{"collection":"scripture-revelation","full_text_available":true,"graph_url":"https://unchartedknowledge.5gfusion.net/v2/api/page/gutenberg_23135/graph","html_url":"https://unchartedknowledge.5gfusion.net/v2/page/gutenberg_23135","id":"gutenberg_23135","license":"Public Domain (US)","rights_basis":"gutenberg_metadata_copyright_false","source":"gutenberg","source_url":"https://www.gutenberg.org/ebooks/23135","summary":null,"tags":["Category: Health & Medicine","Category: History - Other","Category: Religion/Spirituality","Circumcision"],"text":"Produced by Bryan Ness, LN Yaddanapudi and the Online\nDistributed Proofreading Team at https://www.pgdp.net (This\nfile was produced from images generously made available\nby The Internet Archive/Million Book Project)\n\n\n\n\n\n\n\n\n\nNo. 11 IN THE PHYSICIANS' AND STUDENTS' READY REFERENCE SERIES\n\n\nHISTORY OF CIRCUMCISION FROM THE EARLIEST TIMES TO THE PRESENT.\n\nMORAL AND PHYSICAL REASONS FOR ITS PERFORMANCE, WITH A HISTORY OF\nEUNUCHISM, HERMAPHRODISM, ETC., AND OF THE DIFFERENT OPERATIONS\nPRACTICED UPON THE PREPUCE.\n\nBY\n\nP. C. REMONDINO, M.D.\n(JEFFERSON),\n\nMember of the American Medical Association, of the American Public\nHealth Association, of the San Diego County Medical Society, of the\nState Board of Health of California, and of the Board of Health of the\nCity of San Diego; Vice-President of California State Medical Society\nand of Southern California Medical Society, etc.\n\n[Illustration]\n\nPHILADELPHIA AND LONDON:\nF. A. DAVIS, PUBLISHER.\n1891.\n\nEntered according to Act of Congress, in the year 1891, by\nF. A. DAVIS,\nIn the Office of the Librarian of Congress, at Washington, D.C., U.S.A.\n\n\nPhiladelphia Pa., U. S. A.:\nThe Medical Bulletin Printing House,\n1231 Filbert Street.\n\n[Illustration: HEBRAIC CIRCUMCISION]\n\n\n\n\nPREFACE.\n\n\nIn ancient Egypt the performance of circumcision was at one time limited\nto the priesthood, who, in addition to the cleanliness that this\noperation imparted to that class, added the shaving of the whole body as\na means of further purification. The nobility, royalty, and the higher\nwarrior class seem to have adopted circumcision as well, either as a\nhygienic precaution or as an aristocratic prerogative and insignia.\nAmong the Greeks we find a like practice, and we are told that in the\ntimes of Pythagoras the Greek philosophers were also circumcised,\nalthough we find no mention that the operation went beyond the\nintellectual class. In the United States, France, and in England, there\nis a class which also observe circumcision as a hygienic precaution,\nwhere, from my personal observation, I have found that circumcision is\nthoroughly practiced in every male member of many of the families of the\nclass,--this being the physician class. In general conversation with\nphysicians on this subject, it has really been surprising to see the\nlarge number who have had themselves circumcised, either through the\nadvice of some college professor while attending lectures or as a result\nof their own subsequent convictions when engaged in actual practice and\ndaily coming in contact both with the benefits that are to be derived in\nthe way of a better physical, mental, and moral health, as well as with\nthe many dangers and disadvantages that follow the uncircumcised,--the\nlatter being probably the most frequent incentive and determinator,--as\nin many of these latter examples the operation of circumcision, with its\npains, annoyances, and possible and probable dangers, sink into the most\ntrifling insignificance in comparison to some of the results that are\ndaily observed as the tribute that is paid by the unlucky and unhappy\nwearer of a prepuce for the privilege of possessing such an appendage.\n\nThere is one thing that must be admitted concerning circumcision: this\nbeing that, among medical men or men of ordinary intelligence who have\nhad the operation performed, instead of being dissatisfied, they have\nextended the advantages they have themselves received, by having those\nin their charge likewise operated upon. The practice is now much more\nprevalent than is supposed, as there are many Christian families where\nmales are regularly circumcised soon after birth, who simply do so as a\nhygienic measure.\n\nFor the benefit of these, who may congratulate themselves upon the\ndangers and annoyances that they and their families have escaped, and\nfor the benefit of those who would run into these dangers but for timely\nwarning, this book has been especially written. To my professional\nbrothers the book will prove a source of instruction and recreation,\nfor, while it contains a lot of pathology regarding the moral and\nphysical reasons why circumcision should be performed, which might be as\nundigestible as a mess of Boston brown bread and beans on a French\nstomach, I have endeavored to make that part of the book readable and\ninteresting. The operative chapter will be particularly useful and\ninteresting to physicians, as I have there given a careful and impartial\nreview of all the operative procedures,--from the most simple to the\nmost elaborate,--besides paying more than particular attention to the\nsubject of after-dressings. The part that relates to the natural history\nof man will interest all manner of people. I regret that the tabular\nstatistics are not to be had, but in this regard we must use our best\njudgment from the material we have on hand; at any rate, I have tried to\nfurnish a sufficiency of facts, so that, unless the reader is too\noverexacting, he will not find much difficulty in arriving at a\nconclusion on the subject.\n\nP. C. REMONDINO, M.D.\n\nSAN DIEGO, CALIFORNIA, 1891.\n\n\n\n\nCONTENTS.\n\n\n                                                        PAGE\n\nPREFACE,                                                 iii\n\nINTRODUCTION,                                              1\n\nCHAPTER I.\nANTIQUITY OF CIRCUMCISION,                                21\n\nCHAPTER II.\nTHEORIES AS TO THE ORIGIN OF CIRCUMCISION,                28\n\nCHAPTER III.\nSPREAD OF CIRCUMCISION,                                   34\n\nCHAPTER IV.\nCIRCUMCISION AMONG SAVAGE TRIBES,                         42\n\nCHAPTER V.\nINFIBULATION, MUZZLING, AND OTHER CURIOUS PRACTICES,      46\n\nCHAPTER VI.\nATTEMPTS TO ABOLISH CIRCUMCISION,                         63\n\nCHAPTER VII.\nMIRACLES AND THE HOLY PREPUCE,                            70\n\nCHAPTER VIII.\nHISTORY OF EMASCULATION, CASTRATION, AND EUNUCHISM,       82\n\nCHAPTER IX.\nPHILOSOPHICAL CONSIDERATIONS RELATING TO EUNUCHISM AND\nMEDICINE,                                                105\n\nCHAPTER X.\nHERMAPHRODISM AND HYPOSPADIAS,                           117\n\nCHAPTER XI.\nRELIGIO MEDICI,                                          134\n\nCHAPTER XII.\nHEBRAIC CIRCUMCISION,                                    143\n\nCHAPTER XIII.\nMEZIZAH, THE FOURTH OR OBJECTIONABLE ACT OF SUCTION,     150\n\nCHAPTER XIV.\nWHAT ARE THE BENEFITS OF CIRCUMCISION?                   161\n\nCHAPTER XV.\nPREDISPOSITION TO AND EXEMPTION AND IMMUNITY FROM\nDISEASE,                                                 183\n\nCHAPTER XVI.\nTHE PREPUCE, SYPHILIS, AND PHTHISIS,                     187\n\nCHAPTER XVII.\nSOME REASONS FOR BEING CIRCUMCISED,                      200\n\nCHAPTER XVIII.\nTHE PREPUCE AS AN OUTLAW, AND ITS EFFECTS ON THE GLANS,  206\n\nCHAPTER XIX.\nIS THE PREPUCE A NATURAL PHYSIOLOGICAL APPENDAGE?        217\n\nCHAPTER XX.\nTHE PREPUCE, PHIMOSIS, AND CANCER,                       226\n\nCHAPTER XXI.\nTHE PREPUCE AND GANGRENE OF THE PENIS,                   236\n\nCHAPTER XXII.\nTHE PREPUCE, CALCULI, AND OTHER ANNOYANCES,              248\n\nCHAPTER XXIII.\nREFLEX NEUROSES AND THE PREPUCE,                         254\n\nCHAPTER XXIV.\nDYSURIA, ENURESIS, AND RETENTION OF URINE,               275\n\nCHAPTER XXV.\nGENERAL SYSTEMIC DISEASES INDUCED BY THE PREPUCE,        284\n\nCHAPTER XXVI.\nSURGICAL OPERATIONS PERFORMED ON THE PREPUCE,            302\n\nNOTES TO TEXT,                                           323\n\nWORKS AND AUTHORITIES QUOTED,                            336\n\nINDEX,                                                   339\n\n\n\n\nINTRODUCTION.\n\n\nThis book is the amplification of a paper, the subject of which was, \"A\nPlea for Circumcision; or, the Dangers that Arise from the Prepuce,\"\nwhich was read at the meeting of the Southern California Medical\nSociety, at Pasadena, in December, 1889. The material gathered for that\npaper was more than could be used in the ordinary limits of a society\npaper; it was gathered and ready for use, and this suggested its\narrangement into book form. The subject of the paper was itself\nsuggested by a long and personal observation of the changes made in man\nby circumcision. From the individual observation of cases, it was but\nnatural to wish to enlarge the scope of our observation and comparison;\nthis naturally led to a study of the physical characteristics of the\nonly race that could practically be used for the purpose. This race is\nthe Jewish race. On carefully studying into the subject, I plainly saw\nthat much of their longevity could consistently be ascribed to their\nmore practical humanitarianism, in caring for their poor, their sick, as\nwell as in their generous provision for their unfortunate aged people.\nThe social fabric of the Jewish family is also more calculated to\npromote long life, as, strangely as it may seem, family veneration and\nfamily love and attachment are far more strong and practical among this\npeople than among Christians, this sentiment not being even as strong in\nthe Christian races as it is in the Chinese or Japanese. It certainly\nforms as much of a part of the teachings of Christianity as it does of\nJudaism, Buddhism, or Confucianism, only Christians, as a mass, have\npractically forgotten it. The occupation followed by the Jews also in a\ncertain degree favors longevity, and the influence on heredity induced\nby all these combined conditions goes for something. But it is not alone\nin the matter of simple longevity--although that implies\nconsiderable--that the Jewish race is found to be better situated.\nActual observations show them to be exempt from many diseases which\naffect other races; so that it is not only that they recover more\npromptly, but that they are not, as a class, subjected to the loss of\ntime by illness, or to the consequent sufferings due to illness or\ndisease, in anything like or like ratio with other people.\n\nThere is also a less tendency to criminality, debauchery, and\nintemperance in the race; this, again, can in a measure be ascribed to\ntheir family influence, which even in our day has not lost that\npatriarchal influence which tinges the home or family life in the Old\nTestament. Crimes against the person or property committed by Jews are\nrare. They likewise do not figure in either police courts or\npenitentiary records; they are not inmates of our poor-houses, but, what\nis also singular, they are never accused of many silly crimes, such as\nindecent exposures, assaults on young girls; nor do they figure in any\nsuch exposures as the one recently made by the _Pall Mall Gazette_.\n\nAfter allowing all that, which we can, in its fullest limit, to\nreligion, family, or social habit, there is still a wide margin to be\naccounted for. This has naturally let the inquiry, followed in the\ncourse of this book, into a careful review of the Jewish people; into\ntheir religion and its character, its relation to other creeds, and to\nthe world's history; into their many wanderings, and into the\ndispersion, and we have even been obliged to follow them into the midst\nof the people among whom they have become nationed, to try, if possible,\nto find the cause of this racial difference in health, resistance to\ndisease, decay, and death. It has been necessary, in following out the\nresearch, to give a condensed _resume_ of the religious, political, and\nsocial condition of the Jewish commonwealth, which, although in a state\nof dispersion, still exists. I need offer no apology for the extended\nnotice this has received in the course of the book. We read with\nincreasing interest either Hallam or May, Buckle or Guizot, through the\nspasmodic, halting, retrograding, advancing, erratic, aimless, and\naccidental phases that England has plowed through, from the days of\ngoutless, simple, and chaste, but barbarian England of the Saxons, to\nthe present civilized, enlightened, gouty, \"Darkest England\" of General\nBooth; and, after all is said and done, we are no wiser in any practical\nresulting good. We simply know that the English people, so to speak,\nhave, as it were, gone through the figures of some social aspects, as if\ndancing the \"Lancers,\" with its forward and back movements, gallop,\netc., and have finally sat down, better dressed and better housed, but\nin an acquired state of moral and physical degeneration. The Briton of\nQueen Victoria is not the Briton of Queen Boadicea, either morally or\nphysically. On the other hand, the system of sociological tables adopted\nby Herbert Spencer would have but little to record for some six thousand\nyears--either in religion, morals, or physique--as making any changes in\nthe history of that simple people which, in the mountainous regions of\nUr, in distant Armenia, started on its pilgrimage of life and racial\nexistence; in one branch of the family--that of Ishmael--the changes to\nbe recorded are so invisible that its descendants may really be said to\nlive to-day as they lived then. So that I do not feel that I need to\napologize for the space I have given to this subject in the course of\nthe book. The causes that make these racial distinctions should be of\ninterest alike to the moralist, theologist, sociologist, and to the\nphysician.\n\nEcclesiastical writers and moralists, as well as writers of fiction or\ndramatizers, can write on anything they please, and it is eagerly taken\nup and read by the people generally, either of high or low degree,\nalike; and somehow these people seem never to require an apology on the\npart of the author, for having attempted rapes, seductions, or even\nunavoidable fornication committed through the leaves of the story, or\nhaving it imaginably take place between acts on the stage. But if the\nphysician writes a book touching anything connected with the generative\nfunctions, and with the best intent and for the good of humanity, he is\nexpected to make some prefatory apology. He is supposed to address a\npublic who all of a sudden have become intensely moral and extremely\nsensitive in their modesty. Why things are thus I cannot explain. They\nare so, nevertheless. From the time that the celebrated Astruc wrote his\ntreatise on female diseases, near the end of the seventeenth\ncentury,--who felt compelled by the extreme modesty of the people in\nthis particular--but who, outside of medicine, were about as virtuous as\nthe average Tabby or Tom cats in the midnight hour--to write the chapter\ntouching on nymphomania in Latin, so as not to shock the morbidly\nsensitive modesty of the French nobility, who then enjoyed _Le Droit de\ncuissage_,--down through to Bienville, who wrote the first extended work\non nymphomania, and Tissot, who first broached the subject and the\ndanger of Onanism, all have felt that they must stop on the threshold\nand \"apologize.\" Tissot, however, seemed to possess a robust and a plain\nHippocratic mind, and as he apologized he could not help but see the\nridiculousness of so doing, as in the preface to his work we find the\nfollowing: \"Shall we remain silent on so important a subject? By no\nmeans. The sacred authors, the Fathers of the Church, who present their\nthoughts in living words, and ecclesiastical authors have not felt that\nsilence was best. I have followed their example, and shall exclaim, with\nSt. Augustine, 'If what I have written scandalizes any prudish persons,\nlet them rather accuse the turpitude of their own thoughts than the\nwords I have been obliged to use.'\"\n\nFor my part, I think that people who can go to the theatre and enjoy \"As\nin a Looking-Glass,\" and witness some of the satyrical or billy-goat\ntraits of humanity so graphically exhibited in \"La Tosca,\" with evident\nsatisfaction; or attend the more robust plays of \"Virginius\" or of\n\"Galba, the Gladiator,\" with all its suggestions of the Caesarian\nsection, and the lust and the fornications of an intensely animal Roman\nempress, without the destruction of their moral equilibrium or tending\nto induce in them a disposition to commit a rape on the first met,--I\nthink such people can be safely intrusted to read this book.\n\nAnd as to the reading public, there are but few general readers who\ncould honestly plead an ignorance of the \"Decameron,\" Balzac, La\nFontaine, \"Heptameron,\" Crebillon _fils_, or of matter-of-fact Monsieur\nle Docteur Maitre Rabelais,--works which, more or less, carry a moral\ninstruction in every tale, which, like the tales of the \"Malice of\nWomen,\" in the unexpurged edition of the literal translation of the\n\"Arabian Nights,\" contains much more of practical moral lessons, even if\nin the flowery and warm, spiced language of the Orient, than any\nsupposed nastiness, on account of which they are classed among the\nprohibited. To these, and the readers of Amelie Rives's books, or other\nintensely realistic literature, I need not imitate the warning of\nAnsonius, who warned his readers on the threshold of a part of his book\nto \"stop and consider well their strength before proceeding with its\nlecture.\" Metaphorically speaking, the general theatre-going, or modern\nliterature-reading public, can be considered pretty callous and morally\nbullet proof. I shall therefore make no apology.\n\nSome fault may, perhaps, be found with some of the occasional style of\nthe book, or with some of the subjects used to illustrate a principle.\nTo the extremely wise, good, and scientific, these illustrations were\nunnecessary; this need hardly be mentioned; and the passages which to\nsome may prove objectionable were not intended for them, either with the\nexpectation of delighting them or with the purpose of shocking them.\nThese passages, they can easily avoid. This book, however, was written\nthat it might be read: not only read by the Solon, Socrates, Plato, or\nSeneca of the laity or the profession, but even by the billy-goated\ndispositioned, vulgar plebeian, who could no more be made to read cold,\nscientific, ungarnished facts than you can make an unwilling horse drink\nat the watering-trough. Human weakness and perversity is silly, but it\nis sillier to ignore that it exists. So, for the sake of boring and\ndriving a few solid facts into the otherwise undigesting and unthinking,\nas well as primarily obdurate understanding of the untutored plebeian, I\nask the indulgence of the intelligent and broad-minded as well as the\neasily inducted reader. Cleopatra was smuggled into Caesar's presence in\na roll of tapestry; the Greeks introduced their men into Troy by means\nof a wooden horse; and the discoverer of the broad Pacific Ocean made\nhis escape from his importunate creditors disguised as a cask of\nmerchandise. So, when we wish to accomplish an object, we must adopt\nappropriate means, even if they may apparently seem to have an entirely\ndiametrically opposite object. The Athenian, Themistocles, when wishing\nto make the battle of Salamis decisive, was inspired with the idea of\nsending word to the Persian monarch that the Greeks were trying to\nescape, advising him to block the passage; this saved Greece.\n\nThere is a weird and ghostly but interesting tale connected with the\nMoslem conquest of Spain, of how Roderick, the last of the Gothic kings,\nwhen in trouble and worry, repaired to an old castle, in the secret\nrecesses of which was a magic table whereon would pass in grim\nprocession the different events of the future of Spain; as he gazed on\nthe enchanted table he there saw his own ruin and his country's and\nnation's subjugation. Anatomy is generally called a dry study, but, like\nthe enchanted brazen table in the ancient Gothic castle, it tells a no\nless weird or interesting tale of the past. Its revelations lighten up a\nlong vista, through the thousands of years through which the human\nspecies has evolved from its earliest appearance on earth, gradually\nworking up through the different evolutionary processes to what is\nto-day supposed to be the acme of perfection as seen in the\nIndo-European and Semitic races of man. Anatomy points to the\nrudiment--still lingering, now and then still appearing in some one man\nand without a trace in the next--of that climbing muscle which shows man\nin the past either nervously escaping up the trunk of a tree in his\nflight from many of the carnivorous animals with whom he was\ncontemporary, or, as the shades of night were beginning to gather\naround him, we again see him by the aid of these muscles leisurely\nclimbing up to some hospitable fork in the tree, where the robust habits\nof the age allowed him to find a comfortable resting-place; protected\nfrom the dew of the night by the overhanging branches and from the\nprowling hyena by the height of the tree, he passed the night in\nsecurity. The now useless ear-muscles, as well as the equally useless\nseries of muscles about the nose, also tell us of a movable, flapping\near capable of being turned in any direction to catch the sound of\napproaching danger, as well as of a movable and dilated nostril that\nscented danger from afar,--the olfactory sense at one time having a\ndifferent function and more essential to life than that of merely noting\nthe differential aroma emitted by segars or cups of Mocha or Java, and\nthe ear being then used for some more useful purpose than having its\ntympanum tortured by Wagnerian discordant sounds. Our ancestors might\nnot have been a very handsome set, nor, judging from the Neanderthal\nskull, could they have had a very winning physiognomy, but they were a\nvery hardy and self-reliant set of men. Nature--always careful that\nnothing should interfere with the procreative functions--had provided\nhim with a sheath or prepuce, wherein he carried his procreative organ\nsafely out of harm's way, in wild steeple-chases through thorny briars\nand bramble-brakes, or, when hardly pushed, and not able to climb\nquickly a tree of his own choice, he was by circumstances forced up the\nsides of some rough-barked or thorny tree. This leathery pouch also\nprotected him from the many leeches, small aquatic lizards, or other\nanimals that infested the marshes or rivers through which he had at\ntimes to wade or swim; or served as a protection from the bites of ants\nor other vermin when, tired, he rested on his haunches on some mossy\nbank or sand-hill.\n\nMan has now no use for any of these necessaries of a long-past age,--an\nage so remote that the speculations of Ernest Renan regarding the\ndifferences between the Semitic race of Shem and the idolatrous\ndescendants of Ham, away off in the far mountains and valleys of Asia\nlying between the Mediterranean Sea and the Euphrates, seem more as if\nhe were discussing an event of yesterday than something which is\nconsidered contemporary with our earlier history,--and we find them\ndisappearing, disuse gradually producing an obliteration of this tissue\nin some cases, and the modifying influence of evolution producing it in\nothers; the climbing muscle, probably the oldest remnant and legacy that\nhas descended from our long-haired and muscular ancestry, is the best\nexample of disappearance caused by disuse, while the effectual\ndisappearance of the prepuce in many cases shows that in that regard\nthere exists a marked difference in the evolutionary march among\ndifferent individuals.\n\nThere is a strange and unaccountable condition of things, however,\nconnected with the prepuce that does not exist with the other vestiges\nof our arboreal or sylvan existence. Firstly, the other conditions have\nnothing that interferes with their disappearance; whereas the prepuce,\nby its mechanical construction and the expanding portions which it\nincloses, tends at times rather to its exaggerated development than to\nits disappearance. Again, whereas the other vestiges have no injury that\nthey inflict by their presence, or danger that they cause their\npossessors to run, the prepuce is from time of birth a source of\nannoyance, danger, suffering, and death. Then, again, the other\nconditions are not more developed at birth; whereas the prepuce seems,\nin our pre-natal life, to have an unusual and unseen-for-use existence,\nbeing in bulk out of all proportion to the organ it is intended to\ncover. Speculation as to its existence is as unprolific of results as\nany we may indulge in regarding the nature, object, or uses of that\nother evolutionary appendage, the appendix vermiformis, the recollection\nof whose existence always adds an extra flavor to tomatoes, figs, or any\nother small-seeded fruits.\n\nWe may well exclaim, as we behold this appendage to man,--now of no use\nin health and of the most doubtful assistance to the very organ it was\nintended to protect, when that organ, through its iniquitous tastes, has\ngot itself into trouble, and, Job-like, is lying repentant and sick in\nits many wrappings of lint, with perhaps its companions in crime\nimprisoned in a suspensory bandage,--what is this prepuce? Whence, why,\nwhere, and whither? At times, Nature, as if impatient of the slow march\nof gradual evolution, and exasperated at this persistent and useless as\nwell as dangerous relic of a far-distant prehistoric age, takes things\nin her own hands and induces a sloughing to take place, which rids it of\nits annoyance. In the far-off land of Ur, among the mountainous regions\nof Kurdistan, something over six thousand years ago, the fathers of the\nHebrew race, inspired by a wisdom that could be nothing less than of\ndivine origin, forestalled the process of evolution by establishing the\nrite of circumcision. Whether this has been beneficial or injurious to\nthe race will be, in a measure, the object of the discussion in this\nbook.\n\nOne object of this book is to furnish my professional brothers with some\nembodied facts that they may use in convincing the laity in many cases\nwhere they themselves are convinced that circumcision is absolutely\nnecessary; but, having nothing in their text-books to back up their\nopinion with, their explanations are too apt to pass for their mere\nunfounded personal view of the matter. If the patient, or the parents of\nthe patient, ask the physician for his authority, he is at a loss, as\nthere is nothing that deals with the subject in any extended manner; so\nthat this book has been written in as plain English as the\nsubject-matter could possibly allow, so that non-professionals could\neasily read and understand it. I have often felt the need of such a\nwork; people can understand emergency or accident surgery, military\nsurgery, or reparative surgery, but such a thing as surgery to remedy a\nseemingly medical disease, or what might be called the preventive\npractice of surgery, is something they cannot understand. First, and not\nthe least, among the incentives to skepticism on this subject is the\nunwelcome fact of a surgical operation, which, no matter how trivial it\nmay seem to the surgeon, is a matter of considerable magnitude to the\npatient, his parents, or friends; there are risks, pain, worry,\nannoyances, and expenses to be undergone,--considerations which, either\nsingly or unitedly, often lead one to reason against the operation, even\nwhen otherwise convinced of its need or utility.\n\nThe hardest to convince are those, however, who insist on having a\nfour-and-a-half-foot-gauge fact driven through their two-foot-gated\nunderstanding, without it ever occurring to them that the gate, and not\nthe fact, is the faulty article, Some of these gentry are very\nunconvincible. They at times remind one of that description given by\nCarlyle in regard to one of the Georges, who found himself, when Prince\nof Wales, leading an army in Flanders, and actually engaged in a\nbattle. His Royal Highness was on foot, and was seen standing facing the\nenemy, with outstretched legs, like a Colossus of Rhodes, impassive and\nstolid,--the very impersonification of Dutch courage and aggressiveness.\nThere he stood, unconscious whether he was at the head of an army or\nsingle attendant; he might be overridden and annihilated, overturned and\nexpunged, but there he would most assuredly stand and fall, if need be;\noverwhelming squadrons, by their impetus and weight, might ride him down\nand crush him; but one thing was most certain, this certain fact being\nthat he never could be made to retreat or advance, as no impression from\nfront or rear could convince him of the necessity of either.\n\nThen, there is our statistical friend, who cannot discriminate between\nthe exception and the rule by any common-sense deductions. He must have\nall the authentic, carefully-compiled statistics before he can allow\nhimself to form any opinion. As long as there is the smallest fraction\nof a decimal unaccounted for in a mathematical way, this individual is\ninconvincible. These men pride themselves upon being methodically exact;\nthey express their willingness to be convinced if you can present\nacceptable proofs; but, trying to present simple rational proofs to\nthese individuals is considerably like presenting a meal of boiled pork\nand cabbage to a confirmed and hypochondriacal dyspeptic,--it only\nincreases their mental dyspepsia.\n\nHad Columbus waited to discover America, or had Galileo waited to\nproclaim the motion of the earth, until authorized to a serious\nconsideration of the matter by properly-tabled statistics, they would\nhave waited a long, long time; and, it may be added, the inconveniences\nthat attend the proving of a negative will so interfere with the proper\narrangement of statistical matter which relates to the prepuce and\ncircumcision that, before such tables could be satisfactorily and\nconvincingly constructed, time and the evolutionary processes that\nfollow it will bid fair to completely remove this debatable appendage\nfrom man. It may be at a very far-distant period that this evolutionary\npreputial extinction will take place,--probably contemporary with the\nexistence of Bulwer's \"Coming Race,\"--but not at a too remote period for\nthe proper and satisfactory tabulation of the statistics.\n\nThe ideas of the etiology and pathological processes through which we\njourney,--from a condition of health and good feeling to one of disease,\nmiserable feeling, and death,--as described in, or rather as they\ncontrol the sentiment and policy of, this work, are such as have been\nfollowed by Hutchinson, Fothergill, Beale, Black, Albutt, and\nRichardson, so that if I have totally ignored the old conventional\nsystems, with their hide-bound classification of diseases to control the\netiology, I have not done so without some reliable authority. In\nstudying the etiology of diseases we have, as a rule, been content to\naccept the disease when fully formed and properly labeled, being\napparently satisfied with beginning our investigation not at the initial\npoint of departure from health, but at some distant point from this, at\nthe point where this departure has elaborated itself, on favorable\nground, into a tangible general or local disease. As truthfully observed\nby T. Clifford Albutt: \"The philosophic inquirer is not satisfied to\nknow that a person is suffering, for example, from a cancer. He desires\nto know why he is so suffering,--that is, what are the processes which\nnecessarily precede or follow it. He wishes to include this phenomena,\nnow isolated, in a series of which it must necessarily be but a member,\nto trace the period of which it must be but a phase. He believes that\ndiseased processes have their evolution and the laws of it, as have\nother natural processes, and he believes that these are fixed and\nknowable.\" To do this, the physician must travel beyond the beaten path\nof etiology as found in our text-books. He must follow Hutchinson in the\ntrain of reasoning that elucidates the pre-cancerous stage of cancer, or\ntread in the path followed by Sir Lionel Beale, in finding that the\ncause of disease depends on a blood change and the developmental defect,\nor the tendency or inherent weakness of the affected part or organ; to\nfully appreciate the inherent etiological factors that reside in man,\nand which constitute the tendency to disease or premature decay and\ndeath, we must also be able to follow Canstatt, Day, Rostan, Charcot,\nRush, Cheyne, Humphry, or Reveille-Parise into the study of the\ndifferent conditions which, though normal, are nevertheless factors of a\nslow or a long life. We must also be able to appreciate fully the value\nof that interdependence of each part of our organism, which often, owing\nto a want of equilibrium of strength and resistance in some part when\ncompared to the rest, causes the whole to give way, just as a flaw in a\nlevee will cause the whole of the solidly-constructed mass to give way,\nor a demoralized regiment may entail the utter rout of an army. As\ndescribed by George Murray Humphry, in his instructive work on \"Old\nAge,\" at page 11:--\n\n\"The first requisite for longevity must clearly be an inherent or inborn\nquality of endurance, of steady, persistent nutritive force, which\nincludes reparative force and resistance to disturbing agencies, and a\ngood proportion or balance between the several organs. Each organ must\nbe sound in itself, and its strength must have a due relation to the\nstrength of the other organs. If the heart and the digestive system be\ndisproportionately strong, they will overload and oppress the other\norgans, one of which will soon give way; and, as the strength of the\nhuman body, like that of a chain, is to be measured by its weaker link,\none disproportionately feeble organ endangers or destroys the whole. The\nsecond requisite is freedom from exposure to the various casualties,\nindiscretions, and other causes of disease to which illness and early\ndeath are so much due.\"\n\nIn following out our study of diseases, we have been too closely\nnarrowed down by the old symptomatic story of disease; we have too much\ntreated surface symptoms, and neglected to study the man and his\nsurroundings as a whole; we have overlooked the fact that there exists a\ngeographical fatalism in a physical sense as well as the existence of\nthe influence of that climatic fatalism so well described by Alfred\nHaviland, and the presence of a fatalism of individual constitution as\nwell, which is either inherited or acquired. The idea that Charcot\nelaborates, that, as the year passes successively through the hot and\nthe cold, through the dry and the wet season, with advancing age the\nhuman body undergoes like changes, and diseases assume certain\ncharacteristics, are also points that are overlooked; and nowhere is\nthis latter view seen to be more neglected than in the relations the\nprepuce bears to infancy, prime and old age, as will be more fully\nexplained in the chapters in this book which treat of cancer and\ngangrene. Admitting that Haviland has exaggerated the influence of\nclimate as an etiological factor in its specific influence in producing\ncertain diseases; or that M. Taine claims more than he should for his\n\"Theorie des Milieux,\" or influence of surroundings; or that Hutchinson\nhas drawn the hereditary and pedigreeal fatherhood of disease too\nfinely; it must also be admitted that the solid, tangible truths upon\nwhich these authors have founded their premises are plainly visible to\nthe most skeptical; the architectural details of the superstructure may\nbe defective, but the foundation is permanent.\n\nFrom the above outline it will be easier for the reader to follow out\nthe reasons, or the whys or wherefores, of the views expressed on\nmedicine in the course of the book; and, although I do not wish to enter\nthe medical field like a Peter the Hermit on a new crusade, to lure\nthousands into the hands of the circumcisers, nor, as a new Mohammed,\npromise the eternal bliss and glory of the seventh heaven to all the\ncircumcised, I ask of my professional brothers a calm and unprejudiced\nperusal of the tangible and authentic facts that I have honestly\ngathered and conscientiously commented upon from my field of vision,\nwhich will be plainly presented in the following pages. I simply have\ngiven the facts and my impressions: the reader is at liberty to draw his\nown conclusions.\n\nIf I have been too tedious in the multiplication of incidents in support\nof certain views, I must remind the reader that the verdict goes to him\nwho has the preponderance of testimony, and that many a lawsuit is lost\nfrom the neglect, on the part of the loser, to secure all the available\ntestimony. Having brought the subject of circumcision before the bar of\npublic opinion, as well as that of my professional brother, I would but\nilly do justice to the subject at the bar, or to myself, not to properly\npresent the case; as it was remarked by Napoleon, \"God is on the side of\nthe heaviest artillery,\" and he who loses a battle for want of guns\nshould not rail at Providence if, having them on hand, he has neglected\nto bring them into action.\n\nThe reasons for the existence of the book will become self-evident as\nthe reader labors through the medical part of the work. Our text-books\nare, as a class, even those on diseases of children as a specialty,\nsingularly and unpardonably silent and deficient on the subject of\neither the prepuce and the diseases to which it leads, or circumcision;\nand even our surgical works are not sufficiently explicit, as they deal\nmore with the developed disease and the operative measures for its\nremoval than on any preventive surgery or medicine. Our works on\nmedicine are equally silent, and, although from a perusal of the latter\npart of the book the prepuce and circumcision will be seen to have\nconsiderable bearing on the production and nature of phthisis, this\nsubject would, owing to our strabismic way of studying medicine, look\nmost singularly out of place in a work devoted to diseases of the lungs\nor throat. Owing to this poverty of literature on the subject, and that\nthe library of the average practitioner could therefore not furnish all\nthe data relating to it that the profession have in their possession, a\nbook of this nature will furnish them the required material whereupon to\nform the basis of an opinion on the subject.\n\nTo argue that the prepuce is not such a deadly appendage because so many\nescape alive and well who are uncircumcised, would be as logical as to\nassume that Lee's chief of artillery neglected to properly place his\nguns on the heights back of Fredericksburg. He had asserted, the night\nbefore the battle, that not a chicken could live on the intervening\nplateau between the heights and the town. On the next day, when these\nguns opened their fire, the Federals were unable to reach the heights,\nwhile many men were for hours in the iron hail-sweeping discharges of\nthat artillery that mowed them down by whole ranks, and yet the majority\nescaped alive. We take the middle ground, and, while admitting that many\nescape alive with a prepuce, claim that more are crippled than are\nvisibly seen, as, like Bret Harte's \"Heathen Chinee,\" the ways of the\nprepuce are dark and mysterious as well as peculiar.\n\nA discussion of the relative merits of religious creeds, when considered\nin relation to health, has been, from the nature of the subject of the\nbook, unavoidable. Modern Christianity but very imperfectly explains why\nthis rite was either neglected or abolished. Frequent reference is made\nto what Saint Paul said and did, but, as Saint Paul was not one of the\nDisciples, it is inexplicable wherefrom he received his authority in\nthis matter, seeing that the Disciples themselves had no new views on\nthe subject. To the student who prefers to study his subject from all\nits aspects, the question naturally arises, \"Where, when, and why came\nthe authority that abolished this rite?\" There is one probable\nexplanation, this being that Paul, who was the real promulgator of\nGentile Christianity, had to establish his creed among an uncircumcised\nrace; although, as we shall see, devotees have not scrupled to sacrifice\ntheir virility in the hope of being more acceptable to God and to be\nbetter able to observe His commandments, and others, in their blind\nbigotry, have not objected to sitting naked on sand-hills, with a\nsix-inch iron ring passed through the prepuce, it is very evident that\nthe Apostle Paul's good sense showed him the uselessness of attempting\nto found the new creed, and at the same time hold on to the truly\ndistinctive marking of Judaism among Gentiles, the Hebrew race being\nthose among whom he found the least converts, as even the Disciples and\nApostles in Palestine disagreed with him. In the words of Dr. I. M.\nWise, it was impossible for the Palestine Apostles, or their flock,\neither to acknowledge Paul as one of their own set or submit to his\nteaching; for they obeyed the Law and he abolished it; they were sent to\nthe house of Israel only, and Paul sought the Gentiles with the message\nthat the Covenant and the Law were at an end; they had one gospel story\nand he another; they prophesied the speedy return of the Master and a\nrestoration of the throne of David in the kingdom of heaven, and he\nprophesied the end of the world and the last day of judgment to be at\nhand; they forbade their converts to eat of unclean food, and especially\nof the sacrificial meats of the Pagans, and he made light of both, as\nwell as of the Sabbath and circumcision. In the attempted reconciliation\nthat subsequently took place in Jerusalem at the house of James, the\nJacob of Kaphersamia of the Talmud, Paul was charged by the synod of\nJewish Christians \"with disregarding the Law, forsaking the teachings of\nMoses, and attempting to abolish circumcision.\" He was bid to recant and\nundergo humiliation with four other Nazarenes, that it might be known\nthat he walked orderly and observed the Law; Paul submitted to all that\nwas demanded.\n\nThis, in short, with the exception of the sayings of Paul on the\nsubject, which are all secondary considerations, is really all that\nthere is relating to the abolishment of circumcision by the Christians.\nThe real Disciples and Apostles believed in Jesus with as much fervor as\nPaul, but it is singular that they who were with the Master should\nalways have insisted on the observance of the Law, while Paul as\nenergetically insisted on its abolishment.\n\nFrom these premises, I have seen fit to inquire into the relative merits\nof the three religions practiced by what we call the civilized nations,\nas they affect man morally, physically, and mentally. I have given the\nfacts, my impressions, and reasons for being so impressed; from these,\nthe reader can easily see that religion has more to do with man's\ntemporal existence than is generally believed; its discussion is not,\ntherefore, out of place in this book.\n\nRepetitions in the course of the work have been unavoidable. This is not\na novel nor a work of fiction, and wherever the want of repetition would\nhave been an injury, either to the proper representation of a fact or a\nprinciple, the repetition has not been avoided. In describing the\noperations, I had desired to avoid any too numerous descriptions, as\nthat is confusing, but have thought it best to give a number, as the\nreader will thereby obtain the views of the different operators, the\nmode of the operation often being an index to the view of the operator\nin regard to the needs or utility of a prepuce. In the general plan of\nthe work, I have adopted the idea and the historical relation carried\nout by Bergmann, of Strasburg, who included all the mutilations\npracticed on the genitals while discussing the subject of circumcision,\nthey being, in the originality of performance, somewhat intimately\nconnected; this also tends to make the subject more interesting as a\ncontribution to the natural history of man,--something in which all\nintelligent persons are more or less interested.\n\nP. C. REMONDINO, M.D.\nSAN DIEGO, CALIFORNIA.\n\n[Illustration: EGYPTIAN CIRCUMCISION.\n\n(From Chabas and Ebers' description of the bas-relief found in the\ntemple of Khons, near the great temple of Maut, at Karnac.)]\n\n\n\n\nCHAPTER I.\n\nANTIQUITY OF CIRCUMCISION.\n\n\nIf the ceremonials of the Catholic Church or the High Church\nEpiscopalians carry us back into the depths of antiquity, or, as\nremarked by Frothingham, that the ceremonies of St. Peter, at Rome,\ncarried him back to the mysteries of Eulesis, to the sacrificial rites\nof ancient Phoenicia, to what misty antiquity does not the contemplation\nof the rite of circumcision take us? The Alexandrian library, with its\nvast collection of precious records, could probably have furnished us\nsome information as to its origin and antiquity; but Moslem fanaticism,\nwith its belief in the all-sufficiency and infallibility of the Koran,\nwas the destruction of that wonderful repository. We must now depend\nwholly on the relation of the Old Testament or on what has since been\nwritten by the Greek and Italian historians as to its origin and\npractices. The Egyptian monuments and their hyeroglyphics give us no\ninformation on the subject further back than the reign of Rameses II;\nwhile the oft-quoted Herodotus wrote some fourteen centuries after the\nOld Testament relation, and Strabo and Diodorus some nineteen centuries\nafter the same chronicler. We have, therefore, in their chronological\norder, first, the relation of the Bible; then the Egyptian monuments and\ntheir revelations; and, thirdly, the information gathered by Pythagoras,\nHerodotus, and other philosophers and historians. To these three\nsources we may add the misty mixture of tradition and mythological\nevents, whose beginnings as to period of time are indefinite. These are\nthe sources from which we are to determine the origin and antiquity as\nwell as the character of the rite.\n\nVoltaire found in the subject of circumcision one that he could not\nsatisfactorily make enter into his peculiar system of general\nphilosophy. For some reason, he did not wish that the Israelites should\nhave the credit of its introduction; were he to have admitted that, he\nwould have had to explain away the divine origin of the rite,--something\nthat the Hebrew has tenaciously held for over thirty-seven centuries.\nVoltaire thought it would simplify the subject by making it originate\nwith the Egyptians, from whom the Hebrews were to borrow it. To do this\nhe adopted the relation of Herodotus on the subject. His treatment of\nthe Jewish race, however, brought out a strong antagonism from those\npeople to his attacks, and in a volume entitled, \"Letters of Certain\nJews to Monsieur Voltaire,\"--being a series of criticisms on his\naspersions on the race and on the writings of the Old Testament (written\nby a number of Portuguese, German, and Polish Jews then residing in\nHolland[1]),--they proved conclusively that the Phoenicians had borrowed\nthe rite from the Israelites, as they (the Phoenicians) had practiced\nthe rite on the newborn, whereas, had they followed the Egyptian rite,\nthey would have only circumcised the child after its having passed its\nthirteenth year,--these being the distinctive differences between the\nJewish and Egyptian rites.\n\nLuckily, in the small temple of Khons, which formed an annex to the\ngreater temple of Maut, at Karnac, there was found a _bas-relief_,\npartly perfect, which goes far toward giving light on the subject of\nEgyptian circumcision. The upper part of the sculpture was so defaced\nthat the upper portions of four of the five figures were destroyed, but\nthe lower portions were so perfect in every detail as to furnish a full\nhistory of the age of the candidates for the rite and the manner of its\nperformance. It is further interesting from the fact that it establishes\nalso the time during which the rite was so performed. M. Chabas and Dr.\nEbers argue, from the founder of the temple having been Rameses II, that\nthe sculpture refers to the circumcision of two of his children. The\nknife appears to be a stone implement, and the operator kneels in front\nof the child, who is standing, while a matron supports him in a kneeling\nposture, and she holds his hands from behind him.[2] In this\n_bas-relief_ we can see the great difference that existed between the\ntwo forms of the operation, that of the Hebrews being performed, as a\nrule, on the eighth day after birth, while in the _bas-relief_ they are\nten or twelve years old.\n\nAlthough tradition and mythology veil past events in more or less\nobscurity, they do, in regard to circumcision, furnish considerable\nexplanatory light on matters which would be otherwise hard to reconcile.\nCircumcision has been performed by the Chippeways, on the Upper\nMississippi, and its modifications were performed among the Mexicans,\nCentral Americans, and some South American tribes of Indians, as well as\namong many of the natives dwelling among the islands of the Pacific\nArchipelago. There is a tradition, mentioned by Donnelly in connection\nwith the sunken continent of Atlantis, that Ouranos, one of the\nAtlantean kings, ordered his whole army to be circumcised that they\nmight escape a fatal scourge then decimating the people to their\nwestward.[3] This tradition tells us that the hygienic benefits of\ncircumcision were recognized antediluvian facts, as it also points out\nthe way by which circumcision traveled westward across to the Western\nWorld. As Donnelly has pointed out, many of the Americans possessed not\nonly traditions, habits, and customs that must have come from the Old\nWorld, but the similarity of many words and their meaning that exists\nbetween some of the American languages and those of the indigenous\ninhabitants that have still their remains in spots on the southwestern\nshores of Europe--the ancient Armorica whose colony in Wales still\nretains its ancient words--leaves no room for doubt that at one time a\nlanded highway existed between the two worlds. The Mandans, on the Upper\nMissouri, have many words of undoubted Armorican origin in their\nvocabulary,[4] just as the Chiapenec, of Central America, contains its\nprincipal words denotive of deity, family relations, and many conditions\nof life that are identically the same as in the Hebrew,[5] the name of\nfather, son, daughter, God, king, and rich being essentially the same in\nthe two languages. It must have been more than a passing coincidence\nthat gives the Mandans some of their most expressive words from the\nWelsh, or that gave to Central America many cities bearing analogous\nnames with the cities of Armenia.[6] Canadian names of localities, as\nwell as those of the Mississippi Valley, denote the French origin of\ntheir pioneers, as well as the names of Upper California denote the\nnationality and creed of its first settlers. So that there is nothing\nstrange in asserting that American civilization and many of the customs\nas found in the fifteenth century by the early Spanish discoverers were\nnothing more than the remains of ancient and modified Phoenician\ncivilization, among which figured circumcision.\n\nDr. A. B. Arnold, of Baltimore, argues that, with the present state of\nour anthropological knowledge and the material that research has been\nable to furnish, we need no longer be surprised to find customs, laws,\nand morals, among nations living in regions of the world widely apart\nfrom each other, which betray an identity of origin and development, and\nthat beliefs and institutions, whether wise or aberrant, grow up under\napparently dissimilar circumstances, circumcision forming no\nexception.[7] Dr. Arnold leaves too much to chance. It is hardly likely\nthat the similarity that existed between the architecture of the\nPhoenicians and the Central Americans, as evinced in their arches; in\nthe beginning of the century on the 26th of February; the advancement\nand interest taken in astronomical science; the coexistence of pyramids\nin Egypt and Central America; that five Armenian cities should have\ntheir namesakes in Central America, should all be a matter of accident.\nThe historiographer of the Canary Islands, M. Benshalet, considers that\nthose islands once formed a part of the great continent to its west;\nthis has been verified by the discovery of many sculptured symbols,\nsimilar in the Canaries and on the shores of Lake Superior, as well as\nby the discovery of a mummy in the Canaries with sandals whose exact\ncounterparts were found in Central America.[8] A compound word used to\nsignify the Great Spirit being found identical in the Welsh and Mandan\nlanguages, each requiring five distinct sounds to pronounce, words as\nintricate as the passwords of secret societies, can hardly be said to be\nthe result of chance.[9] There must, at some remote period, have existed\nsome communication between the ancestors of these Missouri Mandans and\nthe shores of ancient Armorica; the ancestors of these Mandans may have\nthen been living farther to the east; they even may have then been a\ntribe of since lost Atlantis; but the analogy, not only in regard to the\nword just mentioned,--_Maho-peneta_, of the Welsh and Mandan,--but in\nthe similarity of the pronouns of both languages, and the existence of\nthe idea of the counterpart of the sacred white bull of the Egyptians\nbeing found among the Dakotas, or Sioux, all point to the fact that\nthese people, in common with the rest of the Americans, originally came\nfrom the East; from whence came their languages, manners, customs,\nrites, and what civilization they possessed, among which circumcision\nhas, through the mist of centuries, held its own in some shape or other.\n\nThat some terrible catastrophe occurred to divide the hemispheres is\nevident; the Western World remaining stationary in its civilization and\nretaining the customs and rites of the times as evidence of their\norigin. With this view of the case, the existence of circumcision as\nfound among the inhabitants of the West can easily be traced to its\norigin among the hills of Chaldea. The ancient traditions and\nmythological relations of the Egyptians in regard to the great nation to\nthe West are amply verified by the deep-sea soundings of the\n\"Challenger,\" the \"Dolphin,\" and the \"Gazelle,\" which plainly indicate\nthe presence of a submarine plateau that once formed the continent of\nAtlantis, whose only visible evidence above the waves of the boisterous\nAtlantic is the Azores and the remains of Phoenician civilization among\nthe Americans.\n\nProfessor Worman, of Brooklyn, scouts the idea that circumcision was\never connected in any way or that it originated in any of the rites\nconnected with phallic worship.[10] Bergmann,[11] of Strasburg,\nhowever, not only claims circumcision to be a direct result of phallic\nworship, but looks upon the rite as something that has been reached by\nwhat may be termed a gradual evolutionary process of manners, customs,\nand society, from the time of what is termed the hero-warrior period of\ntraditional history, when war and the clashing of shields and sword or\nspear were the main delights and occupations of man. It is strange to\nnote what difference must have existed between these hero-warriors in\nregard to their ideas of manliness; some were brutal and fiendish,\nwhilst others were magnanimous. McPherson, the historiographer of early\nBritain, cannot help but contrast the superior manliness of the heroes\nof Ossian in his graphic description of the ancient Caledonians, when\ncompared to the brutality of Homer's Greek heroes. The traditions upon\nwhich Bergmann undertakes to found the origin of the rite of\ncircumcision are all connected with the inhuman and brutish passions\nthat animated our barbarous ancestry. The first incident given is the\nEgyptian traditional tragedy, which was, in all probability, the initial\npoint of that phallic worship which, with increasing debauchery,\nassisted in the final demoralization of Rome and Greece, after its\nintroduction into those countries.\n\n\n\n\nCHAPTER II.\n\nTHEORIES AS TO THE ORIGIN OF CIRCUMCISION.\n\n\nWe are told that in battle man looked upon the vanquished as unfit to\nbear the name of man, looking upon the weakness or want of skill which\ncontributed to their defeat as something effeminate. The victor then\nproceeded by a very summary and effective mode, done in the most\nprimitive and expeditious manner, to render his victim as much like a\nfemale as possible to all outward appearances; this was accomplished by\na removal at one sweep of _all_ the organs of generation, the phallus\nbeing generally retained as a trophy,--a practice which was also carried\ninto effect with dead enemies, to show that the victor had vanquished\n_men_. It has been the practice from time immemorial for a victor to\ncarry off some portion of the body of his victim or defeated enemy, as a\nmark or testimony of his prowess; it was either a hand, head or scalp,\nlower jaw, or finger. The carrying off of the phallus or virile member\nwas considered the most conclusive proof of the nature of the\nvanquished, and, as it established the sex, it conferred a greater title\nto bravery and skill than a mere collection of hands or scalps, which\nwould not denote the sex. In conformity with this custom, we find that\nOsiris, when he returned to Egypt and found that Typhon had fomented\ndissension in his absence, being vanquished by the latter in the\nconflict that followed, was dismembered and cut into pieces, the\nfollowers of Typhon each securing a piece and Typhon himself securing\nthe phallus or generative member. Isis, the spouse of Osiris, seems in\nturn to have secured the control of government, and, having secured all\nthe pieces of the dissected Osiris except the phallus,--Typhon having\nfled with that, and, according to some traditions, having thrown it into\nthe sea,--Isis ordered that statues should be constructed, each to\ncontain a piece of the unfortunate Osiris, who should thereafter be\nworshiped as a god, and that the priesthood should choose from among the\nanimals some one kind which should thereafter be considered sacred. The\nphallus which was missing was ordered special worship, with more marked\nsolemnities and mysteries; from this originated the phallic worship and\nthe sacredness of the white bull, Apis, among the Egyptians, which was\nchosen to represent Osiris.\n\nBy gradual evolution and the progress of society, the cultivation of the\nground and the need of menials, warriors found some other use for their\nprisoners taken in strife besides merely cutting off the phallus as a\ntrophy; these prisoners began to have some intrinsic value. From this a\nchange came about; the warrior instinct, however, still claimed that the\nvanquished, even if a slave, should still convey or carry some sign of\nservitude. The original idea of the ablation of the phallus was to\nemasculate the victim; investigation developed the idea that the same\nobject could be accomplished by castration, an operation which also\nfinally reached a tolerable state of perfection through different stages\nof evolution, it first being performed by a complete removal of the\nwhole scrotum and contents. This operation, with the ignorance of the\ntimes in regard to stopping haemorrhage, was, however, accompanied by a\nlarge mortality, and it finally evolved into the simple removal of the\ngland, or its obliteration by pressure or violence. Bergmann conveys the\nidea that circumcision was at one time the indestructible marking and\nthe distinctive feature of the slave, the mind of the period not being\nable to emancipate itself from the idea that the genitals must in some\nmanner be mutilated, not being able to conceive any other degrading mark\nof manhood which barbarians felt they must inflict on slaves.\n\nThe generally accepted idea in regard to the physical mutilation of\ncaptives taken in war, or that some token from the body of the\nvanquished must be carried off by the victor, has not only the support\nof tradition and monumental sculptured evidence, but its practice is\nstill in vogue among many races. Among the ancient Scythians, only the\nwarriors who returned from the battle or foray with the heads of the\nenemy were entitled to a share in the spoils. Among the modern Berbers\nit is still a practice for a young man, on proposing marriage, to\nexhibit to his prospective father-in-law the virile members of all the\nenemies he has overcome, as evidence of his manhood and right to the\ntitle of warrior. The Abyssinians and some of the negro tribes on the\nGuinea coast still follow the custom of securing the phallus of a fallen\nfoe. However barbarous this practice may seem, its actual performance is\nonly secondary, the primary motive being that the warrior wished to\nprove that he had been there, engaged in actual strife, and that his\nenemy had been overcome. The writer remembers that, after one of the\nbattles in the West during the late war, many letters arrived in his\nlocality with pieces of the garments or locks of the hair of the\nunfortunate Confederate general, Zollikoffer, who had been slain in the\nbattle; a disposition in the warrior, seemingly still existing, such as\nanimated the old Egyptians. On an old Egyptian monument,--that of\nOsymandyas,--Diodorus noticed a mural sculpture, a _bas-relief_\nrepresenting prisoners of war, either in chains or bound with cords,\nbeing registered by a royal scribe preparatory to losing either the\nright hand or the phallus, a pile of which is visible in one corner of\nthe foreground; from this sculpture we learn that the practice was not\nonly an individual performance, but that it was a national usage among\nthe Egyptians as well, who subjected, at times, their vanquished foes to\nits ordeal in a wholesale but business-like manner.