History of Circumcision from the Earliest Times to the Present Part 7

In the thirteenth volume of the _British and Foreign Medico-Chirurgical Review_, we find, in a review of the control of prost.i.tution, 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 prost.i.tutes 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 prost.i.tutes of London were suffering under some form of venereal disease, yet we will descend even lower, and presume that of one hundred healthy prost.i.tutes, taken promiscuously from England and Scotland, if each submits to one indiscriminate s.e.xual 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 prost.i.tutes 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 prost.i.tutes will be syphilized during the year; hence, one million six hundred and fifty-two thousand five hundred cases of syphilis in both s.e.xes occur every twelve months_.

"If, then, the entire population had intercourse with prost.i.tutes in an equal ratio, _the gross population of Great Britain, of all ages and s.e.xes, would, during eighteen years, have been affected with primary syphilis_. Be it remembered, we do not a.s.sert 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 Prost.i.tution," observes that among the British troops syphilis is one of the most frequent of diseases, about one hundred and eighty cases occurring annually among every one thousand soldiers.

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

The effect of syphilization in inducing a scrofulous taint and the appearance of a rapidly-marching consumption among savage races has been well observed among the Indians in the southwestern parts of the United States, where the appearance of these fatal diseases can easily be traced to that as a cause. There is something peculiar about the Anglo-Saxon race that is fatal to the Indian; wherever they come in contact, the savage race begins physically and morally to crumble; the habits of the Anglo-Saxon in the matter of intemperance and his l.u.s.t 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, circ.u.mcised races, whose women have not carried a syphilitic taint into the race, are as a cla.s.s 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 circ.u.mcised races.[76]

The absence of the prepuce and the non-absorbing character of the skin of the glans p.e.n.i.s, 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 p.e.n.i.s, 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 a.s.sisted 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 p.e.n.i.s 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 s.e.xual 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 s.e.m.e.n 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 sh.o.r.e, the government further providing for their welfare by causing the a.s.sistant 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 a.s.sistant 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, circ.u.mcision 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 chast.i.ty of their females. This chast.i.ty is, in a great measure, due to the inseparable conditions of their religion,--moral and social fabrics which are welded into one. Their charity a.s.sumes the most practical form, so that it is not possible for one of their females to have to resort to a life of prost.i.tution 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 a.s.sociations of the Jews are among the most efficacious of charitable inst.i.tutions, and no cla.s.s 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 circ.u.mcision and the chast.i.ty 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 a.s.sist 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 circ.u.mcised 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 uncirc.u.mcised 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 const.i.tutional 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 uncirc.u.mcised 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 prost.i.tutes ply their trade, or, to be more definite, so many prost.i.tutes 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 cla.s.s, 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 pract.i.tioners 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 const.i.tution resembling _lignum-vitae_, for a more stubborn-twisted const.i.tution 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 a.s.siduous wors.h.i.+per at the shrine of Venus Porcina, there is another still more fatal danger awaiting him, ambushed in the folds of the v.a.g.i.n.al mucous membrane, or coming along silently out of the cervical ca.n.a.l,--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, uncirc.u.mcised, and easily inoculable-surfaced glans p.e.n.i.s, 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 ent.i.tled 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 pract.i.tioners, all tend to bear testimony to the remarkable difference that exists between circ.u.mcised and uncirc.u.mcised races in regard to the ravages of consumption. Is circ.u.mcision a factor in this difference, or is it not? If it is, then circ.u.mcision 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 CIRc.u.mCISED.

The surgical and medical history of circ.u.mcision 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 circ.u.mcision 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 wors.h.i.+p were accompanied by indulgence in fornication, lascivious songs, and unnatural l.u.s.t. Others of their neighbors wors.h.i.+ped 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 wors.h.i.+p, 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 circ.u.mcision 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 circ.u.mcision 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 circ.u.mcision, 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 circ.u.mcision. 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 c.l.i.torian 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 cla.s.s.

It is only of late years that circ.u.mcision, 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 s.e.m.e.n 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 Circ.u.mcision. 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 circ.u.mcision, 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 pa.s.sed 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-circ.u.mcision 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 a.s.sist one of these domestic surgeons who had undertaken to circ.u.mcise 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 circ.u.mcised 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 s.c.r.e.w.i.n.g 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-circ.u.mcision. He dreaded lest the surgeon should accidentally have it enter his mind to finish the operation with the scissors, and in that case he would be helpless, as the surgeon would, undoubtedly, have a sure and tender hold of it. After executing a number of _pas a deux_ on the Magilton step, while the surgeon endeavored to rea.s.sure 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 a.s.sumed a Taglioni att.i.tude 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 interst.i.tial 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 s.e.xual 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 a.s.sistance 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 circ.u.mcision exempted them from a certain form of disease that affected the p.e.n.i.s. Philon mentions particularly the immunity that the operation conferred against a species of affection which Michel Levy a.s.serts to have been a gangrenous disease. So that, outside of any religious significance, there is no doubt that, in individual cases, circ.u.mcision 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 gra.s.shopper or other small game, or of the female of his own species to gratify his l.u.s.t, or in the frantic rush to escape the clutches, fangs, or claws of a pursuing enemy, he was obliged to fly and leap over th.o.r.n.y 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 gra.s.ses, the coa.r.s.e bark of trees, or the stings and bites of insects, the glans p.e.n.i.s of primitive man would have often looked like the head of the proverbially duel-disfigured German university student, or the Bacchus-wors.h.i.+ping 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 a.s.sumption 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 th.o.r.n.y pa.s.sage through life, but also acted like a protecting aegis to the s.c.r.o.t.u.m 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 furnis.h.i.+ng 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 circ.u.mcision, as in a strictly circ.u.mcised community they would be debarred from this great advantage. An uncirc.u.mcised 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 a.s.sertion 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, "G.o.d bless the man who invented sleep," so we may well join in blessing the inventor of circ.u.mcision, 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 p.e.n.i.s 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 pa.s.sed 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 p.e.n.i.s increases in bulk.

In many cases its tightness prevents the escape of the sebaceous matter that collects in the sulcus back of the corona, and the resulting irritation on the surface of the glans and the inner mucous fold of the prepuce ends in an inflammatory thickening of the latter, its inner surface becoming thick, undilatable, hard, and unyielding, all the natural elasticity that should be present having departed, with more or less inflammatory thickening and adhesions between the two layers of skin that form the prepuce. In this unyielding tube the glans is imprisoned and compressed, often suffering the tortures that the "maiden" of the dungeons of the Inquisition inflicted on the unhappy heretics. It becomes elongated, cyanosed, and hyperaesthetic; the meatus of the urethra is congested and hypertrophied, the corona is undeveloped and often absent, the glans having, on the whole, the long-nosed, conical appearance of the head of a field-mouse. There are hardly five per cent. of the uncirc.u.mcised 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 p.e.n.i.s a.s.sumes the shape and appearance that is seen in the circ.u.mcised. 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 circ.u.mcision base much of their opposition to the fact that circ.u.mcision 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 p.e.n.i.s will, within a week or two after its liberation from its fetters of preputial bands, a.s.sume 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 p.e.n.i.s.