transverse one, making
the prepuce wider and shorter at once; the glans soon develops and
remains uncovered. As there is a very small wound to heal over, the
repair is very prompt.

In adults with a very narrow, thin, not overlong prepuce, a very good
result often follows a combination of the dorsal slit with the inferior
slit alongside of the frenum of Cloquet. The narrower and tighter the
prepuce, the better the result, as the cuts are at once converted from
longitudinal into transverse wounds, and the organ at once assumes the
shape and condition of a circumcised organ, without having suffered any
loss of substance; three stitches or sutures in each cut (silver or
catgut) adjust the cut edges; a small roller of lint and adhesive
plaster, placed so as to shoulder up against the corona, completes the
dressing. Where this operation is practicable, by the thinness and
narrowness of the prepuce, it has many advantages. I have repeatedly
performed it on lawyers, book-keepers, clerks, and even laboring men,
who have gone from the office to the courts, counting-rooms, or stores
without the least resulting inconvenience or loss of time. In laborers
it is better to perform the operation on a Saturday evening, which gives
them a rest of thirty-six hours before going to their labor again. The
operation is comparatively painless and almost bloodless, as there need
not be more than half a teaspoonful of blood lost during the operation;
there is no danger of any subsequent hæmorrhage, and, with proper
precautions against the occurrence of erections, from seventy-two to
ninety-six hours is sufficient for a complete union; the sutures are
then removed and a simple lint and adhesive-plaster dressing worn for a
few days more. In many, no more dressings are required. In many cases,
with a properly adjusted dressing, that comes forward underneath so as
to include the frenum, the simple dorsal slit is sufficient; but if any
of the prepuce depasses the dressing underneath, it will puff and become
oedematous and require frequent puncturing. To avoid it, it is better to
make the Cloquet slit at once. This operation is of no value, and
perfectly impracticable in a thick, pendulous prepuce. Absorption will
often remove considerable preputial tissue, but where there is too much
its very bulk interferes with its removal by any natural means.

Dilatation is recommended by a number of surgeons, but, I must admit, in
my hands it has always proved a failure; it may be, that if the
subsequent history of the cases reported as so operated upon had been
carefully traced, the reports would not have been so good. Nelaton,
whose dilating instrument is generally recommended, seems, himself, to
prefer some of the circumcising methods, as in the volume on "Diseases
of the Genito-Urinary Organs," in his "Surgery," being the sixth volume
of the revised edition of 1884, by Desprès, Gillettte, and Horteloup,
the subject of dilatation is dismissed in two short lines. St. Germain,
of Paris, uses, as has been before observed, a two-bladed forceps, used
after the manner of Nelaton, and reports good results. Dr. J. Lewis
Smith agrees in his statements with Dr. St. Germain. Dr. Holgate, of New
York, reports a like experience. In my own practice the prepuce has
often been made _temporarily_ lax and retractable, but with the usual
results of the return of the contraction, with a possible thickening of
the inner fold, as a result of the interference; so that only in case of
any immediate demand, where the tight prepuce is producing irritation,
either through pressure or adhesions, or retained sebaceous matter, do I
ever resort to dilatation; always, however, even then, not as a final
operation, but merely as preparatory procedure toward a future operation
of a more efficient order.

In cases of timid adults, who refuse all kinds of operative
interference, good results may be obtained by the use of a mild
lead-wash or cold tea-baths and the introduction of flat layers of dry
lint interposed between the prepuce and the glans; this has a very good
effect in keeping the parts apart and dry, and may in time produce a
certain amount of dilatation; but even when this is done, unless it will
render the foreskin sufficiently loose to allow of its being kept
finally back of the corona, it is, after all, but a temporary makeshift.
The corona should be exposed and kept clear of the preputial covering;
anything short of this will not give all the good results to be desired.
I have more than once performed a secondary operation on Jews, who had
been imperfectly circumcised by not having the prepuce removed
sufficiently, and in whom the subsequent contraction of the preputial
orifice had re-covered part of the glans, and only lately visited a
four-year-old boy, circumcised when eight days old, in whom the prepuce
covered half of the glans, the corona acting as a tractive point from
which the penile integument was being drawn forward. In this case the
simple pierced-lint Maltese cross was used, with an adhesive band to
hold the tails down behind and around the penis just back of the corona.

These means, although not circumcision either in a surgical or in the
Hebraic religious sense, are, nevertheless, sufficient in a medical
sense for all desired purposes; provided, however, that there is no
resulting constriction, or a mild condition of paraphimosis, back of
the corona, and that the whole of the glans is sufficiently uncovered,
and that no abnormal dog-ears are left to garnish each side of the penis
like an Elizabethan frill or collar; although Agnew holds that, in
slitting, the practice adopted by many of rounding off the corners is
mostly superfluous, as nature will do so itself in time.

The ordinary way of performing the operation by modern surgeons is by
what is known as the Bumstead circumcision. It was not an invention of
Bumstead, but was adopted by him in preference to all others. The
requisites are a sharp-pointed bistoury, blunt-pointed scissors, and a
pair of Henry's phimosis forceps, with fine needles and fine oculists'
suture silk. The penis is allowed to hang naturally and the position of
the corona glandis marked on the outer skin with a pen and ink, which is
to serve as a guide for the incision. The prepuce is now drawn forward
until this line is brought in front of the glans and grasped between the
blades of the forceps. The prepuce is now transfixed, and, with a
downward cut, that portion is severed; the knife's edge is now turned
upward and the excision finished. The forceps are now removed and the
integument allowed to retract; with the scissors the inner mucous fold
is now split along the dorsum and trimmed off so as to leave about half
an inch in front of the corona. The parts are then brought together with
the continuous suture and dressed according to the fancy of the surgeon.
Care must be taken _not to bruise_ the parts with the forceps, as, in
such cases, sloughing of the sutured edges will be the result instead of
union. I have seen this accident happen more than once, in one case
being followed by a penitis that seriously complicated matters.

It has been my practice to use fine silver-wire and catgut sutures in
all operations on the prepuce; they excite less suppuration as well as
less irritation. In case of need, the silver can be left in longer, and
they are much easier of removal than the silk; besides, they have the
advantage of not cutting. In the after-treatment the same general plan
can be followed as with any amputated stump, except that it must not be
forgotten that at the end of this organ dwells what has been termed the
_sixth_ sense, and that heat and moisture are very apt to awaken the
dormant energies of the organ, even after it has undergone cruel
mutilation, and even has suffered considerable loss of blood; for that
reason it is best always to avoid wet or sloppy dressing, or too much
ointment, as they are more apt to cause erection than to do any good.
Besides, I find water does here, as elsewhere, interfere with the
deposited plastic matter, properly organizing into cicatricial tissue;
so that I prefer a snug, dry dressing, which is left on for four or five
days without being interfered with, and light covering, plain diet,
quiet, with fifteen grains each of bromide of sodium and chloral hydrate
at bed-time to insure rest and freedom from annoying erections. Where
the organ is large in its flaccid state, it is better to support it on a
small oakum-stuffed pillow, made for the purpose, than to let it hang
downward. Should the stitches give way and the skin tend to retract, the
plan proposed on a previous page can be followed to advantage. In
urinating, care must be taken not to soil the dressings; some patients
are very careless about this if not warned. The penis should hang nearly
perpendicular while in the act, and all dribbling should have ceased and
the meatus and underneath be mopped dry with some soft cotton before
raising the organ; nothing so irritates the parts, retards union, or is
more offensive than a urine-saturated dressing.

Dr. Hue, of Rouen, uses an elastic ligature, which he introduces into
the dorsal aspect of the prepuce by means of a curved needle. This he
ties in front, and in three or four days it cuts its way through.
Although Hue reports a large number so operated upon, the tediousness of
the procedure and the swelling and oedema, as well as the active pain
that must necessarily accompany the operation, will hardly recommend the
ligature in preference to the incision by the knife.

Dr. Bernheim, the surgeon of the Israelitish Consistory of Paris, has
operated on over eleven hundred circumcisions, besides the cases of
phimosis occurring in his general practice. His opinion of the procedure
of M. de Saint-Germain by dilatation is not favorable. He has employed
it in a number of cases of phimosis, at the time unfit for a more
radical operation. He has, however, observed that cicatricial
thickenings and recontractions are very apt to occur, and, as to the
septic accidents mentioned in connection with circumcision, he has noted
that they are as liable to occur in hands that are as careless and
slovenly with what they do with their dilating forceps as they are with
what they do with their bistouries. Dr. Bernheim prefers the
circumcision forceps of Ricord, as modified by M. Mathieu. This
instrument he prefers by reason of its gentler pressure, which, at the
same time, is all-sufficient to properly fix the prepuce. In applying
the forceps, he includes as little as possible of the lower part,
keeping away as much as possible from the frenic artery. The dorsum of
the inner fold he cuts with the scissors. In children under two years of
age, he simply turns this back over the free edge of the integument; in
children over two years of age, he uses serres-fines. In children, he
uses a piece of lint dressing steeped in a watery solution of boracic
acid; in adults, he uses iodoform-gauze dressings. He finds cases unite
in from three to ten days. Dr. Bernheim warns us against using
antiseptics on infants or young children, in connection with the
after-dressing of circumcision. Neither phenic acid, corrosive
sublimate, nor iodoform are well borne by these young subjects, and he
has seen serious results follow upon as light an application as a 1/100
solution of phenic acid. In a number of cases he reports operating with
the galvano-cautery of Chardin, instead of the knife. These operations
were bloodless, and cicatrization was as rapid as when the knife was
used. He has in several cases operated by the dorsal incision, owing to
disease of the prepuce not allowing any other operation.

In France, the Bumstead operation is known under the title of Ricord's
procedure. Lisfranc, Malapert, M. Coster, and Vidal all have operations
which are not as useful as Ricord's, and have not, therefore, come into
general use. M. Sedillot condemns the dorsal incision as leaving two
unsightly-looking flaps. The reverse, or inferior incision of M. Jules
Cloquet is likewise not in favor with either Malgaigne or Ricord. This
inferior incision or section, alongside of the frenum was first advised
by Celsus. M. Cullerier contented himself with slitting the inner
preputial fold, longitudinally, from its junction with the skin backward
to the corona. M. Chauvin, by the aid of a complicated instrument with
barbed points, drew out the mucous fold as far as possible before
excising.

There is something unaccountable in the difference in results that
various operations give in the hands of different surgeons. It must be
that all methods are correct _with properly-chosen cases_ and when
properly _performed_, as well as properly looked after subsequently to
the operation. It must not be expected, however, that, in operations
where the kindly assistance of nature is a thing contemplated in
absorbing superfluous tissue, the case will at once give satisfaction to
all. These cases must have the required time before judgment can be
passed upon the merits of the operation, just as required time in cases
of dilatation or in the method of M. Cullerier will often demonstrate
that the benefits are but transient, and that often even cases that have
been so operated upon will require a complete circumcision, _à la_
Ricord or _à la_ Bumstead, owing to the resulting thickening induration
and overconstriction, when, if left alone, the dorsal slitting or the
inferior incision of Cloquet would have previously given satisfactory
results.