\n\nBergmann argues that the Israelites were given to like practices, and\ncites the incident wherein David brought two hundred prepuces--as\nevidence of his having slaughtered that number of Philistines--to Saul,\nas a mark of his being worthy to be his son-in-law. He argues that,\nwhereas many have made that Old Testament passage to read \"two hundred\nprepuces,\" it should have read \"two hundred virile members\" which David\nand his companions had cut off from the Philistines, the word _orloth_\nmeaning the virile member, and not the prepuce. That Israelitish\ncircumcision could have originated from either phallic worship or any of\nthe hero-warrior usages is untenable as a proposition, as regards the\nliving prisoners, and is contrary to the monotheistic idea which ruled\nIsrael, or to the benign nature of their God. The strict opposition of\nthe religion of Judaism to any other mutilation except that of the\ncovenant is also antagonistic to the views advanced by Bergmann, as it\nis well known that even emasculated animals were considered imperfect\nand unclean, and therefore unfit to be received or offered as a\nsacrifice to their deity. No emasculated man was allowed to enter the\npriesthood or assist at sacrifices. The whole idea of Judaism being\nopposed to such mutilations, their observance of circumcision and its\nperformance can in no way have developed from either phallic or other\nwarlike rites or usages; but we must accept its origin as a purely\nreligious rite,--a covenant of the most rigid observance, coincident in\nits inception with the formation of the Hebraic creed in the hills of\nChaldea.\n\nWhat Herodotus or Pythagoras may have written concerning the practice\namong the Egyptians was written, as already remarked, some nine\ncenturies after Moses had recorded his laws; Moses himself having come\nsome centuries after Abraham. Herodotus is quoted as representing that\nthe Phoenicians borrowed the practice from the Egyptians, in support of\nthe theory that Egypt was the central nucleus from whence the practice\nstarted, and not that it traveled toward Egypt from Phoenicia. The\ndifference in the ages, already mentioned, at which the rite was\npracticed--that of Phoenicia and Israel being at one time\nidentical--shows that the testimony of Herodotus in this one particular\nwas the result of faulty judgment, as we find the people who have\nborrowed the practice from the Egyptians, as well as their descendants,\nclosely follow their practice in regard to the age at which the\noperation should be performed. Another evidence of the strictly\nreligious nature of the rite, as far as the Hebrews are concerned, lies\nin the fact that, with all their skill in surgery and medical\nsciences,--they being at one time the only intelligent exponents of our\nscience,--they never made any alteration or improvement in the manner of\nperforming the operation. It is evident that even Maimonides, a\ncelebrated Jewish physician of the twelfth century, who furnished some\nrules in regard to the operation, was held under some constraint by the\nreligious aspect of the rite. As a summary of this part of the subject,\nit may be stated that the Old Testament furnished the only reliable and\nauthentic relation prior to Pythagoras and Herodotus. From its evidence,\nAbraham was the first to perform the operation, which he seems to have\nperformed on himself, his son, and servants,--in all, numbering nearly\nfour hundred males; he then dwelt in Chaldea. In absence of other as\nreliable evidence we must accept this testimony in regard to its origin,\ncauses, and antiquity.\n\nVoltaire, in his article on circumcision in his \"Philosophical\nDictionary,\" seems more intent on breaking down any testimony that might\nfavor belief in any religion than to impart any useful light or\ninformation. He bases all his arguments on the book \"Euterpe,\" of\nHerodotus, wherein he relates that the Colchis appear to come from\nEgypt, as they remembered the ancient Egyptians and their customs more\nthan the Egyptians remembered either the Colchis or their customs; the\nColchis claimed to be an Egyptian colony settled there by Sesostris and\nresembled the Egyptians. Voltaire claims that, as the Jews were then in\na small nook of Arabia Petrea, it is hardly likely that, they being then\nan insignificant people, the Egyptians would have borrowed any of their\ncustoms. To read Voltaire's \"Herodotus\" is somewhat convincing, but\nVoltaire's \"Herodotus\" and Herodotus writing himself are two different\nthings, and the book \"Euterpe\" says quite another thing from what M.\nVoltaire makes it say. A perusal of Voltaire and a study of his Jewish\ncritics on this subject, as found in the \"Jews' Letters to Voltaire,\"\nwill convince any reader that as to circumcision M. Voltaire is an\nunreliable authority.\n\n\n\n\nCHAPTER III.\n\nSPREAD OF CIRCUMCISION.\n\n\nFrom Chaldea, then, in the mountains of Armenia and Kurdistan, the\npractice of circumcision was, in all probability, first adopted by the\nPhoenicians, who finally relinquished the Israelitish rite as to age of\nperformance and exchanged it for the Egyptian rite. From Phoenicia its\nspread through the maritime enterprises of this race to foreign parts\nwas easy. Egypt was the next place to adopt its practice; at first the\npriesthood and nobility, which included royalty, were the only ones who\navailed themselves of the practice. The Egyptians connected circumcision\nwith hygiene and cleanliness; this was the view of Herodotus, who looked\nupon the rite as a strictly hygienic measure. History relates of the\nexistence of circumcision among the Egyptians as far back as the reign\nof Psammetich, who ruled toward the end of the sixth century B.C. The\npractice must then have been of a very religious and national nature, as\nwe are told that Psammetich, having admitted some noted strangers, whom\nhe allowed to dwell in Egypt without being circumcised, brought himself\ninto great disfavor among his subjects, and especially by the army, who\nlooked upon an uncircumcised stranger as one undeserving of favors.\nDuring the next century Pythagoras visited Egypt, and was compelled to\nsubmit to be circumcised before being admitted to the privilege of\nstudying in the Egyptian temples. In the following century these\nrestrictions were removed, for neither Herodotus nor Diodorus, who\nvisited the country, were obliged to be circumcised, either to dwell\namong the people or to follow their studies. There is one curious habit\nthat is mentioned in connection with the rite of circumcision among\nthese people, this being its relation to the taking of an oath or a\nsolemn obligation. Among the Egyptians the circumcised phallus, as well\nas the rite of circumcision, seemed to be the symbol of the religious as\nwell as of the political community, and the circumcised member was\nemblematical of civil patriotism as well as of the orthodox religion of\nthe nation. To the Egyptian, his circumcised phallus was the symbol of\nnational and religious honor; and as the Anglo-Saxon holds aloft his\nright hand, with his left resting on the holy Bible, while taking an\noath, so the ancient Egyptian raised his circumcised phallus in token of\nsincerity,--a practice not altogether forgotten by his descendants of\nto-day. It was partly this custom of swearing, or of affirming, with the\nhand under the thigh, by the early Israelites, that caused many to\nbelieve that their circumcision was borrowed from the Egyptians,\nespecially by M. Voltaire, who insists that it was the phallus that the\nhand was placed on, and that the translation has not the proper meaning,\nas given in the Bible.\n\nAmong the Arabs it was the practice to circumcise at the age of thirteen\nyears, this being the age of Ishmael at his circumcision by his father,\nAbraham. The Arabs practiced circumcision long before the advent of\nMohammed, who was himself circumcised. Pococke mentions a tradition\nwhich ascribes to the prophet the words, \"Circumcision is an ordinance\nfor men, and honorable in women.\" Although the rite is not a religious\nimposition, it has spread wherever the crescent has carried the\nMohammedan faith. Uncircumcision and impurity are to a Mohammedan\nsynonymous terms. Like the Abyssinians, the Arabs also practice female\ncircumcision,--an operation not without considerable medical import, as\nwill be explained in the medical part of the work. This practice is also\ncommon in Ethopia. Some authorities argue, from this association of\nfemale circumcision among the Southern Arabs, Ethiopians, and\nAbyssinians, that they did not derive their rite from the Israelites;\nbut there is not much room for doubt but that the operation came down to\nthe Arabians from Abraham through his son Ishmael. Considering the\noccupancy of Syria, Arabia, and Egypt by the French, and the intercourse\nwith these countries by the British, it is surprising that the\nprofession in the early part of the present century had not full\ninformation regarding the nature and objects of female circumcision as\npracticed in these countries. Delpesh observes, in relation to the\nOriental practice, that his information was too vague to determine\nwhether it was the nymphae or the clitoris that were removed, or whether\nit was only practiced in cases of abnormal elongations of these parts.\nM. Murat, however, writes at length on the subject, very intelligently,\nas well as Lonyer-Villermay, who, writing in the same work with Delpesh,\nthinks it is certainly the clitoris that is removed.[12] In Arabia, the\ntrade or profession of a _resectricis nympharum_ or she-circumciser is\nas stable an occupation with some matrons as that of cock-castration or\ncaponizing is the sole occupation of many a matron in the south of\nEurope. It is related by Abulfeda that, in the battle of Ohod, where\nMohammedanism came very near to a sudden end by the crushing defeat of\nthe prophet and his followers, Hamza, the uncle of the prophet, seeing\nin the opposing ranks a Koreish chief, whom he knew, thus called out:\n\"Come on, you son of a she-circumciser!\" As Hamza was among the slain,\nit is most likely that he met his death from the hands of the chief,\nwhose mother really followed that occupation. So extensive is the\npractice, that these old women sometimes go through a village crying out\ntheir occupation, like itinerant tinkers or scissors-grinders.\n\nThe present ceremonies attending the performance of the rite among the\nArabians are well described by Dr. Delange, a surgeon of the French\narmy, as witnessed by him in the province of Constantine, in Algeria.\n\nWith these Arabs, circumcision is performed on a whole class, so to\nspeak, at the same time, regardless of the trifling differences in their\nages. It is preceded by feasting, the total length of the feast being\nfor eight days. For the first seven days, all the Arabs of the quarter\nwhere the candidates for circumcision reside dress in their best. The\npoor have their mantles and clothes carefully washed, and the rich deck\nthemselves out in their gold and silver brocaded vests and pantaloons.\nDuring these seven days there is general rejoicing, and the Arabs spend\nmost of this time in the village street, racing, firing guns, or\nengaging in sham battles between the different camps, during which one\ncarries the green, or sacred banner, which is supposed to render the\nbearer invulnerable. The battle ends by the standard-bearer being fired\nat by all parties, and falling, but quickly rising again and waving the\nflag in token of its protecting power. The Arabs now adjourn to another\npublic place, where the notables and strangers are furnished seats on\ncarpets; here a dance to the music of tumtums and the singing of\ninvisible females takes place, the dancers being only males.[13] In the\nevening the women sing, to which the men listen in silence, this concert\nbeing kept up until midnight. On the seventh day, the women, decked out\nin their best, and with all their personal ornaments, accompanied by all\nthe young men, armed with their guns and pistols, repair to the\nextremity of the oasis, where they gather plates of fine sand. With this\nsand they return to the village, where it is exposed overnight to the\nglare of the full moon on the terraces of the house. This last day\ncloses with a grand banquet, given by the rich whose children are about\nto be circumcised, to which all the people are invited.\n\nThe next morning all the relatives of the candidates repair to the house\nwhere the rite is to be performed; the women going up into the second\nfloor, wherefrom they can look down into the court from a porch screened\nwith lattice-work, without themselves being seen. The men gather\ntogether on the ground-floor, together with the operator and his\nassistants and the children about to be circumcised, who are dressed in\nyellow, silken gowns. The child to be operated upon is seated in a pan\nof sand, while an assistant fixes his arms and holds the thighs well\nseparated from behind. The circumciser then examines the prepuce, the\nglans, and removes any sebaceous collection. This done, a compress with\nan aperture to admit of the passage of the glans is slipped over the\norgan; a small piece of leather, some six centimetres in diameter, with\na small hole in the centre, is now used, the free end of the prepuce\nbeing drawn through the aperture; a ligature of woolen cord is then tied\non to the prepuce next to the front of the leather shield, and, the\nknife being applied between the thread and the leather, the prepuce is\nremoved at one sweep; the mucous inner layer is then lacerated with the\nthumb-nails and turned back over to join the other parts. The surface is\nthen sprinkled with _arar_ or _genevriere_ powder and dressed with a\nsmall cloth bandage, the subsequent dressings consisting of _arar_\npowder and oil. During the operation the women in the gallery keep up an\nunearthly music by means of tumtums, cymbals, and all the kettles and\nsaucepans of the neighborhood, which are brought into requisition for\nthe occasion. This music is accompanied with songs and chants, each\nwoman striking out with an independent song of her own, either\nimprovised or suggested by the occasion. This not only serves to drown\nthe cries of the children, but it must, in a manner, assist to draw them\naway from the immediate contemplation of their sufferings. The prepuces\nare now gathered together and carried to the end of the oasis, where\nthey are buried with ceremony and rejoicings. This circumcision only\ntakes place once in three or four years, and the children are from four\nto eight years of age; of fifteen circumcised at the feast witnessed by\nM. Delange, only two had passed their eighth year.\n\nIn a very interesting old book,[14] \"The Treaties of Alberti Bobovii,\"\nwho was attached to the court of Mohammed IV, published with annotations\nby Thomas Hyde, of Oxford, in 1690, there is a description of the\nTurkish performance of the rite which leads one to infer that they\ncircumcised the children quite young: \"Et cum puer prae dolore exclamat,\nimus ex duobus parentibus digitis in melle ad hoc comparato os ei\nobstruit; caeteris spectatoribus acclamantibus. O Deus, O Deus, O Deus.\nInterim quoque Musica perstrepit, tympana et alia crepitacula\nconcutiuntur, ne pueri planctus et ploratus audiatur.\" Bobovii says that\nthe age at which circumcision is performed is immaterial provided the\ncandidate is old enough to make a profession of faith,--which, however,\nis made for him by the godfather,--in the following words: \"There is no\nGod but God, and Mohammed is his Prophet,\" or, as rendered by our\nauthor, \"Non esse Deum nisi ipsum Deum, et Mohammedem esse Legatum\nDei.\" To which he adds that the child must not be an infant, but that he\nmust be at least eight years of age. Like to the Arabs, the Turks\ncelebrated the occasion by feasts, plays, and a general good time; the\nchild was kept in bed for fifteen days to allow complete cicatrization\nto take place. The circumcision was performed with the boy standing.\n\nMichel Le Feber, writing in 1681,[15] speaks of the tax levied on the\nChristians by the Turks, that they, the Christians, may enjoy liberty of\nconscience, and observes that, circumcision not being compulsory among\nthe Turks, it often led to trouble and annoyances, as many of the Turks\nevaded the operation. The tax-gatherers in Turkey are very industrious,\nand, as being circumcised was, as a rule, sufficient evidence of not\nbeing a Christian, he often witnessed on the streets scenes wherein\nstrangers, arrested by these tax-collectors, were compelled to show\ntheir circumcision as an indisputable sign of their exemption from the\ntax. He also relates that in their zeal for converts to Mohammedanism\nthe Turks often resorted to presents to induce Christians to embrace\ntheir faith. While in Aleppo, he saw a Portugese sailor, who, through\npresents, had forsaken his religion, but who had repented in the most\nemphatic manner when brought to face circumcision. Finding entreaties in\nvain, the Cadi ordered the immediate administration of a stupefying\ndraught, and the sailor was then seized and circumcised without further\nceremony.\n\nIn cases where the new Mohammedan is reasonable and submits like a hero,\nthe ceremonies are more elaborate. Le Feber relates that if the\ncandidate is a man of note or wealth he is mounted on a horse and\nexhibited all over the city; he is dressed in the richest of Turkish\nrobes and in his hand he holds an arrow with the point directed to the\nsky; he is followed by a great concourse of people, some dressed in\nholiday attire and others in fantastic costumes; and general feasting\nand enjoyment is the rule over the course of the march, where all the\npeople run to swell the crowd. If the man happens to be a poor man, he\nis simply hurriedly marched about on foot, with a simple arrow in his\nhand pointed skyward, to distinguish him from ordinary mortals; before\nhim a crier proclaims in a loud voice that the new religionist has\nennobled himself by professing the faith of the prophet in this solemn\nmanner. A collection for his benefit is taken up among the booths and\nshops, which is mostly appropriated by the conductor, circumciser, and\nhis assistants, after which he is circumcised without further ado.\n\nThe same author describes the operation as performed on the young Turks\nand the accompanying ceremonies. They differ in some respects from those\nemployed in circumcising a convert. The parents of the child give a\nfeast in proportion to their means, to which are invited the relatives\nof the family and personal friends; if of the upper ranks, he is\npromenaded about the town to the music of drums and cymbals, dressed in\nrich attire; two warriors lead the procession with drawn swords, and a\ntroop of females who sing songs of joy bring up the rear; the procession\nnow and then stops, when the two gladiators in the front indulge in a\nfierce set-to, hacking at each other in the most determined and\nmurderous manner, but so studiedly shammy that neither is injured; on\nthe return to the house, the child, who is usually eight or ten years of\nage, is bound hand and foot to prevent his causing any injury to\nhimself, laid on a bed, and circumcised with a razor, the operation\nbeing performed either by a surgeon or the chief of a mosque.\n\n\n\n\nCHAPTER IV.\n\nCIRCUMCISION AMONG SAVAGE TRIBES.\n\n\nE. Casalis,[16] who, in the capacity of missionary, for a very long time\nresided among the Bassoutos, tells us that among that nation the\noperation is performed at the age of from thirteen to fifteen years. The\nceremony is gone through once in three or four years. So important an\nevent is it considered by the Bassoutos that they date events from one\nof these observances, as the Romans dated events from a certain\nconsulship, or the Greeks from an Olympiade. At the time fixed, all the\ncandidates go through a sham rebellion and escape to the woods; the\nwarriors arm and give chase, and, after a sham battle, capture the\ninsurgents, whom they bring back as prisoners, amidst dancing and great\nrejoicings, which are the preludes to the feast. The next day the huts\nof mystery (_mapato_) are erected, where, after the circumcision, the\nyoung men are to reside for some eight months, under the tutorship of\nexperienced teachers, who drill them in the use of the spear, sword, and\nshield, teaching them to endure hunger, thirst, blows, and all manner of\nhardships; prolonged fasts and cruel flagellations being regarded as\npastimes between the exercises. The severity of the regulations may be\njudged from the fact that the instructors have a right to put to death\nany one who may try to escape from these ordeals. The women are\nrigorously excluded from these camps, but the men are allowed to visit\nthem, when they have the privilege of assisting the teachers by adding\nadditional blows and precepts to the backs of the unlucky candidates.\nAfter eight months of such training, the young men are oiled from head\nto foot and dressed in a garment, and are now given the name which they\nare to bear for the rest of their lives. The _mapato_, or mystery hut,\nis now burned to the ground and the young men return to the village. The\nmaternal uncle of the youth here presents him with a javelin for his\ndefense, and a cow that is to furnish him with nourishment. Until the\ntime of his marriage, the newly circumcised dwell together; their duties\nbeing of a menial character, such as gathering wood and attending to the\nflocks and droves.\n\nM. Paul Lafargue looks upon circumcision among the negro races as being\na rite commemorating their advent to manhood; Livingstone, who has also\nobserved the above, related incidents in relation to the performance of\n_boguera_, or circumcision, among the Bassoutos, believes that with them\nthe rite has a purely civil significance, being in no way connected with\nreligion.\n\nAmong many of the African tribes the young maids have an ordeal\napproaching to circumcision that they must pass when near the age of\nthirteen, this rite bearing precisely the same relation regarding their\nentrance into the state of womanhood that male circumcision denotes the\nentrance into manhood on the part of the males among the Bassoutos. At\nthe appointed time the maids are gathered together and conducted to the\nriverbank; they are placed under the care of expert matrons. They here\nreside, after having undergone a kind of baptism; they are maltreated,\npunished, and abused by the old women, with a view of making them hardy\nand insensible to pain; they are also schooled in the science and art of\nAfrican household duties. Among the Gallinas of Sierra Leone, in\naddition to the other observances, the clitoris of the young maid is\nexcised at midnight, while the moon is at its full, after which they\nreceive their name by which they are to be known through life. The\ninitiation of each sex into these mysteries is exclusively for the sex\nengaged, and it would be as fatal for a man to steal into the camp of\nthe women during the performance of these ceremonies as it would be\nfatal for a woman to enter a _mapato_ where the young men are undergoing\ntheir ordeal. After their initiation into womanhood, the maids live by\nthemselves, similarly to the young men, until they marry.\n\nLafargue relates that among the Australians circumcision is held in such\nimportance that tribes at war will suspend all hostilities and meet in\npeace during the observance or performance of the rite. Here, again, we\nhave a repetition, with a slight variation, of the practices of the\nBassoutos,--something which gives some countenance to the hero-warrior\nidea of the origin of circumcision advanced by Bergmann. The Australian\nwarriors go through a mimic battle, and, after a series of combats,\nfinally capture the boys aged about from thirteen to fourteen years,\nwhom they bear away amidst the cries and lamentations of the mothers and\nother female relatives, who, in their excess of grief, mutilate\nthemselves by cutting gashes into their thighs, so that they bleed\nprofusely. The boys are, in the meantime, carried to some out-of-the-way\nplace, where an old man, perched on a tree or some rising ground,\nthrough the means of a musical instrument made of a deal-board and human\nhair, announced that the rite is in process of performance, so that\nneither women nor children might approach. Tufts of moss are placed in\nthe axilla and on the pubis, to represent puberty, and among some tribes\nthe skin of the penis is divided to the scrotum with a stone knife,\nwhile others content themselves with simply making a circular incision,\nwhich removes the prepuce, after the Jewish manner, the excised portion\nbeing placed as a ring on the median finger of the left hand. The\ncircumcised then takes himself to the hills or woods, and there remains\nuntil healed, carefully guarding himself against the approach of any\nfemale. After this the third part of the ceremonies takes place: the\ngodfather of the youth opens a vein in his own arm, the circumcised\nyouth is placed on all-fours, and an incision is made from the neck down\nas far as the lumbar region, and the blood of the godfather is made to\nflow and mingle with that of the godchild; this being in reality a\nbloody baptism, and a near relation to the blood-compacts of the Arabs.\n\nThe Malays, as well as the men of Borneo, are circumcised. The Battos\nlikewise perform the rite. Among the Islanders they sometimes ligate the\nprepuce so that it drops off. Among the Battos the same object is\nreached by small bamboo sticks, between which the prepuce is fastened.\nIn New Caledonia and Tidshi the boys are circumcised in their seventh\nyear. The Tonga Islanders split the prepuce on the dorsum with a piece\nof bamboo or of shell. In the Marquesas and Sandwich Islands the\noperation is superintended by the priests.[17]\n\n\n\n\nCHAPTER V.\n\nINFIBULATION, MUZZLING, AND OTHER CURIOUS PRACTICES.\n\n\nIt seems a matter of controversy as to whether the Mexicans did or did\nnot circumcise their children. That they had a blood-covenant is\nadmitted by the historians, as well as the fact that this blood was\ntaken from the prepuce; but that the prepuce was actually removed is\nsomething that is not agreed upon by all authorities. Las Casas and\nMendieta state that it was practiced by the Aztecs and Totonacs, while\nBrasseur de Bourbourg found traces of its practice among the Mijes. Las\nCasas states that on the twenty-eighth or the twenty-ninth day the child\nwas presented to the temple, when the high-priest and his assistants\nplaced it upon a stone and cut off the prepuce, the excised part being\nafterward burnt in the ashes. Girls of the same age were deflowered by\nthe finger of the high-priest, who ordered the operation to be repeated\nat the sixth year; and once a year, at the fifth month, all the children\nborn during the year were scarified on the breast, stomach, or arms, to\ndenote their reception as servants of their god. Clavigero, on the other\nhand, denies that circumcision was ever practiced. It was customary in\nMexico, according to most authorities, to take the children while\ninfants to the temple, where the priests made an incision in the ear of\nthe females, and an incision in the ear and prepuce of the males.[18]\n\nGrotins and Arias Montan at one time advanced the idea that the western\ncoast of South America was peopled by some mutinous sailors from the\nfleets of King Solomon, who, in their endeavor to go away far enough to\nbe out of reach, were driven by winds and chance to the Peruvian coast.\nOthers have imagined that some of the lost tribes of Israel found their\nway eastward to America, by the way of China, to the Mexican coast. The\nsame ideal tradition has made the lost tribes the fathers of the\nIroquois Nation in the northeastern parts of the United States. An\nauthor, who will be quoted in another part of this work, scouts the idea\nthat the rite, as performed in America, had any connection or common\norigin with the rite performed in Asia and Africa; but, true to his\ntheory of the climatic causes of the origin of circumcision, he\nmaintains that it originated here as it did elsewhere, being a\nperformance born of climatic necessity. He is, however, dissatisfied\nwith Father Acosta for not being more explicit in relation to the _modus\noperandi_ of the Mexican circumcision. The want of being explicit, and\nits consequences in this particular regard, may be inferred from a\n\"Diatribe on Circumcision,\" by a Mr. Mallet, in an encyclopaedic\ndictionary of the last century, in which Mr. Mallet informs his readers\nthat Mexicans were in the habit of _cutting off the ears and prepuces_\nof the newly born. Herrera and Acosta agree with Clavigero in asserting\nthat the Mexicans simply _bled_ the prepuce. Pierre d'Angleria and other\ncontemporary writers are as emphatic in asserting that in the island of\nCosumel, in Yucatan, on the sea-board of the Gulf of Mexico and on the\nFlorida coast, they have observed circumcision by the complete removal\nof the prepuce with a stone knife. The Spanish monk, Gumilla, relates\nthat the Saliva Indians of the Orinoco circumcised their infants on the\neighth day. These Indians also included the females in the observance\nof the rite. The same author tells us of the barbarous and bloody\nperformances, in relation to the rite, of the nations on the banks of\nthe Quilato and the Uru, as well as those dwelling along the streams\nthat empty into the Apure. The same is said of the Guamo and of the\nOthomacos Indians; according to Gumilla, many of these Indians, in\naddition to the rite of circumcision, inflicted a number of cuts on the\narms, legs, and over the body, to a degree that amounted to butchery,\nthe child being reserved for this inhuman treatment until the age of ten\nor twelve years, that he might, by his greater powers of resistance and\nof recuperation, stand some chance of escaping alive from the ordeal.\nThe friar mentions that in 1721 he found a child dying from this\ntreatment, the wounds having become gangrenous and the child dying of\npyaemia; prior to the operation the children were stupefied with some\nnarcotic drink, and were insensible during its performance.[19]\n\nBesides circumcision, the Americans practiced several other operations\nthat bore an analogy to the operation of infibulation, a procedure\ncommon to the Orient and to early Europe, and so ancient that, like\ncircumcision, its source is in the misty clouds of antiquity. It\nconsisted in introducing a large ring, either of gold, silver, or iron,\nthrough an opening made into the prepuce, the free ends being then\nwelded together. Females were treated likewise, the ring including both\nlabia. In some countries an agglutination of the parts induced by some\nirritant or a cutting instrument answered the purpose among females.\nDunglison mentions that the prepuce was first drawn over the glans, and\nthen that the ring transfixed the prepuce in that position; that the\nancients so muzzled the gladiators to prevent them from being enervated\nby venereal indulgence. The ancient Germans lived a life of chastity\nuntil their marriage, and to their observance of a chaste life can be\nattributed the superior physical development of the race, as both males\nand females were not only fully developed, but were not enervated by\neither sexual excess or inclinations before having offspring, which were\nnecessarily robust and healthy. To obtain the same results in a nation\ngiven to indolence and luxury, and lax in its morality, some physical\nrestraint was required, and we therefore find the practice of\ninfibulation coming from the warm countries to the East. The ancients\nnot only infibulated their gladiators to restrain them from venery, but\nthey also subjected their chanters and singers to the same ordeal, as it\nwas found to improve the voice; comedians and public dancers were also\nrestrained from ruining their talents by the means of infibulation. In\nan old Amsterdam edition of Locke's \"Essay on the Extent of the Human\nUnderstanding,\" there is a quotation from the voyages of Baumgarten,\nwherein he states having seen in Egypt a devout dervish seated in a\nperfect state of nature among the sand-hillocks, who was regarded as a\nmost holy and chaste man for the reason that he did not associate with\nhis own kind, but only with the animals. As this was by no means an\nuncommon case, it led the Greek monks, in Greece and Asia Minor, to\nresort to every expedient to protect their chastity; in some of the\nmonasteries not only were the monks muzzled by the process of\ninfibulation, but they even had rules that excluded all females, either\nhuman or animal, from within their convent,--a habit that still prevails\namong many of the convents of the Orient to this day,--that on Mount\nAthos especially, omitting the infibulation of the ancients.\n\nReaders living in the climates of extreme ranges and of seasonal change\ncannot understand the physical temptations that beset mortals in certain\nclimates, any more than they can imagine the faultless condition of the\nclimate itself. The subject of climatic influences will be more fully\ndiscussed further on; but climate, as a factor of habits and usages in\none part of the world, that are incomprehensible to those living in\nothers, plays a part that is but little appreciated or understood;\nwhether it be the question of diet, dress, or custom, climate exerts its\ninfluence in no uncertain manner. As Sulpicius Severus remarked to the\nGreek monks, when they accused the Gaulish monks with voracity and\ngluttony, \"That which you of Greece consider as superfluous, the climate\nof Gaul renders into a positive necessity.\" So of all physical needs and\npassions,--they are subject to a similar law. Those who have read Canon\nKingsley's small work on the \"Hermits of Asia, Africa, and Europe\" will\nappreciate the above remarks; and it may be incidentally mentioned that\nhis description of the climate that is common to the hilly country\nbordering on the eastern half of the Mediterranean Sea gives as vivid\nand as graphic a description of the physical condition of the climate\nand of its effects as can well be written. It occurs in the life of the\nhermit Hilarion, and the description given relates to his last home in\nthe ruins of an old temple, situated on a cliff in the island of Cyprus,\nwhere the air is so invigorating that \"man needs there hardly to eat,\ndrink, or sleep, for the act of breathing will give life enough.\" The\nwork gives the best insight also into origin and causes that led to\nmonachism, as well as it tells the benefit that the condition conferred\non humanity, showing a phase in the march of civilization that is but\nlittle understood.\n\nBut, to return to the subject of infibulation, which has, in a manner,\nnecessitated this digression from the main topic. Thwing[20] informs us\nthat in ancient Germany woman was considered the moral equal of man, and\nthat woman might traverse the vast stretches of country unprotected and\nunharmed. Woman never held such a position in the Oriental countries;\nneither has man, under the sub-tropics, a like self-command as shown by\nthose ancient Gauls. So that, with the advent of Christianity and the\nmoral revolution that followed, primitive methods, either inflicted on\nothers or self-inflicted, were adopted to insure a chaste life.\nInfibulation was known, as already stated, for centuries, and in those\nrude times it seemed as the most natural and effective mode of\naccomplishing the object. It was not as barbarous an operation as\nemasculation on the male, as it only temporarily interfered with his\nfunctions.\n\nIn the Old World the practice is still performed in various manners. In\nEthiopia, when a female child is born the vulva is stitched together,\nallowing only the necessary passage for the needs of nature. These parts\nadhere together, and the father is then possessed of a virgin which he\ncan sell to the highest bidder, the union being severed with a sharp\nknife just before marriage. In some parts of Africa and Asia, a ring, as\nbefore stated, transfixed the labia, which, to be removed, required\neither a file or a chisel; this is worn only by virgins. Married women\nwear a sort of muzzle fastened around the body, locked by means of a key\nor a padlock, the key being only in the possession of the husband. The\nwealthy have their seraglios and eunuchs, that take the place of the\nbelt and lock. Another method is a mailed belt worn about the hips, made\nof brass wire, with a secret combination of fastenings, known only to\nthe husband. In the museum in Naples are to be seen some of these\nbelts, studded with sharp-pointed pikes over the abdominal part of the\ninstrument, which was calculated to prevent even innocent familiarity,\nsuch as nest-hiding, to say nothing of greater evils.\n\nIn the \"Les Femmes, Les Eunuchs, et Les Guerrieres du Soudan,\" Col. Du\nBisson mentions a very peculiar custom invented by the careful jealousy\nthat is inseparable from harem life. He had noticed that many of the\nharem inmates, contrary to the general Oriental custom, were allowed to\ngo about unattended by the usual guard of eunuchs, but that they walked\nin a painful, hesitating, and impeded manner. This walk was not the\nconventional, short, shuffling step that peculiarity of dress and\nshoe-wear imposes on the Japanese beauty, nor the willowy, swaying gait\nproduced in the Chinese beauty by the lack of a sufficiency of foot;\nneither could it be ascribed to the presence of the ancient jingling\nchain of bells which induced the mincing steps of the virgins of\nJudea,--an invention which confined the lower limbs within certain\nlimits by being worn just below the knees, and calculated to prevent the\nrupture of the hymen by any undue length of step or violent exercise;\nhence a tinkling noise and a mincing step always denoted a virgin. In Du\nBisson's cases, however, virgins were out of the question; they might be\nthe victims of enforced continence, but a Soudanese harem contains no\nvirgins. On inquiry he learned that the very peculiar and unmistakably\npainful gait was due to the fact that each woman carried a bamboo stick,\nabout eight inches in length, three inches or more being inserted in the\nvagina so as to effectually fill the opening, the balance projecting\nbeyond, between the thighs of the person; this bamboo stick, or guardian\nof female virtue, was held in place by a strap with a shield that\ncovered the vulva, the whole apparatus being strapped about the hips and\nwaist, and the whole being held in an undisplaceable position by a\npadlock. This was affixed to the woman whenever she was allowed outside\nthe harem grounds, being placed in position by the eunuch, who carried\nthe key at his girdle. In such a harness virtue can be considered\nperfectly safe; even safe from any mental depredation or revolution, as,\nwith the plug causing such uncomfortable sensations, it is perfectly\nsafe to infer that the imagination could not be seduced by any Don\nJuanic or other Byronic unvirtuous revelry. The physical ills that this\ncontrivance must cause are necessarily without number, as the instrument\nis not as lightly constructed as our modern stem pessaries; but to the\nOriental who can replace a woman at any time and who prizes the\nvirginity, continence, and chastity of his slaves, even if enforced,\nmore than their health or their lives, these are matters of secondary\nimportance. In the Soudan there are no divorce courts, hence the\nprobable necessity of the apparatus, and, as the woman is not obliged to\nwear it unless she chooses to go out unattended, it can hardly be\nconsidered as a compulsory barbarity. In the United States such a\npractice might do away with considerable divorce proceedings.\n\nCelsus gives a detailed description of the manner of infibulating as\npracticed among the Romans. According to this authority, it was employed\nby them on the youth attending the public schools, as well as upon the\nactors, dancers, and choristers, who were sold to the directors of the\nplays and spectacles. In the cabinet of the Roman College there are to\nbe seen two small statues representing two infibulated musicians, which\nare remarkable for the excessive size of the ring and the leanness of\nthe persons to which they are attached. The mode of applying this ring\ndid not differ much from the usual method of preparing the ear for\npendants.[21]\n\nAmong the Greek monks mentioned, the infibulation serves a manifold\npurpose; it not only is a sure badge of chastity, but its weight and\nsize is very often increased so as to render it an instrument of\npenitence, and considerable rivalry exists at times in this regard.\nVirey notices that the Hindoo bonze, or fakir, at times submits to\ninfibulation at the same time that he takes his vows of eternal\nchastity. This ring is at times enormous, being sometimes six inches in\ndiameter; so that it is a burden. These saints are held in great esteem\nand veneration.\n\nNelaton, in the sixth volume of his \"Surgery,\" mentions the case of a\nman who presented himself at Dupuytren's clinic with a tumefied,\nthickened, and somewhat dilapidated and ulcerated prepuce; this prepuce\nhad worn a couple of golden padlocks for five years, a woman having thus\ninfibulated his organ.\n\nIn an elaborate work on the subject of circumcision,[22] de Vanier du\nHavre relates, on the authority of M. Martin Flaccourt, that with the\nMadecasses the children are circumcised on the eighth day after birth;\nand that in some portions of the country the mother swallows the removed\nportion of the prepuce, while in others the father loads the prepuce in\nsome form of fire-arm, which is afterward fired in the air. In the\nneighborhood of Djezan, in Arabia, as reported by M. Fulgence Fresnel in\nthe _Revue de Deux Mondes_ of 1838, courtship and matrimony are not so\ngreat social events as they are with our society beaux. The occasion is\nprobably considered social enough by the rest of the invited guests, but\nit can hardly be called an agreeable episode in the life of the groom.\nThose whose bashfulness prevents them from contracting marriage in\ncivilized communities can have the consolation of knowing that in\nfar-off Arabia, among the fierce followers of the conquerors of Spain\nand of the Eastern Empire, they have sympathizing fellow-sufferers whom\nthe conventionalities of the country deter from rushing into matrimony.\nIn this region, circumcision is performed on the adult at the time of\nhis candidacy for matrimonial bliss. A more inauspicious occasion could\nnot possibly have been chosen, unless as in another Mohammedan tribe,\nwho circumcise the bridegroom on the day after his marriage and sprinkle\nthe blood that falls from the cut onto the veil of the bride. The bride\nis present, and the victim is handed over to what might be called the\nexecutioner of the holy office, who proceeds to circumcise the victim in\nwhat might be called its utmost degree of performance and barbarity.\nThis attention does not stop at the pendulous and loose prepuce. He\ndevotes himself to the skin of the whole organ; beginning at the prepuce\nhe gradually works backward, removing the whole skin of the penis--a\nflaying alive, and nothing more. Should the victim betray any sign of\nweakness, or allow as much as a sigh or groan to escape him, or even\nallow the muscles of the face to betray the fact that he is not\nimmensely enjoying the occasion, the bride elect at once leaves him for\ngood, saying that she does not wish a woman for a husband. A large\nproportion of the male population annually die from this operation. So\nthat the Arabs of the Djezin can be likened to those spiders who lose\ntheir life while in the act of copulation,--the female making a dinner\nfrom off the male,--only the spider is said to die a happy death, while\nthat of the Arab is one of misery.\n\nMargrave and Martyr have recorded a very peculiar practice common among\nsome South American tribes: A kind of a tube is fastened onto the\nprepuce by means of threads of the _tacoynhaa_, the latter being the\nbark of a certain kind of a tree. Cabras brought one of the natives, so\nmuzzled, to Lisbon, on the return from his first voyage. Some tribes\nwere observed to wear an apparatus like the old-fashioned\ncandle-extinguisher, the virile member having been forced into this\nreceptacle, which was strapped about the loins.\n\nThe travelers Spix and Martius found the practice of circumcision of\nboth sexes in the region of the upper Amazon River and among the Tuncas.\nSquires mentions a curious custom of the aborigines of Nicaragua. They\nwound the penis of their little sons and let some of the blood flow on\nan ear of corn, which is divided among the assembled guests and eaten by\nthem with great ceremony.\n\nOn the fifth day after birth it is the custom among the Omaha Indians of\nNorth America to christen the infant, the child being stripped and\nspotted with a red pigment; considerable ceremony accompanies the\nact.[23]\n\nAmong the cannibals of Australia, Lumholtz[24] observed a practice that\nseems to have no analogue in the wide world, either as an operation or\nin regard to its purposes. About ninety-five per cent. of the children\nare subjected to the ordeal. This is no less than the formation of an\nartificial hypospadias; this abnormality is formed through the penis\ninto the urethra, near its junction with the scrotum; the wound is about\nan inch in length and is made with a flint knife which serves for no\nother purpose; the edges of the wound are burned with a hot stone, and\nthe wound is subsequently kept open by the introduction of a small piece\nof wood, which, on healing, leaves a permanent opening. These cannibals\nundoubtedly are inspired by some Malthusian spirit which impels them\nthus to functionally eunuchize themselves in one sense, as during\ncopulation the seminal discharge flies out backward through this\nopening, being thereby a most effectual check on further procreation. By\nsome, this practice has been attributed to the unreliability of the\nseasons in regard to food-production; but Lumholtz observes that where\nthe practice is most in vogue--among the tribes to the west of the\nDiamantina River and west and north of the Gulf of Carpentaria--the\nfood-supply is not deficient, the region being full of rats, fish, and\nvegetables. All the tribes are not subject to the practice of the\noperation at the same time of life; in some, the hypospadias is not\nproduced until in adult life and after the person has married and has\nbecome the father of one or two children, when he must submit to the\nrequirements of the law; the operation seems to be invested with some\ncivil or religious significance, as a palisade or stockade of trees is\nplaced around the place where it is performed. A native, aged about\ntwenty years, informed Lumholtz that the operation was performed because\nthe blacks did not like to hear the children cry about the camp, and,\nfurther, that they were not desirous of having many children; this\nnative had not yet become a father and had not yet been subjected to the\noperation. The natives were observed to be fat and in good physical\ncondition.\n\nThere is something mysterious in this operation. It can easily be\nconceived how circumcision might at times have been suggested by its\nspontaneous and natural performance without any assistance from man.\nCullerier reports one case of partial circumcision through the means of\nan accident happening to a painter. The man was at work on a ladder,\nwith a small bucket of paint hooked into one of the rounds above him;\nthrough some means the bucket lost its hold and in falling struck the\npenis on its dorsum with such force that the prepuce was cut through on\na parallel with the corona of the glans for fully two-thirds of its\ncircumference, the glans slipping through the opening and gathering in a\nfleshy bunch underneath the frenum. This man carried this abnormality\nfor some years, when, desiring to marry and seeing that this appendage\nwould be as much of an impediment as one of the huge rings worn by the\nHindoo devotee, he applied to Cullevier for advice, who promptly removed\nit with the knife.[25] The writer has seen three cases, during his\npractice, of spontaneous circumcision, all resulting from phymosis as a\nsecondary affection to venereal disease. The first case occurred when he\nfirst entered into practice; it was in a young, stout, and full-blooded\nman with a violent gonorrhoea. There was much swelling and tumefaction\nof the whole organ, which seemed to be very rebellious to all treatment.\nAt one of his morning visits he was horrified to observe a transverse,\nlivid mark at what seemed to be the middle of the organ; by noon this\nhad gained ground to the right and left and there was no mistaking that\nit meant nothing less than mortification. Never having seen a case, the\nnatural uncomfortable conclusion was that, through some cause or other\nor the natural result of excessive congestion, the man was about to lose\none-half of his organ; and Burnside at Fredericksburg was in no greater\nstate of suspense and uncertainty with the fate of the Army of the\nPotomac on his hands than the writer must acknowledge he was with this\nman and his organ apparently liquefying under his treatment. The\nsurprise can be better imagined than described when, on the following\nmorning, the glans made its appearance safe and sound out of its\nimprisonment, and at right angles with the organ there hung the prepuce,\nthick and as large and as long as the penis itself, inflammatory deposit\nand infiltration having brought it to that shape and consistence; the\nglans became completely uncovered; the parts gathered underneath, where,\nin the course of some weeks, they had shrunk to the size of a walnut,\nwhich was afterward removed by the knife. In this case, as in the other\ntwo cases observed, the corona was very prominent and acted as an\ninternal tourniquet by its upward pressure, the line of demarkation\nbeing on the dorsum in the three cases noted.\n\nThat such cases would suggest circumcision is not only probable but\npossible, as it would point out the manner of performing the operation;\nbut, in the cases of the Australian savages, who performed an artificial\nhypospadias on themselves for a specific purpose, requiring a knowledge\nof the anatomical relation of the parts as well as of their\nphysiological functions, it is hard to speculate how the operation was\nfirst suggested or how it came at first to be performed. As a Malthusian\nagent it is certainly an operation of the highest merit, and it should\nbe introduced, by all means, in the United States, where the wealth and\nluxury in which the people dwell is fast drifting them toward the same\nwhirlpool that engulfed Rome, which was preceded by a dislike to have\nchildren. Whenever the writer sees the poor anaemic, broken-down victim\nof many miscarriages, he cannot help but feel that, if the laws of the\nDamiantina River savages were enforced on their husbands, it would be a\nblessing to the poor women without materially injuring the husbands,\nwho, in case of need of a re-establishment of the functions of\nprocreation, might be fitted with a vulcanite plate for the\noccasion,--something like our cleft-palate patients are supplied with a\nplate that enables them to articulate.\n\nIt was the custom among the Hottentots, when first discovered or known\nto the whites, to remove one of their testicles. This was supposed to\nenable them to run more swiftly and to be lighter-footed in the race.\nThe real reason, afterward found, was a mixture of pure humanitarianism\nand Malthusianism boiled down to Hottentot ethics. With them a monorchid\nwas not supposed to beget twins; when twins are born in the family, the\nmother generally smothers the female, if one happens to be such; if not,\nthen the feeblest of the two is sacrificed. In their migratory and\nnomadic life the mother finds it impossible to either carry or care for\nthe two children. The male Hottentot, rather than have any avoidable\ninfanticide in his family, or that his wife should go through and suffer\nthe annoyance and pangs of an unnecessary and unprofitable pregnancy,\ngenerously has one testicle removed; this is something that the ordinary\ncivilized white man would not do, even if his legitimate wife and all\nhis outside concubines were to have twins or triplets every nine months;\nso that, even as strange as it may appear, civilization must need go to\nthe wild Bushmen in search of that grand old Quixotic chivalry that was\nin ancient times always ready to sacrifice itself for the welfare of\nwoman.\n\nThe old Greek and Roman statues, representing the gods and athletes of\nancient Greece and Rome, are a puzzle to many, owing to the diminutive\nand phimosed virile organ that the artists have attached to them. Galen\nrepresents that the disuse of the organ by the athletes was the cause\nof its undeveloped form, and that as the organ of these did not figure\nin the worship of Venus, or participate in the festivals of Bacchus, but\nwas used solely and simply for micturating purposes, impotence was often\nthe result, citing the case of a patient who came to consult him for an\nobstinate priapism resulting from venereal excess, who met, in his\nanteroom, an athlete who was being treated for the opposite condition,\ndue to the too rigid continence to which he had been for years\nsubjected. Acton does not believe that continued continence has that\neffect, quoting Dr. Bergeret, who had long been physician to a number of\nreligious societies, as saying that he had never seen serious troubles\nof the organs of generation in these communities, which denotes that if\nthey indulged in proper fasting and prayer they were in the same\ncondition of flaccid impotence as the athlete in Galen's anteroom. Louis\nVII, of France, tried fasting and prayer in connection with rigid\ncontinence, and, as a result, his wife, Queen Eleonore, was divorced\nfrom him and married Henry II, of England, who had not been continent.\nHence, we see that the old sculptors, whether wishing to represent\nJupiter or Plato, AEsculapius or Mars, a strongly knit and muscular frame\nwas desired, an athlete, gladiator, or soldier being used as a model;\nthe small, puerile, funnel-prepuced organ belonged to all these muscular\nor well-trained classes, was a natural appendage, as enforced continence\nand the most absolute chastity was the rule, to enforce which they even\nresorted to infibulation. This enforced continence often resulted in\nimpotence, even before the prime of life was passed, accompanied by an\ninevitable atrophy of the male organ, with the resulting prepuce in the\nshape in which it is found in a boy of from eight to twelve years,\nprecisely as they are found on the statues. How faithful the sculptors\nand artists were to nature and life in their representations can well be\nimagined by a critical examination of the Apollo Belvidere, where the\ndifference of the scrotal position that exists between the right and\nleft testicles is carried out to the minutest anatomical detail. In our\nage it is hard to conceive why their most masculine men should be\ndeified, and all their gods represented as the most perfect of bodily\ndevelopment, while at the same time the finest physical specimens of\nmanhood were doomed to a life of the most rigorous continence. It is\nalso astonishing that all this should be done not from any principle or\nconsideration of morality or virtue, but simply as a means subservient\nin producing at its maximum the highest degree of physical development\nand endurance.\n\n\n\n\nCHAPTER VI.\n\nATTEMPTS TO ABOLISH CIRCUMCISION.\n\n\nProbably no rite or practice of a custom has been such a long-standing\nbone of contention as circumcision; nor does the Sphynx surpass this\nrelic of bygone ages in mystery. From time immemorial its practice has\nbeen the subject of disputes, and its literature finds oftentimes its\nfriends and foes ranged side by side. At one time a noted Israelite and\nVoltaire, the scoffer of Judaism, may be consulted on the question as to\nwhether Israelite or Egyptian is entitled to priority as to its original\npractice with a like answer; and, again, Christians are found who, after\na careful investigation, will accord this to the Israelites. In Rome,\nthe persecuted Hebrew was stopped on the street and compelled to show\nthe mark of circumcision, that he might be taxed, and in Turkish parts\nthe Christian was subjected to the same indignity to enable the\ntax-gatherer to harvest the impost which he paid for his liberty of\nconscience and not being circumcised. When the monkish missionaries of\nthe Catholic faith first entered Abyssinia, they were shocked to find\ntheir converts insisting on their time-honored practice of circumcision;\nand later, when the Propaganda sent its own missionaries, they were\nscandalized to see Christians practicing what they looked upon as an\ninfidel rite; and nothing but the most earnest confession of faith, with\nthe assurance that the rite of circumcision was only a physical remedy,\nand that in their conscience it in no wise possessed any religious\nsignificance, and that neither did they, in any sense, hold it in any\nconnection with the sacrament of baptism, permitted these Abyssinians to\nsave themselves from excommunication. Later still, when an Abyssinian\nbishop was present in Lisbon, the clergy of the city refused him the\nright of celebrating the sacrifice of the holy mass in the Cathedral of\nLisbon, on the ground that he, having been circumcised, was no better\nthan a heretic. The Abyssinian Christians still practice the rite at the\npresent day.\n\nThe Turks, although very fanatical and greater proselyters than the\nChristians of Rome, seem now and then to relax in favor of general\nutility, as we find Bajazet II writing to the Pope, Alexander VI,\nsupplicating his Holiness to confer a cardinal's hat on the Archbishop\nof Arles as a special favor to the Turkish emperor, as he knew that the\narchbishop _had a secret leaning toward Mohammedanism_. As the clergy of\nthose days, from the Holy Father down, were more politicians than\nfollowers of the humble Nazarene, the heaven of Mohammed had probably\nmore attractions for their taste than the ideal Christian paradise, and\nit is possible that the good archbishop would have submitted to a\ncardinal's hat and circumcision at the same time to secure the good\nthings of this world and of those in the world to come. History also\nrelates that his most Christian majesty, Henry III, of France, as a\nrelaxation to the interminable squabble between two Christian religious\nfactions which were rending France, and which in the end cost him his\nlife, actually wrote a letter to the Sultan, asking the favor to be\nallowed to stand as godfather at the circumcision of his son. When it is\nremembered that the godfather at a Turkish circumcision has to make a\nstrong profession of Moslem faith and the answers as sponsor for the\nchild, and must promise that the child will be faithful to the Koran and\nMohammed, it will be seen that, however much the lower levels of\nhumanity may quarrel over trifles, the heads of the people easily\naccommodated themselves to any existing circumstances. Friar Clemens\nmight as well have let such a liberal-minded monarch live, as any of the\nexisting churches could easily have got along with him.\n\nOn the other hand, we have the remarkable tenacity to custom and habit\nin this regard, as exhibited by the Moslems, who, although having\nneither ordinance nor authority for its performance, either in their\nlaw, creed, or in any order from their prophet, still no more zealous\ncircumciser exists than the son of Islam, who exacts from all proselytes\nthe excision of the prepuce. Mohammed was circumcised in his boyhood,\nand, although he did not order its performance to his followers, he did\nnot see fit to proscribe a custom so general to the Arabians, where the\ngreater development of the prepuce probably renders circumcision a\nnecessity. From the same reason it is easy to perceive why the rite has\nfound such general observance among the Africans, who are as noted for\nlong and leathery prepuces as for their slim shanks. One author, writing\nin 1772, in a work entitled \"Philosophical Researches on the Americans,\"\ntreats the subject in a very intelligent manner. His arguments are both\ningenious and plausible. This author looks upon circumcision as of\npurely climatic origin in its inceptive causes. From a careful survey of\nthe natural history of man in his general distribution over the globe,\nhe finds that circumcision may be said to be restricted to within\ncertain boundaries of latitude, equidistant on both sides of the line.\nNo circumcised people have ever inhabited northern regions, and the bulk\nof the circumcised races are found within certain climates. From this\nreasoning it is easy to see why the rite should lose its standing under\ncertain climatic conditions, unless bolstered up by some religious\nsignificance, as it is equally easy to foresee why it should flourish\nelsewhere, even without any religious backing or ordinance. It is well\nknown that in Ethiopia and the neighboring countries, excrescences and\nelongation of either the prepuce or nymphae are as probable as the\nexistence of an enlarged thyroid gland or goitre among the inhabitants\nof some of the valleys of Switzerland or of those of the Tyrol.\nAccording to the author of the treatise just quoted, circumcision would\nbe nothing more than a remedy to repair the evils that a faulty\nconstruction of the human body developed in certain climatic conditions.\n\nWith the Israelites it is observed as a religious rite, although they\nare not strangers to the physical benefits that circumcision confers\nupon them; the fact that even where no prepuce exists, as sometimes\nhappens, the circumciser nevertheless goes on with the rite, being\nsatisfied with drawing a few drops of blood from the skin near the\nglans, stamps the operation essentially as being a religious rite.\nPersecutions have signally failed to suppress its performance by those\nof the Hebrew faith. Beginning with the decree of Antiochus, 167 B.C.,\nwhich consigned every Hebrew mother to death who dared to circumcise her\noffspring, they have not ceased to suffer in defense of their rite.\nAdrian, among other repressive measures, forbade circumcision; under\nAntonine this edict was still enforced, but he afterward recalled it and\ngave to the Hebrews the right of observing their religious rites. Marcus\nAurelius, however, revived the edict of Adrian. Heliogabalus, who\nascended the Roman throne in the year 218 A.D., was himself circumcised.\nDuring the reign of Constantine all the laws that interfered with\nHebraic rites were renewed, with the addition that any Hebrew who should\ncircumcise a slave should suffer death. Under the sway of Justinian, in\nthe sixth century, the persecutions against these people were so\noppressive that a Hebrew was not allowed to raise or educate his own\nchild in the faith of his fathers. In the seventh century, the augurs\nhaving prophesied the ruin of the Roman Empire by a circumcised race to\nthe emperor Heraclius, the persecutions were renewed against these\nunfortunate people. In this century, Hebrews refusing baptism suffered\nbanishment and confiscation of all their property; they were obliged to\nrenounce the Sabbath, circumcision, and all Hebraic rites if they wished\nto remain. About this period the success of the Saracens induced\npersecutions of the Hebrews in Spain, where their children were taken\naway from them that they might be raised in the Christian religion. In\nthe fifteenth century they suffered the greatest persecution and\nmartyrdom at the hands of the Spanish Inquisition. The persecutions\nabove cited were national and governmental persecutions levelled\ndirectly at the Jewish nation and creed; the persecutions that they\nmomentarily suffered at other times had no signification beyond the\nexhibition of popular spite and fury, but those above cited were moves\ncalculated to extirpate the creed, if not the people, from off the face\nof the globe. If repressive measures are of any avail, circumcision as\nan Hebraic rite should now have no existence. Its present existence and\nobservance show a vitality that is simply phenomenal; its resistance and\napparent indestructibility would seem to stamp it as of divine origin.\nNo custom, habit, or rite has survived so many ages and so many\npersecutions; other customs have died a natural death with time or want\nof persecution, but circumcision, either in peace or in war, has held\nits own, from the misty epochs of the stone age to the present.\n\nThere is something pathetic and soul-appealing in contemplating the\nearly Christians forced to worship in the catacombs of Rome, hunted like\nwild animals in their subterranean burrows, and then given the choice of\nmaking offerings to the heathen gods or being thrown into the arena as\nprey to wild beasts; so are we stirred when we think of the Spanish Jew,\nwho had made Spain his home for centuries, being driven into exile in\nsuch droves that no country could receive them; we see them perishing of\nhunger by the thousands on the African coast, and dying of starvation on\nthe quays of the ports of civilized Italy. That many, through all these\ntrials, were forced to embrace other religions is not astonishing. In\nSpain apostacy was to no purpose, as the Inquisition could not be\nexpected to split hairs in regard to an apostate Jew, when it sent the\nbest of Gothic blood, raised in the Catholic faith, to the _auto da fe_\nor the scaffold,--the rack respecting neither faith nor profession that\nfell into its clutches. In milder persecutions, however, he escaped by\noutwardly conforming to the demands of his oppressors and history tells\nus of the circumcisions secretly performed on the dead Jew, that the\nspirit of the law of their fathers might be carried out.\n\nIn other cases, threatened exile, confiscation, or exorbitant taxation\ndrove them to adopt every possible expedient to eradicate the sign of\ntheir Israelitism and make attempts to reform a prepuce. The first\nattempts in this line were made during the reign of Antiochus, when a\nnumber of Hebrews wished to become as the people about them who were not\npersecuted--_fecerunt cibi praeputia_. This is no easy operation, and in\nlater times by the aid of appliances, both in Rome and in Spain, they\nundertook to cause the skin to recover the glans. Martial, in speaking\nof the instrument used in Rome, a sort of a long funnel-shaped copper\ntube in which the Hebrew carried his virile organ, terms it _Judaem\nPondum_, the weight of which, by drawing down the skin, was supposed in\ntime to draw it down far enough to answer the purpose. The apostle Paul,\nin his epistle to the Corinthians, refers to these practices when he\nsays, \"Was any one called being circumcised, let him not be\nuncircumcised.\" The operation of reforming a prepuce, or of obliterating\nthe marks of circumcision, does not appear to have been a success.\n\nThe writer had one experience that was interesting. On one occasion he\nadvised circumcision for the relief of a reflex nervous disease, in a\ntall, athletic Austrian sailor from the Adriatic; although the nature of\nthe operation was explained to the man, he evidently did not appreciate\nits full nature and importance until a sweeping cut with a scalpel left\nthe excised prepuce in the operator's hand. Most Adriatic sailors have\nsailed up the Bosphorus and are more or less familiar with both the\nGreek and Turkish nations; the latter they despise with gusto, \"_porchi\ndi Turci_\" being the affectionate appellation they bestow on their\nnational neighbors. No sooner did he perceive the real condition of\naffairs than he began to beat his head, saying that he was disgraced\nforever, as he never would dare to associate with his countrymen again,\nas he would be liable to be taken for a _porcho di Turco_; his frenzy\nincreased to such a pitch that to spare any unpleasantness it was deemed\nadvisable to replace the prepuce, which was done accordingly, the man\nmaking a tolerable good recovery, as far as the grafted prepuce was\nconcerned. It required a secondary operation to overcome some\ncicatricial contraction, and, on the whole, he had a very serviceable\nprepuce; but, what was more to the point, it prevented his ever being\nmistaken for a Turk.\n\n\n\n\nCHAPTER VII.\n\nMIRACLES AND THE HOLY PREPUCE.\n\n\nWhat strange fancies have circled themselves about the subject of\ngeneration or its organisms during the different stages of moral\ncivilization since the world has existed! The efforts in this regard\namong different creeds have been something peculiar. Neither Mohammedans\nnor Hebrews--both zealous circumcisers--ever went to the lengths reached\nby Christian churches and their followers in some particulars concerning\nthis rite; this being especially strange when it is considered that the\nnew creed was the one that abolished the rite and through which the Jews\nsuffered such cruel and unjust persecutions. The early Christian Church\ncelebrated and continues to celebrate the Feast of Circumcision, and\nhistory relates some strange events in connection with this\ncircumcision. Having abolished and repudiated the rite, it would seem\ninconsistent that it should celebrate its performance on any occasion\nand consider such an event sufficiently memorable that its occurrence\nshould excite the veneration of the church and be the means of exciting\nthe pious zeal of the faithful. The strangest events in this connection\nare still more mysterious and incomprehensible, if not amusing, the only\nexcuse for the occurrence being the greedy thirst for relics of any and\nall kinds that in the middle ages pervaded Europe.\n\nAt some remote period--in the thirteenth or fourteenth century--the\nabbey church of Coulombs, in the diocese of Chartres, in France, became\npossessed in some miraculous manner of the holy prepuce. This holy\nrelic had the power of rendering all the sterile women in the\nneighborhood fruitful,--a virtue, we are told, which filled the\nbenevolent monks of the abbey with a pardonable amount of pride. It had\nthe additional virtue of inducing a subsequent easy delivery, which also\nadded to the reputation and pardonable vanity of the good monks. This\nlast virtue, however, we are told, came near causing the loss to the\nabbey of this inestimable prize, for, as a French writer observes, a too\ngreat reputation is at times an unlucky possession; at any rate, the\nroyal spouse of good and valiant King Henry V--he of Agincourt, whom\nEngland waded up to its knees in the sea at Dover to meet on his return\nfrom that campaign--had followed the example of all good dames and was\nabout to give England an heir. Henry then governed a good part of\nFrance. Having heard of the wonderful efficacy of the relic of Coulombs,\nhe early one morning threw the good monks into consternation by the\narrival at the convent gate of a duly equipped herald and messenger from\nhis kingship, asking for the loan of the relic with about as much\nceremony as Mrs. Jones would ask for the loan of a flat-iron or saucepan\nfrom her neighbor, Mrs. Smith. The queen, Catherine of France, was of\ntheir own country and Henry was too powerful to be put off or refused;\nthere was no room for evasion, as the holy prepuce could not be\nduplicated; so the poor monks with the greatest reluctance parted with\ntheir precious relic, entrusting it into the hands of the royal envoy,\nwhich wended its way to London, where it in due time, being touched by\nthe queen, insured a safe delivery. Honest Henry then returned the relic\nto France; but so great was its reputation that royalty caused a special\nsanctuary to be erected for its reception, and a full period of\ntwenty-five years occurred before the monks of Coulombs again regained\npossession of their prize, during which period the population of the\nneighborhood must have suffered from the natural increase of sterility\nand the physicians must have reaped a rich harvest owing to the\nincreased difficulty and complications of labor induced by the absence\nof the relic. On its return, the relic was found to have lost none of\nits virtues, and the good people and monks were all correspondingly made\nhappy; in 1870, when the writer was in France, it was still working its\nmiracles. Balzac found ample facts to found his famous \"Droll Stories\"\nwithout straining his imagination.\n\nSo great an attraction was not to go without attempted rivalry or\nimitators; hence we find in the \"Dictionary of Moreri,\" edition of 1715,\nin the third volume, at page 108, that several other establishments\nclaim the honor of a like relic,--namely, the Cathedral of Puy, in\nVelay; the collegial church of Antwerp; the Abbey of our Saviour, of\nCharroux; and the Church of St. John Lateran, in Rome. All of these have\nhad very adventurous histories. The Abbey of Charroux was founded by\nCharlemagne in 788, and among the relics with which that monarch endowed\nthe abbey the principal one was a fragment of the holy prepuce. This\nabbey enjoyed great reputation, and indulgences were granted by Papal\nbull to all those who assisted at the adoration of the relics. In the\ninternecine wars of the sixteenth century the abbey fell into the hands\nof the godless and heretical Huguenots and the holy relic disappeared.\nIn 1856, while some workmen were at work demolishing an ancient wall on\nthe abbey site, they discovered some relic cases. The bishop was at once\nnotified, who immediately proceeded to investigate, when, lo and\nbehold! there, sure enough, was a piece of desiccated flesh, with marks\nof coagulated blood; nothing more or less than the lost prepuce--long\nlost, but now found. It was placed in charge of the Ursuline Sisterhood,\nwhere it has remained ever since undisturbed, except by a controversy in\nregard to the propriety of the relic, in which the good bishop ambled\nabout in the most ambiguous manner, the only clearly defined portion of\nhis dissertation being the one wherein he laments \"the decadence of that\ntruly Christian spirit which animated the laity of the middle ages with\na radiant zeal. A piety also pervaded those gentle Christians of former\ntimes, who were possessed of a religious instruction which determined\nfor them the tenets of the creed and its practices,--a happy state or\ncondition of affairs, which prevented the intelligence of the faithful\nfrom wandering into the sloughs of unprofitable skepticism.\" This\nsettled the question as to the propriety of the prepuce being converted\ninto a miracle-working relic; at least, as far as the good bishop was\nconcerned.\n\nIt would be an injustice not to mention the other shrines in detail\nafter the prominence that has been given to the abbeys of Coulombs and\nCharroux; so the history of another will be given. We are not told just\nhow the Church of St. John Lateran in Rome first became possessed of\n_its_ holy prepuce, but it nevertheless had one; also the only authentic\none in existence, like all the others. It disappeared at one of the\nperiodical sackings that Rome has repeatedly suffered at the hands of\nGoth, Vandal, or Christian. This time it was the soldiery of the eldest\nson of the church--- Charles V--who did the sacking; it was in the year\n1527, a soldier--probably some impious, heathenish mercenary--broke into\nthe holy sanctuary of the church and stole therefrom the box that\ncontained the holy relics, among them the holy prepuce. These impious\nwretches, as a rule, came to grief in short order; hence we are told\nthat this mercenary and sacrilegious soldier was compelled to secrete\nhis box, when only a short distance from Rome, where the box remains and\nthe mercenary wretch disappears, probably carried off bodily by the\ndevil, as he deserved. Thirty years afterward the box is discovered by a\npriest, who, ignorant of its contents, carries it to the lady on whose\ndomain it was found. On being opened it was found to contain a piece of\nthe anatomy of Saint Valentine, the lower jaw of Saint Martha, with one\ntooth still in place, and a small package upon which the name of the\nSaviour was inscribed. The lady picked up the package, when immediately\nthe most fragrant odor pervaded the apartment, being exhaled by the\nmiraculous packet, while the hand that held it was seen perceptibly to\nswell and stiffen; investigation proved it to be the holy prepuce stolen\nby the miscreant mercenary from St. John Lateran. It is related that in\n1559, a canon of the church of St. John Lateran, impelled by a worldly\ncuriosity untempered by piety, undertook to make a critical examination\nof this relic, in the process of which, to better satisfy himself, he\nhad the indiscretion to break off a small piece; instantly the most\ndreadful tempest broke over the place, followed by crashing peals of\nthunder and blinding flashes of lightning; then a sudden darkness\ncovered the country, and the luckless priest and his assistants fell\nflat on their sacerdotal noses, feeling that their last hour had\narrived.[26]\n\nWonderful and miraculous cures are performed at these shrines, and some\nof the cures are of a nature that would baffle the intelligence of the\nmost learned mind to ascertain the intricate and devious way that\nnature must at times journey to accomplish some of these changes. The\nwriter well remembers seeing, in the Church of Corpus Christi, in\nTurin,[27] a long hall, covered, from marble pavement to ceiling, with\nvotive tablets, after the manner inaugurated in the old temples of\nGreece. Modern votaries have the advantage of being able to record their\ncure, safe venture or escape from peril, by means of faithful\nrepresentation of the event in painting or drawing, as the material and\nart is more common now than in the days of ancient Greece, who recorded\nits cures by simple inscription in laconic terms. Modern medicine labors\nunder the disadvantage of presuming that the people are endowed with an\nintelligence that was unknown to ancient or mediaeval people, when, in\nfact, the people are as credulous and as subject to imposition as they\nwere in the earlier centuries of the present era. With all its supposed\nsuperior intelligence, there is no fatter pasture for quacks and\nimpostors than that presented by the people of the United States.\nWhenever I see the poor, intelligent, broad-minded physician struggling\nalong, barely able to procure for himself the necessaries required to\nmaintain himself with proper books and appliances, while the itinerant\nquack or dogmatic practitioner rolls in undeserved affluence, I question\nthe wisdom of our ethical code. Braddock, at the Monongahela, scorned to\nhave his regulars, who had fought under Marlborough and Eugene, break\nranks before a lot of breech-clouted savages, and take shelter that the\nnature of the ground and the trees could afford, thinking it an unfit\naction for men who had faced the veterans of Louis XIV on many a\nhard-fought European field. I sometimes think that if _our_ regulars\nwere, for only a season, to follow the example of the provincial\nmilitia at that battle, it would be better for the country, the people,\nscience, and last, but not the least, for the profession. The theory\nthat we should not counsel with quacks is altogether mischievous and\nfallacious, although right and rigidly orthodox in its intent; were we\nto counsel and meet these gentry, we should expose their ignorance and\nassumption, and we should not be exposed to the charge of jealousy and\nof fear to meet them in consultation. I remember on one occasion a\nclient went to a lawyer for advice as to how he might dispossess some\nparties who had some adverse claim to some property which he owned,\nafter due deliberation and a protracted siege of the house, in the vain\nhope of gaining admittance; the lawyer advised his client to go and nail\nup all exits and fasten them in, which had the effect of driving them\nout. So with our profession--we should not neglect an opportunity of\nmeeting a quack in consultation, regardless of the nature of the case;\nit is the only way to nail them up; as it is, we have simply chained up\nthe shepherd-dog and given the wolves full play.\n\nThe French Guards at Fontenoy, who out of courtesy refused to fire first\non the English, may have been very ethical and chivalrous, but they were\nvery foolish, as the English discharge nearly swept them from the field,\nand but for the Irish Brigade, who knew no ethics, Louis XV would in all\nlikelihood have followed the example of King John, who, after Crecy,\nvisited England for a season. A disregard of ethics gave Copenhagen to\nLord Nelson, who insisted on looking at Admiral Parker's signal to\nwithdraw from action with his sightless eye, which could not see it. A\nfear of disregarding ethics lost to Grouchy the chance of assisting\nNapoleon at Waterloo. In our strife against ignorance and quackery the\nprofession should follow the general plan of action usually adopted by\nLord Nelson--lie alongside of whom you can and sink or capture your\nenemy; let each man do his duty; never mind any general plan. A reverse\nto this mode of fighting invariably lost the battle to the French and\nSpaniards, who were, as a rule, all tied up in ethical red tape. Our\nprofession is broad, intelligent, and fearless; we do not profess any\nexclusive dogma, and should not, therefore, exclude persons; as a large\nship throws its grappling-irons on to its adversary, we should always\nseek an opportunity to meet these gentry when practicable. As it is, we\nhave placed them on the vantage-ground of appearing as being persecuted;\nour ethics need circumcising in this regard, and the prepuce of\nexclusion should be buried in the sands of the desert.\n\nMoreover, we often are apt to learn something from even the most\nignorant of these men. Rush investigated the nature of a cancer-cure by\nnot refusing to meet and talk with one of this kind;[28] Fothergill\nlearned from an old, unlicensed practitioner that there was a knowledge\nimportant to the physician beyond that picked up in the pathological\nlaboratory or the study of microscopy; and that the practiced eye of an\notherwise unlearned man could detect that there were general physical\nsigns that negatived the unfavorable prognosis suggested by the presence\nof tube-casts.[29] It is related of Sir Isaac Newton, that while riding\nhomeward one day, the weather being clear and cloudless, in passing a\nherder he was warned to ride fast or the shower would wet him. Sir Isaac\nlooked upon the man as demented, and rode on, not, however, without\nbeing caught in a drenching shower. Not being able to account for the\nsource of information through which the rustic had gained his\nknowledge, he rode back, wet as he was, to learn something. \"My cow,\"\nanswered the man, \"always twists her tail in a certain way just before a\nrain, your Worship, and she so twisted it just before I saw you.\"[30]\nAlthough twisting cow-tails do not figure in his \"Principia,\" it is very\nprobable that such a lesson was not without its remote effects on a mind\nlike Newton's. A spider taught a lesson to one of Scotland's kings; so\nthat one man may learn something from another.\n\nProfessor Letenneur, of the Medical School of Nantes, in his \"Causerie a\npropos de la Circoncision,\" mentions that the Convent of Saint\nCorneille, in Compiegne, claims to possess the identical instrument with\nwhich the Holy Circumcision was performed. Such a holy relic must have\nbeen unusually potential in performing many miracles.\n\nIn this connection it will not be amiss to notice the lapping over that\nthe old phallic worship and idea has made on the new religions. It is\nalso as interesting to observe how the human mind still leans toward\nobservances and ideas which are believed to belong to a solely pagan\npeople. Hargrave Jennings, in a chapter devoted to phallic worship among\nthe ancient Gauls, gives many interesting and curious examples, the\nfirst example that he notices being that of Saint Foutin (from whom the\nvery expressive French word \"_foutre_\" is taken). Foutin was the first\nChristian bishop of Lyons, and after his death, so intimately was\npriapic worship intermingled with the religion or theology of the Gauls,\nthat somehow the memory of St. Foutin and the old, dethroned Priapus\nbecame commingled, and finally the former was unconsciously made to take\nthe place of the latter. St. Foutin was immensely popular. He was\nbelieved to have a wonderful influence in restoring fertility to barren\nwomen and vigor and virility to impotent men. It is related that, in the\nchurch at Varages, in Provence, to such a degree of reputation had the\nshrine of this saint risen, it was customary for the afflicted to make a\nwax image of their impotent and flaccid organ, which was deposited on\nthe shrine. On windy days the beadle and sexton were kept busy in\npicking up these imitations of decrepit and penitent male members from\nthe floor, whither the wind wafted them, much to the annoyance and\ndisturbance of the female portions of the congregation, whose devotions\nare said to have been sadly interfered with. At a church in Embrun there\nwas a large phallus, which was said to be a relic of St. Foutin. The\nworshippers were in the habit of offering wine to this deity,--after the\nmanner of the early Pagans,--the wine being poured over the head of the\norgan and caught underneath in a sacred vessel. This was then called\n\"holy vinegar,\" and was believed to be an efficacious remedy in cases of\nsterility, impotence, or want of virility.\n\nNear the city of Bourges, at Bourg Dieu, there existed, during the Roman\noccupation of Gaul, an old priapic statue, which was worshipped by the\nsurrounding country. The veneration in which it was held and the\nmiracles with which it was accredited made it impolitic as well as\nimpossible for the early missionaries and monks to remove it; it would\nhave created too much opposition. It was therefore allowed to remain,\nbut gradually changed into a saint,--St. Guerluchon,--which, however,\ndid not detract any from its former merit or reputation. Sterile women\nflocked to the shrine, and pilgrimages and a set number of days of\ndevotion to this saint were in order. Scrapings from this statue infused\nin water were said to make a miraculous drink which insured conception.\nSimilar shrines to this same saint were erected at other places, and we\nare told that the good monks, who must have had an intense and lively\ninterest in seeing that the population was increased, were kept busy\nsupplying the statues with new members, as the women scraped away so\nindustriously, either to prepare a drink for themselves or for their\nhusbands, that a phallus did not last long. At one of these shrines, so\nonerous became the industry of replacing a new phallus to the saint,\nthat the good monks placed an apron over the organ, informing the good\nwomen that thereafter a simple contemplation of the sacred organ would\nbe sufficient; and a special monk was detailed to take special charge of\nthis apron, which was only to be lifted in special cases of sterility.\nBy this innovation the good monks stole a march on their brothers in\nlike shrines in other localities, such as those of St. Gilles, in\nBrittany, or St. Rene, in Anjou, where the old-fashioned scraping and\nreplacing still was in vogue. Near the seaport town of Brest, in\nBrittany, at the shrine of St. Guignole, the monks adopted a new\nexpedient. They bored a hole through the statue, through which a phallus\nwas made to project horizontally; as fast as the devotees scraped away\nin front the good monks as industriously pushed forward the wooden peg\nthat formed the phallus, so that it gave the member the miraculous\nappearance of growing out as fast as scraped off, which greatly added to\nits reputation and efficacy. The shrine continued in great vigor until\nthe middle of the last century. Delaure mentions a similar shrine at\nPuy, also in France, which existed up to the outbreak of the French\nRevolution. The scrapings in this case were immersed in wine, and the\nguardians of the statue saw to it that no amount of paring or scraping\nshould remove from the saint any of that appearance of vigor or\nvirility which his great reputation demanded, this being done by a\nsimilar procedure as followed at the church near Brest, one of the\nattendants having been sent to investigate into the marvelous growth of\nthe Brest phallus.\n\n\n\n\nCHAPTER VIII.\n\nHISTORY OF EMASCULATION, CASTRATION, AND EUNUCHISM.\n\n\nFor the earliest records in regard to emasculation we must go back to\nmythological relations. In the old legendary lore of ancient Scandinavia\nor of Germany, the loves and hatreds of their semi-mythological heroes\nand heroines space over many romantic incidents before reaching a\nculmination. The swiftly flowing Rhine, with its precipitous banks,\neddies, and rapids; the broad and more majestic Danube or Elb; the broad\nmeadows and Druidical groves on its hilly slopes and stretches of dark\nand gloomy forest,--all conspired to people the fancy with elfs, gnomes,\nfairies, and goblins, who were more or less intermingled in all the\nepisodes that engaged their semi-mythological heroes. This helped to\nfill in all their deeds with entertaining incidents; their halls and\ncastles were made necessary accessories by the rigors of the climate, as\nwell as were the beery feasts and carousals with the inspiration of\nmonotonous song also rendered necessaries by the same element; hence, we\nhave various incidents, either entertaining or exciting, connected with\ntheir legendary tales, acting like periods of intermission between their\nlove scenes, spites, hatreds, murders, and general cremations. From such\nmaterial and such opportunities it was comparatively easy for Wagner to\nconstruct the thrilling and interesting incidents that compose his opera\non the legend of the Nibelungenlied.\n\nThe Grecian landscape and topography does not permit of such richness of\nromantic incidents or details, any more than the love-making of the\nunfortunate spider who is devoured by his spidery Cleopatra at the end\nof his first sexual embrace could furnish any incidents for one of\nAmelie Rives's spirited novels; so that neither minstrel nor bard have\nrecorded the details of the first emasculating tragedy, which from all\naccounts was a kind of an Olympian Donnybrook-fair sort of a\nparicidal-ending tragedy.\n\nUnfortunately, Homer was not there to describe the event, or we might\nhave had a Wagnerian opera with its Plutonic music to illustrate all its\nincidents; or even a Virgil could have made it into interesting verses;\nbut, as it is, we must content ourselves with the laconic recitals that\nhave been handed down by tradition, and, as all the Greek performances\nof those days were marked by an intense decisiveness, with an utter lack\nof circumlocution, it is probable that there was not much to relate\nbeyond the bare facts.\n\nIn Smith's \"Dictionary of Greek and Roman Biographies and Mythology\" we\nfind it related that Uranos, or Coelus, was the progenitor of all the\nGrecian gods. His first children were the Centimanes; his next progeny\nwere the Cyclops, who were imprisoned in Tartarus because of their great\nstrength. This so angered their mother, Gaea, that she incited her\nnext-born children, the Titans, into a rebellion against their father,\nUranos. In the general turmoil that followed Uranos was deposed, and, so\nthat he would be incapable of begetting any more children, Saturnus, the\nyoungest of his sons, with a sickle made from a bright diamond,\nsuccessfully emasculated poor old Uranos. The records are not clear\nwhether the operation only included the penis, or the scrotum and\ncontents, or whether, like the Turkish or Chinese _taille a fleur de\nventre_, Saturnus made a clean sweep of all the genitals; it is\nprobable that he did, however, as the members fell into the sea, and in\nthe foam caused by the commotion from their contact with the element\nVenus was born. Meanwhile, the blood that dripped from the wounded\nsurface caused the Giants, the Furies, and the Melian nymphs to spring\ninto life. Uranos is also represented as being the first king of\nAtlantis; so that the first eunuch was a god and a king, more\nunfortunate than any of Doran's heroes, in his \"Monarchs Retired from\nBusiness,\" because he was more effectually retired from business than\nany monarch that Doran records.\n\nAfter this the practice seems to have been adopted in a general way; and\nthe fact that the future proceedings of men and things on earth do not\nmuch interest these unfortunate members of society in any great degree,\ninterest in worldly affairs and testicles seemingly having been as\nintimately connected in those early and remote days as with us of the\npresent, it very naturally followed that this disinterestedness, as well\nas the docility and pliability which emasculation engenders, first\nsuggested their use as servants or in position of trust, as a eunuch,\nhaving no incentive either to run away or to embezzle, would naturally\nbe a valued and trusted servant. In the days of eunuchism there were no\ndefaulting bank, city, or county cashiers,--a circumstance which would\nsuggest that such a condition should form one of the qualifications for\neligibility to such offices, the very opposition to any such proposal\nthat the class would make showing in itself the benefits that would\nfollow such an innovation, as it would show that the class is not\npossessed with that total spirit of abnegation requisite in the\nguardians of public funds. The requirement might be extended to\nbank-presidents with benefit, if some Cincinnati episodes are any\ncriterion. It is safe to assume that the bank that could advertise, in\nconnection with its attractive quarterly or semi-annual statement, that\nthe president and cashier were properly attested and vouched-for eunuchs\nwould find in the public such a recognition of the fitness of things\nthat the patronage it would receive would soon compel other banks to\nfollow the example. The procedure might, with national benefit, be\nextended as an ordeal to our legislators at the national capitol, as it\nwould do away with the particular influential lobby so graphically\ndescribed in Mark Twain's \"Gilded Age.\" These things or ideas are merely\nthrown out as suggestions to be used by those who write those\ninteresting articles in the _Forum_, or the _North American_ or\n_Fortnightly Reviews_, on government and social reforms, as a perusal of\nthe many articles written in that direction will convince any one that,\nfrom a practical psychological view of the matter, they are sadly\ndeficient. To make those articles effective the reflex impressions made\nby the animal on the psychological and moral nature of man should not be\nneglected.\n\nSemiramis, whose beauty and many accomplishments, assisted by the\nmurders of several of her husbands by the hand of the succeeding one,\nhad this subject in hand in a far more practical manner than it is\ngenerally forced on the understanding; hence we see that she was the\nfirst to introduce the use of eunuchs in the capacity of servants as\nwell as in official positions in and about the palace, as well as\ntrusting some of the positions of the highest importance to the class.\nFrom her epoch, eunuchism has become an inseparable attendant on\nOriental despotism, and has so continued to the present day. Like yellow\nfever, phthisis, and some diseases, as well as many other social\nafflictions and customs, eunuchism does not seem to flourish beyond\ncertain degrees of north and south latitudes,--a fact that probably\nassisted Montesquieu to arrive at the conclusion that climate was a\npowerful factor in all things.\n\nBergmann, of Strasburg, quotes the ancient traditions, wherein it is\nstated that man was taught the art of castration by the brute creation.\nThe hyena is cited as having so instructed man by the habit it exhibited\nof castrating its infant males in removing the testicles with its teeth,\nthe habit being instigated by a jealousy, for fear of future competition\nin the exercise of the procreative act on the part of the young males.\nAnother tradition attributes its origin to the castor. Bergmann here\ntraces out the etymological relation existing between the name of the\noperation and that of the animal with that of a Greek verb that forms\nthe root of _castrum_, or camp; _casa_, or house; _castigare_, to\narrange; from whence also is traced _cosmos_, the world; _kastorio_, the\nGreek for wishing to build, and the Latin _kasturio_ having the same\nrelative but a more imperative signification; _kastor_, signifying as\nloving to build; _castitiator_, Latin for architect, and _casticheur_,\nold French for constructor. The tale or tradition in regard to the\nself-mutilation inflicted by the castor is traced to the Arabian\nmerchants who purchased the castoreum, which was imported from the\nshores of the Persian Gulf and from India. It was called, also, by the\nArabs, _chuzyalu-l-bahhr_, or testicles from beyond the sea; or, in\nFrench, _testicules d'outre mer_. These terms and the tradition that the\ncastor on being pursued, knowing the reason of the chase, was in the\nhabit of tearing out his testicles and throwing them at his pursuers,\nwere invented by these merchants to heighten the price and value of the\narticle intrinsically, as well as to make it more interesting by this\npeculiar individuality of adventure. The Latins, believing and adopting\nthe tradition as a matter of fact, coined the word _castorare_, or doing\nlike the castor. Bergmann uses in this connection a number of terms in\nFrench to denote different forms or degrees of this mutilation which\nhave no equivalents in English,--for instance, _chatrure_, as applied to\nanimals, making also a distinctive difference between the meaning of the\nFrench words _castration_ and _chatrement_. Bergmann is a decided\nevolutionist as regards circumcision being evolved from prior forms of\nphysical mutilation, as will be more fully explained in the next\nchapter; the shaving of the head of a conquered people by the Hindoos,\nor the shearing the royal locks of the ancient Frankish kings; the\nblinding of one eye of their slaves by the old Scythians, or crippling\none foot by the division of a tendon in a captive by the Goths, he\nconsiders as on the same line with the idea that led to castration, the\ndifferent forms of eunuchism, and circumcision.[31]\n\nFrom a purely materialistic and utilitarian view of the subject, he\nobserves that what we call moral progress and civilization owe their\nadvancement more to material interest and cold, selfish calculation than\nto any development of the humanitarian sentiments, and that neither\nmorality nor justice has much to do with it. The evolution of the slave\nand the marks inflicted upon him by his fellow humans are the most\nemphatic evidences of the justness of the above proposition. The study\nof the subject is equally interesting when considered in connection with\nthe evolutions of the Christian Church. In its divergence from Judaism\nand its beneficent laws, both social and moral, the Christian Church was\nbut illy fit to cope with its persecutors of Pagan tendencies, or to\nenforce an unwritten law or code of morality or hygiene among an\nidolatrous, barbarous, and ignorant population such as it had to\nencounter. To its professors, the formation of that monachism which has\nbeen so much misunderstood and abused was but an inevitable\ncondition.[32] These men had not the steady compass to guide them in the\npath that was possessed by the Jewish people. The martyrdom of Christ\nand many of his apostles, and the teachings of the early church, pointed\nto physical denials, castigations, humiliations, and sufferings as the\nonly way to salvation; all pleasures were sin and all denials and pain\nwere looked upon as steps to heaven. The climate pointed to sexual\nindulgence as the sum of all happiness, as can readily be inferred from\nthe Mohammedan idea of heaven; so, with the early Christians who were\nborn in the same climates, the denials of sexual pleasures were looked\nupon as the most acceptable offering that man could make to the Deity.\nContinence, celibacy, infibulation, and even castration were the\nconditions looked upon by many of these men as the only means of living\na life on earth that would grant them an eternal life in the next. This\nview of the situation peopled the deserts with a lot of men dwelling in\ncaves and in huts, living on such a scarce diet that they barely\nexisted. That many went insane, and in their frenzy died while roaming\nin these solitudes, we have ample evidence. The tortures and impositions\nof the Pagan rulers also drove many to this life or death.\n\nReligious mania has caused many cases of self-mutilation, either to\nescape continued promptings and desires, or simply from a resulting\nspecies of insanity. Of the first, Sernin[33] reported to the Medical\nSociety of Paris the case of a young priest who had castrated himself\nwith the blade of a pair of scissors, and who nearly lost his life with\nthe subsequent haemorrhage. The writer saw an analogous case on board an\nAmerican war-vessel, of which Dr. Lyon was surgeon, in the harbor of\nHavre, in the spring of 1871, the subject being the ship's cobbler, a\nreligious fanatic, who was driven insane by self-imposed continence. We\nare not surprised, from the lack of intelligence of the times, the\nextreme but undefined views as to religion that then ruled men, that\nself-imposed castration should have been sanely considered and carried\ninto effect by Origines and his monks. The Cybelian priesthood had\nformerly set the example in their Pagan worship, and when we are told\nthat the monks of Mount Athos accused the monks of the convent of a\nneighboring island with falling away from grace, because they allowed\n_hens_ to be kept within the convent inclosure, we may well believe that\nOrigines and his monks felt that they were gradually ascending in grace\nwhen they submitted to this sacrifice. As strange as it may sound,\nself-castration is still practiced by the Skoptsy, a religious sect in\nRussia. In justice to the Church, however, it must be said that she\nneither asked for nor did she sanction these performances, although she\nwas not quick enough in asserting that she recognized the same law in\nregard to her presbytery that controlled that of the Hebraic priesthood.\n\nEunuchism presents many contradictory conditions; eunuchs have not\nalways been the fat and sleek attendants on Oriental harems as tradition\nand custom places them or would have us believe; neither does the loss\nof virility, in a procreative sense, seem to have always robbed them of\ntheir virility in other senses, as we find eunuchs holding the highest\noffices in the State under the reigns of Alexander, the Ptolemys,\nLysimachus, Mithrades, Nero, and Arcadius. The eunuch Aristonikos, under\none of the Ptolemys, and another, Narces, under Justinian, led the\narmies of their sovereigns. These are, however, exceptional cases; as a\nrule, the result is as we observe in the domestic animals,--loss of\nspirit, vim, and ambition. The Church recognized this result, and, while\nthe Hebraic law excluded eunuchs from participating in the priesthood as\nbeing imperfect and unclean, the Church reproached Origines and his\nmonks and excluded eunuchs from its presbytery on the ground that such\nbeings lack the moral and physical energy requisite in a calling that is\nsupposed to guide or lead men; moreover, there are many reasons for\ndoubting that the ministers of state and the generals of the reigns\nabove mentioned were actually eunuchs in the full acceptance of the\nword. Among the ancients there were several methods of performing the\noperations that made the eunuchs; some were more effectual than others.\nFrom the removal of _all_ the genitals, or the penis alone, or the\nscrotum and testicles, or removing only the testicles, down to\ncompression or to distorting the spermatic vessels, or, as in the case\nof the Scythians, who often became eunuchs from bareback riding, as\nHammond describes a eunuchism manufactured by our southwestern Indians\nof New Mexico and Arizona, are performances that left many degrees of\neunuchism; as we find some eunuchs that not only contracted marriage,\nbut engendered children. Voltaire mentions Kislav-aga, of\nConstantinople, a eunuch _a outrance_, with neither penis, scrotum, nor\nanything, who owned a large and select harem. Montesquieu, in his\n\"Persian Letters,\" admits this class of marriages as being practiced,\nbut doubts the resulting conjugal felicity, especially on the part of\nthe wife. Potiphar's wife was one of these unfortunate wives; no wonder\nthat she tore Joseph's cloak in her desire. Juvenal mentions that some\neunuchs were held in high esteem by the Roman matrons; it possibly could\nhave been some of this kind of a eunuch that led armies or ruled in the\npalaces. Among the sultans and Oriental potentates those who had every\nexterior evidence of virility removed, so as to be obliged to micturate\nthrough the means of a catheter, were considered the safest guards, as\nwell as they were the highest-priced eunuchs, for in their manufacture\nfully 75 per cent. of those operated upon died as a result. It is\nrelated that the Caribs made eunuchs of their prisoners of war on the\nsame principle that caponizing is resorted to for our kitchens,--the\nprisoners were easier to fatten and were more tender when cooked. The\nItalians allowed their children to be eunuchized for chorister purposes\nin church services, their soprano voices after this treatment being\nsimply perfect. It was considered that, in the year prior to the papal\nordinance of Pope Clement XVI forbidding the practice or the employment\nof eunuchs in choirs, four thousand boys, mostly in the neighborhood of\nRome, were castrated for chorister purposes.\n\nIn China eunuchs were in use during the reign of the Emperor Yen-Wang,\nin 781 B.C. The Chinese make their eunuchs by a complete ablation of all\ngenitals. In India the followers of Brahma never placed their women in\ncharge of eunuchs. In Italy it was customary to emasculate boys that\nthey might grow up with the faculty of taking the female parts in\ncomedies, their voices thereby assimilating to that of the other sex,\nthis being on the same principle that the _basso-profundos_ were\ninfibulated that they might retain their bass.\n\nEunuchism resulting from an operation owing to disease has at times\ngiven queer and unlooked-for results, as, for instance, in the case of\nthe old man that Sprengle mentions, in whom castration did not remove an\ninordinate sexual desire. Sir Astley Cooper mentions a case in his\n\"Diseases of the Testes\" that is somewhat unique. After castration Sir\nAstley's patient showed the following results: \"For nearly the first\ntwelve months he stated that he had emissions _in coitu_, or that he had\nthe sensations of emission; that then he had erections and coitus at\ndistant intervals, but without the sensation of emission. After two\nyears he had excretions very rarely and very imperfectly, and they\ngenerally ceased immediately upon the attempt at coitus. Ten years after\nthe operation he said he had during the past year been only once\nconnected. Twenty-eight years after the operation he stated that for\nyears he had seldom any excretion, and then that it was imperfect.\" In\nregard to the mortality from castration done in a professional manner\nand for disease, Curling, in his work on \"Diseases of the Testis,\"\nobserves that he saw or performed some thirty operations without a\ndeath, and that in a table of like operations performed at the Hotel\nDieu, in Paris, it appeared that the mortality was one in four and a\nquarter.\n\nJ. Royes Bell, in the sixth volume of the \"International Encyclopaedia of\nSurgery,\" has the following in regard to the practice among the\nMohammedans in India: \"Young boys are brought from their parents, and\nthe entire genitals are removed with a sharp razor. The bleeding is\ntreated by the application of herbs and hot poultices; haemorrhage kills\nhalf the victims, and at times brings the perpetrators of the vile\nproceeding within the clutches of the law.\"\n\nThe _taille a fleur de ventre_ of the Chinese is a somewhat primitive\nprocedure. According to Dr. Morache, in his account of China in the\n\"Dic. Ency. des Sciences Medicales,\" the operation is as follows: \"The\npatient, be he adult or child, is, previous to the operation, well fed\nfor some time. He is then put in a hot water bath. Pressure is exercised\non the penis and testes, in order to dull sensibility. The two organs\nare compressed into one packet, the whole encircled with a silk band,\nregularly applied from the extremity to the base, until the parts have\nthe appearance of a long sausage. The operator now takes a sharp knife,\nand with one cut removes the organ from the pubis; an assistant\nimmediately applies to the wound a handful of styptic powder, composed\nof odoriferous raisins, alum, and dried puffball powder\n(boletus-powder). The assistant continues the compression till\nhaemorrhage ceases, adding fresh supplies of the astringent powders; a\nbandage is added and the patient left to himself. Subsequent haemorrhage\nrarely occurs, but obliteration of the canal of the urethra is to be\ndreaded. If at the end of the third or fourth day the patient does not\nmake water, his life is despaired of. In children the operation succeeds\nin two out of three cases; in adults, in one-half less. Poverty is the\ncause which induces adults to allow themselves to be thus mutilated. It\nis said to be difficult to distinguish these last from ordinary Chinese\nmen. Adult-made eunuchs are much sought after, as they present all the\nattributes of virility without any of its inconvenience.\"\n\nThe study of the evolutionary moves or processes passed by eunuchism in\nits relation to music and the drama tends to rob these otherwise\ncivilizing and enlightened arts of the aureoles of poetry and gentility\nwith which they have been surrounded. From Bergmann we learn that the\npractice originated in the Orient, where female voices were held in\nhigher esteem in singing, and where the profane songs that accompanied\nthe dance were chanted by women. The Hebraic regulations permitted\nneither women nor eunuchs to sing in their temples. With the\nestablishment of the early Christian Church in Oriental countries, more\nor less of the ancient Judaic customs were retained, and in addition a\ntoo literal interpretation of the words of St. Paul was adhered to,\nwhich said that women should not be _heard_ in the Church. The Oriental\nChurch from these reasons long remained in a quandary; according to the\nceremonials, it was deemed requisite to imitate as near as possible the\nvoices of the angelic seraphims, and this could not be done by the\nrasping bass voices of the well-fed monks; women were out of the\nquestion in the then social stage of church evolution; so that at last a\ncompromise was effected by admitting the eunuch, who could chant in a\nmost seraphic soprano, as his prototype, the mendicant priests of\nCybele, had done before him.\n\nConstantinople became the centre of learning for Greek music, and the\nfine soprano solos which now form the attraction of many of our modern\nchurches were sung by the eunuchs. Eunuchs were not only the chief\nsingers, but they cultivated the art into a science, and Constantinople\nfurnished through this class the music-teachers for the world, as we\nlearn that in 1137 the eunuch Manuel and two other singers of his order\nestablished a school of music and singing in Smolensk, Russia. There is\nno doubt but that in a moral sense, considering that women are generally\nthe pupils, this was a most meet and an appropriate arrangement; for,\nas St. Alphonsus M. Liquori observed, man was a fool to allow his\ndaughters or female wards to be taught letters by a man, even if that\nman were a saint, and, as real saints were not to be found outside of\nheaven, it can well be imagined how much more dangerous it might be to\nhave them taught music and singing by a man not a eunuch,--elements\nwhich have a recognized special aphrodisiac virtue, as was well known to\nthe ancient Greeks, who only allowed their wives to listen to a certain\nform of music when they (the husbands) were absent from home.\n\nThere is not much room for doubt but that both morality and medicine\nhave too much neglected the study and contemplation of the natural\nhistory of man, and relied altogether too much on the efficacy of church\nregulations and castor-oil and rhubarb. There are other things to be\ndone besides simply framing moral codes and pouring down mandrake into\nthe stomach; the old conjoined service of priest and doctor should never\nhave been discontinued, as, by dividing duties that are inseparable,\nmuch harm has resulted. Herein dwelt the great benefit of the early\npractice of medicine among the Greeks, and to the physical understanding\nand supervision of human nature by the Hebraic law may be said that the\ncreed owes its greatness and stability, and the Hebrew race its sturdy\nstamina. The wisdom of the Mosaic laws is something that always\nchallenges admiration, the secret being that it did not separate the\nmoral from the physical nature of man. Bain, Maudsley, Spencer, Haeckle,\nBuckle, Draper, and all our leading sociologists base all their\narguments on the intimate relations that exist between the physical\nsurrounding and the physical condition of man and his morality. Churches\nfoolishly ignore all this.\n\nFrom Constantinople the fashion or custom gradually invaded Italy; and\nas Rome was the centre of the new religion, so it also became the centre\nof music, and Rome and Naples were soon the home of the eunuch devoted\nor immolated to the science of music. The eunuchs reached the height of\ntheir renown in music, as well as what might be termed their golden era,\nwith the establishment of the Italian opera, in the seventeenth century.\nAt this period all the stages of Italy were the scenes of the lyric\ntriumphs of this otherwise unfortunate class, some of whom accumulated\nvast fortunes. In the following century, as has been seen, Clement XVI\nabolished the practice as far as the church was concerned, and in the\npresent century the first Napoleon abolished the practice secularly and\nsocially. Mankind cannot sufficiently appreciate the benefits it\nreceived from the results of the French Revolution; we are too apt to\nlook at that event simply from the unavoidable means which an uneducated\nclass--rendered desperate by long suffering and brutalization under an\norganized system of oppressive misrule--had adopted to remedy existing\nevils. After the dissolution of the Directory France cannot be said to\nhave been in a state of anarchy, and the long and bloody wars with which\nNapoleon is usually blamed should rather be charged to that government\nand imbecile ministerial policy that lost to England the American\ncolonies. The series of battles from Marengo to Waterloo are as much the\ncreation of the cabinet of George III as those from Concord to Yorktown.\nWaterloo involved more than the simple defeat of Napoleon; it meant the\ndefeat of moral and intellectual progress, as well as the suppression of\nthe rights of man. The suppression of the Inquisition in Spain, and of\neunuchism in Italy; the Code Napoleon; the Imperial highways of France;\nthe construction of its harbors,--notably that of Havre; and the\npolitical and social emancipation of the Jews in France, Italy, and\nGermany are monuments to this great man that have not their equals to\ncrown the acts of any other French monarch. Like the Phrygian monk who\nleaped into the arena in Rome to separate the maddened gladiators, and\nwho was stoned to death by the angry and brutal mob of spectators whose\namusement he stopped, Napoleon's work has had its results, in spite of\nWaterloo and St. Helena. The martyrdom of the poor monk caused an\nabolishment of the brutal sports of the Colosseum, which henceforth\ncrumbled to pieces. Little did the people look for this result who\ntrampled the monk under foot. Neither did Blucher, debouching on the\nEnglish left with Bulow's battalions on the evening of Waterloo,\nforesee, some fifty years later, Prussia extending its hand to make a\nunited Italy, which with Napoleon--who was by blood, nature, instinct,\nand education an Italian--had been the dream and ambition of his life.\n\nEunuchism as a punishment is an old practice, as the ancient Egyptians\ninflicted it at times upon their prisoners of war; so it formed part of\ntheir penal code, and we are told that rape was punished by the loss of\nthe virile organ; a like punishment for the same offense was in vogue\nwith the Spaniards and Britons; with the Romans at different times and\nwith the Poles the punishment was castration. The difficulty of proving\nthe crime, as well as the ease with which the crime could be charged\nthrough motives of revenge, spite, or cupidity on innocent persons,\nshould never have allowed this form of punishment to be so generally\nused as history relates that it was; rape being one of the most complex\nand intricate of medico-legal subjects, unless we take M. Voltaire's\nsummary and Solomonic judgment, who relates that a queen, who did not\nwish to listen to a charge of rape made by one person against another,\ntook the scabbard of a sword and, while she kept the open end in motion,\nasked the accuser to sheath the sword.\n\nCount Raoul Du Bisson, _Dedjaz de l'Abyssinie_, gives some very\ninteresting information in regard to eunuchism in his work entitled \"The\nWomen, the Eunuchs, and the Warriors of the Soudan.\" Count Bisson has\nlooked on the question from its moral, physical, and demographic\nstand-points, and, having seen eunuchism in its different aspects, from\nhis landing at Alexandria and Cairo, down through his different\nexpeditions into Arabia, the Soudan, and Abyssinia, his observations are\nwell worth repeating.\n\nFrom a demographic and statistical view of the subject, its truly\nMalthusian results become at once shockingly and persistently\nprominent,--not alone in the interference that the condition induces in\narresting any further procreation on the part of the unfortunate victim,\nbut in the unparalleled mortality that, in the gross, is made necessary\nby the results of the operative procedures. The Soudan alone furnished,\naccording to reliable statistics, some 3800 eunuchs annually, the\nmaterial coming from Abyssinia and the neighboring countries, it being\ngathered by war and kidnapping parties, or by purchase, from among the\nyoung male population of those regions. These children are brought to\nthe Soudan frontier and custom duties are there paid for their passage\nacross the border, the duty being about two dollars per head. At\nKarthoum they are purchased by pharmacists, apothecaries, and others\nengaged in the manufacture of eunuchs, who generally perform simple\ncastration; the mortality among these amounts to about 33 per cent.\nThese simply castrated eunuchs bring about $200 apiece. The great eunuch\nfactory of the country, however, is to be found on Mount Ghebel-Eter, at\nAbou-Gerghe; here a large Coptic monastery exists, where the unfortunate\nlittle African children are gathered. The building is a large, square\nstructure, resembling an ancient fortress; on the ground-floor the\noperating-room is situated, with all the appliances required to perform\nthese horrible operations. The Coptic monks do a thriving business, and\nfurnish Constantinople, Arabia, and Asia Minor with many of their\ncomplete, much-sought-for, and expensive eunuchs. They here manufacture\nboth grades,--those who are simply castrated and those on whom complete\nablation of all organs has been performed, the latter bringing from $750\nto $1000 per head, as only the most robust are taken for this operation,\nwhich nevertheless, even at the monastery, has a mortality of 90 per\ncent.\n\nThe manner of performing the operation is as barbarous and revolting as\nthe nature of the operation itself, and the cruel and ignorant\nafter-treatment is as fully in keeping with the whole. The little,\nhelpless, and unfortunate prisoner or slave is stretched out on an\noperating-table; his neck is made fast in a collar fastened to the\ntable, and his legs spread apart and the ankles made fast to iron rings;\nhis arms are each held by an assistant. The operator then seizes the\nlittle penis and scrotum and with one sweep of a sharp razor removes all\nthe appendages. The resulting wound necessarily bares the pubic bones\nand leaves a large, gaping sore that does not heal kindly. A short\nbamboo cannula or catheter is then introduced into the urethra, from\nwhich it is allowed to project for about two inches, and no attention\nis paid to any arterial haemorrhage; the whole wound is simply plastered\nup with some haemostatic compound and the little victim is then buried in\nthe warm sand up to his neck, being exposed to the hot, scorching rays\nof the sun; the sand and soil is tightly packed about his little body so\nas to prevent any possibility of any movement on the part of the child,\nperfect immobility being considered by the monks as the main element\nrequired to promote a successful result. _It is estimated that 35,000\nlittle Africans are annually sacrificed to produce the Soudanese average\nquota of its 3800 eunuchs._\n\nWhen this immense sacrifice of life, the useless barbarity, and the\nreally unnecessary needs of such mutilated humanity existing are fully\nconsidered, it would seem as if Christian nations might, with some\nreason, interfere in this horrible traffic, by the side of which\nordinary slavery seems but a trifle. When we further consider that, in\nsome instances, the child is also made mute by the excision of part of\nthe tongue,--as mute or dumb eunuchs are less apt to enter into\nintrigues, and are therefore higher prized,--the barbarity, cruelty, and\nextremes of inhumanity that these poor children have to suffer cannot be\noverestimated. Neither must we be astonished at the stolid indifference\nthat is exhibited by the eunuchs in after life to any or all sentiments\nof humanity, or that they should hold the rest of humanity in continual\nexecration.