The final cosmetic results in the combined Cloquet and dorsal-slit
operation, for instance, depend on, first, properly choosing the case.
One on whom the operation is unadaptable it is useless to attempt it on,
as a future circumcision or tedious and annoying re-operation of
trimming would be required. The next care is to properly cut through all
constricting bands, which, like fine, tough strings, will be found to
encircle the penis. These must be carefully clipped with a fine pair of
strabismus scissors, as these bands do not give way, either then or
afterward, of their own accord, but form the nucleus for stronger
constricting bands for the future. Then you must be sure to cut far
enough back, either above or below, until you have reached where you
obtain the normal and largest calibre of circumference of the penis. The
adaptation of the edges of the parts and the proper application of a
smooth, equal pressure, by means of the lint strap, is of the next
importance; and then comes the strapping of the whole surface for about
an inch and a half back of the corona, which should and must include all
the tissues of the preputial part of the frenum. A neglect or careless
performance of any of the details, or the carelessness of the patient in
not keeping the dressing clean, necessitating its change before the
fourth day, all tend not only to interrupt the union, but to mar the
future cosmetic results as well. It may be asked why all this care and
trouble, and not circumcise at once? As already observed, this operation
admits of the patient following his business; whereas circumcision, on
the male, will assuredly lay him up for four or five days, and perhaps
ten days,--something that many, be they rich or poor, cannot afford, and
will not submit to.

The cosmetic condition of the penis as a copulating organ is a thing of
some importance, and this should not be overlooked; for, although the
particular dimension, shape, or peculiarity of the penile end never
figures prominently in the complaints of women who apply for
divorce,--the charges being everything else under the sun,--it can
safely be assumed that this organ and its condition is the original,
silent and unseen, as well as unconscious power behind the throne that
is at the bottom of the whole business in more than one case. Like the
fable of the poor lamb that the wolf wished to devour: the real reason
of his wishing to kill him was that he might eat him, the pretext set
forth by the wolf that the lamb had encroached on his pasture, muddied
his brook, or kept him awake by his bleating having been disproven by
the lamb. Besides, it is well not to leave any distinctive or
distinguishing mark, like an individual baronial crest, on the head of
the organ.

To return, however, to the operative procedures, we find that Dr. Vanier
finds that the operation of Cloquet by incision alongside of the frenum
has the advantage of not leaving any deformity--contrary to the opinion
of Ricord and Malgaigne. He, in fact, holds this procedure in such high
esteem that he considers that Cloquet deserves great credit for reviving
this old Celsian operation. H. H. Smith, in his "Operative Surgery,"
coincides with Vanier in his favorable opinion of this method, as he
there says: "Frequent opportunities of testing the advantages of the
plan of Cloquet having satisfied me of its value, I do not hesitate to
recommend it as that best adapted to the adult, because it fully exposes
the glans and leaves little or no lateral deformity, as is frequently
the case with the dorsal incision,"--an opinion that I can fully agree
with, from the results of the same operation in my hands, although I
have used the method even on infants. Vanier does not approve of the
dorsal incision unless it is made V-shaped, as it otherwise leaves the
unsightly lateral flaps, but thinks well of the modification of
Cloquet's practiced by M. Vidal de Cassis, which is performed in the
following manner: The patient stands before the operator, who remains
sitting; the operator seizes the prepuce on its dorsum and draws it
toward him; he then introduces a narrow, sharp-pointed bistoury, with
its point armed with a small waxen bullet, down alongside of the frenum
until he reaches the pouched extremity of the preputial cavity at this
point; the point of the bistoury is now made to transfix the waxen
bullet and out through the skin, which from this point is divided from
behind forward. Vanier very sensibly suggests that the operation that is
effectual, and which can be accomplished in the least number of
movements or _temps_, as being the least likely to cause extensive pain
and agony, should be the one preferred, and that the aim of the surgeon
should be to simplify the operation by reducing the number of necessary
movements. For this reason, where an excision of considerable amount of
tissue is required by the nature of the case, he prefers another
operation, performed by Lallemand,--that of making a dorsal transfixion
and cutting off the two lateral flaps, which can all be done in three
movements.

It makes but little difference as to which operation is performed on the
adult, but that the subsequent dressing will exercise a good or evil
influence, and greatly assist not only in the present comfort or
discomfort of the patient, but in the ultimate result as well. Bearing
these points in view, Charles A. Ballance, of St. Thomas's Hospital, has
adopted the following procedure:--

"When the patient is etherized, the outline of the posterior border of
the glans is marked on the skin with an aniline pencil. The skin of the
prepuce is slit and removed up to the aniline line. The mucous membrane
is next cut away, leaving only a free edge of about one-eighth of an
inch in width. Any bleeding which occurs should be entirely arrested,
and asepsis must be insured by frequent sponging with carbolic or
sublimate solution. Numerous coarse-hair stitches are then inserted, so
as to bring accurately together the fresh-cut edges of the skin and
mucous membrane, and subsequently, after a further sponging and drying,
a piece of gauze two layers of thickness, and wide enough to reach from
the root of the penis nearly to the meatus, is wrapped loosely around
the penis and secured by several applications of the collodion-brush.
The setting of the collodion is hastened by the use of a fan, so that
the air is kept in motion, and the patient should not be allowed to
recover from the anæsthetic until the dressing is quite firm and hard.
This dressing forms a carapace for the penis, protecting it from the
bedclothes and effectually preventing the annoying and distressing
erections. Mr. Ballance reports excellent results from this dressing."
(Braithwaite's _Retrospect_, July, 1888.)

In applying the above dressing, the shrinking incident to the drying of
the collodion must not be overlooked, and the gauze layers must be
loosely applied, as they would otherwise become too tight. The dressing
is a very ingenious and serviceable one.

Mr. A. G. Miller, at a meeting of the Edinburgh Medico-Chirurgical
Society, reported a new method of dressing after circumcision. "It
consisted in first closely suturing the skin and mucous membrane by
numerous catgut sutures, then painting the surface with Friar's balsam
and covering it over with two or three layers of cotton wadding, on
which the balsam is poured. The glans penis was left sufficiently free
to allow of water passing. The band or ring of dressing should be at
least one inch broad. The dressing was not suitable for young infants
who were frequently wetting. In the case of older children, they might
be allowed to go about on the second or third day, when the dressing
would be quite dry, and would not be required to be changed or renewed."
(Braithwaite's _Retrospect_, January, 1888.)

Any constricting or immovable and inelastic dressing is subject to the
same objections as plaster-of-Paris dressings in thigh-fractures,--that
of being dangerous and not expedient, unless the patient is constantly
under your eye.

Dr. Neil Macleod, in the _Edinburgh Medical Journal_ for March, 1883,
advises a procedure that has always looked favorably to me, and which I
once put in practice through the means of the ordinary ptosis
fenestrated forceps, in place of the ordinary circumcision forceps, the
sutures being introduced through the fenestra and the prepuce cut off on
the outer side of the forceps, the thickness of the steel arm on the
outer side of the fenestra allowing of the properly-sized border for the
hold of the sutures. Dr. Macleod places his sutures all in position
before making any incisions,--a procedure which will be found to save
the patient considerable pain; as with many the seizing and holding of
the edges of the skin and mucous membrane and the forcible pressure
exerted by the fingers or forceps while the needle is being forced
through is the most painful part of the operation. In doing this, care
must be taken to allow sufficient length to each thread to make two
sutures, as well as care must be taken to properly pull out the thread
in the centre between the four folds of tissue and to cut it
equidistant, after the ablation of the prepuce, a blunt hook being used
to fish up the threads from the preputial opening.

Erichsen favors the Jewish operation in young children, as being the
easiest and safest of performance. Slitting, or the inferior or superior
incision, he thought, left too much of the prepuce, which, wherever
there is a tendency to phimosis, should be entirely removed, "with a
view of preserving the health and cleanliness of the parts in after
life." In the phimosis that is acquired by old men, he found dilatation
with a two-bladed instrument to be sufficient, provided the indurated
circle was made to yield. For the circumcision of adults he has invented
an adjustable shield, something like the Jewish spatula, with which he
protects the glans.

Gross (the elder) used both slitting on the dorsum and circumcision. He
found neither objection nor deformity in the flaps left by the dorsal
incision, as they were only temporary; in some cases, he simply followed
the practice of Cullerier, of making multiple slits in the constricting
and inelastic mucous membrane.

Agnew believes in circumcision in the treatment of reflex troubles. He
relates a case, in the second volume of his "Surgery," of eczema
extending over the abdomen, of over a year's standing, cured in a child
by circumcision; he operates by incision on the dorsum, in which he
leaves nature to make away with the flaps, or he circumcises by the
Bumstead method.

Van Buren and Keyes recommend both the incision on the dorsum and the
operation of Ricord; where the mucous membrane alone is tight and
constricted, they follow Cullerier's method of either single or multiple
incisions of the inner coat. They lay great stress on the necessity of
keeping the patient quietly in bed to insure rapid and complete union.

My friend, Dr. Robert J. Gregg, of San Diego, has lately operated on a
number of cases, the operation being perfectly painless, the little
patients submitting to it and feeling no more pain than if it were
having its toe-nails trimmed, the local anæsthesia being produced by the
hypodermatic injection of cocaine. This procedure is now used to a
considerable extent throughout the country, and it is a far safer and
more comfortable performance than either etherizing or chloroforming, as
the sudden and spasmodic filling of the lungs of young children--who
will resist and hold their breath for a long time, then suddenly
inhale--with anæsthetic vapor is almost unavoidable, having in two
instances nearly lost two children from such an accident.

Dr. G. W. Overall, in a late _Medical Record_, which is quoted in the
_Journal of the American Medical Association_ of February 21, 1891,
gives the description of a very good and painless method of producing
this local anæsthesia; for it need hardly be said that with a nervous,
irritable child the introduction of the hypodermatic needle is as
formidable an operation as either slitting or the Jewish operation. Dr.
Overall is in the habit of holding a solution within the preputial
cavity and then to introduce the needle in the mucous fold, having
previously applied a light rubber band back of the corona, on the outer
integument, so as to act like a tourniquet and limit the action of the
anæsthetic effect to the prepuce. By this procedure he avoids all pain
and the operation can be performed while the child is even amusing
itself, care being taken that it does not see it. Sutures that require
removal should not be used, according to the Doctor, and the operation
thereby becomes a perfectly painless and unalarming performance to the
patient in all its details.



NOTES TO TEXT.


    [1] "Letters of Certain Jews to Monsieur Voltaire, Containing an
          Apology for their own People." Pages 451-476. Translated by
          Dr. Lefann. Philadelphia, 1848.

    [2] "Circoncision chez les Egyptiens." Brochure by F. Chabas. Paris,
          1861.

    [3] "Atlantis." By Ignatius Donnelly. Page 472.

    [4] _Ibid._, page 115.

    [5] _Ibid._, page 234.

    [6] _Ibid._, page 178.

    [7] "Circumcision." A. B. Arnold. _New York Med. Record_, Feb. 13,
          1886.

    [8] "Atlantis," page 178.

    [9] This word is, in the Mandan, _Maho-peneta_; in the Welsh,
          _Mawr-penæthir_. "Atlantis," page 115.

    [10] "Cyclopedia of Biblical, Theological, and Ecclesiastical
          Literature," vol. viii, page 58. Article, Phallus.

    [11] "Origine, Signification et Histoire, de la Castration, de
          l'eunuchism, et la circoncision." Par. F. Bergmann. Published
          in the "Archivio per le Traditione Populaire," 1883.

    [12] "Dictionaire des Sciences Médicales." Par une Société de
          médecins et de Chirurgiens. Paris, 1826, 60-volume edition.