\n\nOften-occurring accidents in harems make _complete_ eunuchs a\ndesideratum. Bisson mentions that on one occasion he saw the chief\neunuch of the Grand Cherif of Mecca--a large, finely-proportioned,\npowerful black--on his way to Stamboul for trial and sentence; he was\nheavily chained and well guarded. It appears that the eunuch had only\nbeen partly castrated, and that the operation had been performed during\ninfancy; his testicles had not fully descended, so that in the operation\nthe sac was simply obliterated, which gave him the appearance of a\neunuch. In this condition he seemed to have kept a perfect control of\nhimself and passions until made chief eunuch of the Cherif, who\npossessed a well-assorted harem of choice Circassian, Georgian, and\nEuropean beauties. The _neglige_ toilet of the harem bath and the\nseductive influence of this terrestrial Koranic seventh heaven was too\nmuch for the warm Soudanese blood of the chief; his forays were not\nsuspected until a blonde Circassian houri presented her lord and master,\nthe Cherif, with a suspiciously mulatto-looking son and heir. A\nconsultation of the Koran failed to explain this discrepancy, and\nsuspicion pointed to the chief eunuch, who was accordingly watched; it\nwas found that he had not only corrupted the fair Circassian, but every\ninmate of the harem as well. The harem was promptly sacked and drowned\nand the false eunuch shipped to the Sultan for sentence, the Cherif\nhaving the right to sentence and drown the harem, but having no such\nrights over such a high personage as the chief eunuch.\n\nThere are physiological facts and pathological conditions brought forth\nfor our contemplation, while investigating the subject of eunuchism in\nall its details, that cause us to feel that, after all, the old\nHippocratic principle of inductive philosophy, upon which our study and\npractice of medicine is founded, with rational experience and\nobservation for its corner-stone, is, even if commonplace, the only\nproper avenue of knowledge. To exemplify this proposition we have in\nthis particular subject the practical observations and experience of M.\nMondat, of Montpellier; in his interesting work on \"De la Sterilite de\nl'Homme et de la Femme,\" published in 1840, he details some instructive\ninformation on the subject of eunuchs, giving some explanation as to why\nmany simply castrated eunuchs are, like the much-prized eunuchs of the\nRoman matrons, still able to acquit themselves of the copulative\nfunction. He mentions that while in Turkey he studied the subject in its\ndetails, and, having found some of these copulating eunuchs, he secured\nsome of the ejaculated fluid and subjected it to a careful examination.\nThe discharge was lacking the characteristic seminal odor; it was in\nother respects, to the palpation especially, very much like the seminal\nfluid. He found that these eunuchs were much given to venereal\nenjoyment, but that either legitimate intercourse or masturbation, to\nwhich many were addicted, was apt to be followed by a marasmus ending in\ngalloping consumption. Mondat personally knew the opera-singer Velutti,\nwho died in London; Velutti was, when a child, castrated by his parents,\nhaving both testicles removed, being intended by his father, who had\nhimself performed the operation, for the choir of the Papal Chapel at\nRome. Velutti was as much of a favorite in his day as our present tenors\nand handsome actors. The admiration of the opposite sex was fatal to\nhim; he formed a _liaison_ with a young English lady residing in London,\nand the resulting excesses in which he indulged quickly brought him to\nhis grave. He was passionately fond of women and was able to acquit\nhimself perfectly; at least, as far as the copulative act--barring\nfecundation--was concerned.\n\nIn a previous part of this chapter I have alluded to the very\nappropriate arrangement which formerly existed when music-teachers were\neunuchs, and that our higher circles of society would do well to employ\neunuchized coachmen, especially if possessed of susceptible and elopable\ndaughters; but, from the accounts given by Mondat, it would seem that\nthey are not as safe as might at first be imagined. However, they could\nnot be as dangerous as the chief eunuch of the Grand Cherif of Mecca and\nincrease the population to the same extent; but I should judge that they\nmight be a very demoralizing moral element if introduced into modern\nsociety. If eunuchs must be employed, it can easily be understood why\nthe Turk and Chinese prefer the real, clean-cut article. The New York\n\"Four Hundred\" should make a note of this, as in their present thirst\nfor European aristocratic notions, coats of arms and titles, there is no\ntelling how soon they may cross over into Oriental customs and run a\nharem, in which case it would be sad to have them make any mistakes in\nthe quality and ability of the eunuch.\n\nDr. Gardner W. Allen has furnished the American profession with a\nfaithful translation of the valuable work of Professor Ultzmann on\n\"Sterility and Impotence.\" In this, we have a clear and intelligent\ndissertation that explains the above conditions, and I am only surprised\nthat the observations of Mondat have not developed such explanations\nbefore, as the principle was fully explained in practice fifty years ago\nby the Montpellier physician. According to Ultzmann, there is a form of\nfecundating impotence in persons otherwise well provided with an\napparent complete apparatus, an impotence which he terms _potentia\ngenerandi_. He states, however, that this form of impotence was not\nrecognized until a few years ago, citing the fact that females have had,\nas a rule, to bear all of the blame for the unfruitfulness of the\nfamily, and that they have been accordingly subjected to all manner of\noperations, general and local treatment, even to being sent to watering\nplaces and sanatoria where red-headed male attendants are employed, to\nsay nothing of the prayers, intercessions, pilgrimages, and novenas to\nthe holy shrines, as mentioned in the chapter on the holy prepuce.\nUltzmann observes that a man may be perfectly able to go through the\nprocreative or, rather, the copulative act, even to the great\nsatisfaction of all parties concerned, and yet be perfectly impotent; he\neven goes further, by observing that there are cases in which copulation\nmay take place without any fluid whatever being ejaculated. He mentions\ntwo such cases at pages 87 and 116 of his book. In the first instance\nthe ejaculated fluid is precisely as that observed in such cases as\nthose of the eunuchs and of Velutti, mentioned by Mondat, and consisted\nof an azooespermic discharge, made up mainly from the secretion of the\nseminal vesicles, the accessory glands of the urethra, the prostate, and\nCowper's glands, as well as the discharge from the secretory glands\ndistributed along the course of the urethral mucous membrane. Some of\nthe cases of this form of impotence have exhibited wonderful copulating\ndesire and power of endurance, and, even if unfecundating, they must be\nsaid to be better off than the victims of that other form of male\nimpotence, the _potentia coeundi_ of Ultzmann, where, with a normal\nsemen, either the power of erection or that of ejaculation may be\nentirely absent.\n\n\n\n\nCHAPTER IX.\n\nPHILOSOPHICAL CONSIDERATIONS RELATING TO EUNUCHISM AND MEDICINE.\n\n\nEunuchism does not always subdue the animal passions; this is the view\nthat the church took in connection with the emasculation of Origenes and\nhis monks; the church here held that not only was it possible for them\nto still sin in heart or imagination, but that, even were the complete\neradication of the sexual idea possible, they had by their act lost the\nmain glory of a Christian,--that of successfully striving against\ntemptation, and by a force born of triumphant virtue overcome all the\nwiles of the devil. It is related that among the eunuchs at Rome there\nwere some who, having been made so late in life, still retained the\npower of copulation, although the final act of the performance was\nabsent. Montfalcon relates that Cabral reported dissecting a soldier who\nwas hanged for committing a rape, but who on dissection showed not the\nleast trace of testicles, either in the scrotum or abdomen, although the\nseminal vesicles were filled with some fluid.[34] Sprengle, in his\n\"History of Medicine,\" relates of the complete removal of both testicles\nfrom an old man of seventy years of age, on account of inordinate sexual\ndesire, the operation having no perceptible effect in subduing the\ndisease.[35] These cases are analogous to those exceptionable cases in\nwhich, after extirpation of the ovaries, both menstruation and\nfecundation have still taken place.\n\nModern civilization and its unnatural mode of dressing inflict great\nharm on men by keeping these parts too warm and constricted. Much of\nthe irritability of these organs, as well as their _decadence_ at an age\nsome generation or two before the time when they should still possess\nall their virile attributes, can be directly attributed to this cause. A\nmore intelligent way of dressing would result in less moral and physical\nwreckage, and require less galvanic belts and aphrodisiacs in men under\nfifty. If those who habitually swath their scrotums in the heavy folds\nof their flannel shirts, to which are superadded the cotton shirts,\ndrawers, and outer clothes in which civilized man incases himself, would\ncast a backward eye into the dim and misty past, and see the priest of\nsome of the old Pagan gods soaking the scrotum in hot water, and then\ngradually rubbing the testicles within, by gentle but firm friction, _to\nmake the testicles disappear_, a process by which many of the heathen\npriests prepared themselves for the discharge of their sacerdotal duties\nand the strict observance of those rules of chastity and celibacy which\nthey were henceforth to live up to, they would find _one_ explanation of\nwhy civilized man does not possess that vigor and retain that\nprocreative power into advanced age that was one of the characteristics\nof our ancient progenitors in the days that breeches were as abbreviated\nas those now worn by the Sioux Indians. These are really but leggins,\nwhich run only to the perineum and are simply tied by outer points to a\nstrap from each hip. Finely and comfortably cushioned chairs may be a\nluxury to sit on, but they will have, on the man who uses them in youth\nand in his prime, a wonderful sedative and moral influence later on,\nabout as effectual as the miniature warm baths for the scrotum and\ngentle pressure to the testicles that were used by the heathen priests\nof old, who preferred a gradual disappearance of the glands to the too\nsudden and summary methods of the Cybelian clergy, who used a piece of\nshell and an elaborately-performed castration. According to Paulus\nAEgineta, this was a common practice of making eunuchs out of young boys\nin the Orient, the mortality being hardly any; whereas the _taille a\nfleur de ventre_, the favorite method for making eunuchs for harem\nguards and attendants, and more suited to the jealous disposition of the\nTurk, has a mortality of three out of every four, according to Chardin,\nand of two out of every three, according to Clot Bey, the chief\nphysician of the Pasha,[36] and of nine out of ten, according to Bisson.\nSo prone to reach high offices were intelligent eunuchs that it is\nrelated that parents were at times induced to treat their boys in the\nmanner above stated, that they might be on the highway to royal favor,\nhonor, and rank; such is the ennobling tendency of Oriental despotism,\npolygamy, and harem life. On the same principle Europeans subjected\ntheir boys to a like operation to fit them for a chorister life or the\nstage, where fame and honor and wealth were to be found.\n\nMedicine has been the butt of wits and philosophers, as well as of the\nmen who, from the profession, have gone into the ranks of literature.\nSmollet, himself a physician, gives us an insight into our wandering and\nerratic misapplication of our knowledge on therapeutics in \"Peregrine\nPickle,\" where the poor painter, Pallet, is believed to be a victim of\nhydrophobia. The learned opinion of the doctor, who explains the many\nand various reasons by which he arrives at his diagnosis, the various\nphysical signs exhibited by the patient as being pathognomonic of the\ndisease, and his final venture with the contents of the _pot de\nchambre_, as a diagnosis verifier, which he dashes in the patient's face\nin preference to ordinary water on account of the medicinal virtues\ncontained in urine, which in the case seemed to him to have a peculiar\ntherapeutic value, is something worth reading, however ludicrous it all\nsounds. There are few intelligent physicians but who have seen as\nridiculous performances, in what might be called medical gymnasts, that\nequal, if not surpass, those of Smollet's doctor. Rabelais was also a\nprofessional brother, who, equally with Smollet, attempted to waken up\nthe profession by his satires. Smollet was not only a physician, but in\nhis early life had seen some very active and practical work, having\nparticipated in and been a witness to the ills and misfortunes that\nfollow any attempts to \"lock horns\" with nature through ignorance of\nphysical laws and preventive medicine,--having been a surgeon's mate in\nthe fleet which assisted the land forces in the murderous and ill-fated\nCarthagena expedition which cost England so many lives, ignorantly and\nneedlessly sacrificed to ministerial disregard of physical laws and its\nconsequences,--lessons which, unfortunately, seem to have but little\neffect on cabinets, owing to their shifting _personelle_, England\nfollowing up the disasters of Carthagena with the still greater blunder\nof the Walcheren expedition, where, out of England's small available\nphysical war material, nearly forty thousand men were either left to\nfatten the swamps of Walcheren, or to wander through England in after\nyears on the pension-list, physical wrecks and in bodily and financial\nmisery.[37] Again, the same disregard, born of ignorance and red tape,\ncrippled the British army in the Crimea, causing in its ranks the\ngreatest mortality. It has seemed as if it would be of advantage if all\nthe blunders, either philosophical or of statesmanship, committed by a\ncabinet, should be written in large letters of gold, to be hung in the\ncouncil-halls of the nations, that similar blunders at least might not\noccur again.\n\nDumas, in his \"History of the Two Centuries\" and his \"History of the\nCentury of Louis the XIV,\" gives some very interesting medical touches.\nLe Sage, in his \"Adventures of Gil Blas,\" gives us food for speculating\non medical philosophy in connection with the interesting subject of how\nto make the profession remunerative. Dickens's ideas of the doctor, as\ngiven in his works, are life touches. Witness his description of the\nlittle doctor who superintended little David Copperfield's advent into\nthe world, or of Dr. Slammer of the army; they represent his view of the\nprofessional character. Fontenelle, probably, was right in ascribing the\nfact of his becoming a centenarian, and maintaining a stomach with the\nforce and resistance that are the peculiar characteristics and\nattributes of a chemical retort, to the fact that when sick it was his\npractice to throw the doctor's physic out of the window as the doctor\nwent out of the door, as in his day a man required the constitution of a\nrhinoceros and the stomach of an ostrich, with the external\ninsensibility of a crocodile, to withstand the ordinary doctor of the\nperiod and his medications. Napoleon believed that Baron Larrey was the\nmost virtuous, intelligent, useful, and unselfish man in existence; in\nfact, it is doubtful if any man of his time commanded from this truly\ngreat man so much admiration or respect, either for bravery, courage,\nintelligence, or activity, as the great and simple-minded Larrey. As\nobserved by Napoleon of his bravest general,--poor Marshal Ney, the\nbravest of the brave, the rear guard of the grand army, the last man to\nleave Russian soil,--Ney was a lion in action, but a fool in the closet.\nAll his generals had some great distinguishing characteristic, beyond\nwhich was a barren waste, a vacuity, but too apparent to a man of\nNapoleon's discernment. But the cool, unflinching bravery of Larrey,\nthat did not require the stimulus of the fight or the phrenzy of strife\nto bring it to the surface and keep it alive; bravery and intelligence\nalike active under showers of shot and shell or in the thunders of\ncharging squadrons; in the face of infective epidemics or\ncontagiousness, walking about in these scenes in which his own life was\nas much at stake as that of the meanest soldier, with the same cool\nexercise of his intelligence that he exhibited in the organization and\nsuperintendence of his hospitals in the time of peace; always the same,\nuntiring, unmurmuring, brave, studious, observing, unflinching in his\nduties, unselfish; whether in the burning sands of Egypt or in the snowy\nsteppes of Russia, in the marshy plains of Italy or in the highlands of\nSpain, he always found him the same, and his notes and observations,\nfrom his first government service on the Newfoundland coast to his last,\nalways showed him the same laborer and student in the field of medicine.\nAnd yet at St. Helena we find Napoleon refusing to take remedies for\ninternal disease whose real nature was unknown, and only toward the end\ndid he consent to take anything, and then only when seeing that the end\nwas approaching, and more from a kindly desire to express his\nappreciation of the services of his attendants, and not to wound their\nfeelings, than from any hope of assistance. Napoleon had not neglected\nthe study of medicine any more than he had the study of every other\nscience. This is evident from the instance related as taking place\nduring the march of the grand army from the confines of Poland into\nRussia, in 1812, when dysentery became very prevalent, of his inviting\nseveral of his favorite guard to his own table, where he experimented\non each particular grenadier with a specific form of diet, so as to\ndetermine its cause and possible remedy. He did not look upon our\nknowledge of pathology and our skill in diagnosis as being sufficiently\nadvanced or perfect to make him feel but that a treatment for an obscure\ndisease like his own would be pretty much a matter of guess-work.\nCharles Reade, in his \"Man and Wife,\" shows an intimate knowledge of\nmedical science where he philosophizes on the effects of an irregular\nlife and of over-physical training. His logic is sound science. Defoe\nand Cervantes show a like intelligent insight as to medicine; and it was\nnot without reason that Sydenham, the English Hippocrates, advised a\nstudent of medicine who entered his office as a student to begin the\nstudy of medicine by the careful study of \"Don Quixote,\" remarking that\nhe found it a work of great value, which he still often read. The works\nof Bacon and of Adam Smith on \"Moral Sentiments;\" the famous treatise on\nthe \"Natural History of Man,\" by the Rev. John Adams; the later works of\nBuckle, Spencer, Darwin, Draper, Lecky, and other robust wielders of the\nAnglo-Saxon pen, as well as the works of Montaigne, Montesquieu, La\nFontaine, and Voltaire, are all works that the medical man could\nprobably read with more profit than loss of time. In fact, either Hume,\nMacaulay, or any philosophical work on history will furnish to the\nphysician additional knowledge of use in his profession. No physician\ncan afford to neglect any study that in any manner adds to his knowledge\nof the natural history of man, as therein is to be found the foundation\nof our knowledge as to what constitutes health, and as to what are the\ncauses that lead humanity to diverge from the paths of health into those\nof physical degeneracy and mental and bodily disease.\n\nWe have in medicine many sayings which pass for truisms, which are,\nafter all, misleading. We say, for instance, keep the feet warm and the\nhead cool; this will not always either keep you comfortable or well, as\nwe know that in neuralgias it is absolutely necessary, either for\ncomfort or to get well, to keep the head warm. While so much stress is\nlaid on the necessity of keeping the head cool, a thing a person is sure\nto look after whenever the head becomes uncomfortably warm, and to which\ncan be ascribed but few ailments or deaths, we hear comparatively\nnothing about the thermometric condition of the perineum, which, from\nthe varying temperatures in which it is at times plunged, produces more\nbeginnings for diseases in the future, during youth and our prime, as\nwell as it quite often causes the sudden ending of life in more advanced\nperiods. People who carefully observe the rule of keeping their heads\ncool and their feet warm will stand with outspread legs and uplifted\ncoat-tails with their backs to a blazing grate, and then, going outside,\nincontinently sit down on a stone or iron door-step, or, stepping into a\ncarriage or other vehicle, they sit down on a cold oil-cloth or leather\ncushion, without the least knowledge of the harm or danger that they are\nliable to incur. They little dream of the prostatic troubles that lie in\nwait for the unwary sitter on cold places, ready to pounce upon him like\nthe treacherous Indian lying in ambush,--troubles that carry in their\ntrain all the battalions of urethral, bladder, kidney disease and\nderangments, and subsequent blood disorganization, which often begin in\na chilled perineum, and, in conjunction with the local disease that may\nresult, end in handing us over to Father Charon for ferriage across the\ngloomy Styx long before our life's journey is half over. It is true,\nneither the savage of Africa or America nor the nomads of Asia are\nsubject to any of these troubles; but with us, hampered with all the\nbenefits of the dress, diet, habits, and luxuries of civilization, and\nwith a civilized prostatic gland, it is quite otherwise. Herein, again,\ncomes that connection between religion, morality, and medicine, that\nexisted with so much benefit to mankind, but from which we of later days\nhave, in our greater wisdom, seen fit to separate; although,\ninconsistently as it may seem, the present age has done more than any\nprevious epoch in practically demonstrating the intimate and inseparable\nrelation existing between the physical and moral nature of man. The\npersistent priapism which oftentimes results from riding with a wet seat\nand the inordinate morbid sensibility of the sexual organs that may\nresult from the same cause or from spinal irritation are not to be\nallayed by any homily on morality or on the sanctifying attempts at\nkeeping the animal passions under subjection, any more than will prayers\nor offerings to all the gods of Olympus restore the eunuchized, either\nthrough foolish civilized dress and customs or through excessive\nindulgence. We must mix medicine with our religion and make the clergy\ninto physicians, or ordain our physicians into full-fledged clergymen.\n\nThe science of medicine, or what might be called the natural ways of\nnature through its physical laws, is true to itself; the fault lies in\nour interpretation of its phenomena, which we fail to study with\nsufficient discriminative precision and nicety. We have repeatedly\nmistaken causes and results from this want of close observance and of\nprecision, attributing results to causes which did not exist. As an\nexample, when the early disciples of homoeopathy in ancient Palestine\nundertook to revive poor, old, withered King David, by putting him to\nbed with a young and caloric-generating Sunamite maid, when it was by\nlike incontinent practices that he had brought himself to that state of\ndecrepitude, it is plain that they misunderstood the principle.\nBoerhaave--who, as a true eclectic practitioner, followed these ancient\nand Biblical homoeopaths in their practice in a similar case, the\nsubject being an old Dutch burgomaster, whom he sandwiched between a\ncouple of rosy Netherland maids--also failed to grasp the true condition\nof the nature of things, or the true philosophical explanation. The\nexhalations from the aged are by no means an elixir of health or life to\nthe young, and the fact that the young were apt to lose health by\nsleeping with the aged was wrongly attributed to their loss being the\nothers' gain, and the result of its passing into the bodies of their\naged companions, and not to its true cause,--the deteriorating influence\nto which they were subjected; and, further, when we analyze the subject\nstill more, we can understand how a full-blooded and active,\nlithe-bodied, thin, and active-skinned Sunamite maid might and would\nimpart caloric to King David; but, from our knowledge (not altogether\npractical) of the difference that exists between differently\nconstitutioned and differently built maids in imparting caloric, and\nfrom our knowledge of the physique of the Netherland maids, who are cold\nand impassive, with a layer of adipose tissue that answers the same\npurpose as that of the blubber in the whale,--that of retaining heat and\nresisting cold,--we can well believe that the poor, shriveled\nburgomaster could receive but little heat, even when sandwiched between\nthe two; but, on the contrary, he was, in fact, more liable to lose the\nlittle he had, unless we look at the subject in another light, and\nconsider that sentiment that is common to both animals and men of\nspirit, a sentiment that has furnished the subject for more than one\ncanvas in the hands of the true and sympathetic artist, as seen on the\nawakening and alert attitude of the worn-out and old decrepit war-horse,\nbrowsing in an inclosed pasture, as he hears from afar the familiar\nbugle-notes of his early youth, or some cavalry regiment with prancing\nsteeds and jingling accoutrements, with bright colors and shining arms,\ngoing past the pasture, restoring for a time to the stiffening joints\nand dim eyes the suppleness and fire of bygone times, with visions of\ngallant charges and prancing reviews; or, how the same sentiment erects\nonce more the bowed and withering frame of the old veteran, and once\nagain fires his soul with the martial zeal of his prime as he sees the\npassing colors and active-stepping regiment which he followed in the\nbright sunshine and flush of his youth. Aside from these sentiments,\nwhich might possibly have inspired David and the Dutch burgomaster with\nan infusion of a new and transient good feeling, it is unquestionable\nbut that some heated brickbats or stove-lids, curocoa jugs or old stone\nBurton ale-bottles filled with hot-water, would have been more effectual\nin imparting warmth than either Sunamite or Netherland maids.\n\nIt is hard to reconcile the beliefs of some people or nations with their\nmanners and customs. For instance, there is the Turk; when a Jew becomes\na Mohammedan he is made to acknowledge that Jesus Christ, the son of\nMary, is the expected Messiah, and that none other is to be expected;\nthey know of Christ's speech on the cross, made to the repentant thief;\nthey believe in a heaven full of houris, with large black eyes and faces\nlike the moon at its full, in which all good Moslems are to have\ncontinual rejoicings, and yet they go on performing the most barbarous\nand inhuman forms of castration imaginable, which not only deprives its\nvictims of their virility, but subject more than three-fourths of those\noperated upon to a painful death, and the remaining to a life of\ncontinual misery. Have these poor subjects no right to future bliss, or\nin what shape will they reach there? If the heavens of these eunuchisers\nwere like the heaven of Buddhism, or, as the Chinese call it, the\nParadise of the West, where, although all forms of sensual\ngratifications are to be enjoyed, no houris are to be supplied to the\nsaints of Buddhism,--as even the women who enter this paradise must\nfirst change their sex,--we might understand that, the genitals not\nbeing needed in the eternal world, it might be considered a matter of\nsmall moment to compel a man to go through this short and transient life\nwithout them; but where a robust condition of the sexual organs is\nsuggested as one of the heavenly requisites, it would seem as if the\nTurk would look upon the suffering, misery, and death that they cause,\nin connection with the inhuman mutilation they inflict, with horror.\nDoctrinal theology, whether in the East or West, is something\nincomprehensible.\n\n\n\n\nCHAPTER X.\n\nHERMAPHRODISM AND HYPOSPADIAS.\n\n\nThere exists a class of human beings whose description is connected with\nthe subject of this work. They date back to mythological times, and the\nconfusion incident to the misapplication of names and the want of proper\nobservation on the part of the narrators has tended to carry the\nuncertainty of their real existence to the present day. One reason that\nthis part of the subject would be incomplete without their description\nis on account of the origin of their existence being intimately\nconnected with eunuchism, being, in fact, an outgrowth of this\ncondition; and any history of eunuchism would be but half told, without\nthe additional information concerning these persons.\n\nHermaphrodites, as stated, date back to mythology. Tradition tells us\nthat Hermaphroditus, a son of Venus and Mercury, was educated by the\nNaiades dwelling on Mount Ida. At the age of fifteen years, he began his\ntravels; while resting in the cool shades on the woody banks of a\nfountain and spring near Caira, he was approached by the presiding nymph\nof the fountain, Talmacis, who, becoming enamored of him, attempted to\nseduce him. Hermaphroditus, like Joseph, was the pattern and mirror of\ncontinence, and would not be seduced. Talmacis then, like Potiphar's\nwife, seized on the unlucky pattern of virtue, and prayed to the gods\nthat they should so amalgamate poor Hermaphroditus to her body as to\nmake them one. The prayer was heard on Olympus, and forthwith the two\nbecame one, but with the distinctive characteristics of each sex\nunchanged. Thus began that fabled race of the _androgynes_ of the\nancients. Another tradition, which is probably correct, affirms that\nancient Carnia, or Halicarnassus, was in those days the Baden-Baden of\nAsia Minor; that thither repaired all the victims of gluttony,\ndebauchery, and general physical bankruptcy. Its name in ancient Caria\ndenotes its seaside-resort location, Hali-Karnas-Sos meaning literally\n\"Karnassus-by-the-sea,\" like Boulogne-sur-mer. The city was under the\nprotection of Hermes and Aphrodite, whose temples were near each other.\nHuman nature in the days of Halicarnassus did not much differ from human\nnature at Monte Carlo or Baden-Baden. The baths had a number of young\nand handsome eunuchs who waited on the old, debauched, and nervous\nwrecks, and the nymph who presided over the whole was Talmakis, a name\nderived from the salty nature of the springs which fed the baths; this\nnymph was worshiped as Aphrodite. Pederasty was one of the practices at\nthese baths. From these conjoined conditions the place was said to be\npeopled with hermaphrodites,--meaning, at first, simply that they were\nunder the protection of Hermes and Aphrodite; and latterly the name was\nattached to the passive agent in the pederastic art,--a name that has\nfollowed the class and crossed the ocean into the interior wilds of\nAmerica, as in Powell's history of the manners and customs of the\nOmahas, an Indian tribe of the Missouri, we find that they at times\npracticed pederasty, the passive agent being called by the Indians an\nhermaphrodite, or double sexed.[38]\n\nThe relations that from eunuchism led to pederasty are very easy of\nexplanation. Eunuchism induces an effeminate form, softer body, and\nprevents the growth of the beard; the voice is softer and more\nmelodious; and their timidity renders them also more effeminate,\nobedient, and dependent. The peculiar commingling of the female form\nwith that of the male furnished to the sculptors the models for those\nwonderfully well-made forms which are yet to be seen, representing in\nstatuary the forms of Androgynes and Hermaphrodites; that of the\nfavorite eunuch of the emperor Adrian being remarkable for the symmetry\nof its form and grace of pose.\n\nEurope must have been astonished at the tales that were carried back by\nthe early explorers and voyagers, in relation to the New World. The\nstory of the immensity of the quantity of gold and silver, of great\nstores of hidden treasures, of the quantities of precious gems and\npriceless crystals was fully discounted when, from the Florida coast and\nthe explorers of the Lower Mississippi, men returned with the tale that\nin the everglades and in the trackless forests, intersected by navigable\nsloughs, there dwelt a people half of whom were hermaphrodites. Neither\nthe explorers nor their European historiographers seem able to have\ngrasped the true state of affairs. Many believed in the actual existence\nof such numbers of these monstrosities, while others, arguing from what\nwas then known regarding the extraordinary development of the nymphae and\nclitoris, as well as of the great labia, of the women in the African\nregions, concluded that these supposed _androgynes_, or hermaphrodites,\nmust be women, the dress assumed by these and the menial labors to which\nthey were consigned assisting to favor this opinion. The early\nFranciscan missionaries to California found the men who were used for\npederasty dressed as women.[39] Hammond mentions the practice as in\nvogue among the Indians of the southwest, which in a measure greatly\nresembled that of the ancient Scythians in its operation, the men being\ndressed as women, associating with women, and used for pederastic\npurposes during the orgies of their festivals. These men had previously\nbeen eunuchised by a process of continued and persistent onanism, which\ncaused at the end a complete atrophization of the testicle.\n\nIn regard to the great number of hermaphrodites observed in Florida and\non the Mississippi, the accounts are only reliable as far as they were\npresent in female garb and in an apparent state of slavery, being\ncompelled to do all the menial labor of the villages and camps, besides\nbeing used for pederasty, no examination having been made by any\ntraveler. Their lot was different from those described by Hammond in his\nwork on \"Male Impotence,\" where the whole transaction seems to have some\nsort of religious and civil significance. In Florida, however, they\ntilled the ground, extricated and carried off the dead during a battle,\nand did all the work generally, being used for beasts of burden and not\nallowed to cut their hair; but all authorities are silent or in complete\nignorance as to whether they had suffered castration. Pere Lafiteau,\nhowever, gives an explanation which was in the last century considered\nridiculous, but which, in the light that has been thrown on the\nexistence of a former continent, and of the undisputable relation that\nmust, some ages in the past, have existed between Phoenicia and Central\nAmerica, seems a strongly probable solution of these customs. The Father\naccounts for the presence of these American _androgynes_ in the\nfollowing manner: The Carribeans, or Caribs, were originally a colony\nfrom Carnia; with these colonists was brought over the worship of their\nPagan gods of Caria and Phrygia; these two localities were the homes of\nthe Cybelian priesthood, who dressed in female garb, as did the\nsacrificial priests of the Temple of Venus Urania. It is true that the\nJava or Floridian priest had nothing in common with the priests of\nCybele or of Venus Urania; but, still, Lafiteau gave as lucid an\nexplanation for the existence of these conditions as any of his\ncontemporaries. Charlevoix observed the same practices among the\nIllinois, which he attributed as being due to some principle of\nreligion. The Baron de la Hontan insists that the missionary,\nCharlevoix, was mistaken; that the persons whom he saw in female attire,\nwhom he took to be men, were not men. Hontan asserts that they were\nveritable hermaphrodites. The missionaries were, however, correct, as\nwhat has since been observed confirms their opinion. M. du Mont, who\nascended the Mississippi for a distance of nine hundred leagues, also\nreported meeting Indians at different places attended by these\npetticoated androgynes.[40]\n\nAs strange as it may seem, many intelligent men were loth to part with\ntheir belief in the existence of these double-sexed individuals; the\nlogic used by many of these insisters of hermaphrodism, although now\nvery ridiculous, was no doubt sensible logic one hundred and fifty years\nago. As a matter of curiosity, some of this reasoning will bear\nrepeating. It is taken from a Latin edition of an ancient description of\nFlorida, originally in the English, but translated into the Latin by the\ngeographer, Mercator. In this book we find the roots of some of the\nmyths that led Ponce de Leon and his steel-clad warriors to wander\nthrough Florida in a vain search of that spring or fountain of the\nwaters of perpetual youth and of everlasting life which they were never\nto find. We there learn that, in the days of the good old Spanish\nknight, the inhabitants of Florida lived to a very old age, and that\nthey did not marry until very late in life, as before that period it was\nvery difficult to determine the sex of the individual.\n\nFrom what has since been seen among the Indians, the probability is that\nthese were really eunuchs, and probably in slavery, as the result of the\nfortunes of war, as their great number and servile condition will hardly\nadmit of the belief that they belonged to the same tribe as their\nmasters and oppressors. Pederasty was an old, very old practice, being\nmentioned before circumcision; it prevailed among many of the Orientals,\nand among the many peoples by whom the early Jews were surrounded, who\nwere, according to the Old Testament, about as an immoral, dissolute,\nand bestial a set as one could well imagine. Their religions were\nnothing but a gross mixture of stupid superstition and blind idolatry,\npederasty, fornication, and general cussedness. In the then state of the\nJewish nation, to have allowed them to mingle freely with these people\nwould have ended in having the Jews adopt all their customs and habits.\nThe aim of the Jewish leaders was to prevent any too free intercourse of\ntheir people with these nations, that they might remain uncontaminated\neven while dwelling near them. To accomplish this it was necessary to\nraise a barrier that would be the distinguishing mark of the Jewish\nnation. Jahns, in his learned work on the \"History of the Hebrew\nCommonwealths,\"[41] lays down the idea that circumcision, as well as\nmany articles in their laws,--which to us appear trivial,--were in\nreality intended to separate the Jews farther and farther from their\nidolatrous, bestial, and heathenish neighbors, while at the same time\nthese same ordinances were intended to preserve a constant knowledge of\nthe true and only God, and maintain their moral and physical health.\n\nAlthough hermaphrodism on a large scale, as an existing condition, was a\nmatter of serious belief at the end of the eighteenth century, it has\noccupied no little attention in this. Courts have been called to decide\non cases to invalidate marriages, or to decide the sex, more than once;\nand physicians are often asked the question, Do hermaphrodites really\nexist? Dr. Debierre, of Lyons, published in 1886 a valuable paper,\nentitled \"Hermaphrodism Before the Civil Code: its Nature, Origin, and\nSocial Consequences,\" which was published in the _Archives of Criminal\nAnthropology_ of Lyons, France. In this short but very concise treatise,\nDebierre gives us a complete review of the subject from mythological\ntimes to 1886. It must be quite evident to all that there exists no\nlogical reasons why the sexual or generative organs should be exempt\nfrom, at times, being subject to variations from the normal, either\nthrough the commingling of two conceptions or of faulty development\naffecting other parts of the body,--conditions that go to form\nmonstrosities. Debierre gives one peculiar case of a duplication of\nvagina and uterus in a girl of nineteen, the appearance of the parts and\nthe septum between the vaginae giving to the whole an appearance\nprecisely similar to that of a double-barreled shot-gun. These\nmonstrosities are as likely to happen as the different forms that\naffect--either by arrested development or some abnormality of excessive\ndevelopment--the head, which is a very prolific subject of anomalies.\n\nHermaphrodism is a common attribute in the vegetable kingdom, where\nfixed habitation or position makes such a condition necessary; it is\nalso common to many of our lower forms of animal life, and even in the\nhuman foetus the presence of the Wolfian bodies and the canal of Mueller\nin the same individual attest a primitive case or condition of\nhermaphrodism. In other words, humanity begins its existence in a state\nof hermaphrodism. This condition is found up to the end of the second\nmonth of foetal life in the human being, in common with all mammals, as\nwell as all the vertebrates, where, however, it is subject to variations\nas to time of development and limit of existence in the normal\ncondition. In the chick, it is only after the fourth day that the\ngenital gland begins to determine whether it will turn into an ovary or\na testicle; in the rabbit it is on the fifteenth day, and in the human\nembryo on the thirtieth day. Hermaphrodism does not occur, however, from\nthis at first uncertain state of affairs, but rather from subsequent\ndevelopments of the external organs that by their abnormality of\nformation simulate one or the other sex, while the internal organs may\nbelong without any equivocation of structure to its definite sex; as it\nhas often happened that some of these cases, having been the subject of\ndifferences of opinion among experts during life, were, after death,\nunanimously assigned to one sex by all of the same experts, the organs\nreadily defining the sex being completely of the one sex. As observed by\nDebierre, where the subject is really a female, even where the vagina or\nuterus is unperceived, the presence of the menstrual function or some\nphysical disturbance at its stated periods are sufficient evidences, as\na rule, by which to determine the sex. The case of Marzo Joseph, or\nJosephine, reported by Crecchio in 1865, had rudiments of an hypospadic\npenis ten centimetres in length and a prostate of the male sex, with a\nvagina 6 centimetres in length and 4 in circumference, ovaries,\noviducts, and uterus of the female; it was not until her death, at the\nage of fifty-six, that her sex was fully determined. The case reported\nby Sippel in 1880, supposed to be a male from external evidences, was at\ndeath found to be a female. Guttmann reported a like case in 1882. The\ncelebrated case of Michel-Ann Dronart is remarkable; this case was\ndeclared a male by Morand Pere and a female by Burghart, as well as by\nFerrein; declared asexual or neutral by the Danish surgeon, Kruger; of\ndoubtful sex by Mertrud. The case of Marie-Madeleine Lefort, to which\nDebierre devotes four figures, is full of interest. One of the figures\nis her portrait at the age of sixteen, and another is from her\nphotograph at the age of sixty-five. She has a man's head in every\nparticular of physiognomy and expression, having in the latter figure a\nfull beard and the peculiar intellectual development of a male sage; she\nhas the hairy breast of the man, with the mammary development of the\nfemale, and an abnormally-enlarged clitoris, which was often mistaken\nfor the male organ. The vagina at its lower end was narrow, and the\nurethral aperture opened into it some distance from its outer opening;\notherwise she was sexually a perfect woman, and menstruated regularly.\nDebierre quotes the case which Duval gives in his work on\nhermaphrodites, wherein a man asked for a dissolution of marriage,\nclaiming that his wife had a male organ, which, although she was a woman\nin every other sense, prevented by its interference the consummation of\nthe marriage act. The court had the case examined, when it was found\nthat the erection of the clitoris, which was large, was enough to\ninterfere as the husband had stated. It decreed that the young woman\nshould have the objectionable and interfering member amputated, and on\nthe refusal to have this done the marriage should be dissolved. She\nrefused, and the divorce was consequently granted to the man.\n\nFrom the history of Marie Lefort, it can well be conceived how the\npopular mind, in ignorant times, could easily be imposed upon. Montaigne\nrelates the history of a Hungarian soldier who was confined of a\nwell-developed infant while in camp, and of a monk brought to a\nsuccessful accouchement in the cell of a convent; while Duval reports\nthe case of a priest in Paris who was found to be pregnant with child,\nwho was in consequence imprisoned in the prison of the ecclesiastical\ncourt. These cases were strongly females in every sense, but with some\nmale characteristic sufficiently developed, like in the case of Marie\nLefort, to allow them to believe themselves men and to pass for such.\n\nOn the other hand, males have had some female characteristics so well\npronounced that they have passed for females. Debierre mentions a number\nof cases, to wit: Ambroise Pare reported such a case in his time;\nLadowsky, of Reims, reports the case of Marie Goulich, who, up to the\nage of thirty-three, was believed to be a female, at which time the\ndescent of the testicles removed all doubts as to sex. Sheghelner and\nCheselden have reported analogous cases, and Girand's case--who was\nhappily married to a man with whom he lived until the death of the\nhusband, in which the only female attribute was a blind vagina, which,\nin his case, seems to have answered all purposes--was a most remarkable\ncase. As a rule, the cases of males who have been mistaken for\nhermaphrodites have been cases of hypospadic urethrae in a greater or\nlesser sense of deformity.\n\nDebierre, however, mentions some cases of true hermaphrodism. He quotes\na number of cases, the earliest being from the writings of Coelius\nRhodigin, who claimed to have seen in Lombardy a case in which the\norgans of the two sexes were side by side; Ambroise Pare records that in\n1426 a pair of twins were born, joined back to back, wherein both were\nhermaphrodites. Among the many reporters that he quotes, he mentions\nRokitansky, who reported a case in 1869, at Vienna, this being the\nautopsy of Hohmann, who had two ovaries and oviducts, a rudimentary\nuterus, and a testicle, with a sperm-duct containing spermatozoa. This\nindividual menstruated regularly, and it is an interesting question as\nto what the result would have been had some of the spermatic fluid come\nin contact with some of the ovules that were periodically discharged.\nHohmann had an imperforate penis and a bifide scrotum. Ceccherelli, who\ngives a more minute description of this interesting case, relates that\nHohmann, who died at the age of forty, had menstruated regularly to the\nage of thirty-eight. The penis was imperforate but hypospadic, from\nwhence came the urinary and spermatic discharges, and Hohmann could in\nturn copulate as either male or female. Odin is also quoted in relation\nto the case seen at the Hotel-Dieu-de-Lyon, during the service of M.\nBondet. The subject was aged sixty-three, and named Mathieu Perret. The\ncase greatly resembled that of Hohmann, at the autopsy being found to be\ndouble sexed. So that, while most of the cases mentioned are fictitious\nand only apparent, the fact remains that the existence of true\nhermaphrodites is indisputable.[42]\n\nIf the subject of either apparently or true hermaphrodism is one of\nunhappiness, and oftentimes of discomfort and misery, history relates\nthat this unfortunate class has suffered additionally, from the laws and\naction of ignorant and barbarian times, as such freaks of nature must\nof necessity have occurred at all times; only in the then ignorant state\nof medicine and anatomy they must have been considered as occurring much\noftener--every deviation from the normal being considered as\nhermaphroditic. Opmeyer relates that in excavating in the neighborhood\nof the capitol in Rome, the laborers discovered the bronze tables on\nwhich were inscribed the twenty-two laws of Romulus, termed by many\nhistorians \"The Double Decalogue of Romulus.\" Article XV of this law, as\nwell as Articles IX and X, seem to be directed against the life of these\nandrogynes. In Roman history, however, we have an event which would seem\nto contradict that there existed any laws in actual force against this\nunfortunate class. It happened during the existence of the Punic wars,\nwhen the people were more or less laboring under fear and excitement,\nwhich would readily prepare them to accept any superstitious notion. It\nwas during these times that three of these androgynes were known to\nexist in Italy. Titus Livius mentions that the existence of one of these\nwas denounced during the consulships of C. Claudius Nero and of Marcus\nLivius. Etruscan soothsayers and seers were summoned to Rome, that they\nmight consult the signs and the conditions of the constellations that\naccompanied the nativity of this hermaphrodite, or androgyne. These\nimpostors, after a careful consultation of all attending circumstances,\ngave it as their opinion that the occurrence was an unfortunate\nimpurity, and that it could only result to the disadvantage of Rome,\nunless she at once took steps to purify herself of such a monstrosity,\nwith the conclusion that the androgyne should be first exiled from Roman\nsoil, and then drowned in the depths of the sea. The unfortunate being\nwas accordingly inclosed in a chest and put on board a galley, which\nput immediately to sea; when the vessel was out of sight of land the\nchest was thrown into the Mediterranean.[43]\n\nA hermaphrodite born in Umbria during the consulship of Messalus and C.\nLucinius was condemned to death, as well as was the one born at Luna\nduring the consulship of L. Matellus and Q. Fabius Maximus. Debierre\nstates that in the reign of Nero this barbarous custom was discontinued,\nas this emperor admired these freaks of nature from their novelty, as it\nis related that his chariot was drawn by four hermaphroditic horses.[44]\n\nIn connection with hermaphrodism it has been shown that the males who\nhave been supposed to be so malformed were really, in most instances,\nbut cases of hypospadias. It may not be uninteresting to observe that,\nwhile during nearly four thousand years circumcision has been practiced\nwithout the habit or condition ever having become transmissible or\nhereditary, hypospadias has shown a decided tendency to being\ntransmitted. In Virchow's _Archives_, Lesser reports having treated\neight subjects during one generation in a family.[45] Fodere records the\ncase of hypospadias reported by Schweikard, in a person of forty-nine\nyears of age, whose urethral orifice was near the junction of the penis\nand scrotum, but who, nevertheless, had three fine children. The same\nauthor records the remarkable case reported by Hunter to the Royal\nSociety of London, also so deformed, who successfully impregnated his\nwife by receiving the spermatic fluid in a warm spoon and immediately\ninjecting it into the vagina.[46] Another interesting case is taken from\n_L'Union Medicale_ of August 26, 1856. It instances both the heredity\nconnected with hypospadias and the peculiar circumstances under which\nimpregnation at times takes place; it is reported by Dr. Trexel, of\nKremsier, and is as follows: \"On April 1, 1856, a newborn infant was\nbrought to Dr. Trexel, that he might determine its sex. The father and\nmother were servants of a peasant. On an examination of the alleged\nfather, he was found to have all the external characters of a male; the\nurethra, which was rather shorter than ordinary, but of large size, was\nimperforate; the scrotum was divided into two pouches, each containing a\ntesticle. The apposed surfaces of the scrotal pouches were covered with\na red skin, and the division extended through their entire length. At\nthe root of the penis, in the anterior angle of these pouches, was an\nopening of the size of a lentil; this was the orifice of the urethra.\nThe lower surface of the penis was grooved from the above-mentioned\norifice to the end of the glans. There was no prepuce. Almost in a line\nbehind the corona of the glans, and in the groove, were two elliptical\nopenings, which readily admitted a large hog-bristle; there was a third\nsmaller opening two lines from the orifice of the urethra. This man had\nalways passed for a woman. He lay in the same room with the mother of\nthe child; and they acknowledged having had frequent connection. The\nwoman declared that she had had no commerce with any other man for three\nyears, and the man did not deny this assertion. The idea of cohabitation\nwith another man was further negatived by the circumstance that the\ninfant had the same conformation of the genital organs as the father.\nHow did fecundation take place? The three openings in the penis were\nprobably the orifices of the excretory ducts of Cowper's glands. But\nmight not these have been the openings of the ejaculatory ducts? It is\nto be regretted that Dr. Trexel did not examine these canals; their\nlength and direction would have thrown light on the subject. The fact\nof fecundation may also be explained by supposing that during coition\nthe posterior wall of the vagina supplied the place of the absent floor\nof the urethra, thus forming a complete canal. This is the most probable\nexplanation.\"[47]\n\nThe above case, as stated, had passed for a woman; these cases are by no\nmeans such rarities. The case of Marie Dorothee, mentioned by Debierre\nin his work, was as peculiar. Hufeland and Marsina had pronounced Marie\na woman, while Stark and Martens pronounced her a man, and Metzger could\nnot determine on the sex. The case of Valmont, noticed by Bouillaud and\nManee, is on a par with that of Giraud, in which the party was married\nas belonging to one sex and where it was not until after death\nascertained that the person belonged to the other sex. Valmont had a\nhypospadic urethra and penis; a scrotum without testicles; ovaries with\nthe Fallopian tubes; a uterus opened into a vagina of two inches in\nlength, which, gradually narrowing, ended in the male urethra, to which\nwas attached a prostate gland. Valmont contracted marriage as a man and\nwas not discovered to have been a female until the autopsy revealed her\nto be a woman. The relation does not state anything in regard to\nmenstruation; so that her condition in that regard is unknown.[48]\n\nThere has also been reported a number of cases in the male analogous to\nthe double organed female mentioned by Debierre. Geoffrey St. Hilare\nreports a case where the penis was double, one being above the other,\nurine and semen flowing through both urethras. Gore mentioned a like\ncase to the Academy in 1844. Dr. Vanier (Du Havre) records the case\nreported by Huguier to the Academy, where the organs in the anatomical\npreparation which he exhibited were so anomalous that it was impossible\nto decide the sex. Aside from the medico-legal aspects that these cases\npresent, there is an interesting Jewish theological question connected\nwith them. The law is explicit as to circumcision; the cases presenting,\nif males, should be circumcised, but how to determine the sex where an\nautopsy alone will decide the question is not defined. It has been\ndecided, in such cases where the presumption is that the child is of the\nmale sex, that, like in cases of absence of prepuce, a suppositious\ncircumcision should be performed, so that the covenant should be\nobserved; this being in keeping with the sentiment shown by the Jews\nwhen persecuted by the Romans, or, later, by the Spaniards, who often\nwere not able to circumcise until after death; but they never fail to\ncomply with the covenant as far as it is possible.\n\nCases are liable to occur, however, which, without leaving the question\nas to sex in doubt, if reasoned by exclusion, would not furnish any\npossible opportunity for circumcision. Such a case is reported in\nVirchow's _Archives_, vol. cxxi, No. 3; also in the _British Medical\nJournal_ of December 6, 1890, and in the _Satellite_ for January, 1891.\nIt is one of congenital absence of penis. \"Dr. Rauber records very\nbriefly the case of a shoe-maker, aged 38, who complained of pain and\ntrouble in the anus. On examining him, Rauber found a well-formed\nscrotum containing two testicles, each with a vas deferens and spermatic\ncord, but no trace of a penis. The urethra opened apparently into the\nanterior wall of the rectum. The man occasionally experienced sexual\nexcitement, followed by an emission into the rectum. The burning pain\ncomplained of in the rectum and about the anus was due to the irritation\ncaused by the urine. The man would not allow an ocular inspection of\nthe interior of the rectum. Unfortunately, the details of this very rare\ncondition are incomplete.\"\n\nIt would be interesting to know where the seat of his sexual desire is\nsituated, unless an aching testicle is such. I once knew a Spiritualist\nwho claimed to feel the pains suffered by any friends with whom he was\nin sympathy; he once tried to argue with me that a certain lady\npatient--a warm personal friend of my questioner and a Spiritualist--had\novaritis, because he felt an intense burning pain in his _right ovarian\nregion_ whenever he went near to her. I tried to reason with him that\nthat pain should be in his right testicle, but he would insist on having\nthe sympathetic pain in _his_ ovarian region.\n\n\n\n\nCHAPTER XI.\n\nRELIGIO MEDICI.\n\n\nSir Thomas Browne, in his \"Religio Medici,\"[49] alludes to the scandal\nthat is generally attached to our profession, we being accused of\nprofessing no religion. That this opinion is still prevalent at the\npresent day is undeniable,--philosophers and physicians are believed to\nbe atheists and non-religionists,--while, at the same time, by that\nstrange contradiction that is so common, philosophers and physicians are\nthe known and recognized sources of religions, such is the intimate\nrelation existing between physical and moral hygiene. Confucius, the\ncontemporary of Pythagoras, whose religion was said to be nothing more\nthan the observance of a certain moral and political ethical code, and\nhe who first formulated the text \"that one should do unto others as one\nwishes others to do unto him,\" the founder of the Confucian religion,\nthe orthodox religion of China, was a philosopher. Buddha, the founder\nof the second creed recognized in China, and which forms the religion of\na great part of eastern Asia, was also a philosopher who was endeavoring\nto reduce the Brahminical religion to the simple principles of\nphilosophical religion, based on morality. Moses not only was the\ngreatest philosopher of his time, but also had an insight into medicine\nthat to us of the present day is simply incomprehensible. The Great\nMaster was both a philosopher and a physician, his disputes with the\nlearned and his attention to the sick having given him the titles of\nGreat Master and Divine Healer.\n\nTo use the words of the \"Religio Medici,\" the great body of the medical\nprofession can, without usurpation, assume the name of Christians; for\nno monk of the desert convents of Asia Minor or religious knight of the\nmiddle ages, either in their care of the sick, or giving food and\nshelter to the weary, or protection of sword and shield to the oppressed\npilgrim plodding his way to the Holy Land, were more deserving of the\nname of Christian than the medical man unwearily and unselfishly\npracticing his profession. To the true student of his art there is that\nin medicine which makes of the physician a practical Christian. Nor is\nthere aught in medicine, either in its traditions, history, study, or\npractice, that in the lover of his art should ever make him anything but\na philosophical and practical religionist. The physician, such as is\nactively engaged in the daily practice of his profession, instead of\nhaving no religion, is really a practical religionist, and, although he\nmay subscribe to no outer ceremonial form or dogma, his life is such\nthat a Confucian, a Buddhist, a Christian, or a Hebrew can behold in him\nthe practitioner of the essence of either of their religions,--a\nconception carried out by Lessing, in his play of \"Nathan the Wise,\"\nwhere the Jew, the Saracen, and Crusader teach the impressive lesson\nthat nobleness is bound by no confession of faith or religion; showing\nthe principle that should guide true religion.\n\nThe Rev. Dr. Townsend, of Boston University, has given a very\ninteresting and intelligent relation of the connections that exist\nbetween medicine and the Old Testament, in the light of\nnineteenth-century science.[50] The article in question is interesting\nin its logical reasons as to why the Bible was inspired by a superior\npower, as well as in the comparisons it lays before us of the medicine\nof the Pagans and that of the Bible, during the early history of the\nworld. After reviewing the false, crude, and senseless vagaries and\nsuperstitious notions that passed for medicine from the period of the\nTrojan war, in 1184 B.C., to the dissolution of the Pythagorean Society,\n500 B.C.--periods which existed after the writing of the books of\nMoses,--and the period between 500 B.C. and 320 B.C., or the philosophic\nera of medicine, during which flourished the father of our present\nsystem of medicine, an era of advancement, but which in our eyes is\nstill full of errors and unscientific conclusions. From these two\nperiods we span over centuries of darkness for science and medicine to\nthe ages of Ambroise Pare and the more modern fathers of our art, who by\nperseverance finally extricated medicine from the mass of magical and\nsuperstitious rubbish which, like barnacles, had clung to it during its\npassage through the dark and ignorant ages. After this review our author\nturns to the Bible and discourses in this wise:--\n\n\"Turning our attention to the Bible, we take the position that, though\nit was not designed to teach the science of medicine, still, whenever by\nhint, explicit statement, or commandment there is found in it anything\nrelating to medicine, disease, or sanitary regulation, there must be no\nerror; that is, provided the Bible, in an exceptional sense, is God's\nbook. Now, what are the facts in this case? They are these: though the\nBible often speaks of disease and remedy, yet the illusions, deceptions,\nand gross errors of anatomy, physiology, and pathology, as formerly\ntaught, nowhere appear upon its pages. This, it must be acknowledged, is\nat least singular. But more than this: the various hints and directions\nof the Bible, its sanitary regulations, the isolation of the sick, the\nwashing, the sprinkling, the external applications, and the various\nmoral and religious injunctions in their bearing upon health are\nconfessed to be in harmony with what is most recent and approved. To be\nsure, the average old-school physician of a century ago would have\nblandly smiled at our simplicity, had it been suggested to him that his\nmethods would be improved by following Bible hints. 'What did Moses know\nabout medical science?' would have been his reply. But Moses, judged by\nrecent standards, seems to have known much, or, at least, to have\nwritten well.\"\n\nThe above statement is a truthful relation of facts, from which it can\nwell be conceived that even in the Bible the physician finds something\nto inspire him with the idea of its divine inspiration, as the very\nhistory of medicine, with which it is connected, and with which he is\nfamiliar, only lends him further support in that direction. Most\nintelligent physicians are also lovers of philosophical history. None is\nmore entertaining than Rawlinson, either in his \"Seven Great Monarchies\"\nor his \"Ancient Egypt.\" In his \"Ancient Religions,\" in his concluding\nremarks, he observes as follows, in regard to the Hebraic religion: \"It\nseems impossible to trace back to any one fundamental conception, to any\ninnate idea, or to any common experience or observation, the various\nreligions which we have been considering. The veiled monotheism of\nEgypt, the dualism of Persia, the shamanism of Etruria, the pronounced\npolytheism of India are too contrariant to admit of any one explanation,\nor to be derivative of one single source.... It is clear that from none\nof the religions here treated of could the religion of the ancient\nHebrews have originated. The Israelite people, at different periods of\nits history, came and remained for a considerable time under Egyptian,\nBabylonian, and Persian influence, and there have not been wanting\npersons of ability who have regarded Judaism as a mere offshoot of the\nreligion of one or the other of these three peoples. But, with the\nknowledge that we have now obtained of the religions in question, such\nviews have been regarded as untenable, if not henceforth impossible.\nJudaism stands out from all other ancient religions as a thing _sui\ngeneris_, offering the sharpest contrast to the systems prevalent in the\nrest of the East, and so entirely different from them in its essence\nthat its origin could not but have been distinct and separate.... The\nsacred books of the Hebrews cannot possibly have been derived from the\nsacred writings of any of these nations. No contrast can be greater than\nthat between the Pentateuch and the 'Ritual of the Dead,' unless it be\nthat between the Pentateuch and the Zendavesta, or between the same work\nand the Vedas.... In most religions the monotheistic idea is most\nprominent _at the first_, and gradually becomes obscured, and gives way\nbefore a polytheistic corruption.... Altogether, the theory to which the\nfacts appear on the whole to point is the existence of a primitive\nreligion, communicated to man from without, whereof monotheism and\nexpiatory sacrifice were parts, and the gradual clouding over of this\nprinciple everywhere, unless it were among the Hebrews.\"[51]\n\nMedicine is indebted for its advancement to the Hebraic religion to a\ngreater extent than is generally believed. In the early Christian\ncenturies there existed three great creeds: the Christian, Hebraic, and\nMohammedan. The Christian Church was in a perplexing condition. As\nobserved by Draper,[52] it was impossible to disentangle her from the\nprinciples which had, at the beginning, entered into her political\norganization. For good or evil, right or wrong, her necessity required\nthat she should put herself forth as the possessor of all knowledge\nwithin the reach of the human intellect. But the monk and priest were\nprohibited from studying medicine,[53] as by so doing the church saw\nthat she would have to relinquish the spiritual control of disease were\nmedicine a matter of scientific research; she preferred to hold on to\nher spiritual dominion, and let science slumber in darkness. On the\nother hand, the Mohammedans, recognizing the principle of fatalism in\ntheir religion, it was not to be expected that they should cultivate an\nart entirely opposed to that principle. In this state of affairs the\nJewish physician, led by the teachings of his religion, alone presented\nthe study of medicine in a scientific manner, and its practice and its\nresult taught the Moslems that medical science placed it within the\npower of man to keep himself out of the grave, when either assailed by\ndisease or laid low by the wounds of war. The Arabs were not slow to\navail themselves of this discovery; and to the learning and skill of the\nJewish physician, guided by the light of an intelligent Deity and a\nliberal religion, does medicine owe the existence of those able and\nlearned Arabian physicians that flourished during the eleventh and\ntwelfth centuries.\n\nThere has been more or less of fault-finding in regard to certain rules\nand ordinances being sacramental, which, from the nature of things,\nshould have been merely advisory or suggestive, as they pertained\nmore to the hygienic welfare of the people than to the spiritual. Thus\nto reason, is neither philosophical nor in concert with our knowledge\nof the structure of man, and of the intimate relations that exist\nbetween mind and body, or of good health and good morals. The writer\nhas seen violent catharsis produced by bread pills, after podophyllin,\ncastor-oil, and phosphate of soda in the most generousdoses--administered\nas one would drop a letter in a mail-box--had completely failed; it is\nall in the manner and way we give a medicine or treat a disease. Certain\nnarcotic and irritant poisons or powerful sedative agents have a\nphysical action uninfluenced by the mind, but an intelligent physician\nis hardly supposed to drive at the small tack of disease with such\npowerful sledge-hammers. Charcot, recognizing the power of and availing\nhimself of such a remedial agent as the pilgrimages to the Notre Dame de\nLourdes, is an evidence of the intelligent and enlightened practitioner,\nwho has learned, what the Bible taught, long, long ago, that human\nnature must be taken as it is found, and that, like the homely saying of\nMohammed, as the mountain would not come to him, he must go to the\nmountain. Moses and all the Scriptural writers were well aware of this\nstate of affairs, and their manner of using their knowledge was adapted\nand timed to the general intellectual development of the times.\n\nThere is one point in connection with the above that should not escape\nour attention, this being that, while the Hebraic creed and the people\nstill subscribed to the theological doctrine of the origin of disease,\nin common with the religions then in vogue, here the connection stopped.\nAll other creeds--not excepting Christianity--looked forward to a\ntheological doctrine of the cure of disease. With the Hebrew, disease\nwas looked upon as the result of some infraction on his part of some of\nthe laws, and the consequent expression of displeasure on the part of\nthe Deity. He was taught, however, that the observance of certain\nordinances were both conducive to health and to the prevention of\ndisease, and acceptable to God, as well as to rely upon his study and\nskill to cure disease. This was equivalent to teaching them that\ndiseases arose from physical causes, and that physical means were to be\nused to combat them. From this arose the practice of exposing the sick\nin public places, that they might receive the benefit of the advice of\nsuch who might have had experience in a like case. It is from their\nreligion that Hebraic medicine has received its foundation of\nintelligent philosophy that carried it in its purity through all ages,\nfree from magic, superstition, and imposture. With other creeds and\nreligions, medicine, disease, as well as the physical phenomena\naffecting nature, were believed to be the arbitrary expression of anger\nof their gods, and that the cure of disease, or alterations in physical\nphenomena, were to be as arbitrarily effected, regardless of the\nexistence or action of physical laws. It is to be regretted that one of\nthe sects which has sprung from the Hebraic creed, and which worships\nthe same God, has been unable to emancipate itself or its people from\nthe idea of an arbitrary theological doctrine of the origin and control\nof disease. It is this creation of a narrow-minded theology of a\nvaccilating, unintelligent, unphilosophical, and arbitrary God, who\nwould neither respect nor regard the laws of his own creation, that has\nled the great body of physicians out of the modern churches. They do not\ndeny the existence of the Deity, but the god of their conception is a\nhigher and nobler god,--the Deity of Religio Medici.\n\nWhen the prize for the best essay on \"_the power, wisdom, and goodness\nof God, as manifested in creation_\"--a series of publications known as\nthe Bridgewater Treatises--has been nearly every other time won by\nphysicians, among whom we may mention Sir Charles Bell, Dr. John Kidd,\nDr. Peter M. Roget, and Dr. William Prout,--not only won on their own\nmerit, but in competition with learned theologians and noted\ndivines,--we may truly say that physicians are by no means atheists or\nagnostics, but that, on the contrary, they are the real exponents of a\npractical and intelligent religion, which they not only practice, but\nfully and intelligently comprehend.\n\n\n\n\nCHAPTER XII.\n\nHEBRAIC CIRCUMCISION.\n\n\nThe first mention that we meet concerning circumcision is in Genesis. It\nis the command of God to Abraham; in establishing the covenant with him,\nHe said to him: \"This is my covenant, which ye shall keep between me and\nyou, and thy seed after thee: every man-child among you shall be\ncircumcised. And ye shall circumcise the flesh of your foreskin; and it\nshall be a token of the covenant betwixt me and you\" (Gen. xvii, 10,\n11). It was also ordained that this should be extended to servants\nbelonging to Abraham and his seed, as well as to their own children; and\nthat in case of children it should be done on the eighth day after\nbirth.[54] This was appointed as an ordinance of perpetual obligation on\nthe Hebraic family, and its neglect or omission entailed being cut off\nfrom the people (12, 14). In compliance with this ordinance, Abraham,\nalthough in his ninety-ninth year, circumcised himself and all his\nslaves, as well as his son Ishmael. Slaves by purchase were\ncircumcised,[55] as were any strangers, who were also circumcised before\nbeing allowed to partake of the passover or to become Jewish citizens.\nIt was to be observed by all heathens who became converted to the Jewish\nfaith. During the wanderings in the wilderness circumcision was not\npracticed, but Joshua caused all to be circumcised before they entered\nthe promised land.[56]\n\nThe old Hebrews strictly followed the injunction to circumcise on the\neighth day, and of such importance in a religious sense was this rite\nin their estimation that even when the eighth day fell on the Sabbath\nthe eighth day ordinance was observed. The ordinance, however, was not\nblindly arbitrary, as rules were laid down for exception. For instance,\nwhenever a family had lost two children through circumcision it did not\nbecome obligatory on that family to circumcise the third child, who was\nhowever considered as entitled to all the benefits of the congregation\nor of the Hebraic religion, just the same as if he had been circumcised.\nAgain, Maimonides, or Moussa Ben Maimon, a celebrated physician and\nrabbi, born in Cordova in the year 1135 A.D., among his works on\nmedicine, has left directions in regard to circumcision which have been\nthe guides of the _mohels_. Among the Hebraic physicians it was\nconsidered that the child partook of the constitutional strength or\nfeebleness of the mother; hence the rule above mentioned, in regard to\nexemption to circumcision, only was in operation when the two who had\nformerly died belonged to the same mother as the third one, who would\nthereby be exempt; but if the two children had belonged to another\nwoman, and this third child of the father was not from the same mother,\nthe rule did not exempt. The third child of the mother who had\npreviously lost two infants at the rite was, however, to be circumcised\nwhen arrived at adult age, provided no further counter-indication\noccurred. The opinion that the mother gave the constitution to the child\nwas promulgated by Maimonides and became general.\n\nThe eighth day is believed to refer to the eighth day after full term;\nthus, a child born prematurely is not supposed to be circumcised until\neight days after it would have reached its full term, and only then if\nits general good condition is settled. Maimonides looked upon infantile\njaundice, general debility, and marasmus as contra-indications to the\nperformance of the rite; any erysipelatous inflammation, ophthalmia,\nanaemia, eruption of any kind, fever, tendency to convulsive\nmovements--in fact, any observable departure from normal health should\nbe allowed to pass before performing the rite. Aside from these general\nconditions that denoted that the operation was contra-indicated, the\nlocal condition of the organ itself also was to be examined, and if\ncertain conditions existed the operation was to be put off. These\nconditions consisted in any irritation or red appearance of the prepuce,\ndue to either inflammation or to the irritative action of the sebaceous\nmatter underneath the prepuce, the acrid nature of these secretions\nbeing at times sufficiently virulent to produce an ulceration, even in\nthe newborn.[57]\n\nAmong the Hebrews themselves there are those who do not look upon\ncircumcision in a favorable light, but on something that has served its\ntime in its own day, and within the past year a proselyte has been\naccepted into one of the New York synagogues without previous or\nsubsequent circumcision, these reformed Jews looking upon adult\ncircumcision as too painful an operation to be gone through, as they\nclaim, unnecessarily. It must be said, however, that these persons look\nupon circumcision purely in a sacramental light, and simply as an\narbitrary ordinance of God in the remote ages of antiquity, but which in\nthe present century has not enough practical significance to warrant its\nperformance on the occasion of an adult joining the congregation. These\npersons look upon it, as has been said, in a purely theological light,\nand ignore any and all considerations of hygiene in connection with it,\nclaiming that if it is a simple matter of hygiene, then it is not a\nsacrament, and that, if it is sacramental, then the subject of hygiene\nhas nothing whatever to do with it. The force of their reasoning and\nlogic is very obscure and clouded, to say the least. The covenant either\nexists or it does not; to do away with one ordinance in any arbitrary\nmanner is to gradually begin to crumble down the whole fabric of\nJudaism; for when exceptions are begun, one tenet as well as another is\nliable to topple over. If the rite is a sacrament, then it should be\nperformed on all, and a proselyte should not be admitted without being\ncircumcised, and, if a hygienic measure only, the same rule holds. These\nJews evidently ignore the rationalism that governed the promulgation of\nthe Mosaic law, and its recognition of the inseparability of the moral\nfrom the physical nature of man.\n\nMontaigne has left us a description of the performance of the rite, as\nwitnessed by him in the city of Rome in the sixteenth century. He\nrelates it as follows: \"On the thirtieth of January was witnessed one of\nthe most ancient ceremonies of religion practiced by mankind, this being\nthe circumcision of the Jews. This is performed at the dwelling, the\nmost commodious chamber being chosen for the occasion. At this\nparticular time, by reason of the incommodity of the house, the rite was\nperformed at the door of the domicile. The godfather sat himself on a\ntable, with a pillow on his lap. The godmother then brought the child,\nafter which she retired. The godfather then undressed the child's lower\npart so as to expose his person, while the operator and his assistant\nbegan to chant hymns. This operation lasts at least a quarter of an\nhour. The operator may or may not be a rabbi, as it is considered a\ngreat blessing to perform this operation; so that it follows that many\nare found who are anxious to exercise their faculty in this regard,\nthere being a tradition that those who have circumcised a certain number\ndo not suffer putrefaction in their mouth, nor does their mouth become\nfood for worms after death; so that it often happens that they make\npresents of value to the child for the privilege of operating upon it.\nOn the same table on which the godfather is seated all the required\ninstruments and apparatus are placed, while an assistant stands by with\na flask of wine and a glass. A warming-pan full of coals is on the\nfloor, at which the operator warms his hands. The child being now ready,\nwith its head toward the godfather, the operator, seizing the member,\ndraws the foreskin toward him with one hand, while with the fingers of\nthe other he pushes back the glans; he then places a silver instrument,\nwhich fixes the skin, and which at the same time holds back the glans so\nthat the knife may not cut it. The foreskin is then cut off and buried\nin the little basin of soil that forms one of the appurtenances to the\noperation. The operator then tears with his nails the skin which lies on\nthe glans, which he turns back over the body of the member. This seems\nthe hardest and most painful part of the operation, which, however, does\nnot seem dangerous, as in four or five days the wound has healed. The\ncrying of the child resembles that of an infant undergoing baptism. No\nsooner is the glans uncovered than the operator takes a mouthful of\nwine; he then places the glans in his mouth and sucks the blood out of\nit; this he repeats three times. This done, he applies a powder of\ndragons' blood, with which he covers up all the wound, the parts being\nthen done up in expressly-cut bandages. He is then given a glass of\nwine, over which he says some prayers; of this he takes a mouthful, and,\nafter moistening his fingers in the same, he applies the wine three\ntimes to the child's mouth. The wine is then sent to the mother and the\nwomen, who are in some other apartment, who all take a sip. An assistant\nthen takes a silver instrument, pierced with little holes like a small\nstrainer, which he first applies to the nose of the officiating\nminister, then to that of the child, and afterward to the nose of the\ngodfather.\"[58] The above description of the performance of the rite in\nthe sixteenth century answers to the method of its performance as was\nwitnessed some years ago in France.\n\nIn the \"Biblical, Theological, and Ecclesiastical Cyclopaedia\" of Drs.\nMcClintock and Strong the following description of the rite, as taking\nplace in our modern synagogues, is given:--\n\n\"The ceremony of circumcision, as practiced by the Jews in our own\ntimes, is thus: If the eighth day happens to be on the Sabbath, the\nceremony must be performed on that day, notwithstanding its sanctity.\nWhen a male child is born the godfather is chosen from amongst his\nrelatives or near friends; and if the party is not in circumstances to\nbear the expenses, which are considerable (for after the ceremony is\nperformed a breakfast is provided, even amongst the poor, in a luxurious\nmanner), it is usual for the poor to get one amongst the richer, who\naccepts the office, and becomes a godfather. There are also societies\nformed amongst them for the purpose of defraying the expenses, and every\nJew receives the benefit if his child is born in wedlock.\n\n\"The ceremony is performed in the following manner, in general: The\ncircumciser being provided with a very sharp instrument called the\ncircumcising-knife, plasters, cummin-seeds to dress the wound, proper\nbandages, etc., the child is brought to the door of the synagogue by the\ngodmother, when the godfather receives it from her and carries it into\nthe synagogue, where a large chair with two seats is placed; the one is\nfor the godfather to sit upon, the other is called the seat of Elijah\nthe Prophet, who is called the angel or messenger of the covenant. As\nsoon as the godfather enters with the child, the congregation say,\n'Blessed is he that cometh to be circumcised, and enter into the\ncovenant on the eighth day.' The godfather being seated, and the child\nplaced on a cushion in his lap, the circumciser performs the operation,\nand, holding the child in his arms, takes a glass of wine into his right\nhand, and says as follows: 'Blessed be Thou, O Lord our God, King of the\nUniverse, Creator of the fruit of the vine! Blessed art Thou, O Lord our\nGod! who hath sanctified His beloved from the womb, and ordained an\nordinance for His kindred, and sealed His descendants with the mark of\nHis holy covenant; therefore, for the merits of this, O living God! our\nrock and inheritance, command the deliverance of the beloved of our\nkindred from the pit, for the sake of the covenant which He hath put in\nour flesh. Blessed art Thou, O Lord, the Maker of the Covenant! our God,\nand the God of our fathers! Preserve this child to his father and\nmother, and his name shall be called in Israel, A, the son of B. Let the\nfather rejoice in those that go forth from his loins, and let his mother\nbe glad in the fruit of her womb, as it is written: \"Thy father and\nmother shall rejoice, and they that begat thee shall be glad.\"' The\nfather of the child then says the following grace: 'Blessed art Thou, O\nLord our God, King of the Universe! who hath sanctified us with His\ncommandments, and commanded us to enter into the covenant of our holy\nfather, Abraham.' The congregation answer: 'As he hath entered into the\nlaw, the canopy, and the good and virtuous deeds.'\"[59]\n\n\n\n\nCHAPTER XIII.\n\nMEZIZAH, THE FOURTH OR OBJECTIONABLE ACT OF SUCTION.\n\n\nBiblical and rabbinical traditions throw no light on the origin of the\ndetails of the operation as now performed. That it was anciently\nperformed with a knife of stone is certain; an event common in its\ngeneral observance, and which seems to have pervaded all nations or\nraces, howsoever remote or scattered, that it has induced Tylor[60] to\nascribe the origin of the rite to the stone age. We are told that when\nMoses was returning to the land of Egypt he had neglected circumcising\nhis son, and that because of that neglect he nearly lost his son's life;\nhis wife, Zipporah, the daughter of the Midian king and priest, Jethro,\nseeing the danger and knowing its cause, took her little son Gershom and\ncircumcised him with a stone knife, and offered the foreskin to God as a\npeace-offering. Just where the wine was first used we are not told.\nWine, however, was an emblem of thanksgiving, and, being one of the\nfruits of the earth, was considered an acceptable offering to God. It\nhas since, in some form or other, either as wine or as the\nrepresentative of either divine or human blood, been used in both the\nCatholic and Protestant Churches in their ceremonials or vicarious\nsacrifices, or imitations of old customs. Circumcision was by many\nconnected with a blood sacrifice; it was so suggested by the words of\nZipporah at the circumcision of Gershom: \"And Zipporah, his Midianitish\nwife, took up a sharp stone and cut off the foreskin of her son, and\ncast it at his feet and said, 'Surely a _Khathan_ of blood art thou to\nme.'\" Much speculation has followed the use of this word _Khathan_,\nwhich, in the ordinary Arabian, may mean either husband or son-in-law;\nit also means a newly-admitted member of a family; a similar word means\n\"to provide a wedding feast,\" and one other word from the same root and\nbranch means \"to give or receive a daughter in marriage.\" In our own\nday, the _mohel_, or ministerial circumciser, makes it a practice to\ndraw a little blood from the skin of such as are presented for the rite,\nbut whom nature has not furnished with sufficient foreskin for the\noperation. The application, thrice repeated, of the blood and wine to\nthe lips of the child, is probably used as a sign of the sealing of the\ncompact. Wine is mentioned in connection with the High-Priest\nMelchisedeck as the wine of thanksgiving at his meeting with Abraham;\nwine was presented to Aaron by the angel, who, giving him a crystal\nglassful of good wine, said to him: \"Aaron, drink of this wine which the\nLord sends you as a pledge of good news.\" Originally, circumcision must\nhave consisted of the simple removal of the foreskin, and the\nelaboration of the ceremonial details must have been a subsequent\noccurrence; persons wounding their fingers will instinctively carry them\nto their mouth, and it may be that the suction practiced by the Hebrews\nhad its origin in this natural haemostatic suggestion. Wine as a\nhaemostatic and as an emblem of thanksgiving and an acceptable offering\nnaturally came in as an accessory.\n\nThis practice--which, in the old, patriarchal days of the simple\nshepherds, when men only lived on the flesh of their own flocks, their\ndiet, however, consisting mostly of cakes of flour, milk, honey, a few\nherbs, or the flesh of the goat or sheep--could not have been as\nobjectionable as it is at the present day, with blood and secretions in\na continued ferment through diet and habits. Man, living in the open air\nof Armenia, Palestine, or Arabia, sleeping in the open tents of our\nBiblical forefathers, living on the simple diet of a shepherd's camp,\nwith the abstemiousness that those climates naturally induce in man,\ncould not help but be healthy. In those early days, when neither\npassion, anxiety, nor worry disturbed either digestion or sleep, man had\nno vitiated secretions, wine was then a rarity, and water was the drink.\nOne of the early patriarchs on such diet would have furnished a dainty\nand savory dish to the most fastidious cannibal, who is now tormented by\nthe _komerborg kawan_, this being a term used by the Australian\ncannibals to designate the peculiar nausea that is induced in them when\nthey recklessly eat of white man,[61]--something which they do not\nexperience from feasting on the savages who live on the simple diet of a\npastoral tribe. This primitive gastronomic science in regard to\ncannibalism even reached such a pitch of refinement that, as has been\npreviously mentioned, some tribes even resorted to emasculation to\nimprove the flavor of the animal juices, which by this procedure became\nless acrid. The Arabian and Oriental traditions bring us down tales of\nhow, on the same principles, human beings intended to grace the festive\nplatter were fed exclusively on rice. The salivary and buccal\nsecretions, under such a simple diet as that indulged in by our Biblical\nforefathers, become bland and harmless; not only harmless, but even\nantiseptic and positively beneficial, acting on the same principle as\nlocal applications of pepsin. So that the practice, at the time of the\npatriarchs and in their own family, of this part of the rite could not\nhave offered the same objection that it does at the present day. The\nmodern house-dweller, living on a mixed diet and in a climate that\ninduces him to eat grossly, both as to quality and quantity, partaking\nmore or less of vinous, spirituous, or fermented liquors, as well as\nindulging in tobacco, is quite another being from the Arabian or\nArmenian shepherd of former days. Business anxieties and worry also have\na very pronounced effect; so that, with the change in the conditions of\nman and the inception and multiplication of diseased conditions, as well\nas the creation of constitutional and transmissible diseases, this\npractice of suction should have been stopped.\n\nIntelligent rabbis, devoted to their religion, are necessarily prone to\ndefend any of the details in its ceremonials that age and practice have\nsanctioned, and even some of the later writings of Israelism seem to\nmake the mezizah, or suction, a necessary and ceremonial detail. In the\n\"Guimara,\" composed in the fifth century, Rabbi Rav Pope uses these\nwords: \"All operators who fail to use suction, and thereby cause the\ninfant to run any risk, should be destituted of the right to perform the\nceremony.\" In the \"Mishna\" it says, \"It is permitted on the Sabbath to\ndo all that is necessary to perform circumcision, excision, denudation,\nand suction.\" The \"Mishna\" was composed during the second century. The\ncelebrated Maimonides lent it his sanction, as in his work on\ncircumcision he advises suction, to avoid any subsequent danger. Our\nmodern Israelites are supposed, as a rule, to have taken their\nauthority, aside from previous usage and custom, from the \"Beth Yosef,\"\nwhich was written by Joseph Karo, and subsequently annotated by the\nRabbi Israel Isserth. In all of these sanctions, however, there is no\nreason expressed why it should be performed.[62] Maimonides undoubtedly\nlooked upon this act as having a decided tendency or action in depleting\nthe immediate vessels in the vicinity of the cut surface, and that the\nconsequent constriction in their calibre would prevent any future\nhaemorrhage. That this is the natural result of suction is a fact readily\nunderstood by any modern physician. The depletion of the vessel for some\ndistance in its length, with the contraction in the coat that follows,\nis certainly a better preventive to consequent haemorrhage than the\nsimple application of any styptic preparation that can only be placed at\nthe mouth of the vessel, but which leaves its calibre intact. Hot water,\nor an extreme degree of cold, will answer to produce this contraction\nand depletion, but there is here a local physical reaction that is more\nliable to occur than when the contraction has taken place naturally, as\nwhen induced by depletion, instead of by the stimulus of either heat or\ncold. So that if, in the light of modern civilization and changed\nconditions of mankind, and the existence of diseases which formerly did\nnot exist, we are now convinced that suction is dangerous, we should not\njudge the ancients too hastily or rashly for having adopted the custom,\nas it is certainly not without some scientific merit; although,\nauthorities are not wanting who hold that suction or depletion increases\nthe danger of haemorrhage.\n\nIt can be understood that the results of suction would be in some\nmeasure analogous to those left by the application of an Esmarch bandage\non a limb. The ancients, performing the operation with rude implements\nand having no haemostatic remedies or appliances, naturally followed the\nbest means at their command; they evidently feared haemorrhage, and their\nrule in regard to exemption shows us that they recognized the existence\nof haemorrhagic diathesis or other transmissible peculiarities of\nconstitution. This same fear of haemorrhage probably suggested the second\nstep of the operation being performed, as it is by laceration instead of\nby cutting instruments, showing in this an evident desire to limit the\ncutting part of the operation to as small a limit as possible. Against\nan infant who has decided haemorrhagic tendency, we are about as helpless\nas were the ancient Hebrews, and, while the Turkish or some of the\nArabian methods of performing the operation may be said in ordinary\ncases--by the application of cord and the consequent constriction--to\nlimit the danger from subsequent haemorrhage, still, in the haemorrhagic\ndiathesis this would not be of any avail; so, as already observed, we\nmust not too rashly judge those old shepherds of the Armenian plains for\nadopting a practice which to them was calculated to avert subsequent\ndangers, or their descendants following in their footsteps, until having\nlearned better, even if that practice is to us disgusting, primitive,\nand useless.\n\nCases occur,--happily not frequently,--of alarming and uncontrollable\nhaemorrhage. The following case is suggestive of the alarming extent and\npersistence that may attend one of those haemorrhagic cases, even when\nrecovery eventually takes place. It is reported by Dr. Sannanel in the\n_Gazetta Toscana delle science medicale e fisiche_ of 1844. The case was\nthat of a Jewish infant circumcised on the eighth day. Some hours after\nthe operation the child was observed to be bleeding; the haemmorrhage\nwould only cease for a few moments, and then come on with increased\nforce, and which proved rebellious to ordinary remedies. Dr. Sannanel\nwas called during the night of the third day after the operation. A\nnumber of physicians had been in attendance, and neither ice,\nastringents, pressure, nor any usual haemostatic means had had the least\neffect; cautery with nitrate of silver, sulphuric acid, and the actual\ncautery by means of heated iron were tried in succession, without any\ngood results. Ten days passed in this manner, the haemmorrhage only\nceasing for a few moments at a time, and the child was nearly\nexsanguinated from the continued serous seepage and the paroxysmal\nhaemorrhages, when a lucky application of caustic potassa almost\nimmediately stopped the haemorrhage. This case was seen by nearly all the\nleading medical men of Leghorn, who lent their aid and counsel to save\nthe little life. The case is interesting from the length of time it\npersisted, and that even after all the loss of blood and suffering that\nthe little fellow endured he survived.[63]\n\nDr. Epstein, of Cincinnati, in a letter of March 29, 1872, to the\n_Israelite_ of that city, mentions a nearly fatal case from haemorrage\nafter the rite of \"_Milah_,\" and gives the result of his experience in\nsuch cases. He argues that _Hitouch_ or _Hitooch_ alone, or the first\nstep or cutting off of the prepuce, performed with ordinary care, could\nhardly be followed up with any more serious results than can be\ncontrolled with the application of a little acidulated water. The second\nact, or _Periah_, the act of laceration, he looks upon as one that calls\nfor coolness, judgment, and skill, as the membrane should only be torn\nso far and no farther, the thin, inner fold of the prepuce being\nvascular only in the sulcus back of the corona and at its lower\nattachment, where it forms the frenum, or bridle; any carelessness or\nover-anxiety on the part of the operator in tearing this membrane too\nfar back results in danger of haemorrhage; especially is this part of the\noperation liable to be badly done if the inner preputial fold is thick\nand resisting, as in that case undue force may carry the laceration back\ninto the vascular tissue. The means suggested by Dr. Epstein to arrest\nhaemorrhage are those ordinarily used in haemorrhagic cases, such as will\nbe given presently. The doctor regrets that the operators are not as\nthey should be, physicians, and that, when _mohels_ are employed,\npersons are not sufficiently exacting as to their qualifications.[64]\n\nIn France the government has managed to secure more safety in the\noperation. By a royal decree of date of May 25, 1845, in compliance with\na desire expressed by the Hebrew Consistory, it was ordered that no one\nshould exercise the functions of a _mohel_ or of _schohet_, without\nbeing duly authorized to perform said functions by the Consistory of the\nCirconscription; and that all _mohels_ and _schohets_ shall be governed\nin the exercise of their functions by the Departmental Consistory and\nthe General Consistory. By virtue of this decree a regulation was passed\nby the Consistories on the 12th of July, 1854, ordering that thereafter\ncircumcision should only be performed in a rational manner, and by a\nproperly qualified person. Suction was likewise abolished, and the wound\ndirected to be sponged with wine and water. This decree and the\nresulting regulations have been of the greatest benefit to the French\nIsraelites, and some attention to the matter would not be amiss in the\nUnited States.\n\nThis reformation has met with the approval of the leading French Jews,\nwhose General Consistory decided that suction was not necessarily a part\nof the religious rite, and that, as it was undoubtedly introduced into\nthe rite on the days of primitive surgery, it was perfectly rational to\nsuppress this operative accessory, now that that same science, in its\nenlightenment, pronounced it unsafe. The whole body of the Congregation\ndid not tamely submit to what they considered an innovation, and from\nsome of the mohels all possible resistance was opposed to prevent the\nabolishment of this part of the operation from becoming a law. So\ndetermined was this opposition in some instances that the Consistory of\nParis found it necessary to impose on all the mohels an obligation,\nbound by an oath, that they would respect the law. Those who refused to\ntake the obligation gave up their vocation.\n\nThe Grand Rabbi of Paris, at the time of this reformation, M. Ennery,\nwas one of the most zealous supporters of the new departure. The\ninfluence of the French pervaded northward, and the _mezizah_ was\nabolished in Brunswick, Dr. Solomon, a learned Hebrew of that State,\nbeing instrumental in having it done legally. The discussion of this\nsubject, in 1845, had one very happy effect,--the supporters of the\nreformed idea of the rite issued a circular letter to all the leading\ncontinental surgeons and medical men asking for their opinion on several\npoints in relation thereto, especially, however, on this part of the\nrite. The opinions of many of these will be referred to in the medical\npart of this work.\n\nThe after-treatment of the circumcised infant is governed more or less\nby local habits and the individual intelligence of the mohel and his\nexperience. After turning back the inner fold of the prepuce, the parts\nare covered with a small, square bandage, with an aperture to admit the\npassage of the glans. This, and the subsequent small bandage of old\nlinen, which is calculated to hold it in place, are slightly coated with\na powder composed of lycopodium, with the slight addition, at times, of\nMonsel's salts, alum-powder, or some vegetable astringent. Over these\nanother compress is placed, to prevent the friction of the clothes of\nthe infant or of the bedding. The infant then receives a final\nbenediction, and the godmother then receives the child in her arms and\ncarries it to its cot or crib. The operator generally visits the infant\nin the afternoon of the operation, and carefully inspects the dressings,\nto see that no haemorrhage has supervened.\n\nIt is customary to place the child in a bath, either the same evening or\non the following morning, the object of this being to remove and to\nfacilitate the removal of the dressings, which are more or less\nsaturated and clotted with blood. After the removal of these, the wound\nis redressed, as previously, except that some cerate--ointment of roses\nor some other mild ointment--is used. Some prefer the simple water\ndressing from beginning to end. Since the introduction of creasote, acid\nphenique, and carbolic acid, many mohels are in the practice of washing\nthe parts with water impregnated with one of these before performing the\noperation, and using subsequently the same form of lotion at every\ndressing. In case of haemorrhage there is an haemostatic water or lotion,\nwhich has been long used by the German and Polish mohels with\nconsiderable success, and which, in ordinary cases, has been found to be\nall that was required. This water, called by the French \"Mixture\nd'arguesbusade,\" \"Eau vulneraire spiriteuse de Theden,\" and by the\nGermans as \"Spritzwasser\" and \"Schusswasser,\" is composed as follows:--\n\n  Acetic acid,                  10     grammes.\n  Rectified spirits of wine,     5        \"\n  Diluted sulphuric acid,        21/2       \"\n  Clarified honey,               8        \"\n\nThis mixture is well mixed and filtered, and is then kept in a\ntightly-stoppered vial.\n\nDr. Bergson uses a mixture composed of diluted sulphuric acid, 1 part;\nalcohol, 3 parts; honey, 2 parts; and 6 parts of wine vinegar.\n\nHaemostatic powders are also used by the Hebrews, being more conveniently\nkept or carried than the haemostatic waters. In Russia and in Poland they\nare composed of decomposed or decayed hawthorn-wood powder and\nlycopodium. That of Berlin is composed of Armenian bole, red clay,\ndragons' blood, powdered rose-leaves, powdered galls, and powdered\nsubcarbonate of lead. In France a haemostatic fluid, composed of dragons'\nblood digested in turpentine, is in vogue. The Eau de Pagliari is also\nused; it is composed of a mixture of tincture of benzoin, 8 ounces;\npowdered alum, 1 pound; and 10 pounds of water, boiled together for six\nhours, and is considered a powerful styptic. In addition to these, burnt\nlinen, spiders' webs, starch-powder, powdered alum, and plaster-of-Paris\npowder are used by different mohels. Touching the bleeding points with a\npointed pencil of nitrate of silver is also a practice understood by the\nJewish circumcisers.\n\n\n\n\nCHAPTER XIV.\n\nWHAT ARE THE BENEFITS OF CIRCUMCISION?\n\n\nThere are those, even among the Hebrews, who are so imbued with the\npurely theological idea of the origin, performance, and causes of\ncircumcision, that they cannot see any moral nor hygienic value in the\noperation. Among many Christians the idea still prevails that\ncircumcision is the relic of some barbarous rite, practiced in some\nepoch away in the remote ages of the world, grafted on to the Jewish\nreligion by some accident or other; but that beyond the clinging of the\nJews to this custom, as being a remnant of their old religion, they\nneither see in the rite any other significance, moral results, nor\nhygienic precaution; and the fact of a Jew being circumcised is too\noften made a subject of merriment among the unthinking portion of the\nChristian world. Neither are physicians all of one accord on the subject\nas to whether circumcision is a benefit, or, being useless, a dangerous\nand an unnecessary operation. The writer is most emphatically in favor\nof circumcision, and has the fullest faith in the positive moral and\nphysical benefits that mankind gains from the operation.\n\nIt may well be asked: What does the Jew receive in return for all the\nsuffering that he inflicts through circumcision on himself and his\nlittle children? What is there to repay him or his for all the risks and\nannoyances, besides branding himself and his with an indestructible\nmark, which has been more than once the sign by which they have suffered\npersecution, spoliation, expatriation, and death? Are there any\nbenefits enjoyed by the Jew that the uncircumcised does not enjoy in\nequal proportion?\n\nThe relative longevity between the Hebrew race and the Christian nations\nthat dwell together under like climatic and political conditions\nindicates a stronger tenacity on the part of the Jewish part of the\nnations to life, a greatly less liability to disease, and a stronger\nresistance to epidemic, endemic, and accidental diseases. By some\nauthorities it has been held that the occupations followed by the Jew\nare such as do not compel him to risk his life, as he neither follows\nany labor requiring any great and continued exertion, nor any that\nsubjects him to any great exposure; that, as a rule, when in business,\nby some intuition he follows some branch that has neither anxiety, care,\nnor great chance of loss connected with it; that he does not follow any\noccupation that is attended with any risk of accident for either life or\nlimb. Besides all these, it is also urged that in cities the careful\ninspection of their meat, and the peculiar social fabric of the family,\nthe love and veneration for their aged, as well as their proverbial\ncharity to their own poor and sick, and their provident habits and\nhygienic regulations imposed upon them by the Mosaic law, are all\nconditions that conspire to induce longevity.\n\nThat the Hebrew is generally found in such conditions as above described\nis undisputed; but it is questionable if all these conditions are\nnecessarily such as are favorable to health and long life, and that,\ntherefore, the longevity of the Jewish race cannot altogether be\nascribed to the above conditions. Looking at the subject of occupation,\nif we consult Lombard, Thackrah, and the later works on the effects of\noccupation on life, we must admit that the Jew has no visible advantage\nin that regard, as he follows hardly any out-of-door occupation, being\noften in-doors in a confined and foul atmosphere. To those who have\nclosely observed the race in this country,--coming as they do from the\ncold-wintered climates of Germany, Austria, or Poland, bringing with\nthem the habit of living in small, close rooms, for the sake of economy\nand comfort,--it must be admitted that among the lower classes and the\npoorer of the race, their shops being connected, as they usually are,\nwith their living-rooms, the _toute ensemble_ is anything but conducive\nto a long life. Their anaemic and undeveloped physical condition and weak\nmuscular organization are sufficient evidence that their surroundings\nare not calculated to improve health. In England, statistics\nsufficiently prove that the fisherman on the coast, exposed to all kinds\nof weather, is not as prone to disease as is his brother Englishman who\ndeals out the groceries in his snug shop. Exercise has been held an\nimportant element in the factory of the long-lived. From the time of\nHippocrates down to Cheyne, Rush, Hufeland, Tissot, Charcot, Humphry,\nand all authorities on the factors of old age, exercise has been looked\nupon as favoring long life. Exercise cannot be said to enter in any way\nas a factor in the longevity of the Jew; but, on the contrary, his\nin-door life is known to be very productive of phthisis in other races.\nHis recreations are, as a rule, of the home social order. They visit and\nspend the time allotted to recreation in social intercourse, which their\nhospitality always insists on accompanying with a generous lunch, which,\nto say the least, is not an element that is conducive to either health\nor long life; for no people excel the Jew in home hospitality, and even\namong the poorer classes a stranger is never allowed to depart without\nsome refreshment being offered him. Among the class better able to\nextend hospitality, social reunions and card parties, with lunches of\nfruits, cakes, cold meats and coffee, or wines, are among their regular\noccurrences. Their great affection for the family and for their youth\nand aged suggests these means of recreation, as then they are enjoyed by\nall alike; but, as observed, the hygiene of all this is very doubtful;\nit produces too much irregularity.\n\nIt is related that after the Roman conquest of Palestine many of the\nJews, becoming more or less accustomed to Roman manners and customs,\noften joined in the games which the Romans held in imitation of the old\nOlympic games of the Grecians. Not to be ridiculed, many resorted to the\npractices described in a previous chapter, to efface all the marks of\ntheir circumcision, that they might enter the games with as much freedom\nas the Romans or other uncircumcised nations; so that the present\naversion to out-of-door sports evinced by the Jew is not necessarily a\nracial trait; the persecutions and political inequality that until\nlately he has been made to suffer have driven him into retirement and\nseclusion. Although seeking neither converts nor political power and\ninfluence, he has been hunted down, massacred, and chased about as a\ndangerous beast. As the children of the great Rabbi Moses Mendelssohn\nasked of their father: \"Is it a disgrace to be a Jew? Why do people\nthrow stones at us and call us names?\" It may well be asked, why? These\nactions have forced them into the social and retired habits for which\nthey are noted; although it cannot be said that it is from a lack of\nspirit, as one of the Rothschilds is well known to have been present at\nthe battle of Waterloo, where from a spot in the vicinity of the\nBritish right-centre he observed the events of the battle; and when,\nwith the failure of Ney's last desperate charge with the formidable\nbattalions of the Old Guard, he saw the advance of the Prussians closing\nin on the French right, he galloped to the sea-shore, and, crossing the\nChannel in a frail boat, reached London twenty-four hours in advance of\nthe news of the battle,[65] but long enough for him to clear several\nmillions from off the panicky state of the money market. Marshal\nMassena, one of Napoleon's bravest generals, the defender of Genoa and\nthe hero of Wagram, was of Jewish origin.\n\nAthletic sports are not of necessity conducive to long life, even if\nthey are to temporary robust health; but there is no mistaking the fact\nthat the sedentary and in-door life of the average Jew is a deteriorator\nto health and life, and especially among that class of families who are\npoor and keep no servant; from heredity and home education having\nadopted unhygienic customs, in which they have grown up,--in these a\ntotal disregard for all ventilation forms a part. Were an uncircumcised\nrace so to live, scrofula and phthisis would be the inevitable result.\nThis difference of results I have witnessed more than once as existing\namong the two races coming from the same European nationality, where\ntheir disregard to ordinary rules of hygiene, induced by climatic\ncauses, especially ventilation, were alike in both the Semitic and\nEuropean descendants of the one nation, the purely European being more\nprone to consumption and scrofula. It is interesting to note the\ndifference in the moral, mental, and physical conditions induced by\ncreeds; it would seem as if it should not make any difference. The\ngenerally accepted idea of religion is that it should raise the moral\nstandard of all those nations who practice religion; but the results\nare very peculiar, as we are forced to admit that reformation in\nreligion has not always been a reformation in morals. Take Great Britain\nfor example; if illegitimacy is any criterion of the moral state of\nthose professing creeds, we find the least among the Jew; next among the\nCatholic; next comes the Episcopalian; then last the Presbyterian,--the\noldest creed showing the greatest moral tendency, and that of poor Knox,\nwhich is the youngest, showing the least. This has certainly its\nphysical effects, that are not without its influence in producing a\ngreater or lesser length of life. The evolution of religion has here\ninduced a lower moral tone and a resulting physical degeneracy.\n\nAs observed by alienists, religions of different creeds have different\ntendencies in inducing insanity, both as to ratio of population and as\nto manifestations;[66] the Protestant, when unbalanced by religious\ncause, is generally controlled with some idea that shows itself in wild\nand erratic attempts at scriptural interpretation, caused by want of\nfixed dogmas and the unending splittings that are forever taking place\nin the new faith, and the persistent, intrusive, and belligerent spirit\nof proselytism that controls each new branch as it buds into existence.\nThe Catholic has a fixed dogma, which the church attends to, and he\nneither feels called upon to make his neighbors miserable or himself\ninsane in hunting up new interpretations. When he does go insane on the\nsubject of religion, the cause, as a rule, can be traced to some real or\nimagined moral delinquency, which has brought all the terrors of the\npunishment of the damned forcibly and persistently to his disordered\nimagination. In the insane-asylums of Cork, in Ireland, with its\noverwhelming Catholic population, the ratio of inmates in regard to\ncreeds is as that of one Catholic to ten of the Reformed religion,\nshowing in the most conclusive manner the influence exerted by religion\nin this direction. On the other hand, the Jew has the simplest of\nreligious creeds; he neither wastes useful time, robs himself of sleep,\nnor becomes dyspeptic in hunting for hidden meanings in some ambiguous\nscriptural phrase; he is satisfied with his creed, his dogmas are firmly\nanchored, and the nature of his religion being a sort of family\ncongregation, he is not called upon to go out in search of proselytes,\nany more than the father of an already large family feels called upon to\ngo out and hunt up the homeless, that he may convert his home into a\npromiscuous orphan-asylum. As before remarked, his creed is of the\nsimplest, and there exists a complete and explicit understanding between\nhis God and himself. There are no mystical, hidden meanings in Scripture\nfor the Jew; nor does he dread any eternal, unheard-of, and inexplicable\ntorments. His laws are very clear, and the punishments for their\ninfraction very explicit. To the Jew it is a straight and well-lighted\nroad, as far as religion is concerned. The writer has always felt that\nit took a mind that was incapable of appreciating simple truths, but\nthat loved to hover on that mystical border-land on the confines of\ngloomy insanity that would allow its owner to seriously wander through\nand behold any theological beauties in Bunyan. To the Jew there is none\nof the gloomy, weird, mystical, mind-racking, ungodly theology that some\nof our creeds torture the poor brains of their professors with. As the\nwild Indian of the plains runs sticks through his anatomy and capers\nwildly about to torture his body, so some of the creeds delight in\ntorturing their devotees. The Jewish religion is the one best suited to\ntranquilize the mind; it is very philosophical and rational. Were he to\nacknowledge Christ, he would not have to change his course of life to\nbecome a most exemplary Christian. The celebrated letter of Moses\nMendelssohn to the Swiss clergyman, Lavater, in answer to a dedication\nof the latter to Mendelssohn, is probably the best exposition of the\nessence of the Jewish faith that can be found. Therein he says: \"We\nbelieve that all other nations of the earth have been commanded by God\nto adhere to the laws of nature. Those who regulate their conduct\naccording to this religion of nature and of reason are called _virtuous\nmen of other nations_, and are the children of eternal salvation.\" Such\na religion does not unsettle man's mind.\n\nThese apparent digressions are made to show what additional factors\nexist, besides circumcision, to induce longevity in the Jewish race, and\nthat the subject may be better understood; for these reasons the above\ncomparisons have been made. Students of demographic science are well\naware that form of government, religion, climate, diet, habit, and\ncustom,--all have an important bearing on the mental and physical as\nwell as on the moral nature of man. To the true student of his art all\nthese conditions are but factors in the physical scale, and should so be\nconsidered without fear or favor; to him the whole world is but a unit,\nand the people upon its surface are but as one people, alike subject to\nthe leveling laws of nature, which recognize neither royalty nor\nvagrant, nationality nor creed, color, condition, nor station in life or\nsociety.\n\nProfessor Bernoulli, of Bale, found the Israelite less prolific than the\nChristian;[67] subject to less mortality, greater longevity, less\nstill-born, less illegitimacy, less crime against the person, and less\ninsanity and suicide, when compared with his Christian brother--all of\nwhich he attributes not to a superior physique or organism, but solely\nto the observance of the laws of their religion and to the nature of the\nsame, which exercises a beneficial influence on the mind.\n\nB. W. Richardson, in his \"Diseases of Modern Life,\" in speaking of the\nrelation of race to disease, says: \"Through the valuable labors of MM.\nLegoyt, Hoffmann, Neufville, and Mayer, we have obtained, however, some\ncurious facts relative to the most widely disseminated of all races on\nthe earth, the Jewish. These facts show that, from some cause or causes,\nthis race presents an endurance against disease that does not belong to\nother portions of the civilized communities amongst which its members\ndwell. The distinctness of the Jews in the midst of other and mixed\nraces singles them out specially for observation, and the history they\npresent of vitality, or, in other words, of the resistance to those\ninfluences which tend to shorten the natural cycle of life, is\nsingularly instructive.\n\n\"The resistance dates from the first to the last periods of life.\nHoffmann finds that in Germany, from 1823 to 1840, the number of\nstill-born among the Jews was as 1 in 39, while with other races it was\n1 in 40. Mayer finds that in Furth children from one to five years of\nage die in the proportion of 10 per cent. among the Jewish, and 14 per\ncent. among the Christian population. M. Neufville, dealing with the\nsame subject, from the statistics of Frankfurt, gives even a more\nfavorable proportion of vitality to the Jewish child population.\nContinuing his estimates from the ages named into riper years, the value\nof life is still in favor of the Jews, the average duration of the life\nof the Jew being forty years and nine months and that of the Christian\nbeing thirty-six years and eleven months. In the total of all ages, the\nhalf of the Jews born reach the age of fifty-three years and one month,\nwhilst half of the Christians born only reach the age of thirty-six\nyears. A quarter of the Jewish population born is found living beyond\nseventy-one years, but a quarter of the Christian population is found\nliving beyond fifty-nine years and ten months only. The Civil State\nextracts of Prussia give to the Jews a mortality of 1.61 per cent.; to\nthe whole kingdom, 2.62 per cent. To the Jews they give an annual\nincrease of 1.73 per cent.; to the Christian, 1.36 per cent. The\neffective of the Jews require a period of forty-one years and a half to\ndouble themselves; those of other races, fifty-one years. In 1849,\nPrussia returned one death for every forty-one of the Jews and one for\nevery thirty-two of the remaining population.\n\n\"The Jews escaped the great epidemics more readily than the other races\nwith whom they lived. Thus, the mortality from cholera amongst them is\nso small that the very fact of its occurrence has been disputed. Lastly,\nthat element of mortality, suicide, which we may look upon\nphilosophically as a phenomenon of disease, is computed by Glatter, from\na proportion of one million of inhabitants of Prussia, Bavaria,\nWuertemburg, Austria, Hungary, and Transylvania, to have been committed\nby rather less than one of the Jewish race to four of the members of the\nmixed races of the Christian population. Different causes have been\nassigned for this higher vitality of the Jewish race, and it were indeed\nwise to seek for the causes, since that race which presents the\nstrongest vitality, the greatest increase of life, and the longest\nresistance to death must in course of time become, under the influences\nof civilization, dominant. We see this truth, indeed, actually\nexemplified in the Jews; for no other known race has ever endured so\nmuch or resisted so much. Persecuted, oppressed by every imaginable form\nof tyranny, they have held together and lived, carrying on intact their\ncustoms, their beliefs, their faith, for centuries, until, set free at\nlast, they flourish as if endowed with new force. They rule more\npotently than ever, far more potently than when Solomon in all his glory\nreigned in Jerusalem. They rule, and neither fight nor waste.