    [13] Dr. Delange mentions a peculiar social habit or custom among a
          tribe of Arabians that in a sociological sense is worth
          mentioning. He observes that for these dances females are
          preferred, but owing to the peculiar habit about to be related
          it is impossible to have any of the village women in Algeria
          assist at this part of the festivities; hence the men have to
          do the dancing. It appears that the females of one tribe--this
          being the tribe of Ouleds-Nails, who live on the southern
          borders of Algiers--are in the habit, when young, of
          emigrating to the oases of the Sahara, which are occupied by
          the French and traveling Arabs, where they give themselves up
          to a life of prostitution. After having exercised this life
          for some years they return to the tribe with a dowry in money,
          besides an ample supply of clothes and jewelry,--the result of
          their economy,--which enables them to contract favorable
          marriages. This practice is so common in this one particular
          tribe, and so much have they monopolized the profession of
          courtesan, that the name of the tribe of Ouleds-Nails is in
          Arabia synonymous with that of courtesan. These young women
          dance every evening in the Arab cafés, and are at times
          employed to do the dancing at Arab feasts. For this reason no
          self-respecting Arab woman ever allows herself to dance in
          public, or why the practice of both sexes dancing together is
          not practiced in Algerian villages, as a man would thereby
          consider himself disgraced.--Dr. Delange, in _Receuil de
          Mémoires de Médecine de Chirurgie et de Pharmacie Militaire_,
          No. 105, August, 1868.

    [14] "Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim
          Interpretis primarii, De Turcarum Liturgia, peregrinatione
          Meccana, Circumcisione, Ægrotorum Visitatione," etc. Oxonii,
          1690.

    [15] Michel Le Feber. "Le Theatre de la Turquie." Paris, 1681.

    [16] "La Circoncision, Sa Signification Social et Religieuse." Par
          M. Paul Lafargue, in the _Bulletins de la Société
          d'Anthropologie de Paris_. Tome x, 3d fascicule, Juin à
          Octobre, 1887.

    [17] "Circumcision." By A. B. Arnold. _New York Med. Record_, Feb.
          13, 1886.

    [18] Bancroft's "Native Races," vol. ii, page 278.

    [19] "Recherches Philosophiques sur les Americains, ou Memoires
          Interessants pour servir à l'Histoire de l'Espece Humaine."
          Par M. de P. Edition par Dom Pernety. Tome ii. Article,
          Circoncision, Berlin, 1774.

    [20] "The Family, a Historical and Social Study." By Charles
          Franklin Thwing. Boston, 1887.

    [21] The "Recherches Philosophiques sur les Americains" and Virey,
          in the 24th volume of the "Dictionaire des Sciences
          Médicales," are very full on this subject, and for fuller
          information the reader is referred to those works.

    [22] "Cause Morale de la Circoncision des Israelites, Institution
          Preventive de l'Onanisme des Enfants." Par le Docteur Vanier,
          du Havre. Paris, 1847.

    [23] "Annual Report of the Bureau of Ethnology." By J. W. Powell.
          Washington, 1881, 1882.

    [24] "Among Cannibals, or Four Years' Travels in Australia." By Carl
          Lumholtz. Page 46. Charles Scribner & Son, 1889.

    [25] These interesting historical facts in relation to the holy
          prepuce were published in the _Journal l'Excommunier_ in
          January of 1870, when the writer was in France. They were
          contributed by A. S. Morin, of Miron, a learned
          historiographer and antiquary. Europe has not recovered from
          its love of the supernatural that it had so strongly in the
          middle ages. The blood of St. Gennaro still liquefies once a
          year, and many churches still claim to possess the identical
          winding sheet that served our Lord prior to his resurrection,
          as well as more than one church has the holy cloth that St.
          Veronica used on the way to Calvary, which has an impression
          of the face of the Saviour.

    [26] This church has a remarkable history connected with its
          foundation. The tradition relates that in the dark ages some
          sacrilegious soldier had robbed a church in the neighborhood
          of its holy vessels of gold and silver. In the vessel in the
          Tabernacle there happened to be a consecrated wafer. The
          soldier journeyed on to Turin to dispose of his plunder, when,
          on arriving at the spot on which the church now stands, the
          wafer is said to have ascended miraculously to some distance
          above the soldier's head, while at the same time the mule he
          rode, being imbued with more religious piety than his master,
          reverently knelt down on his front legs. The holy wafer was
          now encircled by a halo of shining light; this, with the
          kneeling donkey and the soldier raining blows on the pious
          animal, while he himself was unconscious of the presence of
          the host above him, attracted the attention of the populace,
          who apprehended the soldier, on whom the stolen vessels were
          found. The bishop in his pontificial robes, in solemn
          procession, received the consecrated wafer, which promptly
          descended into pious hands. The donkey was adopted by the
          bishop and the soldier was promptly hanged, in accordance with
          the general treatment of thieves in those days. The writer has
          more than once seen a flagstone inclosed within a railing that
          occupies the central spot of the floor or pavement of the
          church, it being the identical spot on which the donkey knelt.

    [27] Rush's "Medical Inquiries," vol. i, page 217.

    [28] Fothergill. "Gout in its Protean Aspects," page 158.

    [29] "Philosophy of Magic," from the French of Eusebe Salverte, vol.
          ii, page 143.

    [30] "Dictionaire des Sciences Médicales." Cullerier. Article,
          Phimosis. Vol. xli.

    [31] Bergmann has gone into this subject at length, and the writer
          has drawn freely from his brochure on "Castration and
          Eunuchism," reprinted from the "Archivio per le Traditione
          Populaire" of 1883.

    [32] "The Hermit." By the Rev. Charles Kingsley. See Introduction.

    [33] "Dictionaire des Sciences Médicales," vol. liv, page 570.

    [34] _Ibid._, page 567.

    [35] _Ibid._, page 570.

    [36] "Cyclopedia of Biblical, Theological, and Ecclesiastical
          Literature," vol. iii, page 351.

    [37] Smollett gives a good account of the Carthagena expedition in
          his "Roderick Random," and for a good satisfactory detail of
          the blundering Walcheren expedition the reader is referred to
          Harriet Martineau's "History of England," vol. i, pages 269,
          272, 273, and 354.

    [38] Schoopanism, or pæderastia, is at times practiced by the
          Omahas, and the man or boy who suffers as the passive agent is
          called _min-quga_, or hermaphrodite.--"Third Annual Report of
          the Bureau of Ethnology." By J. W. Powell. Washington, 1881,
          1882.

    [39] When the missionaries first arrived in this region they found
          men dressed as women and performing women's duties who were
          kept for unnatural purposes. From their youth up they were
          treated, instructed, and used as females, and were even
          frequently publicly married to the chiefs or great
          men.--Bancroft's works, vol. i, "Native Races," page 415.

    [40] "Recherches Philosophiques sur les Americains," tome ii.

    [41] "The History of the Hebrew Commonwealth." From the German of
          John Jahn, D.D. Page 25. Oxford, 1840.

    [42] "L'Hermaphrodite devant le Code Civil." Par le Docteur Charles
          Debierre. Bailliére et Fils. Paris, 1886.

    [43] "Recherches Philosophiques sur les Americains," tome ii, page
          78.

    [44] "L'Hermaphrodite devant le Code Civil." Debierre.

    [45] _Occidental Medical Times_, Sacramento, Cal., October, 1890,
          page 543.

    [46] "Dictionaire des Sciences Médicales," vol. xxxi., page 41.

    [47] _British and Foreign Medico-Chirurgical Review_, vol. xviii,
          1856.

    [48] "L'Hermaphrodite devant le Code Civil." Debierre.

    [49] Sir Thomas Brown's works, vol. ii, "Religio Medici."

    [50] "The Bible and other Ancient Literature in the Nineteenth
          Century." L. T. Townsend, D.D. Chautauqua press, 1889. See
          pages 32-45.

    [51] "The Religions of the Ancient World." George Rawlinson, M.A.
          Alden edition of 1885. Page 174.

    [52] "The Intellectual Development of Europe." John W. Draper. Vol.
          ii, page 113.

    [53] _Ibid._ vol. ii, page 122.

    [54] In "Clarke's Commentary," vol. i, page 113, the reason of
          choosing the eighth day is given. Circumcision was not only a
          covenant, but an offering to God; and all born, whether human
          or animal, were considered unclean previous to the eighth day.
          Neither calf, lamb, or kid was offered to God until it was
          eight days old.--Lev., xxii, 27.

    [55] A father circumcised his children and the master his slaves. In
          case of neglect the operation was performed by the magistrate.
          If its neglect was unknown to the magistrate, then it became
          the duty of the Hebrew, upon arriving of age, to either do it
          himself or have it done.--"Clarke's Commentary," vol. i, page
          113.

    [56] Bishop Newton points out the remarkable analogy that marks the
          Hebrew race as descendants of Isaac and the Arab race as the
          descendants of Ishmael, from whom sprung the Saracenic people.
          These are the only two races that have gone on in their purity
          from their beginning. They intermarry only among themselves
          and have, alike, the same customs and habits as their fathers.
          The sculptured faces of the Hebrew on the Babylonian monuments
          are the same faces that are met in the synagogues of Paris or
          New York. So with the descendants of Ishmael, in whom there
          flows partly the blood of the dominant element of ancient
          Egypt; neither custom, habit, nor physiognomy have changed. In
          these two races, as observed by Bishop Newton, we have an
          ocular demonstration of the Divine origin of our faith, if
          verification of Scripture history is any criterion.--"Clarke's
          Commentary," vol. i, page 111; also, Hosmer's "Story of the
          Jews," page 5.

    [57] "Cause Morale de la Circoncision." Vanier, du Havre. Pages
          40-45.

    [58] "De la Circoncision." Par le Dr. S. Bernheim. Page 7. Paris,
          1889.

    [59] "Cyclopedia of Biblical, Theological, and Ecclesiastical
          Literature," vol. ii, page 350.

    [60] Among the Semitic race, however, it seems possible to bring
          forward better evidence than this of an early Stone Age. If we
          follow one way of translating we find, in two passages of the
          Old Testament, an account of the use of sharp stones or stone
          knives for circumcision,--Exodus, iv, 25: "And Zipporah took a
          stone"; and Joshua, v, 2: "At that time Jehovah said to
          Joshua, Make thee knives of stone." ... The Septuagint
          altogether favors the opinion that the knives in question were
          of stone, by reading, in the first place, a stone or pebble,
          and, in the second, stone knives of sharp-cut stone. These are
          mentioned again in the remarkable passage which follows the
          account of the death and burial of Joshua (Joshua, xxiv, 29,
          30),--"And it came to pass, after these things, that Joshua,
          the son of Nun, the servant of Jehovah, died, being a hundred
          and ten years old, and they buried him in the border of his
          inheritance in Timnath Serah, which is in Mount Ephraim, on
          the north side of the hill of Gaash." Here follows, in the
          LXX, a passage not in the Hebrew text, which has come down to
          us: "And there they laid with him in the tomb, wherein they
          buried him there, the stone knives wherewith he circumcised
          the children of Israel at the Gilgals, when he led them out of
          Egypt, as the Lord commanded. And they are there unto this
          day." The rabbinical law, in connection with this subject,
          reads as follows: "We may circumcise with anything, even with
          a flint, with crystal (glass), or with anything that cuts,
          except with the sharp edge of a reed, because enchanters made
          use of that, or it may bring on a disease; and it is a
          precept of the wise men to circumcise with iron, whether in
          the form of a knife or scissors, but it is customary to use a
          knife." This mention of the objectionable nature of the reed
          as a circumcising medium is attributed to the danger that may
          arise from splinters. The Fiji Islanders use both a rattan
          knife and a sharp splinter of bamboo in performing
          circumcision and in cutting the umbilical cord at child-birth.
          Herodotus mentions the use of stone knives by the Egyptian
          embalmers. Stone knives were supposed to produce less
          inflammation than those of bronze or iron, and it was for this
          reason that the Cybelian priests operated upon themselves with
          a sherd of Samian ware (Samia testa), as thus avoiding danger.
          There seems, on the whole, to be a fair case for believing
          that among the Israelites, as in Arabia, Ethiopia, and Egypt,
          a ceremonial use of stone instruments long survived the
          general adoption of metal, and that such observances are to be
          interpreted as relics of an earlier Stone Age.--"Researches
          into the Early History of Mankind." By Edward B. Tylor. Pages
          217-220. London, 1870.