\"[68]\n\nRichardson attributes the great benefits enjoyed in this regard by the\nJewish race to the soberness of their lives. This position is, however,\nnot altogether tenable, if by that we mean abstemiousness; they are\nextremely temperate, but not abstemious. Tissot, Cornaro, Lessius,\nHufeland, Humphry, Sir Henry Thompson, as well as the older Greek and\nRoman authorities, all are agreed that an abstemious life is the one\nthat is most conducive to long life. There is no race that is more\nproverbial for their good cheer and indulgence in the good things of the\ntable than the Jewish; no race enjoys feasting any more than they, and\nfrom childhood they are accustomed to a generous and nutritious diet, as\nwell as to their share of the wines with which their tables are\nsupplied. Their greater thrift and application to business, their habits\nof economy and carefulness in business affairs enable them to better\nsupply their tables. In California there is no class that lives better\nor whose tables are supplied so well either as to quality or quantity as\nthose of the Jews, and yet no class is more exempt than they from the\nclass of diseases that originate in too good living. As before remarked,\nin relation to the poor of that faith, who are unable to keep a servant,\nand who live in a combination of shop and home in the most unhygienic\ncondition, disregarding ventilation and every other sanitary needs, but\nwho, nevertheless, escape the evil results that would and do attend such\nsocial conditions among those of other races, so in this instance of\ngood living: the better class of Jews do not suffer in anything near a\nlike proportion to the better class Christians from diseases incident to\ntoo full habits and an inactive life. Richardson observes that he drinks\nless and that he eats better food than his Christian brother. In regard\nto the drinking habit, overindulgence is not a Jewish failing; they do\nnot drink to excess, but total abstinence is not in their vocabulary. It\nis inconsistent with their idea of wine as being a gift of God, and\nsomething that is symbolical of good faith and thanksgiving. Nor is\ntotal abstinence consistent with their idea of generous hospitality. On\nthe eighth day after birth the Jew tastes wine, and from the time he is\nable to sit at table he becomes familiar with its use. To him wine is\nnot symbolical of either moral depravity, mental or physical\ndeterioration, or of death. Their females are all accustomed to its use\nfrom childhood, but it does not cause them to become either immoral or\nunchaste; so that in neither sex does wine produce that moral and mental\nwreckage which abbreviates the length of human existence among those of\nother creeds. Radical fanaticism, that drives a tack with a maul and a\ntwenty-penny spike with a tack-hammer, cannot be expected to study this\nor any other question in any rational manner; but to the sociologist,\nthe question as to what produces this remarkable soberness, in the midst\nof the habitual and continued use of wine in the race from the time of\nits earliest history, is something worthy of calm and careful\nconsideration. How much circumcision may have to do with this will be\ndiscussed in the medical part of the volume.\n\nIn London, according to Dr. Stallard, the mortality among Jewish\nchildren from one to five years is only ten per cent., while among the\nchildren of the Christians it is fourteen per cent., the rate being\nanalogous to that observed by Mayer among those of these ages in Furth.\nAmong the London adults the average duration of life among the Jews is\nforty-seven years, while among the Christians it is only thirty-seven.\n\nDr. Hough[69] has gathered some interesting historical and statistical\nmatter bearing on the subject of Jewish resistance to disease and the\nbenefit possessed by the race in relation to the immunity enjoyed by\nthem in prevailing epidemics. The plague of 1346 did not affect them;\naccording to Fracastor they escaped the typhus of 1505; Rau remarks\ntheir immunity to the typhus of 1824; Ramazzini noticed their exemption\nto the fatal intermittents of Rome, in 1691; and Degner says that they\nescaped the epidemic dysentery at Nimegue, in 1736. Richardson truly\nobserves that \"from epidemics the Jews have often escaped, as if they\npossessed a charmed life.\" This racial difference and benefit, when\ncompared to other races, has more than once cost them dear. In the dark\nand ignorant ages, when men reasoned nothing from a physical basis, but\nattributed all and every phenomena to some supernatural agency, either\nheavenly or diabolical, it was but natural for such minds to associate\nthis exemption with some purchased compact made with the devil, who was\noften also held accountable for the existence of the epidemics. The\nrational and law-of-nature observing Jew supposed to be in league with\nhis satanic majesty could neither be seen nor heard in his own defense;\nconsequently, massacres, pillaging, and such other barbarities that an\ninsane popular fury could suggest, were the humane manifestations with\nwhich a Christian people visited their Jewish brothers, whose only sin\nconsisted in worshiping the God of their fathers, and in strictly\nobserving His laws and commandments.\n\nIn France, Dr. Neufville found that, of one hundred children in the\nfirst five years of life, among the Jewish population, 12.9 die; while\nfrom the same number of the same aged class of Christians 24.1 die.\nOne-half of all the Christians die at thirty-six years, and one-half of\nall the Jews at fifty-three years and one month.\n\nDr. John S. Billings has gathered statistics relating to 10,618 Jewish\nfamilies, consisting of 60,630 persons,[70] living in the United States\nin December, 1889, mostly descendants of Jews from the northern or\nmiddle nations of Europe. For our purpose only the deductions as to\ndeath-rate and tendency to longevity will be given. In this valuable\npaper Dr. Billings says: \"When we come to examine the reports of deaths\nfor five years furnished by these Jewish families, we find that they\ngive an average annual death-rate of only 7.1 per 1000, which would be\nabout one-half of the annual death-rate among other persons of the same\naverage social class and condition living in this country.\" To this he\nadds that, provided the deaths at different ages among the Jews have\nbeen correctly reported, this race will, on comparison with those of\nother races, show a greater tendency to longevity, as the Jewish\nexpectation of life is at each age markedly greater than that of the\nclass of people who insure their lives, the average excess being a\nlittle over twenty per cent.\n\nIn speaking of the death-rate among children, Dr. Billings makes the\nfollowing comparisons: \"The low death-rate among the Jews is especially\nmarked among the children, and this corresponds to European\nexperience. Thus in Prussia, in 1887, the death-rate of the Jews under\nfifteen years of age was 5.63 for 1000, while among the remainder of the\npeople it was 10.46 per 1000.\" This result he accounts for partly to the\nfact that among the Jews illegitimacy is comparatively rare and to the\nhigh rate of mortality among the illegitimate born, which raises the\naverage of the other classes.\n\nIn regard to the immunity of the race from consumption or tubercular\ndisease, the statistics of the above Jewish families gives to the Jews\nless than one-third of the number of deaths from these diseases than\nwhat occurs among the others as to the male population, and less than\none-fourth as to the female population. These statistics coincide with\nthe observations of the writer on this part of the subject, and are even\nmore than corroborated by the French War-Office Reports from Algeria,\nwhere the deaths from consumption among the Christians amount to 1 for\neach 9.3 deaths, and among the Jews to 1 in 36.9, while among the\nMohammedans it is only 1 in 40.7 deaths. In Algeria the relative\nmortality from all causes is only about three-fifths of that of the\nChristian, and the Turk, although seeming to enjoy a greater exemption\nfrom phthisical or tubercular diseases than the Jew, falls below the Jew\nin exemption from deaths due to general causes, as his mortality is\none-eighth greater than that of the Jew. Dr. Billings gives us some\ninteresting food for thought in the course of his article and some more\nparticularly bearing on the subject of immunity from consumption. He\nasks: \"Are these differences due to race characteristics, properly\nso-called, to original and inherited differences in bodily organization,\nor are they, rather, to be attributed to the customs, habits, and modes\nof life of the two classes of people?\"\n\nSome years ago, Henry I. Bowditch, of Boston, put on foot an extended\nsystem of inquiry in regard to ascertaining the causes or antecedents of\nconsumption in the State of Massachusetts. In answer to some of the\nquestions of the circular, Rabbi Dr. Guinzburg, of Boston, answered as\nfollows, under date of October 29, 1872:--\n\n1st. The number of Jews living in Boston is about 5000.\n\n2d. There certainly have not died of consumption, during the last five\nyears, more than eight or ten Jews in the various congregations.\n\nTo this Dr. Bowditch adds, as follows:--\n\n\"If Dr. Guinzburg's data be correct, they show a very great immunity\nfrom consumption on the part of the Jews, compared with the citizens\ngenerally, as will be seen by the following comparison between these\nnumbers and those procured from the Registration Reports, published by\nthe State. In the report published in 1869, page 64, we find that for\nthe five years preceding 1869 the annual average of deaths by\nconsumption was 338 for every 100,000 living. These data from Dr.\nGuinzburg and the State Report give the following table:--\n\n                              Proportion of Deaths to\n                                 100,000 of Living.\n  All religions,                        338\n  Jews,                                  40\n\n\"These statements from Dr. Guinzburg are confirmed by the following\nletter from Dr. A. Haskins, of this city. Dr. Haskins is connected with\none of the Jewish benevolent associations for the benefit of the sick. I\nsent to him similar questions and make the following extracts from his\nreply:--\n\n\"'I am generally employed in about sixty families (Jewish). I have had\nthese families under my care for two and a half years. During this time\nI have seen but one case of consumption. I have averaged among these\nsixty families about two visits daily. In my other Jewish practice,\nwhich is not inconsiderable, I have in this time (two and a half years)\nseen two cases of consumption.... I am sorry I have no statistics\nwhereby I could compare the two peoples, viz., Jews and Christians. I\ncan, therefore, give you only my impressions. I should say that I find\nconsumption less frequent among the Jews than among Christians. This\nwould be my own impression without any data to fortify it.'\n\n\"Dr. Waterman also sustains the same idea. The following extract will\ngive some idea of his opportunities for observation and the sources of\nhis deductions:--\n\n\"'BOSTON, November 2, 1872. Dear Sir,-- ... First, I have attended four\ncharitable associations; number about forty, fifty, sixty, and one\nhundred families. At present I only attend one, containing one hundred\nfamilies, and on which I average a fraction over one visit a day. I\nhave, besides, many private families among the Jews. I have attended but\nfew cases of consumption, and I think the disease is not so prevalent as\namong Christians.'\"\n\nThe same report of Dr. Bowditch quotes from Stallard's \"London Pauperism\nAmongst Jews and Christians,\" as saying that there is no hereditary\nsyphilis, and scarcely any scrofula to augment the mortality in the\nJewish families.\n\nIn relation to the liability of the Hebrew race to phthisis, Richardson\nhas the following at page 22 of his \"Diseases of Modern Life\": \"The\nspecial inroads on vitality made on other races by disease are not\neasily determined, because of the difficulties arising from temporary\nadmixture of race. I tried once to elicit some facts from a large\nexperience of a particular disease, phthisis pulmonalis, and, as the\nresults of this attempt may be useful, I put them briefly on record.\n\n\"At a public institution at which large numbers of persons afflicted\nwith chest diseases applied for medical assistance, and at which I was\nfor many years one of the physicians, I made notes during a short\nportion of the time of the connection that existed between race and the\nparticular disease I have instanced--phthisis pulmonalis, or pulmonary\nconsumption. The number of persons observed under the disease was three\nhundred, and no person was put on the record who was not suffering from\na malady pure and simple; I mean without complication with any other\nmalady. They who were thus studied were of four classes: (_a_) those who\nwere by race distinctly Saxon; (_b_) those who were of mixed race, or\nwhose race could not be determined; (_c_) those who were distinctly\nCeltic; (_d_) those who were distinctly Jewish.\n\n\"The results were, that of the three hundred patients, one hundred and\nthirty-three, 44.33 per cent., were Saxon; one hundred and eighteen,\n39.33 per cent., were of mixed or undetermined race; thirty-one, 10.33\nper cent., were Celtic; and eighteen, 6 per cent., were Jewish.\"\n\nAlthough Dr. Richardson admits it would be unfair to accept the above\nfigures as a basis for general application, he argues that they are, on\nthe average, sufficiently suggestive, as among the Saxons it was noticed\nthat there were more cases in whom the disease was hereditary, while\namong the others it was generally acquired.\n\nIn going over the subject of this question in regard to phthisis, we\nmust admit that, although the Jew in his own home, synagogue, or in his\nsocial reunions, is not exposed to tubercular emanations, and that he\nhas less chance of contracting the disease from tuberculous meats, he\nis, after all, a theatre-goer; a pretty constant inhabitant of the\nsleeping-car and hotel, as a commercial traveler and general merchant;\nand that, on the whole, he eats the same food, breathes the air and dust\nof the same streets, and drinks the same milk and water as the\nChristian, and, as observed by Dr. Billings, cooking destroys the\nbacillus in meats. So that the comparative exposure in this\ncountry--where the practice is not as prevalent as in Germany of eating\nraw minced-meat sandwiches--existing between the Jew and the Christian\nto tubercular infection from meat are about equal. The records of the\nJewish Hospital of New York gives, out of 28,750 persons admitted, only\n44.17 per 1000 of its admissions as being due to consumption; while\nthose of the Roosevelt Hospital, out of 25,583 admissions, gives a per\n1000 of 67.93.\n\nFrom what is known of the relation of syphilis to consumption, not only\nas affecting the primary individual, but the subsequent generations of\nthe same, and the known greater exemption of the Jew to syphilitic\ninfection, owing to the protecting influence of circumcision, it is safe\nto assert that therein is to be found one of the main reasons of the\nexemption of that race to consumption. If we but look at the\ngeographical distribution of phthisis and the history of its progress,\nwe shall find that it has had syphilis as its _avant courrier_ on more\nthan one occasion. Lancereaux, in his \"Distribution of Pulmonary\nPhthisis,\" points to the fact that where consumption has made its\ngreatest ravages, and where it has nearly depopulated one of the great\ndivisions of the globe,--namely, the groups of islands in the Pacific\nOcean,--the disease had no existence at the beginning of the present\ncentury. Syphilis, scrofula, and a quick, galloping consumption have,\nsince the last ninety years, taken off the greater part of the\npopulation. The same course of transition from the best of physical\nconditions to racial deterioration and extinction from the same relative\ncondition of causes--syphilis, scrofula, and phthisis--has been observed\namong the open-air dwellers of the New Mexican Plains, in the mountains\nof Arizona, and on the arid wastes of the Colorado Desert, where the\nappearance of consumption cannot be attributed to housing or incipient\ncivilization, as it is attributed to housing among the Chippeways,\nSioux, or Mandans in the regions that formerly formed the Northwest\nTerritory. The question is very plainly answered as to how consumption\nwas introduced or whence it sprung that has so ravaged the Oceanic\nIslands. The sailors who first visited those islands were not, as a\nrule, a batch of consumptive tourists on a voyage in search of health or\nrecreation; but we can well understand that the proverbially improvident\nmariner has not always had his health looked after by an Anson or a\nCook, and that many a festive tar who induced the unsophisticated Indian\nmaid to join him in worship at the shrine of Venus Porcina carried in\nthe innermost recesses of the folds of his pendulous and sea-beaten\nprepuce the remnants of former Bacchanalian festivities performed in the\nquestionable temples of Venus and Bacchus in Portsmouth or London.\nConsumption, as such, was neither imported nor propagated by Europeans\ninto those islands, its original entry being in the shape of syphilis.\nHad it been the ancient mariners of old Phoenicia in the days of its\ncircumcision, or the circumcised marines of the ancient Atlantean fleets\nfrom the sunken continent of Plato, instead of the uncircumcised\nsailors of modern England, that first and since visited those islands,\nit is safe to say that consumption would not now exist there. From this,\nit may be well to inquire what would be the relation between the Jewish\nrace and consumption; were circumcision among them to be done away with,\nwould it not be greatly on the increase?\n\nThe weight of testimony is evidently convincing that the Jew has a\ngreater longevity and stronger resistance to disease, as well as a less\nliability to physical ills, than other races; that all these exemptions\nor benefits are not altogether due to social customs is evident; how\nmuch circumcision may have to do in inducing these favorable conditions\ncan be better appreciated by a consideration of how circumcision affects\nthose of other races, and more particularly how its performance works\nchanges in the individual in his general health and condition, and in\ndoing away with many physical ailments that the individual was\npreviously subjected to. So that the Jew cannot be said to be a loser by\nhis observance of this rite, and he and his race have been well repaid\nfor all the sufferings and persecutions that its observance has\nsubjected them to. As observed by John Bell, \"The preservation of health\nand the attainment of long life are objects of desire to every man, no\nmatter in what age or country his lot is cast, nor by what arbitrary\ntenure he holds his life. They are the wish of the master and the slave,\nof the illiterate and the learned, of the timid Hindoo and the warlike\nArab, of the natives of New Zealand not less than of the inhabitants of\nNew England,--an indispensable condition for the greatest and longest\nenjoyment of the senses and propensities; for the widest range and\nexercise of intellect and gratification of the sentiments, whether these\nbe lofty or ignoble, health, in any special degree, has ever been a fit\nsubject of contemplation and instruction by the philosopher and\nlegislator. Their advice and edicts on the means of preserving it have\nfrequently been enforced as a part of religious duty, and, at all times,\ncivilization, even in its elementary forms, has been marked by laws on\nthis head. With the numerous and minute hygienic enactments of the great\nJewish lawgiver for the guidance of the people of Israel we are all\nfamiliar. Prompted, we may suppose, in part by the example of Moses, and\nalso by considerations growing out of the nature of the climate in which\nhe lived, Mohammed incorporated with the mingled reveries, ethics, and\nblasphemies, which composed his Koran, dietetic rules and observances of\nregimen that are to this day implicitly obeyed by his zealous\nfollowers.\"[71]\n\nIf circumcision is not a factor in the difference that exists between\nthe Jewish race and other races, if it goes for nothing as an exemptor\nof disease and the promoter of longevity, then there must exist some\nother factor or cause that induces these conditions. What this factor\nis, the legislator, the sociologist, and the physician should make it\ntheir business to find out.\n\n\n\n\nCHAPTER XV.\n\nPREDISPOSITION TO AND EXEMPTION AND IMMUNITY FROM DISEASE.\n\n\nThe peculiar differences that exist between different animals in regard\nto their susceptibility to the action of drugs is even more remarkable\nthan the differences that exist in their susceptibility to certain forms\nof disease. We can understand and appreciate what Koch tells us in\nregard to the different susceptibilities exhibited by the house-mice and\nthe field-mice to the anthrax bacillus, or why a nursing child should\noffer different results, when exposed to the diphtheria bacillus or the\ncontagious poison of any of the exanthemata, from those witnessed in the\nmeat or promiscuously dieted child. We can also appreciate that\ndifferent individuals have different susceptibilities to disease, as\nwell as we understand that the same degree is not always in an unvarying\npoint of resistance or susceptibility in the same individual. The\ninvestigation and study of these conditions teach us, however, that\nthere is a cause, or that there are causes that induce and modify this\nsusceptibility. But there are conditions that are as yet beyond our\ncomprehension. Take, for instance, two animals, both vertebrates,\nmammals, and dwelling together, eating the same food, and even having a\nmutual understanding or sympathy of mind and affections, having a like\ncirculation, a like brain and nervous system, it would naturally be\nsupposed that these two would exhibit a like susceptibility to the\nactions of narcotic poisons; but when we are told that one dog has\ntaken 21 grains of atropia with impunity we are staggered. Atropia may\nnot affect rabbits (as it does not), but the rabbit does not approach\nman in the same close relationship as the dog. Richardson administered\nto a healthy young cat 7 drachms of Battley's solution of opium, then 10\ngrains of morphia, and a little later 20 grains more of morphia without\nrendering the cat unconscious. The same experimenter gave to a pigeon\n21, 30, and 40, then 50 grains of powdered opium on succeeding days with\nno bad effect. S. Weir Mitchell gave to three pigeons, respectively, 272\ndrops of black drop, 21 grains of powdered opium, and 3 grains of\nmorphia without any effect.[72] On the other hand, horses show a like\nsusceptibility to man to the action of drugs. In the island of Ceylon, a\nsloth can take 10 grains of strychnia with safety,--chickens presenting\na like immunity to the poisonous effects of this alkaloid. While the dog\noffers such a contrast to the action of drugs as compared to man, he is\nas subject to goitre, and they have been seen in a true state of\ncretinism.[73]\n\nAn Apache, or Colorado Indian, will prefer a dessert of decomposed\ngophers to one composed of the best canned peaches or Bartlett pears; he\nwill devour the mass without any resulting evil, while a German--after\nmany generations of training on all forms of sausages in every degree of\nage and ripeness, and on every form of cheese, from the refreshing\ncottage cheese from curdled milk and the delicious cream cheese, down\nthrough to all and every grade as far as Limburgher, or maggoty, common\ncheese--has not, in every case overcome the tendency of the civilized\nintestine and constitution to the action of sausage poison, something\nthat has no effect on the ordinary Indian, or on the uncivilized\ndweller north of the arctic circle. Even the house-dog, that faithful\ncompanion of man, in many cases living on exactly the same fare as his\nmaster, is insensible to the action of this poison. An Indian will gorge\nand gormandize, after a prolonged fast, on such quantities and qualities\nof food that, if the ordinary white man were to indulge in a like feast,\nhe would be in imminent danger of literal rupture or explosion, or\nliable to end in sudden apoplectic seizures, or, in case of a too\nhealthy and active digestion, liable, owing to a lack of a\ncorrespondingly active condition of the excretory organs, to go off in\nuraemic coma. This sporadic and fitful feasting has no perceptible effect\non the Indian, who either simply works it off in exercise, or sleeps it\noff in a long and prolonged period of sleep, during which his lungs work\nwith the deep and steady pull and persistence that a tug-boat exhibits\nwhen towing in a large ship against the tide and a head wind,--working\nin and out more air in one respiration than the ordinary white man will\nin a dozen. All these different conditions are more or less plain to us\nand as easy of explanation,--just as plain as to how and why some birds\neat gravel to improve their digestion. In the cases of different\nsusceptibility to the action of strychnia or of narcotics, the\nexplanation must of necessity, for the present, be more or less\nspeculative. But how are we to account, even in the way of speculation,\nfor the peculiar immunity, lack of predisposition and hereditary\ntendencies to disease exhibited by the Hebrew, who, since the history of\nthe world, has been a civilized and rational being,--even for decades of\ncenturies before the civilization of Europe? Living under the same forms\nof government, climate, and shelter, practically using the same\nvarieties of food and drink, he exhibits an entirely different vitality\nand resistance to disease, decay, and death,--being, in fact, a puzzle\nto the demographic student. The only really marked difference that\nexists between this race and the others lies in the fact that the Hebrew\nis circumcised, other differences not being sufficiently constant to be\naccounted as factors. Circumcision is, in the opinion of the writer, the\nreal cause of the differences in longevity and faculty for the enjoyment\nof life that the Hebrew enjoys in contrast to his Christian brother.\nChristian and uncircumcised races may individually, or in classes,\ndevelop some peculiar immunity or exemption, as, for instance, the\ntolerance to arsenic exhibited by some German mountaineers, or the\npeculiar safety enjoyed by the butcher class from attacks of continued\nfever;[74] but these exemptions are purchased at the expense of the\nfuture, the effects of arsenic, long continued, finally having its\nmorbid effects, and the very plethora which is the bulwark of resistance\nin the butcher, this plethora being in the end a treacherous foe,\ndiseases result from it which make a sudden ending to this class when it\nis least expected.\n\nFor an all around long-liver the Hebrew holds a pre-eminence, and, as\nthe factor in this pre-eminence, circumcision has no counter-claimant.\nCircumcision is like a substantial and well-secured life-annuity; every\nyear of life you draw the benefit, and it has not any drawbacks or\nafter-claps. Parents cannot make a better paying investment for their\nlittle boys, as it insures them better health, greater capacity for\nlabor, longer life, less nervousness, sickness, loss of time, and less\ndoctor-bills, as well as it increases their chances for an euthanasian\ndeath.\n\n\n\n\nCHAPTER XVI.\n\nTHE PREPUCE, SYPHILIS, AND PHTHISIS.\n\n\nIt is not alone the tight-constricted, glans-deforming,\nonanism-producing, cancer-generating prepuce that is the particular\nvariety of prepuce that is at the bottom of the ills and ailments, local\nor constitutional, that may affect man through its presence. The loose,\npendulous prepuce, or even the prepuce in the evolutionary stage of\ndisappearance, that only loosely covers one-half of the glans, is as\ndangerous as his long and constricted counterpart. If we look over the\nworld's history, since in the latter years of the fifteenth century\nsyphilis came down like a plague, walking with democratic tread through\nall walks and stations in life, laying out alike royalty or the vagrant,\nthe curled-haired and slashed-doubleted knight, or the tonsured monk, we\nmust conclude that syphilis has caused more families to become extinct\nthan any ordinary plague, black death, or cholera epidemic. Without\nwishing to enter into a history of syphilis, it is not outside of the\nprovince of this book to allude to its frequency and spread.\n\nSyphilis is not restricted to classes by any means; it is not those of\nthe lower class alone who are its victims. Dr. Fr. J. Behrend, in his\nwork, \"Die Prostitution in Berlin,\" observes that abolition of the\nbrothels in that city in 1845, '46, '47 and '48, trebled the number of\ncases of syphilis treated at the Der Charite; in the year 1848 the cases\nof syphilis treated at that hospital numbered over 1800. It was also\nremarked during this period of legally-enforced virtue, that, as\ninconsistently as it might appear, the disease invaded the best of\nfamilies. From Dr. Neumann, in his brochure entitled \"Die Berliner\nSyphilisfrage,\" published in 1852, we learn that, in the Trades and\nMechanics' Benevolent Union of Berlin, in 1849, 13.51 per cent. of the\nsick were so from syphilis.\n\nIn the thirteenth volume of the _British and Foreign Medico-Chirurgical\nReview_, we find, in a review of the control of prostitution, an\nestimate in regard to the syphilization of a nation. The estimates are\nmade on the most conservative figures, as, in the desire of the reviewer\nnot to overestimate, he starts by figuring out the actual number of\nprostitutes in England, Wales, and Scotland to be only 50,000, when they\nwere estimated, by those who had carefully studied the subject, as being\nmore than double that number; the conservative estimate is, however,\nsuitable for our purpose; so that we cannot be accused of overestimating\nthe results. The portion of the review to which we wish to call\nattention is as follows:--\n\n\"Though the result of the evidence contained in the first report of the\ncommissioners on the constabulary force of England and Wales was that at\nthat time about 2 per cent. of the prostitutes of London were suffering\nunder some form of venereal disease, yet we will descend even lower, and\npresume that of one hundred healthy prostitutes, taken promiscuously\nfrom England and Scotland, if each submits to one indiscriminate sexual\nact in twenty-four hours, not more than one would become infected with\nsyphilis, an estimate which is without doubt far too low; yet, if\nadmitted to be correct, the necessary consequence will be, _that of the\nfifty thousand prostitutes five hundred are diseased within the\naforesaid twenty-four hours_.\n\n\"If we next admit that a fifth of these five hundred diseased women are\nadmitted to hospital on the day on which the disease appears, it follows\n_that there are every day on the streets four hundred diseased women_.\nLet it be supposed that the power of these four hundred to infect be\nlimited to twelve days, and that of every six persons who, at the rate\nof one each night, have connection with these women, five become\ninfected, it will follow _that there will be four thousand men infected\nevery night, and consequently one million four hundred and sixty\nthousand in the year_. Further, as there are every night four hundred\nwomen diseased by these men, one hundred and eighty-two thousand five\nhundred _public prostitutes will be syphilized during the year; hence,\none million six hundred and fifty-two thousand five hundred cases of\nsyphilis in both sexes occur every twelve months_.\n\n\"If, then, the entire population had intercourse with prostitutes in an\nequal ratio, _the gross population of Great Britain, of all ages and\nsexes, would, during eighteen years, have been affected with primary\nsyphilis_. Be it remembered, we do not assert that more than a million\nand a half of _persons_ are attacked every year, but that that number of\n_cases_ occurs annually in England, Wales, and Scotland, though the same\nindividual may be attacked more than once. Although it is evident that\nall the estimates used for these calculations are (we know no other word\nthat expresses it) ridiculously low, yet we find that more than a\nmillion and a half of cases of syphilis occur every year,--an amount\nwhich is probably not half the actual number. How enormous, then, must\nbe the number of children born with secondary disease! How immense the\nmortality among them! How vast an amount of public and private money\nexpended on the cure of this disease!\"\n\nThe same reviewer (P. S. Holland), in another article on the \"Control of\nProstitution,\" observes that among the British troops syphilis is one of\nthe most frequent of diseases, about one hundred and eighty cases\noccurring annually among every one thousand soldiers.\n\nThe effect of syphilis in depopulating the islands of the Pacific has\nbeen pointed out in a former chapter; the nature and origin of the\ndisease that takes them off is unmistakable. Scrofula and rapid phthisis\nare taking off the inhabitants at a rate that, in those islands most\naffected, the native population will soon become extinct. According to\nLancereaux, in the Marquesas group the women do not live beyond the age\nof thirty to thirty-five years, three or four months being the duration\nof the disease. Ellis, in his \"Polynesian Researches,\" published in\n1836, remarks that at that date the disease, as above described, had but\nrecently appeared. In the nineteenth volume of the \"Archives de Medecine\nNavale,\" Rey mentions that at the Easter Island pulmonary phthisis is\nthe dominant affection with the adults, and that scrofula is very\nprevalent with the children.[75]\n\nThe effect of syphilization in inducing a scrofulous taint and the\nappearance of a rapidly-marching consumption among savage races has been\nwell observed among the Indians in the southwestern parts of the United\nStates, where the appearance of these fatal diseases can easily be\ntraced to that as a cause. There is something peculiar about the\nAnglo-Saxon race that is fatal to the Indian; wherever they come in\ncontact, the savage race begins physically and morally to crumble; the\nhabits of the Anglo-Saxon in the matter of intemperance and his lust\nsoon end the poor Indian; while, on the other hand, the Latin races mix\nwith them without any physical detriment to the Indian. In what was\nformerly the Northwest Territory the French and Indian intermarried, and\nsyphilis did not begin to tell on the Indian until the Americans settled\nthe country. From these observations it is very evident that in the\nPolynesian Archipelago syphilis must have been the precursor of the\nphthisis and scrofula, as we know it to have been that which induced\nthose diseases among the Indians of the Mississippi or Missouri Valleys,\nor of the Colorado and Mojave Deserts, or in the mountains and valleys\nof Arizona.\n\nOn the other hand, circumcised races, whose women have not carried a\nsyphilitic taint into the race, are as a class free from any syphilitic\ntaint. Neither their teeth, physiognomy, skin, nor general condition\ndenote any syphilitic inheritance. This is true of the Jewish\ndescendants of Abraham, who have more strictly adhered to the\nnon-intercourse or marriage with other races, and whose women have\nabstained from vice; the Arabian descendants of Ishmael have, in a great\nmeasure, also retained their marked family individuality, except it be a\nfew tribes, who, by contact with the soldiery of European nations, have\nhad their women corrupted and syphilis introduced into the tribe through\nthis channel.\n\nRichardson, in his \"Preventive Medicine,\" observing on the effects of\nsyphilis in inducing deterioration of the organs of circulation and\ntheir degenerative changes, says that, in his opinion, syphilis is the\nprogenitor of various diseases, and that those who give this opinion the\ngreatest range are, unfortunately, nearest the truth. The breathing\norgans, he remarks, are distinctly susceptible to injury from this\nhereditary cause.\n\nIn 1854, at the Metropolitan Free Hospital, situated in the Jews'\nquarter in London, Hutchinson observed that the proportion of Jews to\nChristians among the out-patients was as one to three; at the same time\nthe proportion of cases of syphilis in the former to the latter was one\nto fifteen. Now, this result was not due to any extra morality on the\npart of the Jews, as fully one-half of the gonorrhoea cases occurred\namong those of that faith. J. Royes Bell also observes the less\nsyphilization among circumcised races.[76]\n\nThe absence of the prepuce and the non-absorbing character of the skin\nof the glans penis, made so by constant exposure, with the necessary and\nunavoidably less tendency that these conditions give to favor syphilitic\ninoculation, are not evidently without their resulting good effects. Now\nand then syphilitic primary sores are found on the glans, or even in the\nurethra or on the outside skin of the penis, or outer parts of the\nprepuce; but the majority are, as a rule, situated either back of the\ncorona or on the reflected inner fold of the prepuce immediately\nadjoining the corona, or they may be in the loose folds in the\nneighborhood of the frenum, the retention of the virus seemingly being\nassisted by the topographical condition and relation of the parts, and\nits absorption facilitated by the thinness of the mucous membrane, as\nwell as by the active circulation and moisture and heat of the parts. It\nmust be evident that but for these favoring conditions the inoculation\nor infection would and could not be either as sure or as frequent. Any\nprotecting mechanical aid that interferes with these favoring conditions\ngrants an immunity to the individual, even when he is freely exposed;\nthis protection has often been obtained by applying to the glans and\npenis a substantial coat of some tenacious oil like castor-oil, which\nwas afterward gently washed off, first in a shower of tepid water and\nafterward in a tepid bath of warm water and borax.\n\nHorner, formerly of the navy, in his interesting little work on \"Naval\nPractice,\"[77] relates that it was customary, in the older navy of the\nUnited States, to allow public women to come on board at some of the\nports and to go down to the men between decks, the Department of the\nNavy being probably actuated by the same humane principle that used to\ninduce some of the West Indian cannibals to lend their wives to their\nprisoners of war who were intended, in the shape of roast or\n_fricandeau_, to grace the festive board, as it was deemed inhuman by\nthese philanthropists to deprive a man of his necessary sexual\nintercourse, even if they were soon to roast him and pick his bones.\nThey may, however, have been selfish in the matter, as by some\nauthorities it is represented that this was done to improve the flavor\nof the prisoner, who was said to offer a more savory dish through this\nconsiderate treatment, the strong flavor that the semen gives to flesh\nbeing well eradicated by free fornication. Whether it was through these\nmotives of humanitarianism, or the feeling that an American tar was the\nequal of the British tar, whose praises and equality Sir Joseph Porter,\nK.C.B., writes a song about in \"Pinafore,\" who had as much right to\ncontract a left-handed marriage as any Prince of Wales or any other\nprince or crowned head of Europe, the women were, nevertheless, allowed\nto go down between decks in preference to giving the men indiscriminate\nliberty on shore, the government further providing for their welfare by\ncausing the assistant surgeon to examine the women at the gangway or\nhatchway, to see that they were not diseased. Horner relates the\nludicrous appearance presented by a near-sighted assistant at one of\nthe hatchways while making this professional examination, surrounded by\nthe sailors and marines, who were greatly-interested spectators. Had the\ngovernment provided a pot of castor-oil wherein the tar could dip his\npenile organ, as bridge piles are dipped into a creasoting mixture,\nthese humiliations to our professional brother could have been avoided.\n\nIn the conclusion to be reached, circumcision is not put forward as the\nonly exempting element or preventive measure that deserves all the\ncredit for the immunity that the Jews enjoy from syphilis, or to the\nabsence of hereditary diseases that are secondary or due to the presence\nof that disease in the parents, as considerable credit is to be given to\nthe well-known chastity of their females. This chastity is, in a great\nmeasure, due to the inseparable conditions of their religion,--moral and\nsocial fabrics which are welded into one. Their charity assumes the most\npractical form, so that it is not possible for one of their females to\nhave to resort to a life of prostitution to save herself or her children\nfrom starvation, as, unfortunately, is too often the case in Christian\ncommunities, where religion is put on and off with Sunday clothes. The\ntemperance and sobriety, as well as the economy and industry of the\nfather, are not without a good moral as well as a hereditary effect on\nthe daughters, who are neither rendered brutal nor demoralized through\nthe example and instigation of drunken fathers. They have, therefore, a\nbetter average homelife, to which they cling and which protects them.\nThe aid and benevolent associations of the Jews are among the most\nefficacious of charitable institutions, and no class gives more freely\nor generously for this purpose. The Home for Aged Hebrews in New York is\nan example of the character with which they dispense charity. We need\nnot, therefore, be surprised to find, in statistics of illegitimacy by\nreligious denominations taken in Prussia, that the Jewish women are\nthree times as chaste as the Catholics and more than four times as\nchaste as the Evangelists.[78] The Jew has, therefore, two avenues of\ninfection from syphilis cut off,--the lesser liability due to his\ncircumcision and the chastity of the women.\n\nRichardson mentions the immunity of the Jewish race from tubercular\ndisease, and notices the well-known relation existing between a\nsyphilitic taint and a phthisical tendency. The comparative statistics\noffered by the Mohammedans, Jews, and Christians in regard to deaths\nfrom consumption have already been mentioned in a former chapter, they\nbeing as four Christians to one Jew, while the Mohammedan, from his\ngreater abstemiousness and temperance to assist him, shows a still lower\npercentage than the Jew. There can be but little doubt that to this\nparticular and well-marked less syphilization the Hebrew race owes much\nof its exemption from many other diseases and its greater resistance to\nordinary ailments and epidemic diseases.\n\nThe relative less frequency of syphilis among all circumcised people is\nnoticed by Dr. Bernheim, in his brochure \"De la Circoncision,\" he being\nthe surgeon of the Israelitish Consistory of Paris. His utterances on\nthis subject are worthy of attention, he having not only paid particular\nattention to this, but having had unusual opportunities for the basis of\nhis opinions. Dr. Bernheim looks upon coition as a frequent source of\ntubercular infection, and the sensitive and absorbing covering of the\nuncircumcised glans as a ready medium of transmission of the virus from\none system to the other. He calls attention to the frequent granular\ncondition of the uterine os, in confirmed cases of tuberculosis, as\nsomething that is too much overlooked. This view of the case, from Dr.\nBernheim's stand-point, is worthy of greater consideration than it has\ngenerally received at the hands of the profession.\n\nThe great number of examples that have recently come to light in\nconnection with the direct inoculability of tubercular consumption, both\nin the later works on phthisis and in the medical press, are not without\ninterest or without a lesson. The case recorded within the past year of\na healthy chambermaid, who was immediately inoculated with tubercular\nmatter with rapidly-following constitutional effects through a scratch\non the hand, received from the sharp edge of a broken china cuspidor\nthat a consumptive was using, is one of these cases that are to the\npoint; so it is evident that the uncircumcised need not always wait for\nthe degeneration of syphilis into syphilitic phthisis or syphilitic\nscrofula to become a consumptive, but it is within the greatest range of\npossibility and probability that he may become at once a consumptive\nthrough an excoriation or abrasion received during coition with a\ntubercular woman. So many tubercular prostitutes ply their trade, or, to\nbe more definite, so many prostitutes become tubercular, and in its\ndifferent stages follow their occupation as the only means of keeping\nout of the poor-house, that man runs as much if not more risk, in\nconsorting with the class, of contracting tuberculosis than that of\ncontracting syphilis.\n\nThere is something about syphilis that is not generally noticed; we are\nall well acquainted with the dire results that usually follow syphilitic\ninfection, its course through every stage of suffering and misery, its\ntransmission and effects in tubercular meningitis or in syphilitic\naffections of the mesentery through heredity in children, and of the\nmany horrible cases of destruction of tissue, in skin, mucous membrane,\ncartilage, or bone, with their attending mutilations and disfigurations;\nbut there is no record of the great number of cases, and very few\nphysicians of any extended practice but who can recall some such cases,\nwhere, after undoubted syphilitic infection, with the usual course of\nprimary sores and secondary eruption, the patient has suddenly blossomed\nout into a state of robust health that his system was an entire stranger\nto before the infection. The writer has, in the course of a long\npractice, seen a number of such results follow both the infection\nattended with a miliary eruption and that followed by the large\nsmall-pox-appearing eruption, both kinds being preceded by the primary\nsore; and these results have been observed in cases of both what are\ncalled the soft and multiple and the hard or Hunterial initial sore.\nSome of these cases rapidly gained in flesh, with an evident increase in\nthe redness of their blood, increasing in vigor and strength with a very\nperceptibly less tendency to attacks from accidental or previously\nsubject-to diseases.\n\nThe same result has been observed to follow an attack of small-pox with\nsome individuals, and the writer well remembers a similar result\nfollowing a very extraordinary event. The subject was a man well known\namong his old comrades of the First Minnesota Infantry as \"Duke,\" and to\nmany of the older practitioners of Wabashaw County, of that State, as\n\"Old Duke.\" In early life he was sickly and weakly, never having fully\nrecovered from a malarial fever contracted in the Mexican war. Coming to\nMinnesota, he adopted the life of a raftsman, with all the\nirregularities that accompanied such a life. On one occasion, after a\nprotracted spree, feeling the need of stimulation and not having the\nwherewith to procure it, he secured a jar in which a snake and several\nother reptiles were preserved in spirits, and drank the fluid contents.\nHe was, some days afterward, taken violently ill with a high fever and\nracking pains, ending in an eruption of boils that covered him from head\nto foot; he made a slow and tedious recovery; but when recovered he\nseemed to have become imbued with a constitution resembling\n_lignum-vitae_, for a more stubborn-twisted constitution never existed\nthan that of \"Old Duke.\" The power of resistance that this man developed\nwas something wonderful. Dr. C. P. Adams, of Hastings, Minnesota, and\nthe St. Paul physicians who were connected with the regiment well\nremember, though, wiry, precise, and soldierly \"Duke,\" who, even in the\nold Army of the Potomac, immersed up to his ears like the rest of the\narmy in the mud and dirt of the encampment of Falmouth, above\nFredericksburg, came out on general inspection as prim as if he had just\nstepped out of a bandbox, for which he received a medal for soldierly\nconduct and bearing.\n\nThese apparent digressions are not made either to be tedious or to weary\nthe reader, nor without an object. They are made to show that, whereas\nsyphilis is looked upon as such a deadly disease, and it may be said to\nbe the sole cause of fear to the assiduous worshiper at the shrine of\nVenus Porcina, there is another still more fatal danger awaiting him,\nambushed in the folds of the vaginal mucous membrane, or coming along\nsilently out of the cervical canal,--like the legions of Cyrus stealing\nalong the dry bed of the Euphrates into ancient Babylon, to fall\nunawares on the feasting Nebuchadnezzar on that fatal night. So, in like\nmanner, the virus of tuberculosis, either extruding from a granular os\nor from its neighborhood, gradually moves down on the unsuspecting,\nuncircumcised, and easily inoculable-surfaced glans penis, to infect the\nsystem with a tubercular poison that has no such exceptions as those\nabove noted, as at times are the followers of syphilis. It is not alone\nthe individual himself that may be the sufferer from this poison, but\nhis progeny for several generations may have to suffer for the infection\nthus received, just as much as they would were that infection to have\nbeen syphilitic. As before remarked, this has heretofore not\nsufficiently occupied the consideration of the profession, and, as it\ncannot certainly be denied that such a source of tubercular infection is\nboth possible and probable, the subject is entitled to more serious and\ndeliberate consideration than that which has heretofore been paid to it.\n\nTuberculosis certainly has these two channels of entrance: either\nthrough direct infection or through an evolutionary process resulting\nfrom syphilis. The appearance and vital statistics offered by the French\nWar Office in regard to the Algierine provinces, the report of the\nUnited States Census, the opinion of Dr. Billings deduced from the\ncensus reports, the opinions of Hutchinson, Richardson, Bernheim, and\nmany other observers, as well as the personal but unrecorded\nobservations of many practitioners, all tend to bear testimony to the\nremarkable difference that exists between circumcised and uncircumcised\nraces in regard to the ravages of consumption. Is circumcision a factor\nin this difference, or is it not? If it is, then circumcision should\nreceive more attention than it has; if it is not, then we should not be\nidle in hunting up the cause of difference, for an ounce of prevention\nis certainly worth in this regard a whole pound of Koch's lymph as a\ncurative agent.\n\n\n\n\nCHAPTER XVII.\n\nSOME REASONS FOR BEING CIRCUMCISED.\n\n\nThe surgical and medical history of circumcision is intimately connected\nwith the remotest ages, this being, in fact, the earliest surgical\nprocedure of which we have any record. From the same records we obtain\nhints as to two conditions for which circumcision probably was\nsuggested, either as a preventive or as a remedy.\n\nJahn, in speaking of the people by whom the early Hebrews were\nsurrounded, mentions their idolatrous practices, and that their peculiar\nforms of Pagan worship were accompanied by indulgence in fornication,\nlascivious songs, and unnatural lust. Others of their neighbors\nworshiped the \"_hairy he-goat_,\" with which they also practiced all\nmanner of abominations. Sodomy, or pederasty, seemed a sort of religious\nceremony with some of these heathen nations; from a religion it\nnecessarily became a social practice; this, in connection with the\nphallic practices and worship, necessitated frequent exposure of the\nmale member. The evil results, to say nothing of the disgusting and\ndemoralizing tendency of these practices of the Pagan, were evidently\nwell known to the Jews. The contrast between the physique and health of\nthe pastoral habits, out-of-door life and simple diet of the Jews, and\nthe necessary opposite condition of health and physique due to luxury\nand to these practices among their neighbors, could not have escaped\ntheir attention. How much onanism had to do with the establishment of\ncircumcision may well be conjectured. Again, the other hint is in\nreference to procreation, as some stress is laid to the connection\nbetween the conception of Sarah and the circumcision of Abraham. Here we\nhave suggestions of a preventive to onanism, and a cure to male\nimpotence when due to preputial interference.[79]\n\nStrange as it may seem, these two important results, due to\ncircumcision, seem to have been lost sight of for some thousands of\nyears, as even the able works of the physicians of the latter part of\nthe last century have nothing to say connecting onanism and\ncircumcision. Neither the works of Tissot on male onanism nor the\npioneer work of Bienville on nymphomania speak of the presence of the\nprepuce in the male, or of the nymphar or clitorian prepuce in the\nfemale, as being causative of, or their removal curative of, either\nmasturbation, satyriasis, or nymphomania; moral, hygienic, and internal\nmedication being by both these authors considered to be all that our\nscience could offer or do to alleviate or cure this unfortunate class.\nIt is only of late years that circumcision, in its true relations to\nonanism, has received full consideration. In regard to its being a cure\nof impotence, its recognition has been of longer duration.\n\nIt is related by Leonard, in his \"Memoires,\"--who, in his capacity of\nhair-dresser in ordinary to her Majesty, the unfortunate\nMarie-Antoinette, had ample opportunity for picking up all the domestic\nsmall talk of the royal family and their affairs,--that Louis XVI, in\naddition to all his troubles and the indignities which he suffered,\nbesides finally being beheaded, was afflicted with a congenital phimosis\nwhich prevented the flow of semen from properly discharging itself. It\nappears that his Majesty was no little annoyed at not being able to\nprocure an heir to his throne. His royal sister-in-law, the Countess\nd'Artois, had given birth to a prince, the Duke of Angouleme, who was\nthe heir presumptive to the throne in case of the non-issue from Louis;\nanother sister-in-law had been brought to bed with a royal princess, and\nhere was the king himself without any prospective possibility of any\nheir. Like all kings, he was more or less unreasonable; so he blamed his\nfirst surgeon in ordinary for all these short-comings,--as if it were\nthe duty of these court surgeons, among their many other tribulations,\nto furnish heirs to thrones. The surgeon finally informed his Majesty\nthat if he wished to become a father it would be necessary for him to\nsubmit to the slight operation that was the subject of the church\nfestival of the first day of January, namely, the Feast of the\nCircumcision. His most Christian Majesty entered a protest to this\nacknowledgment that there was anything in Judaism worth imitating. The\nsurgeon insisted that the operation celebrated on the first of January\nwould put him in a way to have the much-desired heir. The king finally\nwaived all objections from any religious scruples, but could not be\nbrought to look at the prospective operation with any sentiments of\nagreeable expectation.\n\nThe king finally became good-natured, and a touch of that plebeian\njollity which at times made him quite agreeable spread over his features\nas he imagined the ludicrousness of the spectacle that would be\npresented by a king of France in the hands of these handlers of the\nscalpel, treating him like an African savage. He took some days to\nconsider the matter. On the next day he informed M. Louis, his first\nsurgeon in ordinary, that he had decided on submitting to the operation,\nand the day and hour were fixed. The royal circumcision, however, never\ntook place, as it is most likely that in the privacy of his chamber his\nMajesty worked, like many a plebeian or man of low degree had done\nbefore him and has done since, to bring a refractory prepuce to terms.\nThe king was somewhat of a mechanic, as his skill as a locksmith has\npassed into history; so that it is not unlikely that, with what little\ninformation he had on the subject, he managed to sufficiently dilate, by\nscarification and stretching, the preputial opening, as from the year\n1778 the queen had three children.\n\nCases of attempted self-circumcision are not rarities, as people have\nsome inexplicable idea that a self-inflicted cut is not as painful as\none that is done by others. The writer well remembers being called to\nassist one of these domestic surgeons who had undertaken to circumcise\nhimself with his wife's great scissors. The man had a very long but thin\nand narrow prepuce that had always been an annoyance to him. The writer\nhad circumcised two of his children for the same malformation, and the\nfather, seeing the benefit to these two, determined to share in the\ngeneral benefit; but at the same time he arranged to do it all by\nhimself, and give the family and the surgeon a sample of his courage and\na simultaneous surprise party. Securing the scissors, he wended his way\nunperceived into the recesses of his wood-shed. The mental and physical\nanguish the poor man underwent, and what soliloquies he must have\naddressed to the rafters of the wood-shed while making up his mind and\nscrewing up his physical courage for the last fell act with the\nscissors, can hardly be described, as, in all probability, they were of\nthe most rambling and inconsistent order. At any rate, he must have\nreached a climax in time and grasped the fated prepuce with a revengeful\nglee, and, with all his powers concentrated in his good right hand, he\nmust have closed the remorseless blades of the scissors on the unlucky\nprepuce. When the surgeon arrived at the scene of carnage, he was\ndirected to the wood-shed, on the outskirts of which hovered the family,\nfrantic with fear and apprehension; within, in the darkest corner, with\nwildly dilated eyes, and performing a fantastic _pas seul_, was a man\nwith a huge pair of scissors dangling between his legs, warning all\nhands as they valued his life not to approach or lay a hand on him. He\nhad shut the scissors down so that it clinched the thin prepuce, and\nthere his courage and determination had forsaken him; he lost his\npresence of mind, and was not even able to take off the scissors; he had\nsimply given one wild, blood-curdling yell--like the last winding notes\nfrom Roland's horn at Roncevalles--that had brought his family to the\nwood-shed-door, and they had then sent for a surgeon. New terrors here\nawaited the unlucky victim for self-circumcision. He dreaded lest the\nsurgeon should accidentally have it enter his mind to finish the\noperation with the scissors, and in that case he would be helpless, as\nthe surgeon would, undoubtedly, have a sure and tender hold of it. After\nexecuting a number of _pas a deux_ on the Magilton step, while the\nsurgeon endeavored to reassure him and gain his confidence, promising to\nremove the scissors without inflicting any further harm, he was finally\nallowed to approach, and, while the patient assumed a Taglioni attitude\non one foot, the other leg being extended at right angles with the body\nand his hands clawing the air, the scissors was removed. The patient,\nthrough the aid of lead lotions and a week's rest, made a good recovery\nwith a whole prepuce, chagrined at his failure, but happy to have\nescaped immediate pain.[80]\n\nThere is not much doubt but that the operation could have been\nsuggested by its, at times, spontaneous performance, a case of which, by\nCullerier, and some other additional cases have been mentioned in a\nformer chapter. Cases occur at times, also, wherein the person having a\npreviously normal and uninterfering prepuce has, through either herpetic\ninflammations or through impure connection, spurious gonorrhoea, or the\nuse of some venereal-disease preventing-wash after connection, produced\nsome irritation resulting in the abnormal thickening of the inner fold,\nor an interstitial deposit at the junction of the skin and mucous\nmembrane, with consequent constriction, this deposit finally forming a\nhard, inelastic ring, which prevented a free exposure of the glans and\ninterfered in sexual connection. In such cases,--like in stricture of\nthe meatus,--any mechanical interference short of cutting with a knife\nonly aggravates the existing difficulty, and it is not uncommon to have\nsuch cases apply for assistance after they have in vain tried to dilate\nthe constricting preputial orifice. In the early writings of the Greeks,\nit is mentioned that among the Egyptians circumcision exempted them from\na certain form of disease that affected the penis. Philon mentions\nparticularly the immunity that the operation conferred against a species\nof affection which Michel Levy asserts to have been a gangrenous\ndisease. So that, outside of any religious significance, there is no\ndoubt that, in individual cases, circumcision has more than once been\nsuggested, although it cannot be said that such individual cases would\never, or could, lead to its becoming a national or racial, much less a\nsectarian, rite.\n\n\n\n\nCHAPTER XVIII.\n\nTHE PREPUCE AS AN OUTLAW, AND ITS EFFECTS ON THE GLANS.\n\n\nRicord has well termed this appendage to civilized man \"a useless bit of\nflesh.\" Times were, however, when--man living in a wild state, and when\nin imitation of some of our near relatives with tails and hairy bodies;\nwhen he still found locomotion on all-fours handier than on his two\nfeet; when in pursuit of either the juicy grasshopper or other small\ngame, or of the female of his own species to gratify his lust, or in the\nfrantic rush to escape the clutches, fangs, or claws of a pursuing\nenemy, he was obliged to fly and leap over thorny briars and\nbramble-bushes or hornets' nests, or plunge through swamps alive with\nblood-sucking insects and leeches--Ricord's definition would certainly\nhave been inapplicable. In those days, but for the protecting double\nfold of the preputial envelope that protected it from the thorns and\ncutting grasses, the coarse bark of trees, or the stings and bites of\ninsects, the glans penis of primitive man would have often looked like\nthe head of the proverbially duel-disfigured German university student,\nor the Bacchus-worshiping nose of a jolly British Boniface. So that in\nthose days, unless primitive man was intended to have an organ that\nresembled a battle-scarred Roman legionary, a prepuce was an absolute\nnecessity.\n\nWith improvement in man's condition and his gradual evolution into a\nhigher sphere, the assumption of the erect posture, and the great stride\nin civilization that originated the invention of the manufacture of the\nperineal band, which not only protected the glans in its thorny passage\nthrough life, but also acted like a protecting aegis to the scrotum and\nits contents, the prepuce became a superfluity; not only a superfluity,\nbut, now that its natural office had been replaced by the perineal\ncloth, it actually began to be a nuisance, as its former free contact\nwith the air had retained it in a state of vigorous and\ndisease-resisting health which was now fast departing. As Montesquieu\nobserves, in the causes that led to the decline and fall of the Roman\nEmpire, those seasons of trials, tribulations, and struggle for\nexistence are those of health and progress and healthy life, and the\nperiods of luxury and idleness are those of degeneracy and decay. So\nwith the prepuce, the luxury and idleness, voluptuousness and consequent\nfeasting incident to its being supplanted in its original functions by\nthe perineal cloth, which left it thenceforth unemployed, led it in the\npathway of disease and death. This first innovation in civilization was\nto the prepuce the beginning of its decay and fall. Like Belshazzar in\nhis great banquet-hall in ancient Babylon, the prepuce might have read\nthe hand-writing on the wall, \"_Mene, Mene, Tekel, Upharsin_,\" and\nforeseen the gory end that awaited it. Like to other human affairs,\nhowever, even in his fallen estate a kind word can be said for the\nprepuce. Puzey, of Liverpool, has found it of extreme value, and even\nunequaled by any other part of the body, for furnishing skin-grafts,[81]\nthese grafts showing a vitality that is simply phenomenal, considering\nthe laxity of its tissues and its seemingly adipose character. There is\nno doubt, however, that for skin-transplanting there is nothing superior\nto the plants offered by the prepuce of a boy, and where any large\nsurface is to be covered this should undoubtedly be chosen, as offering\nthe greatest and quickest success and the least chances of failure.\nThis is really the only disadvantage that can be charged against\ncircumcision, as in a strictly circumcised community they would be\ndebarred from this great advantage. An uncircumcised individual could be\nprocured, however, to supply the deficiency. It is related that in the\nlatter part of 1890, a Knight Templar, in Cincinnati, required a great\nsupply of grafts or skin-plants to cover a largely-denuded surface, and\nthat the whole of his Commandery chivalrously and generously supplied\nthe needed skin-plants in a body. A few healthy prepuces would have been\nmore efficacious. In advising the use of the prepuce for these purposes\nit must not be overlooked that in case of a white man it would not do to\nuse skin of any other color besides his own. We have no data to base any\nassertion as to the relative action of skin-grafts taken from Mongolians\nor Indians, but we have very reliable data in relation to the\nproliferating action of those of the negro,[82] which induces a growth\nof epidermis of its own kind; so that preputial grafts from the negro,\ncombining the extra vitality and proliferation of the preputial tissue\nwith the strong animal vitality of the negro, if applied to a white man,\nmight not produce the most desirable cosmetic effects, especially if on\none side of the countenance.\n\nBut, taken as a whole, when considered in its relation to onanism,\nnocturnal enuresis, preputial calculus, syphilis, cancer, and a lot of\nnervous and other ailments, or induced abnormal physical conditions, we\ncan really conclude that the days of the prepuce are past and gone, that\nit has outlived its usefulness, and that those whom a religious or civil\nordinance or custom happily makes them rid of it are people to be\ngreatly envied. As Sancho Panza remarked, \"God bless the man who\ninvented sleep,\" so we may well join in blessing the inventor of\ncircumcision, as an event that has saved some parts of the human family\nfrom much ill and suffering.\n\nPhimosis is an ancient attendant on our inheritance of the prepuce, we\nbeing, in fact, born with it; this is the rule. There are, however,\nexceptions to this rule, which, singularly enough, are found to be\nhereditary. The writer has met with a number of such instances, and they\nhave always been found to have been family traits. Within the past year,\nafter attending a confinement, his attention was called to the child by\nthe nurse, who thought that the child was deformed; the nurse,\nsingularly enough, never having seen a natural-looking glans penis in\nall her life, was astonished at the size and appearance of the member.\nOn examination, the organ showed a complete absence of prepuce. On\ninquiry, the father and another son, born more than twenty years\npreviously,--this comprising every male member of the family,--were\nfound to have been thus born, with the glans fully exposed. The family\nis now residing in San Diego, and is naturally one of more than superior\nphysical health and intelligence. I saw another family similarly\naffected in the north of France, and of individual cases, without\nknowing the history of the rest of the family, I have seen a large\nnumber. As the prepuce can be observed in every stage of disappearance\namong mixed races, it would seem that in time it would disappear\naltogether. Its effectual absence in so many cases evidently belongs to\nsome evolutionary process, and shows beyond question that nature does\nnot insist on its presence either as a necessity or as an ornament.\n\nThe word or term \"phimosis\" is derived from two Greek roots, signifying\n\"string\" and \"to tighten,\" or \"to tie with a string.\" Galen, from its\nsignification, accepted the word, and from him it has been transmitted\nthrough the different epochs of medicine down to our own times. In\nvirtue of its etymological significance, it was formerly applied to any\nstenosis or closure of duct or aperture, but at present the term is used\nsimply to denote that constriction that affects the prepuce, and which\nprevents the glans from being passed through the preputial orifice.\nPhimosis is said to be congenital or natural and acquired. The first of\nthese is the common lot of all, as a rule, and with some it remains so\nthroughout life. As babyhood advances in boyhood and boyhood into youth,\nthe prepuce gradually becomes lax and distensible, and in proportion to\nthe existence of these conditions it also loses in its length. Where,\nhowever, the distal end persists in its constricted condition it is\ndrawn forward as the penis increases in bulk.\n\nIn many cases its tightness prevents the escape of the sebaceous matter\nthat collects in the sulcus back of the corona, and the resulting\nirritation on the surface of the glans and the inner mucous fold of the\nprepuce ends in an inflammatory thickening of the latter, its inner\nsurface becoming thick, undilatable, hard, and unyielding, all the\nnatural elasticity that should be present having departed, with more or\nless inflammatory thickening and adhesions between the two layers of\nskin that form the prepuce. In this unyielding tube the glans is\nimprisoned and compressed, often suffering the tortures that the\n\"maiden\" of the dungeons of the Inquisition inflicted on the unhappy\nheretics. It becomes elongated, cyanosed, and hyperaesthetic; the meatus\nof the urethra is congested and hypertrophied, the corona is undeveloped\nand often absent, the glans having, on the whole, the long-nosed,\nconical appearance of the head of a field-mouse. There are hardly five\nper cent. of the uncircumcised but who suffer in some degree from this\nconstricting result of the prepuce, to a greater or less extent.\n\nOn the other hand, the unconstricted glans penis assumes the shape and\nappearance that is seen in the circumcised. The head is shorter, the\nface flat and abrupt, and the meatus, instead of being at the end of a\nconical point, is situated on the smooth, rounded front of the glans,\nand does not differ in color from the covering of the glans itself. From\nthe superior commissure of the meatus to the sulcus in the rear of the\ncorona its topographical outline may be said to describe two opposite\nsegments of a circle, as seen in the cuts representing the glans in its\nnatural shape. The corona is prominent and well developed.\n\nThe opponents of circumcision base much of their opposition to the fact\nthat circumcision interferes with the natural condition of the parts.\nThe question may well be asked, which of these two shaped glans is the\nnatural product as nature intended it should be? It is a well-known fact\nthat the most forlorn and mouse-headed, long-nosed glans penis will,\nwithin a week or two after its liberation from its fetters of preputial\nbands, assume its true shape. We may naturally inquire if nature made\nthe glans of a certain shape, which seems to be the proper shape for\ncopulative purposes, only to have the condition most effectually\nabolished by a constricting, unnatural band? How much the shape of this\nglans, from meatus to corona, may have to do with retaining the urethra\nto a healthy and normal calibre and condition has not been inquired\ninto, but, as far as the writer has observed, a normal glans seems to\nhave less abnormalities of the urethra, and in treating such cases he\nhas always found that when the urethra of one of these normal-glans\nsubjects was affected it was far easier to manage; on the other hand,\nsecondary and even a tertiary recurrence to an operation is often the\nfate of a long, narrow, conical-pointed penis.\n\nPhimosis is known to have been a cause of male impotence by its direct\ninterference with the outward flow of the seminal fluid; but, although\nwe have cases where impregnation has taken place by the aid of a warm\nspoon and a warm syringe, as in the case related in a former chapter, it\nmust be admitted that the corona is not without some functional office\nin the act of procreation. Its shape indicates a valve action like that\nof the valve in a syringe-piston, and if we examine the two extremes of\nthese conditions of glans--one devoid of corona, as many are, and the\nother with the corona in its most pronounced form, when in a state of\nerection--the difference, either in the appearance of the two organs or\nin the different philosophical action and results that must necessarily\nfollow the use of these two differently shaped glans, will at once be\napparent. Unfortunately--or, as many may consider it, most\nfortunate--the female organs are not always so shaped as to be in\nthemselves wholly favorable to impregnation. The wearing of corsets, the\nhabitual constipation of females, the relaxed and unnatural condition of\nthe uterine ligaments and vagina in civilized women, all favor uterine\ndisplacement, with any or all forms of uterine ailments. To this we may\nadd the effect of repeated miscarriages, application of astringent\nwashes, irregular menstruation, etc., all of which conditions often\nresult in an elongation of the neck, constriction of the cervical canal,\nwith the external os placed on the depended point of the sharply pointed\ncervix, which is liable to point in any direction. Just imagine one of\nthese conditioned females and one of the mouse-headed, corona-deficient,\nlong-pointed glans males in the act of copulation! The conical penis\nfinds its way in the reflected fold of the vagina, while the point of\nthe uterus may be two or three inches in some other direction, making\nimpregnation wholly impossible; besides, in the normal-shaped penis, the\ncorona acting as a valve, behind which the circular muscular fibres of\nthe vagina close themselves, tends to retain the seminal fluid in front,\nwhile the very shape of the organ assists in straightening out the\nvaginal canal and to bring the uterus in proper position. In the long,\nthin, narrow and pointed glans, devoid of corona, there is no mechanical\nmeans to retain the seminal discharge. Some years ago some one\nintroduced the idea of postural copulation, to be tried in cases of\nsterility, and it has been found that impregnation would take place in\nsome cases where it had formerly appeared impossible, this position\nhaving the effect of righting malpositions during the act, which were\nthe cause of the sterility; but it stands to reason that, where the\nshape of the organ is such that it further favors malpositions, as well\nas where it offers no obstacle to the vagina immediately expressing or\ndropping out all the seminal fluid, impregnation is more difficult, and\nthat, where the uterine deformity is coincident with this condition of\npenis to assist, it becomes well nigh impossible. Fodere mentions a\npenis about the size of a porcupine-quill on an adult male, and Hammond\nmentions one of the size of a lead-pencil in diameter and two inches in\nlength. From total absence of the penis, either through disease or\naccident, to the diminutive organs mentioned by Fodere and Hammond, and\non up to the full-sized and normal-shaped organ, we have every degree of\nsizes and shapes, and with these go every conceivable degree of ability\nor faculty for impregnation.\n\nAside from the foregoing considerations, there are others equally\nimportant. Although Greece was involved for years in war and ancient\nTroy was destroyed and all its inhabitants slaughtered because of the\nseduction of one woman; and Semiramis, through her beauty, got all her\nsuccessive husbands in chancery; and poor, susceptible Samson, from\nfiring Philistine vineyards and killing lions bare-handed, and the\nPhilistines by the thousands with the jaw-bone of an ass, was reduced\nthrough Delilah to bitter repentance and turning Philistine mill-stones;\nand we know that the familiar infatuation of Antony for Cleopatra ruined\nAntony; and we are familiar with the well-known maxim of the French\npolice-minister, that to catch a criminal it was but necessary to first\nlocate _the woman_ and the man would soon be found,--society has\ndetermined to ignore the influence of the animal passions as factors in\nour every-day life, or factors in the estrangements, coldness, and the\nbickerings that end in divorces. Not to shock the reader with detailed\naccounts as to what an important factor the shape of the penis may be in\nthe domestic economy, I will refer the reader to Brantome's works.\n\nAlthough the councils of the older church were not above giving these\nconditions their calm and deliberate consideration, which resulted in\nthe foundation of the present physical considerations in relation to\ndivorce laws, such studies or considerations are at present only touched\nupon gingerly and with apologies for doing so, as if the \"study of man\"\nwas of any less importance to-day from what it was in the days of Moses,\nthe elder church, or when Pope formulated his oft-quoted but\nlittle-followed maxim, that \"the proper study of mankind is man.\" The\npresent miscalled \"delicacy of sentiment\" is about as misplaced a\ncondition of disastrous and misleading morality as was the out-of-place\nand untimely bravery of poor old Braddock when refusing Washington's\nadvice at the Monongahela. The success and beauty of the Mosaic law is\nits squarely facing the conditions of actual life, and its absence from\nnonsense or nauseating sentimentality. Were our present churches to\nobserve more of this plain talk, for which the good old Anglo-Saxon is\nas fully expressive and convincing as the old Hebrew, and deal less in\nrhetorical flourishes and figurative mean-nothings to tickle the ears of\nour modern Pharisees, mankind as well as womankind would be infinitely\nso much the better off, mentally, morally, and physically, and there\nwould be less of the conflict between science and religion. Luther's\ndream of restoring religion to its primitive purity has come to but as\npoor realization at the hands of his so-called followers, which leads\none to think that if the martyrs of the Reformation could come back and\nsee the fruits of their martyrdom--suffered that pure religion might\nlive--they would conclude that, for all the resulting good accomplished,\nthey might as well have kept a whole skin and a whole set of bones.\n\nIn cases of pronounced phimosis the aperture in the prepuce may not be\nin a line with the meatus, and the resulting discharge of urine or the\nejaculations of seminal fluid may from this cause be unable to find an\negress. The fluid escaping from the urethra will, in case the opening is\nat the side or upper part of the prepuce, cause it to balloon out until\na sufficient quantity is thrown out so as to distend, the opening as\nwell as the prepuce, before it can find its way out; in such cases\nimpotency is liable to be as complete as in those cases of stricture\nwherein the seminal fluid is forced backward into the bladder. Having\ngiven this general view of the effects of phimosis as it may affect man\nin the shape of his organ, which may have a serious result in his\ndomestic relations or in becoming a father, we will proceed to the\nconsideration of diseases and conditions that phimosis encourages and to\nwhich it renders man more liable. In the consideration of these cases it\nmust not be forgotten that the sexual relations are much more to man or\nwoman than is generally acknowledged. The days for the establishment of\nthe Utopian republic of Plato are not yet with us. That Platonic love\ndoes exist is true, as it has in the past and will in the future.\nScipio, refusing to accept the beautiful betrothed bride of an enemy as\na present, or Joseph leaving his coat-tail in the hands of the amorous\nbride of the eunuch Potiphar, with the suicide of Lucretia, in the past,\nare events which virtue and modern continence probably duplicate every\nday; but these are exceptions to the rule. Physicians daily see\nevidences of the most devoted Platonic affection in either sex, but they\nalso see enough of the opposite side of the question to convince them\nthat in the majority of cases the sexual relations are the bond of\nunion, as well as the mainspring of love. As observed by Montesquieu,\nthe bride of a first-class Turkish eunuch has but a sorry time, and a\nwoman of the same calibre of mind as that possessed by the ordinary\nCircassian or Armenian bride cannot be in a much happier condition with\na husband partly eunuchised by a constricted prepuce.\n\n\n\n\nCHAPTER XIX.\n\nIS THE PREPUCE A NATURAL PHYSIOLOGICAL APPENDAGE?\n\n\nBy many surgeons the idea of circumcision, unless connected with an\nimmediate demand for interference,--such as a phimosis unmanageable by\nany other means, an induced phimosis from gonorrhoea or other\nirritation, syphilis in its initiatory sore, cancer or some such\ncause,--is looked upon as an unwarrantable operation, a procedure not\nonly barbarous, painful, and dangerous, but one that directly interferes\nwith the intentions of nature. The prepuce is by many looked upon as a\nphysiological necessity to health and the enjoyment of life, which, if\nremoved, is liable to induce masturbation, excessive venereal desire,\nand a train of other evils. The question then resolves itself, What is\nthe real physiological status of this appendage, if it has any, and, if\nit is a physiological appendage, when does it merge into a pathological\nappendage? As by some it is held that the prepuce enjoys the same right\nto live and exist as the nose, ear, or a limb, which are only subject to\namputation in case of a serious disease, they should be reminded that\nthey are not taking into consideration that the nose and ear are\ncalculated to warn us of danger, and that our legs are very useful; as\neven the great orator Demosthenes, by the timely and rapid use of his\nlegs, was enabled to escape from a battle, where his oratory was of no\navail against the illiterate javelins of the unscholarly Macedonians. If\nthe prepuce only was endowed with an olfactory sense,--as, for instance,\nif a nervous filament from the first pair of nerves had been sent down\nalongside of the pneumogastric and then, by following the track of the\nmammary and epigastric arteries, had at last reached the prepuce, where\nthe olfactory sense could have been turned on at will, like an\nincandescent lamp,--it might have been a very useful organ, as in that\nsense it could have scented danger from afar, if not from near, and\nenabled man to avoid any of the many dangers into which he unconsciously\ndrops. But, seeing that the prepuce, to say nothing of being neither\nnose, eye, nor ear to warn one away from danger, or a leg to run away on\nafter once in it, having not even the precautionary sensitiveness of a\ncat's moustachios, it cannot, in any way that we can see, be compared to\nany other useful part of the body.\n\nAll attempts to find reasons for its existence that are of real benefit\nto man have so far proved unsatisfactory, and, unlike the reasons for\nits removal, are, as a rule, founded on speculation. To further reason\nout the why and wherefore of its existence or of its summary surgical\nexecution, we must consider its shifting positions as to the effects it\nproduces, as well as to its conditions at different ages, sitting on its\ncase like an impartial jury in the case of some unconvicted but\ndiabolically-inclined criminal.\n\nAs before remarked, we are, as a rule, born with this appendage, just as\nmuch as we are with the appendix vermiformis, which rises up, like\nBanquo's ghost, whenever we eat tomatoes or any small-seeded fruit. This\nprepuce is then long, and the penis is found at the end of an\nundilatable canal, which is formed by the constricted prepuce; at this\nearly stage of our existence it is often additionally bound down to the\nglans by a greater or less number of adhesions. We are then in what many\nterm a state of physiological phimosis, that being a perfectly natural\ncondition, and one consistent with health; at least, we imagine it is\nnormal.\n\nPhimosis in childhood is generally considered a physiological state,\nonly to be taken as a pathological condition under certain\ncircumstances. Preputial adhesions may, according to many observers,\nalso be classed as physiological at an early period of life, as it is by\nthem considered as congenital, and common enough to warrant its being\nclassed as normal. As to the first, or phimosis, it undoubtedly is a\nphysiological condition during infancy; but why, we do not know; and it\nis also a fact that from birth to puberty it remains so in fully over\none-half of the cases. Out of 98 children, from one week to sixteen\nyears of age, examined by Dr. Packard, the prepuce was entirely\nunretractable in 54, partly so in 3, and wholly so in 36; while in 1 it\nonly half-covered the glans and in 4 the glans was wholly uncovered, 1\nof these 4 being an infant only five weeks old.\n\nDr. Packard also gives the result of 172 examinations by himself, of\nfrom twelve to seventy-three years of age, and 106 examinations by Dr.\nMaury, a total of 278, in whom 100 had a long prepuce, 97 a\npartly-covered glans, and 81 (of whom 2 had been circumcised) in whom\nthe glans was exposed.[83] As to adhesions, there is an unaccountable\ndiversity of opinion as to their constancy as a natural condition, being\nfrequent enough to class them as physiological occurrences. Dr. A. B.\nArnold, of Baltimore, states that his experience in reference to\npreputial adhesions leads him to conclude that the frequency of its\noccurrence has been much overstated. In the number of children that he\nhas circumcised, which exceeds 1000, he has met with it in less than\nfour per cent. of the cases. He also mentions that in the adult the\nadhesions show greater firmness.[84]\n\nOn the other hand, Dr. Bernheim, of the Paris Israelitish Consistory,\nobserves that, of over 3000 newborn whom he has examined, with but few\nexceptions he found the presence of preputial adhesions. He remarks,\nhowever, that in the majority these are detached or broken by the first\nattempt at erection.[85]\n\nBokai, out of 100 children, found 8 who were over seven years of age,\nwho were perfectly free; while of the remaining 92 under that age 6 more\nshowed no adhesions and 86 had various degrees of adhesions.[86]\n\nDr. Holgate, of the out-door department of Bellevue, considered that all\nphimosic cases have adhesions; while Dr. Moses, of New York, out of some\nfifty circumcisions performed at the eighth day, found only adhesions\nthree times.[87]\n\nThese observations are, however, in perfect accord. If we connect the\nstatement of Dr. Arnold, in regard to the increasing character of the\nfirmness in the adhesions of the adult, with the statement of Dr.\nBernheim, that the first erection is often sufficient to break up the\nexisting adhesions in the infant, we must conclude that they are nothing\nmore at first than a slight agglutination, which the slight manipulation\nrequired to properly locate the position of the glans, and to space out\nthe prepuce preparatory to the operation of circumcision, must, in the\nmajority of cases, be sufficient to liberate the prepuce from the glans;\nthis is evident also from the statement of Dr. Moses, who only found six\nper cent. of the cases operated upon by him as being so affected.\n\nThe writer has been present at a large number of Hebrew circumcisions\nperformed on the eighth day, and from that up to the sixth month (as in\nmany communities they wait until a number of children are collected, so\nto speak, before sending for the mohel, who may reside at quite a\ndistance), and in all of those witnessed he has never seen any\ncomplications from adhesions; but cases of adhesion have been often\nencountered from the second to the eighth year, and it has always been\nthe case, as a rule, that the older the child the greater the firmness\nof the adhesion. In these cases the practice generally advised of using\na probe is not practicable, as the person is more apt to wound the sound\nprepuce than to tear the adhesions; the practice most effectual is to\nhold the glans firmly but gently with the thumb and forefinger of the\nright hand, and then to draw the prepuce as firmly back with its fold\nheld in the forefinger and thumb of the other. It is a more expeditious\nmode, and the least painful; by this method extensive adhesions can\nreadily be broken up; vaselin and a piece of fine lint should then be\ninterposed for a couple of days to prevent a re-adherence.\n\nAnother co-existing condition with phimosis, very often found, is a\nshortening of the frenum. Dr. Jansen, out of 3700 soldiers of the\nBelgian army, found 12.3 per cent. with this pathological condition and\n2.5 per cent. with a narrow prepuce.[88]\n\nTake the three conditions above enumerated,--phimosis, preputial\nadhesions, and short frenum,--all are but a departure from a normal, in\na greater or less degree; and whether the resulting discomfort consists\nin mere mechanical impediment to urination, erection, or as a factor in\nnocturnal enuresis, dysuria, impotence, either through reflex action or\ninterference with emission, malposition of the urethral orifice during\ncopulation owing to any of these conditions, or in any of the nervous\nderangements that may accompany this condition, or in the more serious\nresults, ending in positive deformity of body or limb, or in the\nwarping of moral sentiments, or, even further, in inducing insanity, it\ncannot well be seen how the conditions that will certainly produce these\nresults, in a more or less degree, can ever, in any logical sense, be\nconsidered a physiological condition.\n\nThere are certain conditions to life, up to the time of birth, which,\nunless they then cease at once to exist, immediately become from a\nphysiological into very serious pathological conditions. These are well\nunderstood, and have their reasons for existing during our pre-natal\nexistence; but the prepuce has no known function during uterine life or\nsubsequently; and there being no valid reason for its existence, there\nare certainly no logical grounds for its being considered a\nphysiological condition, especially when the serious results attending\nthe most accentuated form of the above three conditions are considered,\nand as its necessity, in cases of its entire absence, has not yet been\ndemonstrated.\n\nIt can well be said that about two-thirds of mankind are affected in a\ngreater or less degree with these pathological conditions, causing them\nmore or less annoyance. Of these, a certain percentage suffer a life of\ncontinued misery, as a direct or indirect result of these conditions.\n\nAs to the actual necessity of a prepuce existing, or as to what\nannoyances or diseases persons are subjected to who are born without it,\nthere is a most singular and expressive silence in medical literature.\nIt stands to reason that, if it is a necessity, some one person should\nhave found it out long ago, and there should then be some evidence to\npresent in relation thereto. There are cases reported in some of the\nolder surgeries wherein an attempt has been made, in the absence of a\nprepuce, to restore or manufacture one by means of a plastic operation.\nVidal describes such an operation,[89] but there is no reason given as\nto why the operation was undertaken; there is no record of any diseased\ncondition which it was intended either to cure or to alleviate; so that\nwe are left to infer that the person simply submitted to the operation\nfrom purely cosmetic reasons. The Hebrews of Palestine, after the Roman\nconquest, or those in Italy or Spain, attempted a like operation, but\nnot from any reason of lessened health or to restore any lacking\nphysiological action, their aim having simply been to hide their\nidentity, for the purpose of escaping persecutions, exactions, or\nannoyances, either from their rulers or their fellow-citizens.\n\nDr. A. B. Arnold, in a paper on circumcision, read before the Academy of\nMedicine of Baltimore, argues that it is not difficult to divine the\npurposes of the prepuce, holding that it is necessary to protect the\ntactile sensibility of the glans, due to the presence of the Pacinian\nbodies which Schweigger Seidel discovered in the nerves, and that a\nbetter provision than the anatomy of the prepuce cannot be conceived for\nshielding the very vascular and sensitive structure of the glans from\nexternal sources of irritation and friction, that might rouse the\nsensibility of this organ, which, on physiological grounds, may cause\nearly masturbation; further arguing that, the corona being undoubtedly\nthe most excitable part of the glans, its denudation by circumcision\nleaves it more apt to be affected by chance titillations.[90] In this\nlatter view of the case the preponderance of views is, however, in the\nopposite direction. J. Royes Bell states that, owing to the induration\nof the glans through the means of circumcision, masturbation and\nsyphilis are less rife amongst the circumcised than amongst the\nuncircumcised.[91] M. Lallemand, whose experience in the treatment of\nseminal emissions is of the greatest value, looked upon circumcision as\none of the means of curing those diseases, looking on the diminished\nirritability of the glans resulting from the operation as the curative\nelement.[92] Dr. Cahen, in a \"Dissertation sur la Circoncision,\" in\n1816, before the Faculty of Medicine of Paris, called the attention to\nthe diminished sensibility of the glans induced by circumcision. Dr.\nVanier, of Havre, looks upon the prepuce as the most frequent cause of\nonanism. \"If the prepuce is lax, its mobility produces an irritation to\nthe highly irritable and sensitive nervous system of the child by the\ntitillation in its movements on the glans; if too tight and constricted,\nthen it compresses the glans, and by its irritation it leads the child\nto seize the organ.\"[93] So that in either case he looks upon the\nprepuce, through the sensitiveness it retains and induces in the glans,\nas the principle cause of masturbation. M. Debreyne, the Trappist monk\nand physician of La Trappe, who has paid considerable attention to\nmedicine as applied to morality, practically makes the same\nobservations. In children who have not yet the suggestions of sexual\ndesire imparted by the presence of the spermatic fluid, the presence of\nthe prepuce seems to anticipate those promptings. Circumcised boys may,\nin individual cases, either through precept or example, physical or\nmental imperfection, be found to practice onanism, but in general the\npractice can be asserted as being very rare among the children of\ncircumcised races, showing the less irritability of the organs in the\nclass; neither in infancy are they as liable to priapism during sleep as\nthose that are uncircumcised.\n\nDr. Bernheim says that \"the prepuce may be said in general to be an\nappendage to man, if not positively harmful in some cases, at least\nuseless, requiring constant care, the neglect of which is liable to\nentail disease and suffering; the irritation it produces through the\nsebaceous secretion is a frequent cause of masturbation which nothing\nshort of circumcision will remedy.\"\n\nThrough middle life, unless the prepuce be the subject of some vicious\nconformation, little inconvenience may result from its presence, except\nit be from the dangers to infections already pointed out during this\nperiod of life; an ordinarily movable and retractable prepuce will not\nacquire the condition of phimosis, unless it be through disease or\naccident; but with our entrance into old age, or after having passed our\nvigorous prime, the torment of the days of our infancy and childhood\ncome to harass us again. Persons given to corpulency, with a long\nprepuce, are apt to become affected with phimosis in their latter years,\nas such persons are more subject to loss of their sexual vigor and power\nof erection than lean and spare people; in these, the gradual diminution\nof the size of the erectile tissues of the organ and its retraction\nallows of the reconstriction of the preputial opening, which, in the\nend, will not allow the prepuce to be drawn back over the gland. These\nconditions are followed by the irritating affections incident to\nphimosis of our earlier life, with the modification that age has induced\nin making us subject to more serious and fatal ailments, both locally\nand generally.\n\n\n\n\nCHAPTER XX.\n\nTHE PREPUCE, PHIMOSIS, AND CANCER.\n\n\nIn the _British Medical Journal_ of January 7, 1882, there is an\ninteresting article by Jonathan Hutchinson on the \"Pre-cancerous Stage\nof Cancer.\" In this article he states that, whereas, twenty years\npreviously, his suggestion had been to treat all suspicious sores as\nbeing due to syphilis until a clearer diagnosis could be made out, he\n\"had more recently often explained and enforced the doctrine of a\npre-cancerous stage of cancer. According to this doctrine, in most cases\nof cancer, either of penis, lips, tongue, or skin, there is a\nstage--often a long one--during which a condition of chronic\ninflammation only is present, and upon this the cancerous process\nbecomes ingrafted. Phimosis and the consequent balanitis lead to cancer\nof the penis.... A general acceptance of the belief that cancer usually\nhas a pre-cancerous stage, and that this stage is the one in which\noperations ought to be performed, would save many hundreds of lives\nevery year.... Instead of looking on whilst the fire smouldered, and\nwaiting till it blazed up, we should stamp it out on the first\nsuspicion.... What is a man the worse if you have cut away a warty sore\nfrom his lip; and, when all is done, a zealous pathologist demonstrates\nto you that the ulcer is not cancerous, need your conscience be\ntroubled? You have operated in a pre-cancerous stage, and you have\nprobably effected a permanent cure of what would soon have become an\nincurable disease. I do not wish to offer any apology for carelessness,\nbut I have not in this matter any fear for it.\"\n\nIn view of the great frequency of the occurrence of cancer of the penis,\nand the facts pointed out by Roux, that, after the removal of the\ncancerous prepuce or a portion of the penis for cancer, in case of a\nrecurrence the disease does not do so in the penis, but that it attacks\nthe inguinal glands, showing conclusively that the prepuce is the\ninciting cause as well as the initial point of attack, the sentiments in\nthe foregoing paragraph, taken from the words of Hutchinson, are worthy\nof our most careful consideration.\n\nM. Roux, Surgeon to the Charite, during the second decade of the present\ncentury, first called the attention of the French profession to the\nintimate relation or dependence that cancer of the penis bears to\nphimosis. In England he was preceded in this field of surgical\ninvestigation by William Hey, whom Roux met in London in 1814. Hey had\nthen operated by amputation of the penis on twelve cases of cancer, nine\nof whom had had phimosis at the time of the development of the cancer.\nWadd at this time also published a work on the subject, but, although he\nnoticed that phimosis was a cause of cancer, he did not fully grasp the\nsubject as Hey and Roux had done, as he believed a cancerous diathesis a\nprimary necessity, and did not then recognize that the primary cause was\nfully to be found in the prepuce itself.\n\nRoux was probably the first to point out the peculiarly local character\nof penile cancer, as there is no locality wherein a timely operation is\nless apt to be followed by a recurrence. He records a number of cases\nwhere the prepuce alone was affected when first seen, but none wherein\nthe glans was attacked and where the prepuce was exempt, giving ample\nevidence of the original starting-point of the disease.[94]\n\nErichsen also remarks on the little liability to recurrence of cancer of\nthe penis after a timely operation; he divides the cancer to which the\npenis is subject to as being of two distinct kinds,--scirrhus and\nepithelioma. The latter variety commences as a tubercle in the prepuce,\nand, according to Erichsen, does not occur in the body of the penis\nexcept as a secondary infiltration or deposit.[95] Travers states that\nJews who are circumcised are not subject to either form of cancer.[96]\n\nRepeated attacks of herpes preputialis and some consequent point of\ninduration are looked upon by Petit-Radel, Chauvin, and Bernard as\nfrequent starting-points for the cancerous affection of the prepuce. The\naged or persons of lax fibre being more subject to these inflammatory\nattacks, are also the most frequent victims of cancer in this situation.\nThe celebrated Lallemand, in regard to the tendency to cancer induced by\nthe presence of the prepuce, observes as follows:--\n\n\"Besides simple balanitis ... there also result various indurations,\nwhich are proportionate in their degree to the length or time and\nintensity with which the inciting inflammatory conditions have existed.\nI have repeatedly found the mucous lining of the prepuce thickened,\nhardened, ulcerated, and nodulated; at other times converted into a\nfibrous or even into cartilaginous tissue of excessive thickness; in\nothers, still, in which it had assumed a scirrhous and cancerous nature.\nI have repeatedly operated on such cases, wherein the prolongation of\nthe prepuce was the only recognized primary cause, the subjects being\noften countrymen of from fifty to sixty years of age, who had never\nknown any women except their own, but who had, nevertheless, been long\nsufferers from balanitic attacks, accompanied by abundant acrid\ndischarges, swellings of the prepuce, with more or less consequent\nexcoriations and narrowing of the preputial orifice.\"[97]\n\nClaparede sums up the inconveniences and dangers to which the possessor\nof a prepuce is liable to suffer from, as follows: \"The retention of the\nsebaceous secretion is liable to alter its character, converting it into\nan acrid, irritating discharge, which induces more or less burning,\nsmarting, itching, excoriations, and swelling, which, affecting the\nlittle glands situated about the corona and sulcus, induces them to\nsecrete an altered and vicious secretion. In this manner a simple\nelongation of the prepuce will produce an inflammation of the surface of\nthe glans (balanitis), or that of the prepuce itself (posthitis), or the\ntwo conjoined (balano-posthitis), complicated possibly with phimosis. By\nan extension to the mucous membrane of the urethra of the same condition\nof the inflammatory process, we have blennorrhagia; blennorrhagia is\nliable to be followed by inguinal swellings or tenderness, orchitis,\nstricture, and prostatic disease; the formation of preputial calculus,\nfrom retention of the urine in the prepuce; and cancer is apt to be the\nend of any of these conditions.\"[98]\n\nJ. Royes Bell, in Ashhurst's \"International Encyclopaedia of Surgery,\"\nobserves as follows: \"Carcinoma attacking the genital organs usually\nassumes the form of epithelioma; the other kinds are rarely met with.\nEpithelioma may invade the prepuce, or the whole penis, or any part of\nit. The most common age for it is fifty years or over. In the great\nmajority of cases there has existed a congenital or acquired phimosis. A\ncontusion or a urinary fistula may be the exciting cause. With a\nphimosis the parts are not kept clean, but the gland is macerated and\nrendered tender and excoriated by retained secretions, and the\nirritation causes an epithelioma to grow in those predisposed to the\ndisease, as is found to be the case when the tongue is irritated by a\nbroken tooth, or the scrotum by the presence of soot in its folds.\nSyphilis has no direct influence in inducing the disease, but a\nsyphilitic chap or ulcer may be the starting-point of an epithelioma.\nTwo kinds of epithelioma affect the penis,--the indurated and the\nvegetating, or cauliflower growth.... The nature of the disease, in\neither the prepuce or the glans, is masked by a phimosis.... The\nprognosis in these cases is much more hopeful than in epithelioma, in\nother situations.... Sir William Lawrence operated on a patient who was\nquite well years afterward, and Sir William Ferguson amputated the penis\nof a man of note in the political world, who lived many years after the\noperation, and died at an advanced age.\"\n\nAgnew, of Philadelphia, describes an epithelioma of the prepuce\noccurring in persons past middle life, beginning as a tubercle, crack,\nor wart, for which he advises an early circumcision; he admits, however,\nto not having sufficient data to determine whether Jews and circumcised\npersons are exempt from carcinoma of the penis; but as its usual\nstarting-point he evidently admits to be in the prepuce, circumcision\nmust certainly be a preventive to its appearance. Gross gives\nsubstantially the same opinion as Agnew in this regard. Dr. John S.\nBillings, in his article on the \"Vital Statistics of the Jews,\" in the\nJanuary _North American Review_, of 1891, on the subject of cancer,\nobserves as follows:--\n\n\"As regards cancer and malignant tumors, we find that the deaths from\nthese causes among the Hebrews occur in about the same proportion to\ndeaths from other diseases as they do in the average population. But as\nthe ratio of deaths to population is less among the Jews, so the ratio\nof deaths from malignant diseases to population is also less. Among the\nliving population the proportion found affected with cancer among the\nJews was 6.48 per 1000, while of those reported sick by the United\nStates census of 1880, for the general population, the proportion was\n10.01 per 1000.\"\n\nThere are no convenient data as to the prevalence or percentage of cases\nof cancer among the Arabian or Mohammedan population of Asia and Africa,\nbut the above comparison of 6.48 per 1000 among the Jews of the United\nStates, against 10.01 per 1000 of the general population, shows that the\ncircumcised race does, in the instance of cancer, certainly enjoy a\ncertain amount of immunity, having in this regard not quite such an\nexemption as they enjoy from consumption, but still sufficient to assist\nin making them longer-lived and more able to enjoy life and die a less\nlingering and painful death.\n\nIt is surprising that, in view of the fact that carcinoma of the penis,\nstarting with such frequency in the prepuce, should have left any doubt\nbut that with the absence of this appendage there would follow less\nliability to cancer. Cullerier informs us that he had several times\namputated the penis for cancerous diseases, but that he is unable to\ntell us whether the persons were affected with phimosis, remarking that\non the last case he had observed the indurated remains of the prepuce;\nhe had, however, recognized the necessity of freely exposing the gland\nin cases where, from continued irritation and inflammation, there was\ndanger of cancer formation.\n\nNelaton describes two varieties of cancer that affect the penis,--that\nwhich attacks the integument and that which attacks the glans. The\nfirst of these varieties he observes as generally beginning as a\nhardened nodule in the prepuce, which becomes at once more or less\nthickened and indurated. He gives Lisfranc the credit of pointing out\nthe fact, that, even in the most hopeless-looking case, the glans and\nbody of the penis may be simply pushed back and compressed, but\notherwise sound, and that before resorting to an amputation of the whole\norgan it is better to make a careful exploratory dissection in search of\nthe penis, as it oftentimes happens that the prepuce and integument can\nbe dissected off, leaving the organ intact. He also mentions that\nelephantiasis of the penile integument generally begins in the prepuce.\n\nBaron Boyer believed that the vitiated preputial secretion allowed to\nremain beneath the prepuce was one of the causes of cancer of the penis,\nobserving that it would be interesting to know whether cancer of the\npenis was a rarity among circumcised people, such as the Jews and\nMohammedans.[99]\n\nIt is easy to perceive why or how Agnew, Gross, Cullerier, and many of\nthose who have written on the subject, have failed to appreciate the\nexistence of the prepuce as an exciting cause, or as being, in the\nmajority of instances, the part primarily attacked. The nodule,\nexcoriation, or abrasion that develops into a cancer generally produces\nmore or less local disturbance; in many it produces a phimosis that is\nonly relieved by the ulcerative process that exposes the gland, which\nmay by that time itself be attacked or even destroyed. They are then\nseen by either the rural practitioner or the family physician, but\nbefore submitting to an operation they run the gauntlet of many\nphysicians, and, when it comes to operating, they generally apply to\nsome one of great skill and reputation. By this time there is little\nleft of the organ, and, as a rule, the party is unable to tell where the\ndisease originated, whether in the prepuce or glans, to them the swollen\nprepuce seeming to be the whole organ. Of late years, however, it has\nbeen pretty well established that it generally begins in the prepuce,\nand the great number of amputations of the penis on record for this\ndisease does not lead one to believe that it is as rare a disease as was\nformerly believed. In Langenbeck's _Archiv_, Bd. xii, 1870, Dr.\nZielewicz reports fifty cases of amputation of the penis by the\ngalvano-cautery loop, mostly for carcinoma, one of the fifty being for\ngangrene and one other for a large papillary tumor. That one surgeon was\nable to report forty-eight cases of carcinoma or cancer that were\ntreated by one special system of operating tells us plainly enough that\nthe unfortunate possessor of a prepuce, no matter how normal or\nunobjectionable it may seem to be in the prime of man's existence, or\nhowever physiologically necessary it may be deemed, runs too many risks\nin holding on to his possessions.\n\nThe views set forth by Hutchinson in the beginning of this chapter are\nprecisely those that are held by the writer, who would even go further,\nby advising all such as have, in their youth or since, suffered with\nbalano-posthitis in any degree or form, or whose prepuce shows a\ntendency to elongation with age, to have the same removed at once; where\nthe prepuce is not redundant, but only tight, a slight operation, such\nas slitting, will at once remove the possibility of any future danger,\nwithout keeping a man from his business a single day.\n\nIt may here be remarked that, although always favorably impressed with\nthe great benefits arising out of circumcision, nothing ever resulted in\nsuch a serious consideration of the subject as seeing a professional\nbrother dying with a cancerous affection of the penis. The disease had\noriginated in the mucous lining of the prepuce, and when seen in\nconsultation with his attending physicians the gland had already\ndisappeared and the inguinal glands were affected. The man was in the\nprime of life, and, aside from the local trouble, a specimen of perfect\nhealth and physique. He informed us that while a youth he had suffered\nfrom repeated attacks of herpes preputialis; that he had suggested\ncircumcision more than once to his father, who also was a physician, but\nwho, unfortunately for the son, could not see any merit in circumcision.\nTo his eyes there was nothing that circumcision could do but what could\nbe accomplished by washing and personal attention to cleanliness. When\nolder, the prepuce gave him less trouble, and for a long time after his\nmarriage it ceased to trouble him altogether. The idea of the necessity\nof circumcision did not occur to him again until the appearance of the\ncancerous disease; even then, not appreciating the danger, and looking\nupon the trouble as a simple transient result of some inflammatory\naction, he waited until the parts would be in a better state or\ncondition of health before resorting to an operation,--that time never\ncame.\n\nAlthough to Roux, Wadd, and Hey the credit must be given for bringing\nthe subject of cancer of this organ so prominently before the\nprofession, the knowledge of the existence of the disease has long been\na matter of record. Patissier, in the fortieth volume of the \"Dict. des\nSciences Medicales,\" quotes from the third volume of the \"Memoires de\nl'Academie Royale de Chirurgie,\" that in 1724 an officer, aged fifty,\nwas attacked by a cancerous affection originating underneath the\nprepuce; at the time he consulted MM. Chicoineau and Sonlier the\ndisease had existed for two years, the inguinal glands were implicated,\nand even the suspensory ligament was affected. These surgeons,\nnevertheless, determined upon an operation, and, after a long chapter of\nhaemorrhagic accidents, the patient finally made a recovery. Another\ncase, quoted by Patissier, was operated upon by M. Ceyrac de la Coste,\nthe patient a man of sixty, the disease originating, like the preceding\ncase, underneath the prepuce.\n\nWarren, in his \"Surgical Observations on Tumors,\" observes that cancer\nof the penis begins by a warty excrescence on the glans or prepuce.\nWalshe, in his work on the \"Nature and Treatment of Cancer,\" says: \"The\ndisease may commence in almost all parts of the organ, but the glans and\nprepuce are by far its most common primary seats. It may originate\neither from a warty excrescence or a pimple, or it may infiltrate the\nglans, or appear as a complication of venereal ulceration. Phimosis,\neither congenital or acquired, is an exceedingly common accompaniment,\nand it appears probable that the irritation occasioned by this condition\nof the parts may act as an exciting cause of the disease in persons\npredisposed to cancer. Circumcision is, therefore, an advisable\nprophylactic measure, where the constitutional taint is known to\nexist.\"\n\n\n\n\nCHAPTER XXI.\n\nTHE PREPUCE AND GANGRENE OF THE PENIS.\n\n\nAnother accompaniment of that preputial appendage is gangrene of the\npenis, which, like carcinoma, starting in at the prepuce, may invade the\npubes and scrotum. This disease is not so rare as to merit the little\nattention it has received from our text-books. M. Demarquay has\ncollected the history of twenty-five cases; from him we learn that the\nprepuce is the most frequent seat of the start of the affection, from\nwhence, according to Astruc, it rapidly spreads to the skin of the whole\norgan, and then attacks the corpora cavernosa; it may even extend as\nhigh as the umbilicus. This disease spares no age; it attacks young and\nold alike.\n\nThere is not a case recorded of this disease that particularized any\nother starting-point than the swelling, tension, active or passive\ncongestion that takes place in the integument of the penis. By this it\nmust not be understood that the initial disease or inflammatory action\nthat produces the gangrene must necessarily have its seat in the\nintegument, but that it is the integument of the penis (and especially\nthat of the prepuce) in which, through the laxity of its tissues,\npassive congestion is favored that the gangrenous action begins. That\nthis is the actual case there can be but little doubt about, as, even\nwhere the gangrene invades the body of the penis itself, even where the\ninflammatory action may have started from a violent urethritis, that\ncondition of blood which favors gangrenous results will be found to\nhave begun during its state of stasis, where it has parted with much of\nits watery element, as well as considerable of its vitality, while in\nits slow, tedious, and obstructed passage through the prepuce. Some of\nthis dark, thickish blood, finding its way from the integumentary return\ncirculation to that of the deeper structure, becomes there a mechanical\nas well as a pathological cause for that impediment to the free\ncirculation of the parts, through its altered physiological condition.\nThe deeper structures of the penis, besides their own blood-supply,\ncarry back into the deeper or systemic circulation a large supply from\nthe integumentary tissues, when in the latter, owing to the greater\nsupply due to any inflammatory action, the blood-current is delayed and\nimpeded in its lax and easily-dilatable tissues, and blood-changes occur\nfavoring the gangrene in the deeper tissues, so that, whether the\ngangrene first takes place in the body of the penis or in the scrotum,\nit will be in the prepuce or adjoining integument that its real\noriginating causes will be found.\n\nBaron Boyer, in speaking of the inflammation of the penis, observes that\nthe intensity of the swelling, great pain, and difficulty of urination\nthat follow have led many to believe that the inflammation of the deeper\nstructures really always formed a part of the disease. In otherwise\nhealthy and vigorous subjects it does not, however, extend beyond the\nskin, as has been demonstrated where the resulting gangrene from excess\nof inflammatory action has ended in resolution, the deeper tissues not\nhaving been found to be injured. It is only where the tone of the\ngeneral system is lowered, through disease, age, or other deteriorating\nconditions, that the whole organ is liable to become affected or to\nbreak down.\n\nBoyer, in the tenth volume of his \"Treatise on Surgical Affections,\"\ngives several examples of this affection not due to age: one case was a\nperson, simultaneously attacked by an adynamic fever and a\nblennorrhagia, who suffered from gangrene of the penis; the local and\nconstitutional disturbance was not high, however, and the patient\nescaped with the simple loss of the prepuce.\n\nAnother case admitted to the Charite, aged thirty-six, was afflicted\nwith a blennorrhagia, upon which an attack of low fever supervened. The\npenis inflamed, became engorged and livid, and soon gangrenous symptoms\npresented themselves, making rapid progress; at first the integument\nalone was affected, but later all the structures became implicated and\nthe penis was completely destroyed, the sloughs detaching themselves in\nshreds, leaving a conical stump that healed but slowly.\n\nOne case, a young man of twenty, also at the Charite, was admitted with\nadynamic fever; a few days after admission the prepuce was observed to\nbe somewhat inflamed; in spite of all treatment this progressed so\nrapidly that the purple discoloration presaged a gangrene, which was not\nslow in following; the focus seemed to be at the superior and back\nportion of the prepuce; an incision evacuated a quantity of purulent,\nserous fluid; the disease, however, extended up the organ as far as its\nmiddle before its actions ceased; the sloughs were then cast off, when\nit was found that part of the gland and a portion of the cavernous body\nhad followed the integument in the general wreck, subjecting the patient\nto intolerable pain during micturition. After the recovery from the\nfever, the remaining portion of the gland and the mutilated parts of the\ncavernous body were amputated to remedy this condition; the patient\nsubsequently admitted to have had a blennorrhagia at the time of his\nadmission to the hospital.\n\nThe gangrenous action may, in proportion to the low condition of the\npatient, be as proportionately rapid. Another case from Boyer, quoted\nfrom the works of Forestus, relates how the whole organ underwent such\nspeedy disorganization that its liquefied remains were found in a\npoultice, which had been applied with a view of relieving the\ncongestion,--a very dear price to pay for retaining the prepuce, that\nthe exquisite sensitiveness of the tactile faculty for enjoyment,\nresident in the corona of the gland, might not be interfered with.\n\nGross does not mention this affection in his work on surgery, but Agnew\ndevotes considerable space to its description, dividing the disease into\ntwo forms: the inflammatory, such as may follow venereal primary sores\nor operations on the penis, not excepting circumcision; and the\nobstructive variety, such as may follow embolism or any mechanical\nobstruction, either purposely or accidentally applied. Of the latter he\ngives a number of quoted instances; he only admits seeing one case, that\nof an aged man in the Pennsylvania Hospital, in whom the disease was\ncaused by embolism of the dorsal artery.\n\nJ. Royes Bell, in the \"International Encyclopaedia of Surgery,\" pays more\nattention to it than any of our American authors; mentioning, among the\ncauses which may give rise to it, the exanthemata, especially small-pox,\nand the poisoning by ergot of rye and erysipelas. Among the local causes\nlie mentions phimosis, paraphimosis, and balano-posthitis.\n\nBell quotes the case reported by Mr. Partridge, in the sixteenth volume\nof the \"Transactions of the Pathological Society of London,\" wherein a\nsober man, aged forty, lost the whole of his penis up to the root,\nduring the course of a typhus fever. Also the case reported by Mr. Gay,\nin the thirtieth volume of the same \"Transactions,\" wherein a\ncabinet-maker, aged thirty-one, lost his penis through the probable\nresults of rheumatic phlebitis, and due to the presence of a plug in the\ninternal iliac vein. In the twelfth volume of the \"Transactions\" of the\nsame society he finds the record of the case of a soldier who lost his\npenis through gangrene induced by syphilitic phagedena.