    [61] The cannibals of Australia do not eat white people, as the
          flesh of these produces a nausea, which the flesh of the
          vegetable-fed blacks does not do. The rice-fed Chinese are
          considered a treat, and these are slaughtered in great number,
          ten Chinamen having been served up at one dinner.--"Among
          Cannibals." By Carl Lumholtz. Page 273.

    [62] "Cause Moral de la Circoncision." Par le Dr. Vanier. Page 266.

    [63] _Ibid._, page 288.

    [64] _Cincinnati Clinic_, vol. ii, page 165.

    [65] "The Story of the Jews." Hosmer. Page 263.

    [66] "Traité d'Hygiène, publique et privée." Michel Levy. 2d.
          edition, vol. ii, page 754.

    [67] _Ibid._

    [68] "Diseases of Modern Life." B. W. Richardson. Page 19.

    [69] "Longevity and other Biostatic Peculiarities of the Jewish
          Race." By John Stockton Hough, M.D. _New York Med. Record_,
          1873.

    [70] "Vital Statistics of the Jews." By Dr. John S. Billings. _North
          American Review_, No. 1, vol. 152, page 70, January, 1891.

    [71] "On Regimen and Longevity." By John Bell, M.D. Page 13.

    [72] _British and Foreign Medico-Chirurgical Review_, vol. xliii,
          page 539.

    [73] _Ibid._, vol. xlii, page 17.

    [74] In "Influence of the Trades on Health," Thakrah mentions the
          peculiar exemption enjoyed in this regard by the butcher
          class. He quotes Tweedie in saying that he never saw a butcher
          admitted to the fever hospital.

    [75] Lancereaux. "Distribution de la Phthisie Pulmonaire."

    [76] Ashhurst. "Int. Enc. Surgery."

    [77] Horner. "Naval Practice."

    [78] _Cincinnati Lancet and Observer._, vol. xvi, 1873.

    [79] It may well be a question of some interest whether the atrophy
          of the testicle in the aged may not at times be partly due to
          the compression exercised by the prepuce on the glans through
          reflex action, and whether at times the virility that is
          departing cannot be restored by circumcision in such cases. I
          have seen such results, being guided to the idea by the
          Biblical relation in the case of Abraham.

    [80] This patient subsequently died of a uræmic complication
          following on an attack of fever. The man was in his prime, and
          had been of most exemplary habits. The fever that he had was,
          I had every reason to believe, directly due to the results of
          imperfect blood depuration incident on the irritability of his
          kidneys, which, retroactively, again allowed the uræmic
          condition to assume that dangerous degree that suddenly and
          very unexpectedly to his friends and family ushered the
          patient into eternity. This man had only been merely
          inconvenienced by his prepuce up to the time that it caused
          his death. It is interesting to observe what little trifles
          bring about the end of some men. The unlucky habit of putting
          the royal countenance on paper brought Louis XVI to a sudden
          halt at Varennes, and his head to the scaffold. The lucky
          meeting of the _aides_ of Bonaparte and Desaix between Novi
          and Marengo gave to France its empire and to Europe the
          enlightenment that was diffused by that event. If such trifles
          affect individuals and nations, we must not be astonished that
          the little useless prepuce should be endowed with the
          mischief-working power of the historical old cow and kerosene
          lamp that reduced Chicago to ashes.

    [81] In the London _Lancet_ for 1885 there is a very interesting
          communication at page 46 on this subject. There is no doubt
          but that the prepuce offers the best skin-grafting material.

    [82] In the seventeenth volume (third series) of "Guy's Hospital
          Reports" there is a most interesting report at page 243 of a
          case of skin-grafting that was performed by Thomas Bryant. The
          case was an extensive ulcer resulting from an injury. Bryant
          took some skin-grafts from the man's arm and some from a
          colored man in an adjoining bed. The account gives the daily
          report as taken from the note-book of Mr. Clarke, and is
          accompanied by a colored plate to illustrate the subject; the
          proliferation of the black skin is astonishing. In closing the
          report Mr. Clarke says: "But in the figures depicted the
          amount of increase in the black patches will be well seen. In
          ten weeks the four or five pieces of black skin, which
          together were not larger than a grain of barley, had grown
          twentyfold, and in an another month the black patch was more
          than one inch long by half an inch broad, the black centres of
          cutification having clearly grown very rapidly by the
          proliferation of their own black cells."

    [83] _American Journal Med. Sciences_, vol. lx.

    [84] "Circumcision." By Dr. A. B. Arnold, of Baltimore.

    [85] "De la Circoncision." By Dr. S. Bernheim. Paris.

    [86] The reader is referred to a very interesting paper detailing
          conditions of adhesions in the _American Journal Med.
          Sciences_ for July, 1872. It is taken from the Hungarian of M.
          Bokai.

    [87] _New York Med. Journal_, vol. xxvi.

    [88] _American Journal Med. Sciences_, vol. lx.

    [89] Dr. Vanier describes this operation of Celsus mentioned by
          Vidal in his work on "Circumcision," at page 294, which
          consisted in making, by a circular incision immediately back
          of the glans, like in a circular amputation, a complete
          detachment of the integument from back of the corona. The
          penis was then made to retreat into the sheath thus made and a
          short catheter introduced into the urethra, to the end of
          which the free end of the new preputial fold was made fast, a
          piece of oiled lint being interposed between the raw inner
          surface and the glans. Another operation consisted in
          forcibly drawing the integument forward and in making a number
          of transverse incisions in the integument so as to assist its
          extensibility. By these means it was drawn sufficiently
          forward so as to fasten it to a canula or catheter made fast
          in the urethra. But it can well be imagined that a person must
          possess the most exalted idea of the physiological needs of a
          prepuce and feel the most sensitive need of such an appendage
          to submit to the first of these operations, although it is
          more than probable that many Jews submitted to the operation
          in the days of Celsus to avoid being exiled or plundered of
          all their possessions. The resulting prepuce could not have
          been a much more unsightly appendage than that which ornaments
          the overburdened virile organ of many Christians, and there is
          no doubt but that in many cases they passed muster.

    [90] "Circumcision." Dr. A. B. Arnold.

    [91] Ashhurst. "Int. Enc. Surgery," vol. vi.

    [92] "Pertes Seminales."

    [93] "Circoncision." Dr. Vanier, du Havre.

    [94] "Dictionaire des Sciences Médicales."

    [95] Erichsen's "Surgery," page 1144. Edition of 1869.

    [96] _Medical News_ of Philadelphia, page 115. Vol. for 1860.

    [97] "Pertes Seminales." In the fourth American edition of the
          English translation of McDougall of Lallemand we find that he
          fully appreciated the dangers that lurk in a prepuce. At page
          216 he says: "Such is the condition which the parts present in
          cases of recent balanitis, and these are the inflammations and
          ulcerations that cause more or less extensive adhesions of the
          prepuce to the glans. Such adhesions are generally cellular,
          but sometimes fibrous or even cartilaginous, according to the
          severity and frequent repetition of the inflammation. Various
          degrees of induration also results according to the intensity,
          the duration, and the frequency of the phlogosis. Thus, I have
          often found a mucous membrane hardened, thickened, and covered
          with numerous papillæ, sometimes fibrous or cartilaginous,
          with three times its natural thickness. I have also met with
          cases in which the prepuce has become cancerous. I have
          operated in several cases of cancer of the penis, too, which
          certainly arose from no other cause. The patients were
          generally peasants between fifty and sixty years of age, who
          had never known other than their own wives, but who had
          frequently suffered from balanitis attended by abundant
          discharge, swelling of the prepuce, and excoriation of its
          opening, which was so contracted as to prevent the passage of
          the glans. I have seen one case, also, in which balanitis,
          irritated by a forced march and the abuse of alcoholic
          stimulants, passed into gangrene, by which the greater part of
          the glans was destroyed. Such have been the accidents which I
          have observed on those whose prepuce was too narrow to permit
          the glans being uncovered; accidents which I can only
          attribute to the long retention of the sebaceous matter in a
          kind of _cul-de-sac_, into which a certain quantity of urine
          passes every time the patient makes water."

    [98] Claparède. "La Circoncision."

    [99] Baron Boyer. "Traité des Maladies Chirurgicales," vol. x, page
          370.

    [100] I have practiced considerably among the Jewish people, but I
          have never seen their elderly men suffer with prostatic
          troubles like our own people who are uncircumcised. From
          having observed the tendency to prostatic complications in
          young people with troublesome prepuces, and that the great
          number of the elderly people who are affected with prostatic
          disease or enlargement are the unlucky possessors of long or
          large prepuces, I have arrived at the conclusion that the
          prepuce can be entered as a factor in the etiology of enlarged
          prostate.

    [101] I have now under my care a poor consumptive who has all the
          appearance of having always been as virtuous as Joseph, but
          who, unlike Joseph, has from infancy had as a constant
          companion a long, miserable, smegmanous, and annoying prepuce.
          The young man has an oedema which first affected his feet, but
          one day, owing to the irritation of a slight balanitis, the
          prepuce swelled at once; it proceeded through the penis
          integument to the scrotum; the penis itself retracted, leaving
          the integument and scrotum to assume a translucent, puffy,
          cork-screw appearance and attitude; from its labyrinthic
          passage the urine slowly dribbles during urination in a
          scalding stream. In addition to the physical sufferings, he is
          tormented by the knowledge that his friends attribute all his
          disease and troubles--since the occurence of the penile
          oedema--to the fact that his earlier manhood must have been
          indiscreet, as well as sinful. The laity cannot connect any
          penile, scrotal, or testicular disease with anything except
          venereal disease; and if the physician attempts to explain
          matters, they simply look upon it as the good-natured and
          well-intentioned efforts of the doctor to deceive them and to
          cover up the shortcomings of some frail mortal. Many a poor
          fellow has to leave this world under a cloud of mistrust and a
          bad odor of past deviltry to which he is not entitled, and
          suffer all this in addition to all his physical ills, owing to
          his having been ornamented through life with an annoying
          prepuce,--the luckless heritage of having been born a
          Christian. Columbus in chains moralizing on the ingratitude of
          this world is nothing to the poor invalid with a swollen
          prepuce, innocently acquired, silently "cussing" the ignorance
          of his relatives and friends.

    [102] This patient, on convalescing, suffered considerable from the
          action of numerous small carbuncles, resulting from the
          toxæmic condition induced by the partial suppression of urine
          that he at times suffered from, and, when nearly well, brought
          on a serious relapse by the mail-bag appendage at the penis
          working up the organ into a state of erection. While so
          situated he had intercourse, and from 99° his temperature
          immediately rose to 104½°, where it remained for several days,
          lengthening out his illness by several weeks, into a
          long-protracted convalescence. The man is not yet circumcised,
          and, from the knowledge that I have of his tendency to uræmia,
          I feel that, although in his prime, a fever or an accident may
          take him off at any moment.

    [103] In looking over the literature of reflex neuroses and more
          direct injurious results, I find that George Macilwain, in a
          work on "Surgical Observations on the More Important Diseases
          of the Mucous Canals of the Body," published in London in
          1830, calls special attention to the case of a man aged
          thirty-eight, admitted to the Finsbury Dispensary, and who was
          in the care of Mr. Hancock. The patient was suffering from
          excruciating pain in different joints, the pain being so
          great that he was confined to his bed and unable to stand on
          his feet. He was unable to rest at nights, and neither
          rheumatic nor any other apparently suitable treatment was of
          any service. Rigors were soon added to his other troubles, and
          during their continuance the pain in his joints was greatly
          aggravated. He was referred to Mr. Macilwain for treatment,
          who promptly relieved him by the removal of a urethral
          stricture, which had quietly been the cause of all the
          disturbance. It is particularly interesting that even at that
          early day the reflex neuroses and complications that may arise
          from the irritability of the genito-urinary organs were so
          well understood. How well Dr. Macilwain appreciated the nicety
          of these relations can be seen from his remarks in connection
          with the above case, in which he says: "It may be observed
          that the severity of the symptoms is not always commensurate
          either with the duration of the disease or the degree of
          stricture, and that, although the progressive development of
          them varies considerably in rapidity, in different
          individuals, it is, nevertheless, in the latter stages, always
          more rapid." Macilwain also graphically describes the
          insidious approach of these genito-urinary troubles. In
          speaking of stricture he says: "Although minute inquiry
          generally informs us that the stricture has been of some
          standing, and in some instances has existed for years, yet it
          may happen that it is only a few months or a year since the
          patient's attention has been directed to the disease. This is
          very intelligible; for, in conformity with what we observe in
          other parts of the body, the bladder has a power of
          accommodating itself to a change of circumstances. Its
          strength, for a long time, may increase so correctly in
          proportion to the increase of the obstacle which opposes the
          ejection of its contents that a very considerable period
          elapses before the difficulty in making water becomes
          cognizable to the patient, or it occasions an annoyance so
          trifling as scarcely to excite his attention. This increase of
          strength in the bladder frequently renders the formation of
          stricture so insidious that the urethra at the affected part
          is very narrow before the individual is aware of the existence
          of any contraction whatever; the bladder, however, at length
          becomes unable to empty itself, and the abdominal muscles and
          diaphragm powerfully act as coadjutors, so that each effort to
          make water is accompanied by a straining which is very
          distressing, and the complete evacuation of the bladder is
          often not accomplished even by these combined forces. The
          straining which accompanies stricture, and which seems
          necessary to evacuate the bladder, although it be occasionally
          exceedingly annoying to the patient at the time, is more
          important with reference to the results which are its
          consequence. I am firmly of opinion that there are a great
          number of patients laboring under hernia which has been
          produced by no other cause. I must confess that I had seen a
          great number of instances of stricture in ruptured patients
          before I drew any inference from the observation of their
          co-existence." The foregoing observations of Macilwain, made
          in 1830, are here reproduced for their clearness of expression
          and explanation, as well as to show what injuries can be
          produced on the young child afflicted with phimosis. We are,
          as surgeons, familiar with the anatomical and pathological
          changes there are undergone by the bladder and its lining
          membrane, as well as in the ureters and kidneys, in many
          cases of stricture, as well as of the great amount of
          prostatic irritability and enlargement that is due to the same
          cause. How similarly these results can be and are actually
          produced by phimosis is undeniably expressed by the
          post-mortem appearances in the poor infant described by
          Golding Bird to the London Medical Society, and mentioned in
          the London _Lancet_ of May 16, 1846. The bladder and ureter
          were like those of a man who had long suffered from stricture.
          From the remarks of Dr. J. Lewis Smith, that phimosis may be
          productive of inguinal hernia and prolapsus of the rectum, and
          the observations of Edmund Owens and Arthur Kemp, both high
          authorities on children's diseases, being both connected with
          children's hospitals, as well as the remarks of Mr. Bryant in
          his "Surgical Diseases of Children," who all concur in looking
          upon phimosis as a great factor in hernia, Bryant having
          observed thirty-one in fifty consecutive cases of phimosis, we
          are certainly warranted in assuming that phimosis is not only
          a mere local timely inconvenience that will disappear with the
          approach of puberty, but a condition which, in the more easily
          affected organism of the child,--lacking, as it does, that
          resistance that comes with our prime,--is productive of
          serious harm; as even the first few years of life, even a few
          months of infant life, with a phimosis, are sufficient to so
          change the structures of parts that the poor child will grow
          into a man with an impaired kidney or sacculated ureter. The
          strain required to induce a prolapsus of the bowel or a
          rupture into the inguinal canal is exerted as much on the
          bladder, ureter, and kidney as on the other localities.
          Physicians who have taken the pains to observe must have
          noticed, more than once, how the child afflicted with a
          phimosis has not only at times to wait for the stream of urine
          to appear, there seemingly being some obstruction to its
          starting, but how often such a case is afflicted with a
          stammering, halting urination. A child thus started out into
          life, with a defective kidney or kidneys, is sadly handicapped
          in his usefulness, comfort, or in properly competing in the
          race of life. No parent would for a moment think of starting
          his son in life by giving him a business that is heavily
          mortgaged at the start, but many a parent unconsciously
          launches the unsuspecting child into a life of such ill
          health--resulting from a simple narrow prepuce--beside which a
          heavy mortgage or a heavy yearly tribute would be but a mere
          trifle. I have seen such men, who in after life, broken-down
          and perfectly physical wrecks, would gladly have given all
          their wealth and been willing to have some genii set them down
          in the middle of the Sahara, shirtless and pennyless, provided
          they had their health. To say nothing of the trifling loss of
          the prepuce, these parties would gladly have had a foot or a
          leg go with the prepuce if necessary, and have their health.

    [104] I have often performed dilatation where, for some reason,
          either the timidity of the parents or the health of the child
          seemed to contraindicate any more radical procedure. It is
          customary to advise mothers or the nurses to retract the skin
          daily, but even after a good dilatation I have found as sudden
          a recontraction, and even in the majority of cases, where
          daily drawing back the skin might have been practicable, the
          cries and struggles of the child are a positive prohibition to
          these instructions being carried out; it is not once in ten
          times that it can be carried out. I have seen two very
          annoying cases of paraphimosis resulting from this procedure,
          the struggles of the child having prevented the return of the
          prepuce to its proper place, and the violent crying and
          sobbing of the child having assisted to congest the organ.

    [105] It may well be a question, considering the well-established
          fact that nervous injuries and affections are easily
          transmissible and become hereditary, how much
          feeble-mindedness is due to an heredity originally induced in
          either parent through reflex neuroses from the genital organs.
          The Jews have a very small percentage of feeble-minded; it is
          true that they have not any inebriates to assist in their
          manufacture, but still the absence of these well-pronounced
          cases of reflex neuroses among the race must be largely
          ascribed to their practice of circumcision, as that operation
          cures the gentiles so afflicted.

    [106] I have seen precisely similar conditions resulting from a
          sphincterismus being relieved by anal dilatation. I had one
          such case who had fallen into the hands of a quack, who made
          him believe that he was being affected with incipient
          softening of the brain; systematic dilatation or a rupture of
          the sphincter _à la_ Van Buren is the appropriate remedy.

    [107] In the first volume of the "American and English Encyclopedia
          of Law" there is an interesting account of a young child (who
          had been bound out by the parish officials) who murdered his
          little bed-fellow and, on trial and conviction, was sentenced
          to be hanged, but who was reprieved by royal favor on account
          of his tender years, the sentence being changed to
          imprisonment for life. The little fellow was only eight years
          of age. On the trial the boy said he was driven to commit the
          crime because the other child soiled the bed. The two children
          being both paupers, it may well be imagined that their bedding
          was none of the cleanest at the best, or that their bed-room
          had the best of ventilation. As at the time the murder was
          committed English paupers were not treated in the most humane
          manner, it is not surprising that a nervous, sensitive child
          would, under such a combination of circumstances, be converted
          into an insane murderer.

    [108] The study of prematurely acquired impotence in the male is a
          most interesting one. I have frequently seen it result from
          the presence of anal or rectal irritation, from hæmorrhoids. I
          have seen cases who could not have erections, and in whom all
          sexual desire was extinct at a very early age, who have
          informed me that, although unable to have sexual intercourse
          because of the total absence of sexual desire, the flaccidity
          of the organ, and the want of sound physiological organic
          functional activity to suggest the thought, they had,
          nevertheless, frequently been the victims of nocturnal
          emissions before the total extinction of the function. As a
          rule, much of this premature impotence--induced by either
          irritation of the genital organs or rectal or anal
          troubles--runs its unfortunate possessor through such a course
          of physical incidents as described by Hammond, as the wild
          Indians of the Southwest induce in the _mujerado_. At first
          the sound organ responds in a natural manner to any stimulus
          that may affect it, but soon a local satyriacal condition is
          set up, which, running a more or less rapid period of intense
          activity, soon leaves its victim completely, permanently, and
          hopelessly impotent, even as much so as if eunuchized in the
          most approved manner. Hammond's description of the manner in
          which these unfortunates are manufactured is an interesting
          addition to the facts contained in the natural history of man,
          and is as follows: "A _mujerado_ is an essential person in the
          saturnalia, or orgies, in which these Indians, like the
          ancient Greeks, Egyptians, and other nations, indulge. He is
          the chief passive agent in the pederastic ceremonies which
          form so important a part in the performances. These take place
          in the spring of every year, and are conducted with the utmost
          secrecy, as regards the non-Indian part of the population. For
          the making of a _mujerado_ one of the most virile men is
          selected, and the act of masturbation is performed upon him
          many times every day; at the same time he is made to ride
          almost continuously on horseback. The genital organs are thus
          brought, at first, into a state of extreme erethism, so that
          the motion of the horse is sufficient to produce a discharge
          of seminal fluid, while at the same time the pressure of the
          body on the animal's back--for the riding is done without a
          saddle--interferes with their proper nutrition. It eventually
          happens that, though an orgasm may be caused, emissions can no
          longer be effected, even upon the most intense degree of
          excitation. Finally, the accomplishment of an orgasm becomes
          impossible; in the meantime the penis and testicles begin to
          shrink, and in time reach their lowest plane of degradation.
          But the most decided changes are at the same time going on,
          little by little, in the instincts and proclivities of the
          subject. He loses his taste for those sports and occupations
          in which he formerly indulged, his courage disappears, and he
          becomes timid to such an extent that, if he is a man occupying
          a prominent place in the council of the pueblo, he is at once
          relieved of all power and responsibility, and his influence is
          at an end. If he is married his wife and children pass from
          under his control,--whether, however, through his wish or
          theirs, or by the orders of the council, I could not
          ascertain. They certainly become no more to him than other
          women and children of the pueblo." Hammond examined one of
          these men, who had, as he himself informed him, formerly
          possessed a large penis and testicles "grande como
          huevos,"--as large as eggs. The penis was in its flaccid state
          and about an inch and a half in length, with the glans about
          the size of a thimble, which it very much resembled in shape.
          The glandular structure of the testicles had disappeared; they
          were atrophied, little besides connective tissue remaining. He
          examined another _mujerado_ in the pueblo of Acoma, who had
          been so made when at about the age of twenty-six. The penis
          was not more than an inch in length and about the diameter of
          the little finger, and of the testicles there was apparently
          nothing left but a little connective tissue. Both of these men
          had high-pitched voices. The last one examined was then
          thirty-six years of age. (Hammond: "Male Impotence.") The
          foregoing detailed description shows an extreme degree of
          results produced by an equally extreme degree of intense and
          persistent irritation applied to the genital organs, purposely
          employed to obtain certain results. In the cases cited the
          irritation or excitation is directly applied, but it is safe
          to assume that reflex irritability from the anus or rectum,
          or from that of a stricture or of a prepuce, will in some
          cases produce a certain degree of excitation in the testicles
          that may result in their functional or organic derangement, in
          a degree proportionate to that of the amount of excitation
          from which they have suffered. That the testicles are very apt
          to suffer from the existence of a stricture is a well-known
          fact. I have myself worried over a case of stricture, in whom
          the attempted passage of a filiform bougie was always
          immediately followed by a severe attack of epididymitis, and
          who had always been afflicted with a tenderness and a tendency
          to inflammation of the testes. I have also noticed a much
          greater tendency to orchitis in the wearer of an irritating
          prepuce than where it was absent; so that the presence of a
          satyriacal tendency, no matter in what proportion of a degree
          it may be present, can safely be assumed to result in a
          corresponding degree of apathy, due to an actual physical
          degeneration of the parts. That these conditions, when present
          in any degree of permanency or persistence, will in the end
          induce early impotence, I have no reason to doubt. In this
          regard we must not overlook the fact that persons with
          phimosis, stricture, or other genital irritants and
          impediments, are more liable to be afflicted with hæmorrhoids,
          prolapsus ani, or other anal and rectal irritation, which
          retroactively assist in bringing about the condition under
          question. How much this may have to do with certain prolific
          peculiarities among the Jews may well be questioned; it is a
          well-known fact that in London the Jewish excess of male
          births has been as high as eighteen per cent., while among the
          Christian or Gentile population it is only six and one-half
          per cent.,--a somewhat analogous condition of proportion being
          also observable in the United States. Here, it is accounted
          for, in a measure, by Dr. Billings, in the following words:
          "This comparatively large proportion of males among the Jews
          is probably due to the fact that the death-rate of their
          infants is less for males, as compared with females, than it
          is among the average population." Children gotten during the
          prime of life of the parents are naturally more virile and
          have better stamina than those gotten before full maturity is
          reached. If the father is on the verge of impotency just about
          the time he is expected to beget his best offspring, that
          offspring cannot be expected to present an extra amount of
          vitality, virility, or physical stamina; hence, the prepuce
          can be brought in as directly tending--in no matter how small
          the degree it may be, but nevertheless a factor--to the
          physical degeneracy of the race, as well as it demonstrates
          the existence of some law for the production of the sexes
          which we do not as yet fully comprehend. Aside from the above
          considerations, there are those of the actual bar to the
          increase of population which the prepuce induces, either by
          primarily being the cause of impotence or by direct
          interference, as already mentioned, and the impotence that
          naturally results from the causes set forth in this note. The
          results of a prepuce are certainly such as must act like a
          moist, warm, and oily poultice to the irritability induced in
          the most confirmed Malthusian when contemplating the--to
          him--rapid and unwarranted increase of population.



WORKS AND AUTHORITIES QUOTED.


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Thèse à la faculté de Médecine de Strasbourg. Par J. B. A. Chauvin.
Consideration sur le Phimosis et Operation de la Circoncision par un
procédé nouveau. Strasbourg, 1851.

De la Circoncision chez les Egyptiens. F. Chabas. Paris, 1861.

Cause Morale de la Circoncision des Israelites. Vanier, du Havre. Paris,
1847.

La Circoncision, son importance dans la Famille et dans l'Etat. Par le
Docteur Claparéde. Paris, 1861.

Dissertation sur la Circoncision, sons les rapports religieux,
hygieniques, et Pathologiques. Par le Docteur Moyse Cahen. Paris, 1816.

Origine, Signification, et Histoire, de la Castration, de l'Eunuchisme,
et de la Circoncision. Par le Docteur F. Bergmann de Strasbourg.
Archivio per le Tradizioni Populari, vol. ii.

Darstellung der Biblichen Krankheiten. Von Dr. J. P. Trusen. Posen,
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Archives Israelites de France, No. 9, 4em année, Septembre, 1843.

Bulletins de la Société d'Anthropologie de Paris. Tome x (serie iii), 3d
fascicule, Juin à Octobre, 1887.

Recueil de Mémoires de Médecine, de Chirurgie, et de Pharmacie
Militaires. Tome xxi (serie iii), No. 105, August, 1868.

Traité d'Hygiène, publique et privée. Michel Levy. 2d ed. Paris, 1850.

Neuroses des Organes Génito-Urinaires de l'homme. Ultzmann. Paris, 1883.

L'Hermaphrodisme, sa Nature, son Origine, ses Consequences Sociales. Par
le Docteur Charles Debierre. Paris, 1886.

L'Onanisme. Tissot. Lausanne, 1787.

Traité de la nymphomanie. Dr. Bienville. Amsterdam, 1784.

La Folie Erotique. Par Prof. B. Balt. Paris, 1888.

Des Pertes Seminales Involontaires. Lallemand. Paris, 1836.

Spermatorrhoea. Lallemand and Wilson. Philadelphia, 1861.

The Philosophical Dictionary. Voltaire. London, 1765.

Oeuvres Complétes, avec notes, etc. Montesquieu. Paris, 1838.

Dictionaire d'Hygiène, publique et de salubrite. Tardieu. Paris, 1862.

Guide du Posthétomiste. Par le Docteur L. Terquem. Paris.

La Circoncision et ses suites. Par A.S. Morin. Ext. du Journal
l'Excommunié, January, 1870.

La Circoncision. Par le Docteur S. Bernheim.

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 proposés par une Société de savants voyageant an
Arabie, Michealis. Amsterdam, 1774.

Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim Interpretis
primarii, De Turcarum Liturgia, peregrinatione Meccana, Circumcisione,
Ægrotorum Visitatione, etc. Oxonii, 1690.

Le Theatre de la Turquie. Michel Le Feber. Paris, 1681.

Recherches Philosophiques sur les Americains, ou Mémoires Interessants
pour servir à l'Histoire de l'Espece Humaine. Par M. de P. Augumentée
par Dom Pernety. Berlin, 1774. (Also the first edition of the same work
printed at Cleves in 1772.)

History of the Hebrews' Second Commonwealth. Wise. Cincinnati, 1880.

History of the Hebrew Commonwealth. Jahn. Oxford, 1840.

Jews' Letters to Voltaire. Philadelphia, 1848.

The Jewish Nation. Revised by Kidder. New York, 1850.

The Jews Under Roman Rule. By W. D. Morrison. New York, 1890.

The Story of the Jews. By James K. Hosmer. New York, 1887.

The History of the Jews. By the Rev. H. H. Milman. New York, 1843.

Early Oriental History. By John Eadie, D.D., LL.D. London, 1852.

The Bible and the Nineteenth Century. By L. T. Townsend, D.D. New York,
1889.

Legends of the Patriarchs and Prophets. By the Rev. S. Baring-Gould. New
York, 1884.

The Religions of the Ancient World. By George Rawlinson, M.A. New York,
1885.

The Hermits. By the Rev. Charles Kingsley. New York, 1885.

Letters on Demonology and Witchcraft. Letters addressed to J. G.
Lockhart, Esq., by Sir Walter Scott. London, 1831.

The Philosophy of Magic, Prodigies, and Apparent Miracles. From the
French of Eusebe Salvert. New York, 1855.

Atlantis, the Antediluvian World. Donnelly. New York, 1882.

Sir Thomas Browne's Works. London, 1852.

Physical Education, or the Health Laws of Nature. By Felix Oswald, M.D.
New York, 1882.

The Family: an Historical and Social Study. By Thwing. Boston, 1887.

The Intellectual Development of Europe. By John W. Draper, M.D. New
York, 1876.

History of European Morals. By W. E. H. Lecky, M.A. New York, 1884.

Longevity and other Biostatic Peculiarities of the Jewish Race. By John
Stockton Hough. Reprinted from New York Medical Record, 1873.

Vital Statistics of the Jews. By Dr. John S. Billings, in North American
Review for January, 1891.

On Regimen and Longevity. By John Bell, M.D. New York, 1842.

Diseases of Modern Life. By B. W. Richardson, M.D. New York, 1876.

Cyclopedia of Biblical, Theological, and Ecclesiastical Literature. By
McClintock and Strong. New York, 1886.

Early History of Mankind. Tylor. London, 1870.

Dictionaire des Sciences Médicales. 60-vol. edition. Paris, 1816.

British and Foreign Medico-Chirurgical Review, vols. for 1846, 1854,
1856, 1858, 1863, 1868, and 1869. London.

Braithwaite's Retrospect of Medicine and Surgery.

The Chinese. By John Francis Davis, Esq., F.R.S. London, 1851.

Massachusetts State Board of Health Report for 1873.

On Diseases of Children. Stewart. New York, 1844.

Diseases of Children. West. Philadelphia.

Lectures on Diseases of Children. Henoch. New York, 1882.

Women's and Children's Diseases. Dillnberger. Philadelphia, 1871.

Male Impotence. Hammond. New York, 1883.

Genito-Urinary Diseases. Otis. New York, 1883.

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.

Traité sur les Maladies des Organes Génito-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.

Traité 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;
  Claparède's case, 249;
  composition of preputial, 249;
  Civiale's case, 249;
  induced by phimosis, 287

Canary Islands, remains of an antediluvian world, 25

Cancer of the penis, 232;
  views of Jonathan Hutchinson as to its origin, 226;
  pre-cancerous stage of, 226;
  views of Lallemand, 228, 329;
  statistics of, 231;
  Cullerier on, 231;
  fifty cases reported by Dr. Zielewicz, 233;
  early mention of, 234;
  views of Prof. John C. Warren, 235;
  views of Walshe, 235

Canon of St. John Lateran and his profane doubts, 74

Carter, Dr. Wm., on toxic urines, 298

Casalis, M., on Bassouto circumcision, 42

Cases of spontaneous circumcision, 58

Castration, etymology of the term, 80;
  as a self-sacrifice to deities, 89

Celsus, on Roman infibulation, 50;
  on operations on the prepuce, 302, 313, 328;
  originator of Cloquet's operation, 313

Chabas, M., description of Egyptian _bas-relief_, 23

Charlemagne endows an abbey with a holy prepuce, 72

Charles V sacks Rome, and robbery of the holy prepuce, 73

Chastity among Egyptian dervishes, 49;
  belt of brass mail of the Ethiopians, 51;
  plug of bamboo of Soudan, 51;
  rings to insure chastity in the male mentioned by Nelaton, 54;
  enforced among the Hindoo bonzes by infibulation, 54;
  among the Cybelian priesthood, 89;
  Greek monks, ideas of, 89;
  comparative, among the different religious creeds of Prussia, 195

Chinese, peculiar liability of, to calculous disease, 248;
  considered a delicate diet by Australian cannibals, 327

Chippeway Indians and circumcision, 23

Chivalry of the male Hottentot, 60

Christian abolishment of circumcision, 18;
  circumcision in Abyssinia, 63

Circumcised phallus as a religious and civic symbol, 35;
  races peculiarly exempt from syphilis, 192

Circumcising knife (see Knife).

Circumcision, abolished by Christians, 18;
  among Chippeway Indians, 23;
  among the Atlanteans of Plato, 23;
  among the Phoenicians, 34;
  among the Egyptians, 34;
  Arabian, 35, 54;
  during the reign of Psammétich, 34;
  civil and religious symbol of ancient Egypt, 35;
  Aztec, 46;
  among the Mijes, 46;
  Mexican, 46;
  Totonac, 46;
  among the Orinoco Indians, 47
  the climatic limits of, as a general rite, 47;
  in the Island of Cosumel, 47;
  in Yucatan, 47;
  in old Florida, 47;
  Apure Indians, 48;
  among the Amazons, 56;
  accidental case of, mentioned by Cullerier, 57;
  spontaneous, 58;
  abolished by the Romans, 66;
  destroying marks of, 68;
  of Abraham, 143;
  Hebraic, 143;
  not practiced in the wilderness, 143;
  physical conditions that exempt Jewish children from, 144, 145;
  description of Hebraic, by Montaigne, 146;
  as a cure for epilepsy, 261;
  as a preventive of hernia or rupture, 263;
  as a preventive to prolapsus of the bowel, 263;
  as a preventive of idiocy, 266;
  as a cure for dyspepsia, 270, 271

Civiale, on moral effects of penis amputation, 247;
  case of phimosis and preputial calculi, 249

Claparède, on evils resulting from the prepuce, 229;
  on preputial calculi, 249

Clarke, Sir Andrew, on renal inadequacy, 300

Clavigero, on Mexican circumcision, 46

Climatic limits of circumcision, 65

Cloquet operation, 306, 316

Colchis, colony of, 33

Constantine punished circumcisers with death, 66

Constipation as a divine attribute, 288;
  as a result of phimosis and its results, 292

Consumption, relation of, to Jewish race, 178, 179

Controversy about the holy prepuce, 73

Convent of St. Corneille and the holy knife, 78

Convulsions induced by phimosis, 260, 261

Cullerier, accidental circumcision, 57;
  on penile cancer, 231

Cybelian priesthood and castration, 89


Dakotas, the white bull sacred among the, 26

David and the Philistine prepuces, 31

Debreyne, trappist, monk, and physician, 224

Delange, on Arabian circumcision, 37

Delpech, on female circumcision, 36

Demarquay, on penile gangrene, 236

Dervishes, holy and chaste, 49

Difference between Turkish and Buddhist heaven, 116

Dilatation of prepuce, 308, 312, 332

Donnelly, Hon. Ignatius, on Atlantean circumcision, 23

Dressing in cases of retraction of penile skin, 304;
  C. W. Ballance's, after circumcision, 317;
  A. G. Miller's, 318

Du Bisson, on Soudanese harems, 52

Dyspepsia induced by preputial irritation, 270, 271


Ebers, Dr., on Karnac _bas-relief_, 23

Eczema induced by phimosis, 320

Effect of the holy prepuce on the hands of a lady, 74

Effects of age on the prepuce, 285

Egypt, uncircumcised persons not allowed to study in ancient, 34

Egyptians emasculated their prisoners, 30

Emasculation, its early practices and evolutions, 29;
  of Uranos, 83

Emperor Adrian forbids circumcision, 66

Endurance and fortitude of Arabs, 55

Enforced continence and its effects on the penis, 61

Ennery, M., Grand Rabbi of Paris, 158

Enoch, Prof., of Berlin, on preputial calculi, 249;
  on results of phimosis, 266;
  on enuresis, 277

Enuresis, 275

Epilepsy, induced by the prepuce, 258, 261, 301

Epstein, Dr., of Cincinnati, 156

Erichsen, Prof., on cancer of the penis, 228

Ethics at the battle of Fontenoy, 76

Ethiopian infibulation of infant females, 51

Eunuchism, beneficial to guardians of public funds, 84;
  as excluding from the priesthood, 90;
  in Italy, 91;
  in China, 91, 93;
  in India, 92;
  in the Soudan, 99;
  and music, 94;
  as a punishment, 97;
  mortality attending its manufacture, 91, 92, 93, 99, 100, 107;
  does not prevent copulation at all times, 92, 100, 101, 102, 103;
  manner of procedure among the Pagan priesthood, 106;
  prices of eunuchs, 99;
  numbers annually made, 91, 98;
  fecundating eunuch of Mecca, 100;
  Velutti, the opera-singer, 102;
  eunuchs as possessors of harems, 90;
  eunuch warriors and statesmen, 90

Evidence of circumcision on Egyptian monuments, 23

Extraordinary results of phimosis, 282


Female circumcisers in Arabia, 36

Females subject to preputial reflex neuroses, 267, 268

Flaccourt, M. Martin, account of the Madécasses, 54

Fothergill and the unlicensed practitioner on renal pathology, 77

French war-office records, on Jewish vital statistics, 175

Frenum, statistics relating to abnormalities of, 221

Frerichs' ammoniæmia, 300

Fresnel, M., on marriage circumcision, 54

Full-moon rites among the Bassouto maidens, 44


Galen, on the flaccid virile member, 60, 61

Gangrene of the penis, 236

Golden padlocks worn on prepuce for five years, 54

Greek and Roman statuary and the penis, 60

Greek monks' object in infibulations, 54;
  extreme ideas of chastity, 89

Gregg, Dr. Robert J., operative procedure, 320

Griffith, Dr. J. D., cases of reflex irritation, 261

Gross, Prof. S. D., on penile cancer, 230;
  operations, 320

Grotius and the origin of the Peruvians, 46

Guimara, the, 153

Guinzburg, Dr., on Jewish vital statistics, 176

Gumilla and his South American voyages, 47


Hæmostatic powders, 160

Hare, Prof. Hobart A., on circumcision, 301

Haskins, Dr. A., on Jewish vital statistics, 176

Heaven, Turkish, 115;
  Buddhist, 116

Hebraic idea of parental origin of constitution of the child, 144

Hebrew Consistory of Paris, 157

Hebrew words in Central American languages, 24

Hebrews, attempts to efface signs of circumcision, 69;
  secretly circumcise their dead, 68;
  Hebrew vital statistics, 169 to 179;
  as proverbial good livers, 171;
  escape epidemics, 173;
  peculiarly free from syphilitic taint, 191;
  their circumcision suitable to young children, 306

Heliogabalus, Emperor, was circumcised, 66

Henry III of France as a Moslem godfather, 64

Henry V of England and the holy prepuce, 71

Heraclius, Emperor, persecuted the Jews, 67

Hermaphrodites, earliest mention of, 117;
  pederasty causes belief in their existence, 118, 119, 120;
  Debierre on, 123;
  notable cases of, 124, 125, 127, 128

Hernia induced by phimosis, 263

Herodotus, his views adopted by Voltaire, 22;
  visits Egypt, 34

Herrera, on Mexican circumcision, 47

Hey, Dr. William, on preputial cancer, 227

Hindoo devotee wears a six-inch ring in prepuce, 54

Hitouch, 156

Holgate, Dr., of New York, on preputial adhesions, 220;
  on preputial dilatation, 308

Holy circumcision, 70, 78
  prepuces, 70, 72
  vinegar and its miraculous effects, 79

Homer, Surgeon U. S. Navy, on the worship of Venus Porclna, 193

Horrible marriage performance, 54

Hottentot restriction on making twins, 60

Hough, Dr., on Jewish longevity, 173

Humphry, Geo. Murray, on "Old Age," 14

Hutchinson, Dr. Jonathan, on the pre-cancerous stage of cancer, 226;
  on urethral child, 300

Hypospadias, as a heredity, 129;
  artificially made, 56;
  formerly led to belief in hermaphrodism, 129;
  fecundation in, 129;
  difficulty in determining sex owing to, 131


Idiocy induced by phimosis and preputial adhesions, 265, 269

Impious wretch steals the holy prepuce, 74

Impotence, holy vinegar and shrinal observances in, 71 to 81

Indians and circumcision, 46 to 48

Induration of prepuce, 250

Inflbulation practices, 48 to 52

Isis inaugurates Osirian rites, 29

Isserth, Rabbi Israel, 153


Jansen, Surgeon of the Belgian Armies, on frenum deformities, 221

Jews' letters to Voltaire, 22;
  Jews (see Hebrews).

Judaism unfavorable to religious insanity, 166

Justinia, Emperor, persecuted the Jews, 67


Karo, Joseph, and the "Beth Yosef," 153

Kemp, Dr. Arthur, on phimosis as a cause of hernia, 264

Kerr, Dr. J. G., on Chinese preputial calculi, 248

Keyes, Dr. E. L., on composition of preputial calculi, 249, 264

King David, the first homoeopathic patient, 113;
  secures two hundred Philistine prepuces, 31

Knife, circumcising, used in ancient Egyptian rite, 23;
  of shell used by Tonga Islanders, 45;
  of stone used by Australians, 45;
  of the holy circumcision, 78;
  made of rattan among the Fiji Islanders, 327


Lafargue, on Australian circumcision, 44

Lallemand, on masturbation, 223;
  on tendency to preputial cancer, 228, 329;
  on circumcision, 317

Las Casas, on Aztec circumcision, 46

Leech, Dr. T. F., on preputial irritation, 260

Letenneur, Prof., on the knife of the holy circumcision, 78

Life-insurance and the circumcised, 290

Lisfrane, rules for operations on the penis, 232;
  on recession of the body of the penis, 306

Livingstone, on Bassouto circumcision, 44

Longevity of Hebrews, 162, 169, 179

Lonyer-Villermay, M., on female circumcision, 36

Louis XVI as a candidate for the rite, 201

Love, Dr. I. N, on the Mosaic law, 262

Lumholtz, on Australian hypospadias, 56


Macilwain, on reflex neuroses, 330

Magruder, Dr. G. L., on reflex irritation, 261

Maids as heat radiators, 114

Maimonides, Jewish rabbi and physician, 32, 144, 153

Malay circumcision, 45

Malgaigne, operative views, 313, 316

Mapato, or mystery hut, 42

Marriage preceded by circumcision, 54

Martius and Spix, on circumcision on the Amazon, 56

Mastin, Dr. C. H., on calculous disease, 248

Masturbation, 224

Maury, Dr. Frank, on preputial statistics, 219

McLeod, Dr. Neil, circumcision operation, 318

McMahon, Dr. W. R., on reflex epilepsy, 261

Mendelssohn, Rabbi Moses, 164, 168

Mexican circumcision, 46

Mezizah, or act of suction, 150

Milah, 156

Miracles performed by the holy prepuce, 70 to 74

Mishna, the, 153

Mohammed, 65

Mohel, 157, 158

Moses, Dr., of New York, preputial statistics, 220

Moses circumcises his son, 150

Mott, Jr., Dr. A. R., cases of reflex irritation, 258

Music, first schools of, 94

Music at Algerine circumcision, 39;
  at Mohammedan, in Asia, 39;
  at Turkish feast, 41


Nelaton, case of infibulation, 54;
  on penile cancer, 231;
  on penile hypertrophy, 252

Nelson, Lord, disregard for red tape, 77

New Caledonian circumcision, 45

Newton, Sir Isaac, and the storm-predicting cow, 77

Nicaraguan baptism of blood, 56


Oath of mohel, 158

Oath, Egyptian manner of making oath, 35

Obod, Battle of, 36

Operations on the prepuce, 302;
  Cloquet's, 306;
  Bumstead's, 310;
  Hue's, 312;
  Bernheim's, Sedillat's, 313;
  Chauvin's, 313;
  Cullerier's, 313;
  Vanier's, 316;
  Vidal de Cassis', 316;
  Lallemand's, 317;
  A. G. Miller's, Neil McLeod's, 318;
  Erichsen's, 319;
  Gross's, 320;
  Van Buren and Keyes', 320;
  D. Hayes Agnew's, 320;
  Overall's procedure, 321

Origin of phallic worship, 29
  of human slavery, 29

Orinoco, circumcision on the, 47

Orloth, penis or prepuce? 31

Osiris vanquished by Typhon, 28

Othomacos Indians and their bloody rite, 48

Owen, Dr. Edmund, on phimosis, 263


Packard, Dr., on preputial statistics, 219

Papal indulgences to worshipers of holy prepuce, 72

Paralysis induced by phimosis, 259

Penis, absence of, 132;
  diminutive specimens, 213;
  amputation of, 230, 233, 234, 247;
  cancer of, 232;
  gangrene of, 236;
  hypertrophy of, 248, 251, 252

Periah, 156

Persecutions on account of circumcision, 66

Phoenician origin of circumcision, 22

Phimosed penis on ancient statues, 60

Phimosis, 218, 221;
  as a cause of hernia, 263

Physicians as practical Christians, 141

Pooley, Prof. J. H., case of preputial irritation, 260

Popè, Rabbi Rav, and the _Guimara_, 153

Portuguese sailors as Mohammedan proselytes, 40

Potentia generandi, 103
  coeundi, 104

Prepuce, infibulated, 54;
  swallowed by mother, 54;
  fired off in gun, 54;
  holy, 71;
  useful for skin grafts, 207;
  absence of, 209;
  influence on man at different ages, 225;
  induration of, 250;
  warts of, 250;
  reflex neuroses from, 256

Preputial miracles, 72;
  statistics, 219;
  adhesions, 219, 220;
  calculi, 248

Price, Dr. M. F., on reflex neuroses, 265;
  on female preputial irritation, 267, 268

Primitive phallic rites, 28
  homoeopaths, 113

Procedure in retraction of skin of penis after circumcision, 304

Proselytes, Mohammedan, how circumcised, 40, 41

Public women between decks in U. S. Navy, 193

Puzey, Dr., of Liverpool, on preputial skin grafts, 207

Pythagoras 32;
  visits Egypt, 34


Ralfe, on causes of interstitial nephritis, 300

Rameses II, circumcision of his sons, 23

Ranney, Prof. A. L., on enuresis, 282

Reconstruction of a prepuce, 68, 69, 328

Rectum, prolapsus of, induced by phimosis, 263

Reflex neuroses from preputial irritation, 254, 330, 331

Regulations of French Hebrew consistories of 1854, 157

Religion, its connection to insanity, 166

Resectricis nympharum, profession of, 36

Restriction on impregnation, 57;
  on twins, 60

Retraction of skin of penis after circumcision, 303

Richardson, Dr. B. W., on relation of race to disease, 169, 170, 171, 177

Ricord's definition of the prepuce, 206;
  operations on the prepuce, 313

Roman infibulation, 58

Royal decree of 1845 in France, 157

Roux, on cancer of the prepuce, 227

Rush, Benjamin, and the cancer quack, 77


Saint-Germain, Dr., on preputial abnormalities, 264

Saint Foutin and his shrine, 78

Saint Guerluchon at Bourg-Dieu, 79

Saint Guignole and the miraculous phallus, 80

Saint Coulombs and the miraculous prepuce, 70

Saturnus the first eunuchiser, 83

Sayer, Prof. Lewis A., contributions to medical science, 255

Scythians carry off heads of the slain, 30

Self-circumcision, attempt at, 203

Semiramis first employs eunuchs, 85

Severus Sulpicius, on effects of climate, 50

Sham battles at circumcision feasts, 37, 41, 42, 44

She-circumcisers, 36

Shrine for the recovery of impotent males, 79

Smith, Dr. J. Lewis, on preputial irritation, 263

Solomon, Dr., of Brunswick, on suction, 158

Soudanese chastity protector, 52

Sphincterismus due to phimosis, 292

Spiked chastity belt in Naples museum, 52

Stallard, Dr., on Jewish vital statistics, 173

Sterility cured at sacred shrines, 71 to 81

Stricture of urethra and phimosis, 289, 290

Styptics used by mohels, 158, 159

Syphilis, statistics relating to, 187 to 199

Syphilis and scrofula, 190


Taylor, Dr. C. F., on masturbation, 269

Totonac circumcision, 46

Tonga Islanders' rite, 45

Toxæmia, resulting from phimosis, 293;
  of von Jaksch, 294

Tube, penis carried in, 56

Tunca Indian circumcision, 56

Turkish circumcision, 39 to 41

Tylor, on the Stone Age and circumcision, 336


Van Buren and Keyes, on circumcision, 320

Vanier du Havre, Dr., 54, 224;
  on operations, 316

Venus, birth of, 84

Vidal de Cassis, on preputial operations, 316

Virey, account of Hindoo bonze, 54

Virgins' chain of bells in ancient Judea, 52

Vital statistics of Jews, 169 to 179

Voltaire, on origins of circumcision, 22

Von Jaksch's definition of Toxæmia, 294


Wadd, Dr., on preputial cancer, 227;
  on hypertrophy of penis, 252

Walshe, on preputial cancer, 235

Warren, on preputial cancer, 235

Warts of penis and prepuce, 250

Waterman, Dr., on Jewish vital statistics, 177

Wax images of penis deposited on shrines, 79

Welsh words in Mandan language, 24

Wet dressing objectionable after circumcision, 304, 311

White Bull, sacred among Sioux and Egyptians, 26;
  origin of sacredness, 29

Willard, Dr. De Forest, observations on the prepuce, 262

Wine at circumcision feasts, 151

Wirthington, Dr. F. J., on preputial irritation, 259

Wise, Dr. I. M., on St. Paul the apostle, 19

Warman, Prof., of Brooklyn, on circumcision, 26



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_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 £30,000, and special honors were awarded
him. It is a singular fact that all of the benefactors of the human
race--those who have benefited it by discoveries of any kind
whatever--have met with the most violent opposition, treachery, and
often disgrace, before they could make the world see the value of their
discoveries. Such was the case with Dr. Jenner, but his firmness and
truth at last gained the victory.]

The best _form_ for a surgeon who attempts the most severe
operations is the round build of body and head, and many of them
are of this shape. The muscular system should be supreme, with
the brain system a close second, the bony and thoracic systems
about equal and next in development.

The muscular tissue is _comparatively unfeeling_--insensitive;



_FAC-SIMILE PAGE FROM "STANTON'S PHYSIOGNOMY"--Reduced._

OTHER CLASSES OF SURGEONS" 1145

in the body. Form and Size are also requisite to aid the memory of
the shape and relative position of each part, and to assist Locality.
Human Nature is essential in order that he may be _en rapport_
with his patients, and also to enable him to _divine_ instinctively all
bodily and mental states. He should be a good physiognomist, and
be well versed in the _pathology_ of physiognomy. He must have
large Observation, in order to take cognizance of the most minute
changes and appearances. Calculation is a useful trait also, as it
is required in many ways in the medication and treatment of the
wounded, as in chemistry and in making surgical implements, etc.
He should have large Friendship; in order to attach his patients to
him and to command their esteem; enough Benevolence to sympathize,
but not enough to weaken the feelings when severity is required.
The faculty of Amativeness is necessary to _comprehend_ the nature of
the opposite sex; Love of Young also, that he may inspire children with
love and confidence.

The sense of Weight should be a strong one, for the muscular
sense is dependent upon its power in order to _gauge_ the amount
of force to be used in handling instruments and in bandaging
wounds, limbs, etc. Executiveness is required to assist authority
and give resistance. Self-will is another ally most necessary, as
well as Analysis, Time, Order, and Reason. A fair share of
musical ability is required to assist the ear in making examinations
of the heart and lungs, and in auscultation for various other purposes.
If to these faculties one adds large Intuition, he has a fine
bodily and mental equipment for the practice of surgery.


OTHER CLASSES OF SURGEONS.

Many army surgeons are characterized by a round and broad
form, with broad, rather low, and round heads; short, round arms,
and round and tapering fingers. This build is the most suitable
for those severe operations which require the greatest exhibition of
force, endurance, and coolness; another class of surgeons--those
who undertake the more delicate and less forceful operations--are
characterized by about an equal development of the brain and
muscular systems. This class of surgeons tend naturally to the
treatment of those finer, less difficult, and more delicate cases of
operative surgery, such, for example, as treatment of the ear, the
eye, etc. This class of surgeons require a fine endowment of the
brain and nervous system. In short, the muscles as well as nerves
of this class must be sensitive to a great degree, and this combination
calls for a fine and high organization.

The surgeon should be something of an actor in order to
know when to be sympathetic and when to be severe. Yet he



  +--------------------------------------------------------------+
  | Transcriber's Notes and Errata                               |
  |                                                              |
  | Footnotes 25-30 have been renumbered in sequence.            |
  |                                                              |
  | The anchor for footnote 102 was missing. Has been inserted   |
  | at the appropriate place.                                    |
  |                                                              |
  | 'oe' ligatures have been expanded to separate 'o' and 'e'    |
  | characters.                                                  |
  |                                                              |
  | The following words were found in both hyphenated and        |
  | unhyphenated forms once each.                                |
  |                                                              |
  |                |bed-clothes   |bedclothes   |                |
  |                |co-existence  |coexistence  |                |
  |                |short-comings |shortcomings |                |
  |                                                              |
  | The word 'pre-cancerous' occurred four times in the text,    |
  | while 'precancerous' occurred twice, both in the index.      |
  | These index entries have been hyphenated.                    |
  |                                                              |
  | The following typographical errors have been corrected.      |
  |                                                              |
  |                |Error        |Correction   |                 |
  |                |route        |rout         |                 |
  |                |prepuse      |prepuce      |                 |
  |                |a a          |a            |                 |
  |                |siezes       |seizes       |                 |
  |                |Stèrilitè    |Stérilité    |                 |
  |                |others       |others'      |                 |
  |                |Tranyslvania |Transylvania |                 |
  |                |occasian     |occasion     |                 |
  |                |suprised     |surprised    |                 |
  |                |function     |junction     |                 |
  |                |orginated    |originated   |                 |
  |                |smoulderd    |smouldered   |                 |
  |                |wes          |was          |                 |
  |                |tisses       |tissues      |                 |
  |                |dut          |but          |                 |
  |                |innner       |inner        |                 |
  |                |may          |many         |                 |
  |                |brakemen     |brakeman     |                 |
  |                |thinnes      |thinness     |                 |
  |                |totel        |total        |                 |
  |                |America      |American     |                 |
  |                                                              |
  +--------------------------------------------------------------+





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