\n\nIn the consideration of the subject of the prepuce as connected with\npenile gangrene, it must not be overlooked that the presence of a\nprepuce may be the inciting cause of some rheumatic affection (the\nwriter has repeatedly seen such), just as such cases are often the\nresult of stricture; as cases of rheumatism that have resisted all\nremedial means, but that have readily given way to the dilatation of a\nstricture, are by no means uncommon; not a mere muscular reflex\nrheumatic pain, but even when accompanied by a rheumatic blood\ncondition. So that even in such a case as above reported as being due to\nrheumatic phlebitis, or the case reported in the fortieth volume of the\n\"Dictionaire des Sciences Medicales\" by Patissier, wherein a man lost\npenis and scrotum through gangrene, induced by urinous infiltration, may\nall in the origin be due, if not to the immediate, to the remote effects\nof the presence of the prepuce.\n\nIn the first volume of the _Journal of Venereal and Cutaneous Diseases_\nthe writer reported a case of the complete loss of penis in a young man\nas a result of phagedena due to syphilis. The man had had a long and\npendulous prepuce; in his case, had circumcision been performed in early\nchildhood, it would have lessened the chances of primary infection, and\nhad it been performed after his infection, it would have removed one\ncause--if not the principal cause--of the ease with which the phagedenic\naction was inaugurated. The case already mentioned as an example of\nspontaneous and natural circumcision belongs to the gangrenous results\nfollowing phimosis, ending with the loss of the prepuce. In Maclise's\n\"Surgical Anatomy\" several specimens of deformity are figured, showing\nthe results of this mildest of the effects of a phagedenic action. The\nbeginning of the interference in the return preputial circulation\nundoubtedly always takes place over the superior aspect of the corona,\nwhere the pressure of the glans is most sharply defined against the\ninner fold of the prepuce.\n\nThere are milder conditions, wherein the circulation of the prepuce is\nmaterially interfered with, both through the lax tissues of the parts\nand the peculiar anatomical construction and shape of the neighboring\nparts, wherein, without going as far as gangrenous breakdown, the person\nsuffers considerably nevertheless, and is placed in danger of losing his\npenis; for, as observed by Patissier, whenever a person affected with a\ngonorrhoea is attacked by a putrid or any low-grade fever, he runs the\ngreatest danger of losing his virile member through gangrene.\n\nEven where phimosis does not exist, but only the long, lax, and\nretractable prepuce, that is considered a perfectly physiological\ncondition, the prepuce is liable to cause very distressing and\ncomplicating annoyances during the progress of other diseases. The\nwriter has noticed that cases with a thick, leathery, and redundant\nprepuce, even when perfectly retractable, are more liable to require the\nuse of the catheter during the course of a continued fever. Such a\ncondition is also a very frequent accompaniment of prostatic\nobstruction. So often has this been noticed that its association with\nprostatic trouble or disease tends to the belief that the irritation\nproduced by this condition of prepuce often lays the foundation for\nprostatic disease in not a few cases.[100] In elderly people, with the\natrophied penis and elongating prepuce, the constant moisture from the\nurine on the inner fold and glans adds greatly to the irritation as well\nas to the discomfort of the patient.\n\nA number of affections are accompanied by oedema, especially toward the\nlatter stages of the disease; such, for instance, as the ending of cases\nof mitral insufficiency. In these, the distension of the prepuce and the\nresulting balano-posthitis is at times a source of great distress, and\nat times the resulting engorgement produces a retention of urine. It was\nafter an attendance on one such case that required daily and frequent\npuncturings for its relief, but which, in spite of all care, finally\nbecame gangrenous, that a fellow practitioner cheerfully submitted to\ncircumcision, to avoid the possibility of any such complication\noccurring to embitter his closing illness.[101]\n\nThe prepuce is the starting-point of many of the cases of penitis and\nretention of urine that often accompany attacks of gonorroea; especially\ncan this result be anticipated where the prepuce is long, pendulous, and\nwith its veins in a varicose condition. Why it should be so is\nself-evident. Anything that will add to the interference of the return\ncirculation only exaggerates the tendency to penis engorgement; this\nincreases the difficulty of urination, which, by the retention that\nresults, in turn increases the constriction at the root of the penis,\nand adds to the already difficult return circulation. The bladder by its\nurine, and the penis by its blood, actually form, by their mutual\npressures, an impassable dam at the root of the organ. That this is the\ntrue condition has been more than once verified from the instant relief\ngiven to the whole condition by the prompt employment of the supra-pubic\npuncture or aspiration, as catheterization in such cases is altogether\nout of the question, and should never be attempted or employed unless a\nsoft catheter can be inserted.\n\nA person laboring under a continued fever has his blood in a condition\nto favor sphacelus; with the slow-moving current of vitiated blood and\nits retention in such lax tissues as those of the prepuce, through the\nmedium of the enlarged preputial veins, coupled with the lessened\nsensibilities of the bladder and his perhaps semi-conscious or\nunconscious condition, and an equally unconscious bladder, he is, to say\nthe least of it,--if in possession of a prepuce,--also the unconscious\npossessor of a certain degree of percentage, no matter how small or\nfractional that may be, of recovering from his fever without his penis.\nDr. W. W. McKay, of the U. S. Marine Hospital Service of San Diego,\nattended a case of typho-malarial fever in consultation with me, where,\nbut for the persistent, intelligent, but delicate use of the catheter\nfor nearly three weeks the penis would have become gangrenous. The\nsubject was an uraemic, irritable, nervous, leathery-prepuced individual;\nthe organ was unusually large, the skin of the penis thick, and it was\nonly by keeping the bladder empty that prevented a state of engorgement\nthat would have effectually interfered with further catheterization. As\nit was, the penis was often dank, livid, and discolored from the passive\nengorgement.\n\nThe writer saw a similar case with the late Dr. F. H. Milligan, of\nMinnesota. The congestion in this case was due to a gonorrhoeal\ninflammation involving the skin of the whole penis, retention having\nfollowed painful micturition, and the swelling of the penis following\nthe retention; the prepuce was enormously distended, and the penis\nseemed in a state of erection as far as dimension and rigidity were\nconcerned. The man, a steam-boat cook, informed us that it was fully\ntwice as large as when rigidly erect in health. All efforts to reduce\nthe swelling were unavailing; neither punctures, leeches, nor\nscarifications were of any avail; catheterization was impossible, but,\nafter relieving the bladder by the supra-pubic aspiration, the patient\nexperienced some relief. He, nevertheless, lost the whole skin of the\npenis, with that of the pubis and on the front of the scrotum. The man\nran into a low form of fever, with uraemic symptoms; the stench was so\ngreat that it was almost impossible to remain in the same room with him;\nbut he finally made a slow and very tedious recovery. In healing there\nwas considerable downward curvature of the penis, which, however, did\nnot prevent him from following his old, dissolute course of life.[102]\n\nA calm, unprejudiced consideration of the subject of the liability of\nthe uncircumcised races dwelling in the temperate and semi-tropical\ncountries to cancer, gangrene, and elephantiasis might well lead one to\nask: Why are we afflicted with a prepuce? We can understand how a man\nmay become gouty, and become a subject in the end for a gangrene of the\nextremities; or how senile gangrene may, through a series of\npathological processes and blood changes, with the aid of age, finally\nbe reached; or how, by a like course of diseased processes, we reach the\napoplectic stage. These conditions, however, can be put off, or partly,\nif not wholly avoided, by a proper course of life, and, at the worst,\nit is only after the fires of our youth and prime have completely burned\nout, that these conditions are liable to claim us as their lawful\nvictim. Not so, however, with some of these conditions that may end in\npenile gangrene; that are liable to pounce upon us unawares, like an\nApache in an Arizona canyon; or as the hired mercenaries of old Canon\nFulbert did upon poor Abelard in his study, and, without further ado or\nceremony emasculate man as effectually as the most exacting Turk could\ndemand, with a veritable _taille a fleur de ventre_ operation.\n\nNature has her own ways of protecting what there is of any utility;\nthere is a law of the survival of the fittest that we all appreciate.\nIf, then, this penile appendage is of any utility, why is it that,\nunlike the rest of the body, it falls such an easy victim to gangrene?\nThe procreative function seems to be, in a sense, one of the main cares\nof nature in its relation to the animal as well as the vegetable\nkingdom; but here is a useless bit of skin, adipose tissue, mucous\nmembrane, and some connective tissue, that on the least provocation is\nliable to go off into a gangrene and drag one of the main generative, or\neven all the procreative, apparatus into the general wreck. Nature\ncertainly never intended anything of the kind. To be generous, and not\nlibel nature, we must conclude that the prepuce is a near relative to\nthe fast-disappearing climbing-muscle; very useful in our primitive,\narboreal days, when we needed such a muscle to reach our perch for the\nnight, and a prepuce or something of the kind, in default of a\nbreech-cloth, to protect the glans penis from being scratched by the\nbriars or thorny and rough bark of the trees in our ascent. The prepuce\nwas well enough in our primitive and arboreal days,--ages and ages ahead\nof our cave and lake dwellings,--when the notch in a tree and its rough\nbark formed our couch; but in these days of plush-cushioned pews and\nopera-seats, cosy office-chairs, car-seats, and upholstered furniture or\npolished-oak seats, it serves no intelligent purpose.\n\nEmasculation has never been looked upon with favor by its victim, and it\nwould be but natural to suppose that man would take every precaution\nagainst the accidental occurrence of such an undesired condition. The\nwriter well remembers that, in his \"Tom Sawyer\" days on the banks of the\nupper Mississippi, in the happy days of the crack rafting crews, before\nthe introduction of the towage steamer, when the river towns were more\nor less terrorized by wild gangs of these men, some of whom were always\nfighting and quarreling and drinking when not at work. In the lot there\nwas one man with a great reputation at a rough-and-tumble fight. His\nmain hold was that he generally tried to emasculate his adversary by\ndestroying the physiological condition of the testicle. The man was not\na large or powerful man, nor was he a great boxer or wrestler, but this\nreputation made him feared by all the bullies on the river. The report\nthat not a few who had tackled him had subsequently been of no value,\neither as fornicators or fecundators, or had to be castrated on account\nof the resulting testicular degeneration, seemed in no way to encourage\nany one to wish to meet him in a personal encounter. It would seem as if\nthe desire to avoid such an accident--provided persons knew the dangers\nthat lurk in a prepuce--would induce many to submit to circumcision.\nThat many more do not do so can only be attributed to the general human\nwish to escape a less present evil for a greater unknown one, being\nevidently deterred by the prospective pain that must be suffered\nimmediately.\n\nThere is a question that should interest man above that of the simple\nloss of penis. It appears that there is a powerful moral effect that\nfollows this loss, as might, in the majority, be anticipated. According\nto the experience of Civiale, many who have lost the penis, through\namputation for disease or through disease itself, end in suicide. He\nmentions particularly a patient at the Charite who had lost his penis,\nwho, finding no other means to take himself off, saved up sufficient\nopium, from that given him to calm his pains, to take all at one dose\nand commit suicide. In the London _Lancet_ for March 27, 1886, there is\nreported a discussion on this subject, to which the reader is referred,\nas it fully covers the moral and physical effects of castration and\npenis amputation for disease. M. Roux, who amputated the penis of a\nbrother of Buffon, in 1810, reported that, in that case, M. Buffon lost\nnone of his customary gayety.\n\n\n\n\nCHAPTER XXII.\n\nTHE PREPUCE, CALCULI, AND OTHER ANNOYANCES.\n\n\nFrom an article published in the New York _Medical Times_ of March,\n1872, from the pen of Dr. J. G. Kerr, of Canton, China, we learn that\nphimosis is not an uncommon occurrence among the Chinese. As has been\ndemonstrated by C. H. Mastin, of Mobile, climate is a great factor of\ncalculus. (\"Transactions International Medical Congress\" of 1876, page\n609.) That of China seems a most favorable climate in this regard; so\nthat, between the prevalence of phimosis among the Chinese and the\ncalculus-producing tendency of the climate, China may be said to be the\nclassic land of preputial calculi, as England is that of the gout, or\nthe United States that of delirium tremens. From Dr. Kerr we learn that\nthe occurrence of these concretions were, as a rule, multiple, and that\nin two cases that fell under his observation the number of stones from\neach individual exceeded one hundred. In one case there were forty, and\nin three cases there were between twenty and thirty. These were of\ndifferent sizes and weight, some being an inch and five-eighths in\ndiameter, and from that size down to where one hundred and sixteen taken\nfrom one individual case only weighed one ounce. The tendency to\ncalculous disease in that climate may well be imagined, when the same\nobserver relates a case of urinary infiltration into the skin on the\nunder side of the penis that gave rise to the formation of a collection\nof calculi in that locality, four of which were the size of pigeons'\neggs; and another case in which a urinary fistula induced the formation\nof a calculus in the groin, near the scrotum, the calculus weighing two\nand a half drachms and measuring one and a half inches by three-quarters\nof an inch in diameter.\n\nClaparede mentions a case in the practice of M. Dumeril, in which the\nstone extracted from the prepuce weighed two hundred and twenty-five\ngrammes, or about eight ounces. Civiale speaks of a young man of twenty\nwith phimosis, who, after practicing sexual connection for the first\ntime, experienced pain and a purulent discharge, from whom, on\nexamination, he removed five stones as large as prunes. The patient had\nfelt them in their position, but had imagined the condition to be a\nnatural one.\n\nE. L. Keyes gives their composition as being of calcified smegma, urate\nof ammonium, triple and earthy phosphates and mucus, and as symptoms and\nresults: pain, purulent discharges, interference with urination and the\nsexual act, involuntary emission, ulceration of the preputial cavity,\nand impotence.\n\nEnoch mentions a child of two years in the Charite, who, being operated\nupon for phimosis, was found to have a preputial calculus occluding the\nurethral meatus. At the autopsy a calculus as large as an egg was found\nin the bladder.\n\nThe presence of these formations, although not necessarily dangerous in\nthemselves, may, by their effects and in the irritation they induce, be\nthe means of producing serious mischief. The only preventive or remedy\nfor this condition is circumcision.\n\nAcquired phimosis has been mentioned as a result of inflammatory lotion,\nsuch as is connected with balano-posthitis; it sometimes happens that,\nthe act of coitus being done forcibly, especially with public women, who\nare apt to use very astringent and constricting washes, the prepuce\nbecomes injured, with the result of producing a phimosis. One man will\nproduce the same results through the means of some vaunted wash or dip\nwhich is supposed to act as a prophylactic to any venereal infection.\nOne patient had developed a chronic herpetic affection by the constant\nuse of an iodized ointment which he regarded as an infallible\nprophylactic. Many cases of phimosis result from the attending\ninflammation that follows on the liberal domestic application of nitrate\nof silver to an abrasion after connection, in the mistaken idea that the\nparty labors under, that he is destroying some venereal virus.\n\nBy the irritation that all these applications and accidents induce,\nwarts and vegetations are the but too frequent results. These I have\nnever seen in a circumcised individual, and their occurrence and\nfrequency, as well as persistency, are directly proportionate with the\ndegree of tightness, thickness, or redundancy of the prepuce and the\nirritability of the gland. As remarked by Lallemand, in reference to the\nvictim of nocturnal enuresis becoming a future victim of nocturnal\nemissions, so it may be said of the person subject in early life to\neither warts, excoriations or vegetations on the penis, that it is this\nclass that furnishes in after life the subjects for cancerous disease as\nwell as furnishing the easiest victims for venereal infection. These\nwarts, although easily removed, have a tendency to recurrence,\nespecially as long as the moist bed that has once grown them there is\nstill vegetating.\n\nThe prepuce is liable to indurations and hypertrophy. Of the first\nanomaly, the London _Lancet_ of 1846 has a record of two cases in which\nparaphimosis was induced in elderly subjects, and of one in which it\ninduced phimosis. Since then a number of cases of thickening and\ninduration have been reported. Hypertrophy may take place in any degree,\nvarying from the mere leathery and overpendulous but unobstructive\nprepuce to the case recorded by Vidal, in the fifth volume of his\n\"Pathologie Externe et Medecine Operatoire,\" which happened in the\npractice of M. Rigal, de Gaillae. The hypertrophied prepuce was\nsomething enormous, and hung down to below the patient's knees; it was\npear-shaped, with the base hanging downward; this base was as large as a\nman's head. This prepuce was successfully removed by M. Rigal, who\npresented the specimen before the Paris Surgical Society, who were then\ndiscussing a somewhat similar but not so extensive a case, presented by\nM. Lenoire. Vidal mentions having operated on a number of cases of this\ndeformity of the prepuce in various degrees of growth.\n\nAs a rule, simple hypertrophic disease of the penile integument does not\ninterfere with the sexual functions of the male organ after its removal;\nit being susceptible of complete removal in exaggerated cases, even\nwithout touching the body of the organ. There are exceptions to this\nrule, however, when even this otherwise non-malignant disease may entail\nthe loss of all the genitals. In the London _Lancet_ of July 11, 1846,\nat page 46, there is a record of a remarkable case of this nature\nreported by F. H. Brett, Esq., F.R.C.S. The case was that of a locksmith\nof forty years of age, who was naturally much phimosed. The penis was\nenormously enlarged, as well as the scrotum, which was more or less\nulcerated and full of sinuses filled with a serous pus; some six months\nprior to the final operation, a part of the prepuce was removed to\nfacilitate urination, but the whole mass had to be subsequently removed,\nincluding the whole of the skin of the penis and the scrotum, the\ntesticles having been carefully dissected out and recovered with some\nskin flap.\n\nIn this case the disease was believed to have originated from a perineal\nfistula. The pathological investigation in the case, however, by Mr.\nQuekett, who submitted the mass to a microscopical examination,\nconfirmed Mr. Brett in his original opinion that the disease had the\nsame pathological conditions as the similar disease found in India,\nwhere it originates from local inflammatory causes. In this case the\npreputial irritation was, in all probability, the precursor of the\nconditions that led to the perineal fistula, the patient having had a\nstricture for some twelve years. Mr. Brett states that the man had been\nabandoned by his wife on account of his previous sexual disability, and\non account, as well, of his having been incapacitated from following any\nvocation. After the operation all his functions were restored and his\norgans were sound.\n\nNelaton records a case reported by Wadd, in 1817, of an African negro so\naffected, whose penis measured fourteen inches in length and twelve and\na half inches in circumference; also the case reported by Gibert, of\nHospital St. Louis, of a subject \"with a penis the size of a mule's.\"\n\nMr. Brett attributes the recovery of his case as being due in a great\nmeasure to the moral support given to the patient from the knowledge\nthat his procreative organs were not interfered with, and on the same\ngrounds he attributes the great fatality previously attending the\noperation to the fact that it previously had been the custom in many\ncases to make a clean general _taille a fleur de ventre_, sacrificing\nall the genital organs. In simple hypertrophy, he considers that the\nbody of the penis and the testicles will always be found to be in a\nnormal condition; a careful dissection of the parts will invariably save\nnot only the man's sexual functions, but his moral stamina, which he\nsadly needs in such an emergency. In the discussion on this subject\nheretofore mentioned as taking place in the London Medical Society, Mr.\nPye, Mr. John A. Morgan, and others insisted on the necessity of\nretaining the testicles, whenever possible, in all these sweeping\noperations upon the genitals, they being actually necessary for the\nmoral and physical support of man, Mr. Morgan observing that their\nremoval would depress parts controlled by the sympathetic system.\n\n\n\n\nCHAPTER XXIII.\n\nREFLEX NEUROSES AND THE PREPUCE.\n\n\nWe have seen in the previous chapters what the immediate effects of the\nprepuce may lead to; we have followed its local effects in childhood to\nyouth, thence into what it does in our prime, and we have seen how, when\nwe are on the down grade, owing to the increase of years, then, like the\nminute-men of Concord, wakened up by Paul Revere's classic ride, hanging\non to the rear of the retreating and disheartened British, it harasses,\nworries, and downs a man here and there, striking down the man as if it\nhad some undying, irremediable spite, which nothing but his misery and\ndeath could alleviate. Some authorities will argue that all that is\nrequired is cleanliness; that all men need do is to be like a true\nAmerican, with the old Continental watchword of \"eternal vigilance is\nthe price of liberty\" in continued active practice. A bowlful of some\nantiseptic wash and a small sponge should always be at hand, and he\nshould be as industrious as if haltered in a tread-mill; he should make\nthis a part of his toilet, and his daily and hourly care. This will, we\nare told, lessen his chances of becoming a victim to the many ills that\nlie in wait for him, all on account of the glory, honor, and comfort of\nwearing a prepuce, which is a perfectly physiological appendage.\n\nFrom these visible and apparently easily understood conditions and\nresults we are now to enter a broad field, wherein the prepuce seems to\nexercise a malign influence in the most distant and apparently\nunconnected manner; where, like some of the evil genii or sprites in\nthe Arabian tales, it can reach from afar the object of its malignity,\nstriking him down unawares in the most unaccountable manner; making him\na victim to all manner of ills, sufferings, and tribulations; unfitting\nhim for marriage or the cares of business; making him miserable and an\nobject of continual scolding and punishment in childhood, through its\nworriments and nocturnal enuresis; later on, beginning to affect him\nwith all kinds of physical distortions and ailments, nocturnal\npollutions, and other conditions calculated to weaken him physically,\nmentally, and morally; to land him, perchance, in the jail, or even in a\nlunatic asylum. Man's whole life is subject to the capricious\ndispensations and whims of this Job's-comforts-dispensing enemy of man.\n\nAs strange as it may seem, this field of knowledge, this field of misery\nand suffering, disease and distortion, of physical and mental obliquity,\npresided over by this preputial Afrit of malignant disposition, was an\nunknown, undiscovered, and therefore unexplored region for some\nthousands of years, and it remained for an American to discover and\ndescribe this vast territorial acquisition, and to annex it to the\ndomain of medicine, which, through its skill, could modify the influence\nof the evil genius that there presided and spare humanity much of the\nills to which it had been subjected.\n\nIn this regard, Louis A. Sayre was to medicine what Columbus was to\ngeography. Neither Strabo nor Herodotus had anything to say regarding\nwhat existed beyond the pillars of Hercules, and neither Hippocrates nor\nGalen had anything in regard to this preputial Merlin, which in their\nday, even, had its existence. Neither did Tissot nor Bienville, the two\npioneers in the field of our knowledge regarding onanism and\nnymphomania, dream of the existence of this one cause of the diseases\nto which they gave so much time and study. It is only some twenty years\nsince Louis A. Sayre read his paper, entitled \"Partial Paralysis from\nReflex Irritation Caused by Congenital Phimosis and Adherent Prepuce,\"\nbefore the American Medical Association. This was the starting-point\nfrom whence the profession entered into what had previously been a\nveritable \"Darkest Africa.\"\n\nWhen we read that only some fifty years before the times of Columbus\nChristian Europe had no lunatic asylum,--not that there was a lack of\nlunatics or that the existence of lunacy was entirely ignored, but that\nthe then state of medicine and the general intelligence was not\nemancipated from the idea of demoniacs,--and we are told that the\nlunatics were in many instances hung, quartered and burned, hooted and\nchased about the streets, or chained in gloomy dungeons; until, as\nrelated by Lecky, a Spanish monk named Juan Gilaberto Joffe, filled with\ncompassion at the sight of the maniacs who were hooted by crowds through\nthe streets of Valencia, founded an asylum in that city. His movement in\nthis direction called the attention of the Church and people to this\nclass in a practical light, and from Spain a more enlightened idea in\nregard to this class swept onward throughout Europe. As observed, it\nseems strange to us of the present day that such ignorance in these\nmatters should, or could, have so long existed. It seems impossible for\nus to conceive how these conditions of incoherent action and of mental\nderangements could have existed and their causes have not been fully\nappreciated; and yet we were not above, some twenty years ago only,\nsubjecting children to punishment and scoldings for being addicted to\nnocturnal enuresis, or of accusing cases of nocturnal and involuntary\nemissions as being due to masturbation. The child was allowed then to\ngrow up paralytic, or with a deformed limb, or continually punished to\ncorrect what was imagined to be a condition of willful carelessness,\nirritability, or willful moral perversion. Perversion, stupidity, and\nirritability of the mind or temper were not known to depend, in many\ninstances, on preputial irritation; children were, accordingly, worried\nand punished for something over which they had no earthly control or the\nleast volition. Humanity cannot, at present, sufficiently appreciate\nwhat Louis A. Sayre has done in its behalf. It is here that we realize\nthe hidden wisdom of the Mosaic law and the truth of the assertion of\nthe late Dr. Edward Clarke, that, \"The instructors, the houses and\nschools of our country's daughters, would profit by reading the old\nLevitical law. The race has not yet outgrown the physiology of Moses.\"\n\nThese irritations from the preputial irritability are not always so slow\nmoving as to span over either months or years in their fell work.\nInstances of their sudden action have been sufficiently recorded as to\nwarrant them as being classed as causative agents in acute affections\nthat instantly threaten life. In the London _Lancet_ of May 16, 1846,\nthere is a record of a very peculiar case reported to the London Medical\nSociety by Dr. Golding Bird: \"The case was that of a child seven or\neight weeks old only, an out-patient of Guy's Hospital. The child had\nbecome almost lifeless immediately after nursing, and to all appearances\nlooked as if under the influence of some narcotic. It had not, however,\nhad anything of the kind given to it, nor had it sustained a fall, nor\nwas the head so large as to lead to suspicion of congenital\nhydrocephalus. On inquiring if the child passed water, the answer led to\nan examination of the prepuce, which was found to be elongated, and had\nan aperture only of the size of a pin-hole, like a puncture in the\nintestines. The urine was dribbling out; it was evident that the child\nhad never completely emptied its bladder. Mr. Hilton slit up the\nprepuce, and all the symptoms were immediately relieved and soon\nentirely removed.\" Dr. Bird referred to a case which he had related to\nthe Society some years before, which was reported in the _Lancet_ at the\ntime, of a child who fell a victim to a malformation of this kind, and\nafter death the bladder and ureter were found like those of a man who\nhad long suffered from stricture. Mr. Hilton has seen many cases similar\nto the one mentioned by Dr. Bird. The greatest benefit resulted from\nslitting up the prepuce. In this case the benefit was very remarkable, a\npartial paralysis of the left side, under which the little patient\nlabored, being quite removed in twenty-four hours.\n\nIn this case the difficulty was evidently both the result of mechanical\npressure and reflex irritation. A somewhat similar case as to its\nresults is given by Dr. Sayre, to whom the case was reported by Dr. A.\nR. Mott, Jr., of Randall's Island, in January of 1880: \"John English,\naged 46, native of England, widower, clerk; admitted to workhouse\nhospital. Patient had been at work for a week as a prisoner; on the 23d\nof December was noticed to be restless and uneasy, and finally, in the\nevening, he fell from his bunk in a fit. During the next forty-eight\nhours he had several convulsions, and during the intervals lay in a\nsemi-comatose condition, showing no consciousness except to stir a limb\nwhen pinched. Pulse, 120; temperature, 1011/2 deg.; respiration, 18.\nSwallowed nothing, and passed faeces in bed. Continued in this condition\nuntil December 25th (temperature having fallen to 100 deg.), when a string\nwas discovered passed twice around the penis behind corona and tied, the\nlong prepuce serving to conceal it from observation. While not\nsufficiently tight to occlude the urethral canal, still a firm,\nindurated band remained after the string was cut, and did not disappear\nfor four or five days.\n\n\"Within one hour after the removal of the string the man sat up and\nasked for milk, and from this time remained perfectly well (was under\nobservation for three months). He declared that he remembered nothing\nthat had taken place during the past three days; had never had fits,\ndenied venereal diseases, was moderately addicted to drink, but had led\na 'virtuous life since the death of his wife, two years before.'\"\n\nThe following case in the practice of Dr. F. J. Wirthington, of\nLivermore, Pa., was also reported to Dr. Sayre: \"When the child was\nborn, he was considered the biggest and finest boy that had been born in\nthe community for a long time, until, when he was about two and a-half\nyears old, and being sick, a doctor was called in, who told them that\ntheir child was paralyzed, the paralysis being in his lower extremities,\nand who treated him with the usual nerve-tonic and with electricity.\nNotwithstanding all this, the boy went steadily down, and the paralysis\ncontinued until he was seen by Dr. Wirthington. The child was then\nunable to walk; on examination, the prepuce was found to be adherent\nalmost all the way around the glans penis. Behind the corona was a solid\ncake of sebaceous matter. The case was promptly operated upon, and,\nalthough the previous attendant had not found any cause to account for\nthe paralysis, a rapid recovery took place, the boy being able to walk\neven before the complete cicatrization of the wound, and was soon the\npicture of health.\"\n\nDr. T. F. Leech, of Attica, Fountain County, Ind., reports a case of a\nfourteen-month-old child, who had been the terror of all that part of\nthe town for over six months, as he cried constantly. Except when asleep\nor nursed by his mother, he would lie perfectly still and squall, not\nshowing any disposition to sit up; nor did he like to be raised up. He\nwas very nervous, and would have times when his limbs would be rigid.\nThis state of things grew worse, until the child was accidentally seen\nby Dr. Leech, who, on examination, found a contracted and adherent\nprepuce, the child being at the time in a high fever and suffering great\nnervous excitement. An operation by slitting and breaking up the\nadhesion afforded immediate relief; the spinal irritation, partial\nparalysis of the lower extremities, spasms during urination, and all\ntrouble disappeared as if by magic.\n\nProf. J. H. Pooley, of Columbus, Ohio, reported the case of a fine,\nhealthy boy who, up to three months before being seen professionally,\nhad always been well and in perfect health. His condition was found by\nProfessor Pooley to be one of localized chorea, manifesting itself in\nconstant convulsive movements of the head. They were nodding or\nantero-posterior movements, alternating with lateral or shaking and\ntwisting motions; these movements had become almost constant during the\nwaking hours of the child. There was no distortion of the features nor\nany choreic movements of the extremities; indeed, the whole affection\nconsisted in the nodding and shaking movements of the head referred to.\nThese were almost incessant, sometimes slow and almost rhythmical, then\nfor a minute or two rapid and irregular, seeming to fatigue the little\nfellow, and accompanied by a fretful, whimpering cry. The child had been\nsubjected to a variety of treatment, but without any benefit or effect\nof any kind. Upon the most careful examination of the patient and his\nhistory, Professor Pooley could not discover anything that seemed to\nthrow any light upon the case, except a condition of well-marked\nphimosis. Acting upon this, the Professor immediately circumcised the\nchild, and from the very day of the operation the spasmodic action began\nto diminish, and in two weeks he was entirely well, without any other\ntreatment of any kind.\n\nDr. W. R. McMahon, of Huntington, Indiana, has reported three cases of\nepilepsy in children caused by congenital phimosis that were entirely\nrelieved by an operation without any subsequent return of the\ndifficulty. One of the cases was in a boy ten years old, with very firm\npreputial adhesions and a high grade of inflammation of the parts.\n\nDr. J. D. Griffith, of Kansas City, Mo., operated on a case of phimosis\non a child nearly three years of age, who was afflicted with repeated\nattacks of convulsions and paralysis of the hips and lower extremities;\nthe little fellow had as many as fifteen convulsions in a day; the\npatient was greatly troubled with painful urination and priapism. On\nexamination at the operation, a firmly adherent prepuce and a large roll\nof caseous matter was found just back of the corona. A complete recovery\nfollowed the removal of these conditions.\n\nThe above cases are taken from the paper read before the Section of\nDiseases of Children at the International Medical Congress of 1887, by\nDr. Sayre. It contains a number of additional cases of an analogous\ncharacter to the above, reported to him by physicians in different parts\nof the country. They show the variety, extent, and far-reaching\ncharacter of the diseases induced by any preputial irritation. Dr. G. L.\nMagruder, of Washington, D. C., in the same paper, has a record of\ntwenty-five cases of various nervous disturbances which he had entirely\nrelieved by circumcision or dilatation, without any medication whatever.\nDr. Magruder, in concluding his report, in which he quotes the authority\nof Brown-Sequard, Charcot, and Leyden, as having noticed serious nervous\ndisturbances resulting from reflex irritation due to affections of the\ngenito-urinary organs, observes as follows:--\n\n\"From the foregoing, I think that we are justified in the conclusion\nthat phimosis and adherent prepuce give rise to varied troubles of more\nor less gravity, manifesting themselves either in the muscular, osseous,\nor nervous systems; and that the removal of these abnormal conditions of\nthe penis frequently affords marked relief, and, at times, perfect and\npermanent cure.\"\n\nIn the discussion that followed the reading of Dr. Sayre's paper, Dr. De\nForest Willard, of Philadelphia, remarked that he had operated by simply\nstripping back the prepuce and that he did not circumcise, but that he\nlooked upon the subsequent cleanliness of the parts as the greatest\nsafeguard, not only as against reflex irritation, but also against\nmasturbation. Retained filth and smegma are far more likely to call a\nboy's attention to his penis by their unrecognized irritative effects\nthan washing can possibly do. His practice is in accordance with the\nbelief that young children can be relieved by the simpler methods, such\nas dilatation; but he also observes that when a child has reached eight\nor ten years of age, and has never been able to expose the glans,\ncontraction is almost certain to be present, and circumcision must be\nperformed. In adults there is rarely any escape when the prepuce is\ntight.\n\nDr. I. N. Love, of St. Louis, said: \"It has been my judgment and my\npractice for many years, in these reflex irritations, to pursue the\nradical course of circumcision. I believe thoroughly in the Mosaic law,\nnot only from a moral but also from a sanitary stand-point. All genital\nirritation should be thoroughly removed. It is all very well to instruct\nthe mother or the nurse to keep the parts within the prepuce clean, but\nthey can not or will not do it. Complete and proper removal of the\ncovering to the glans takes away all the cause of disturbance. Dr. Sayre\ntakes a more pronounced position on this subject than the majority of\nthose who have discussed his paper. An improper performance of a\nsurgical procedure is no argument against the operation, but rather\nagainst the operator. For the reasons I have given, I am in favor of the\nradical application of the Mosaic rite of circumcision.\"\n\nDr. J. Lewis Smith, the president of the Section, believed in the evil\nresults of the reflex irritation due to abnormality of the prepuce. In\nmany instances the causative relation of the preputial disease to the\nsymptoms which it produces is not so apparent as it may be in others,\nbut after correct treatment of the prepuce they disappear. There was one\nresult of phimosis which, he observed, neither Professor Sayre nor those\nwho contributed to his paper noticed. The expulsive efforts accompanying\nurination sometimes cause prolapsus of the rectum, and frequently\nproduce inguinal hernia. In a lecture before the Harveian Society\n(_British Medical Journal_, February 28, 1880), Edmund Owen, Surgeon to\nSt. Mary's Hospital and to the Hospital for Sick Children, says:\n\"Perhaps the commonest cause of hernia in childhood is a small preputial\nor urethral orifice, and next to that I would put the smegma-hiding or\nadherent prepuce.\" Arthur Kemp (London _Lancet_, July 27, 1878), Senior\nHouse-Surgeon to the Children's Hospital, says: \"Phimosis is a common\noccurrence, and numerous ill effects can undoubtedly be attributed to\nit;\" and he alludes to the observation of Mr. Bryant, as published in\nhis book on the \"Surgical Diseases of Children\": \"In fifty consecutive\ncases of congenital phimosis, thirty-one had hernia, five had double\ninguinal hernia, and many had umbilical hernia besides. In no one was\nthe hernia congenital, its earliest occurrence being at three weeks.\nCircumcision was performed in these cases, and all were much\nbenefited.\"[103]\n\nDuring the session of the Ninth International Congress, where the above\npaper was read and remarks made, which appear in the third volume of its\n\"Transactions,\" another paper was also presented by Dr. Saint-Germain,\nof Paris. The Doctor fully recognized the dangers from a narrow or\nadherent prepuce, but did not think that more than one case in three\nhundred really required circumcision; he believed in dilatation, as\nemployed by Nelaton, with the exception that, whereas Nelaton employs\nthree branches to his dilator, Saint-Germain preferred only a two-branch\ndilator.\n\nDr. Lewis, the president of the Section, related a number of cases where\nthe use of uncleanly instruments had resulted disastrously. But, for\nthat matter, the same objection can be offered against dilatation, as a\nfilthy instrument is as liable to infect the patient as a knife. There\nis no earthly excuse why a knife that has been used on a case of\ndiphtheritic croup should be used some hours afterward to circumcise a\nchild. As to the operation of dilatation practiced by Dr. Holgate, it\ncan really be said to answer the _immediate_ demands, but how far its\nutility is efficient as to _permanent_ results Dr. Holgate has not\ngiven the profession any information.[104]\n\nOne of the most interesting and instructive papers that it was ever the\nfortune of the writer to listen to, touching on the subject of reflex\nnervous diseases or neuroses due to preputial adhesions, was one\nprepared by Dr. M. F. Price, of Colton, California, and read at the\nsemi-annual meeting of the Southern California Medical Society, at its\nPasadena meeting in December, 1889. In the course of the paper he gives\na considerable number of examples, of which some extracts are herewith\ngiven: One case was a boy aged seven, who for two years had had frequent\nattacks of palpitation of the heart; when seen by Dr. Price the little\nheart was laboring hard, beating at a furious rate (far beyond\ncounting), with a loud blowing or splashing sound, and the pulse at the\nwrist a mere flutter. The breath was inspired in a series of jerks, the\nface flushed and somewhat swollen. The chest-wall was visibly moved at\nevery thump of the heart. The doctor attended the child for a month\nwithout the little patient making any appreciable improvement. Some time\nduring this period of observation the father happened to mention that\nthe boy sometimes complained of his penis hurting him at the time of an\nerection. This led the doctor to examine the parts, when he found a long\nprepuce, with a mucous membrane adherent to the glans, about a line\nbeyond the corona, the whole circumference of the organ. With the use of\ncocaine and a blunt instrument the adhesions were removed, with an\nimmediate amelioration of all the reflex symptoms. The very next\nparoxysm was lighter and less exhausting; the improvement was\ncontinuous. The child soon went to school and had no further trouble;\nbut, in the doctor's opinion, the two years' hard struggle have not\nbeen without its evil results on the constitution and organism of the\nchild.\n\nThe next case was born November 2, 1888; a large, healthy boy at birth.\nBy June of the following year the child was afflicted with what the\nmother called \"jerky spells;\" up to this time the boy seemed listless,\ndid not care to sit up, and seemed from some cause to be in more or less\npain, with his eyes turned to the left. The parents dreaded that the\nchild, their only one, would turn out idiotic. The spasmodic spells\nalluded to were of a tetanic nature, the body being thrown backward; his\nhead and eyes continued to be turned to the left, and nothing could\nattract the child's attention. The boy cried night and day, but he was\nin good flesh, had all the teeth he should have, bowels were regular,\nand the appetite good. Whatever the doctor did in the medical way seemed\nto be of no avail. One day, however, he thought of examining the\nprepuce, thinking, perhaps, that it might be contracted and that the\nconvulsive movements might be reflexes from the parts. On examination\nthe prepuce was found elongated and distended, with a very minute\nopening; this was dilated with difficulty, when the inner fold was found\nadhering almost the whole extent of the glans; the dilatation and\nbreaking down of these adhesions was slowly persevered in, until\nsufficient dilatation was obtained and the glans was freed. From the\nvery first operation the convulsions commenced to diminish, both in\nforce and frequency, and a constant and rapid improvement of the child\ntook place. Six months afterward the boy was perfectly normal, stood by\nhimself, played with play-things, and was an interested member of the\nfamily circle.\n\nCase No. 3 was a repetition of Case No. 2, except that, with the\nexperience of the latter case, the doctor wasted no time with\nmedication, but proceeded at once to examine the prepuce, which was\nfound to be very long, and with a pin-hole opening. The dilatation of\nthis and the breaking up of the adhesions gave immediate relief. During\nthe course of the paper he quoted the case related by Brown-Sequard, and\nrecorded in the New York _Medical Record_, vol. xxxiv, p. 314, where he\n\"related a very interesting case that presented all the rational signs\nof advanced cerebral disease, a case that he considered quite hopeless,\nthat was relieved by an operation for phimosis and the treatment of an\ninflammatory condition of the glans penis.\" To use Brown-Sequard's own\nwords, \"So rapid was the recovery that within six weeks from the day of\nthe operation he presented himself at my office perfectly well in every\nrespect.\"\n\nIn the early part of this book, in speaking of female circumcision, it\nwas mentioned that when the medical part of the volume should be reached\nsome medical reasons for its necessity would be given. Dr. Price, in his\npaper, gives some information on this subject, which is of the greatest\ninterest. In the course of the paper he says as follows: \"Nor do I think\nthese reflex neuroses from adherent prepuce wholly confined to the male\nsex. The preputium-clitoridis may be adherent and produce in the female\nsimilar reflexes. During the session of the American Medical\nAssociation, held in Chicago in 1874, I think, I attended one afternoon\na clinical lecture by Dr. Sayre. A little girl, fourteen years of age,\nbut about the size of a seven-year-old child, was brought in, who had\nnever walked nor spoken, but with quite an intelligent countenance, who\nwas in constant motion, and who presented very many nervous symptoms.\nDr. Sayre examined her, and found the prepuce adherent the whole extent\nof the clitoris. He gave it as his opinion that here was the primary and\nsole cause of the symptoms, and that appropriate treatment shortly after\nbirth would have prevented all the serious consequences so painfully\napparent, and which was then too late to remedy.\n\n\"I once had occasion to pass a catheter into the bladder of a lady who\npresented an innumerable train of nervous symptoms, often bordering on\ninsanity, but was unable to do so without exposing the parts. Although\nthe meatus could be distinctly felt, the catheter would not enter. On\nexposure to view, an opening was seen in the clitoris, which was firmly\nbound down by preputial adhesions near the extremity of the organ.\nEntering the catheter at this point, it readily passed through the\nclitoris, then down through a passage under the mucous membrane to the\nnatural site of the meatus, on into the urethra, and through into the\nbladder. In the light of recent experience, my opinion now is, that here\nwas the cause of all the nervous symptoms in this case.\"\n\nThe relative disposition in regard to the irritability of the external\nsexual organs as existing in the female, when contrasted with the male,\nis, for some reason, not sufficiently considered or understood. The idea\nof masturbation or of irritation from the genitals ending in reflex\nneuroses is always, as a rule, associated with the male, and that it has\nnot been more associated with the female has deprived her of the same\nbenefit that the prosecution of the study in this regard has been to the\nmale sex. Masturbation among the feeble-minded, which is so common,\nmust, of necessity, have for its determining cause a foundation of\nmorbid irritability of the sexual organs. This is well known to be so\namong the males, whose hands seem instinctively to be drawn to those\nparts. Dr. C. F. Taylor, of New York, in an article on the \"Effect of\nImperfect Hygiene of the Sexual Function,\" published in the _American\nJournal of Obstetrics_ for January, 1882, gives us an account of his\ninvestigations in this regard, with the following results: \"In an asylum\nfor the feeble-minded of both sexes, it was found that the habit was\nabout equal in the two sexes, there being only this difference: that the\nfemales began to masturbate one or two years earlier than the males, and\nthat the habit, once established, was found to be more persistent than\nin the males. It was, further, ascertained that the habit came\nnaturally, without the aid of precept or example to either sex.\"\n\nIt may well be a question as to whether the feeble-mindedness be not a\nreflex condition from this excessive morbid irritability of the sexual\norgans. There is not much doubt but that, if one of the cases reported\nby Dr. Price had not been circumcised, the expressionless, listless\ninfant would have grown, in time, into a masturbating, feeble-minded,\nidiotic creature, as many others, so situated, have done before it. Now,\nwould it have been logical to have laid the morbid irritability of its\ngenerative organs to its feeble-mindedness, when its feeble-mindedness\nwas fully demonstrated to have been wholly dependent on the sexual\nirritation? From these premises we might take another step forward, and\nask whether, under a proper hygienic prophylaxis,--which would involve a\nthorough inspection of the genitals of _all_ children reported to be\neither physically or mentally deficient,--such a course would not\ngreatly diminish the number of paralytics, feeble-minded, and generally\ndeficient of both sexes? If the results in private practice are any\ncriterion, it is safe to assert that a strict adherence to the Mosaic\nlaw for the males and to some of the African customs for the females\nwould most assuredly relieve all these cases that might come under the\ncaption of results of reflex neuroses. Twenty years ago this subject\nwas, to the body of the profession, a _terra incognita_ in regard to the\nmale, and, as the female is similarly subject to the same morbid\ninfluence, it is to be hoped that in the present decade she will receive\nthe same attention which the profession is now beginning to pay to the\nmale sex.[105]\n\nIn the foregoing parts of this chapter, examples of reflex neuroses have\nbeen given to show the different effects that genital irritation will\nproduce. The cases given were chosen for the diversity of variety of\nsymptoms, and as cases representing the affection, without any other\ncomplication. Many more could have been added, but they are unnecessary.\nIn the writer's practice there has been a number of cases in the adult\nthat have exemplified that this form of ailment is by no means\nrestricted to children, as has been shown in the case reported by Dr.\nMott to Dr. Sayre, in regard to the middle-aged man with a string about\nhis penis. One of these cases was that of a young man, six feet in\nstature, broad-shouldered, and well built. He applied for relief for a\ndyspepsia that affected his stomach and also his heart. The man had an\napparently feeble and irritable heart; cold, clammy skin; disturbed\ndigestion, and uneasy sleep; was constipated and flatulent. No treatment\nseemed to make any impression upon his case. At last he began to\nemaciate and look haggard. His mind was also becoming visibly weaker,\nwas attacked by dizziness, and on several occasions he fell in a fit.\nWith this condition he at last began to have frequent nocturnal\nemissions. On account of the latter his genital organs were examined,\nand the penis was found smaller than the average, with a long and narrow\nprepuce. The glans could easily be uncovered, but the tightness of the\nprepuce and its unyielding qualities made paraphimosis a possibility; so\nthat the young man, having once or twice had considerable difficulty in\nreturning the prepuce to its place, never attempted its retraction\nagain. There were no adhesions, but the inner fold of the prepuce had\nbeen thickened by balanitis. Seeing the need of circumcision _for the\nlocal benefit_, the operation was suggested with a view of relieving the\npressure on the glans, which was looked upon as the probable cause, in\nhis broken-down condition, of the advent of the nocturnal emissions. He\ngladly submitted, and, to the surprise of both physician and patient,\n_all_ his troubles disappeared, and he at once became a changed man. So\nimpressed was he with the result, that, on his return to his home, he\nexamined his younger brother, and, finding him with a like long, narrow\nprepuce, he immediately brought him in and had him circumcised, as a\nprophylactic against his being subjected to the risk of lost health as\nhe himself had suffered.\n\nAnother case, a man of forty-five, also a farmer, was afflicted with\ndyspepsia, palpitation of the heart, general debility, constipation,\nconstant headache, etc. He could not cut up an armful of wood without\nbringing on palpitations and gaseous eructations, or being upset for the\nday; and after having connection with his wife he generally had a\nterrific headache, lasting for two or three days;[106] he could stand no\nprotracted mental effort, even such as is required to make an addition\nof a long line of figures, or the least business worry, without the\nsupervening headache. All treatment against these conditions was\nuseless; the colon was kept empty, the diet was changed; pepsin and\nbismuth, tonics, frictions, Turkish baths, and all hygienic observances\nand moral treatment were all of no avail. One day, on consulting the\nwriter, he complained of a pruritus at the head of the penis. On\nexamination it was found that he had a narrow, long prepuce, a\ncongenitally-contracted meatus, and was then suffering with a slight\nbalanitis. He was very careful to keep the parts clean, but, he informed\nme, that in spite of all precautions, these attacks would come on. The\nmucous covering of the inner fold of the prepuce and glans was so\nirritable that connection often brought it about. The glans was small\nand elongated, with the meatus red, and with lips oedematous and\ncongested. To free him from this tormenter, circumcision was advised.\nThe party could not, however, remain away from home for the time\nrequired for the operation; so that a compromise operation was\nperformed,--one that would not keep him from business, and, at the same\ntime, relieve the contracting pressure on the glans. This was by\nClouquet's operation and bandaging back the prepuce over the penis, back\nof the corona,--an operation that, in my hands, has often filled all the\ndesired purpose. The meatus was also incised. After the operation _all_\nof his troubles disappeared, as they had done in the preceding case, and\nhe was soon a hearty and well man, able to chop wood, attend to\nbusiness, and, in case of need, do family duty for a Turkish harem\nwithout recurrence of his old tormenting, dyspeptic palpitation or\nsick-headache.\n\nThe writer has resorted to circumcision in many cases to improve the\ntemper and disposition of children, with the best of results, and in one\ncase, in association with another physician, performed the operation on\na lunatic, whose lunacy ran to women and girls, with whom he would fall\ndesperately in love, without any encouragement or provocation, or even\nacquaintance; finally reaching spells of such incoherence of action and\nspeech that confinement would be required. The peculiarity of his\nhallucinations called attention to the genital organs. This man had\nnever masturbated, and was, when well, a compactly-built, active, and\nintelligent man. By occupation he was a contractor, and a man of more\nthan usual executive ability besides. On examination it was found that\nhe was a subject of congenital phimosis, never having been able to\nuncover the glans. He had been in the habit of washing out the preputial\ncavity by the aid of a flat-nozzled syringe. The prepuce was long, but\nnot thick; nevertheless, it was inelastic and very firm. The examination\nseemed to have a good mental effect upon the man, as it made him quite\nrational for the moment. He entered into the idea that this condition\nhad some connection with his derangement very intelligently, even\nsuggesting many symptoms and attacks that he had suffered from childhood\nup as probably gradual-stepping processes through which his present\ncondition had been reached. He cheerfully submitted to a thorough\ncircumcision, which had the effect of ameliorating his condition. He was\nsubsequently sent to an asylum, where, after a short time, he was\ndischarged well. Some years afterward, conscious of feeling a return of\nthe mental derangement, he voluntarily applied for admission to the same\ninstitution and remained until better.\n\nThis case is very instructive. The patient readily connected his\nmental trouble, by a retrospective view through a series of\ngradually-increasing troubles, that originated in the preputial\ncondition, to the phimosed condition of that appendage, and he was\ncertain that this prepuce had been at the bottom of all the physical and\nmental trouble he had experienced. The reflex nervous train of\naffections had undoubtedly produced some localized lesion in the\nbrain-structure. The natural sound, healthy organism of that organ, and\nthe bright, active nature of his mind, however, prevented a total\nwreckage of the mental faculties. It is safe to assume that, had he had\nthe ordinary listless, unresisting mind, disposed to brood, and easily\ncast down, he would, from the first derangement, have become a hopeless\nand demented lunatic. The circumcision could not undo all the mischief\nthat had been accomplished, some of which had certainly left a permanent\ntaint, but the mildness of his future attacks and the better exercise of\nhis volition were the undoubted results of the operation.\n\n\n\n\nCHAPTER XXIV.\n\nDYSURIA, ENURESIS, AND RETENTION OF URINE.\n\n\nAny dissertation on circumcision and its many uses, either prophylactic\nor curative, would be incomplete without a reference to enuresis;\nanother reason for making a somewhat full reference to the subject would\nbe the undecided position that this morbid condition seems to occupy in\nmedical literature, as well as the meagre and unsatisfactory treatment\nit has received by the majority of those who have mentioned it. It is\nanomalous, to say the least, to find, in general or special literature,\nenuresis mentioned as a diseased condition peculiar from babyhood to\npuberty; to find it fully described and to have it stated that it is a\nwidely-prevalent distemper, affecting both sexes alike; to know that it\nis an annoying, intractable, persistent condition, wearing to the child\nin every sense, subjecting it to a demoralizing mortification as well as\nto unmerited scoldings, humiliations, and punishments, and that its\nhabit, in badly-ventilated quarters, will breed other diseases,[107] as\nwell as that its continued action tends to the development of onanism,\nwith its long and widely-ramifying trains of physical and social ills;\nand to find works especially devoted to children's diseases silent on\nthe subject. Knowing all these things, and also that Ultzmann,\nLallemand, and others who have treated this affection, mention it as a\nchildren's disease, it is unaccountable to reason out why most of our\ntext-books and treatises on children's diseases should be so remarkably\nand unreasonably silent. It certainly cannot be laid to its lacking in\nstudy material, as the author of \"Quain's Dictionary of Medicine\" says:\n\"It is one relative to which much might be written without exhausting\nthe subject, the pathology of which has wide and manifold relations....\nThere appears to be something analogous between this condition and that\nwhich determines in after life the seminal emissions under similar\ncircumstances.\" Our American works are notably deficient in this regard;\nalthough Stewart, of New York, in his \"Diseases of Children,\" published\nover fifty years ago, devotes a chapter to dysuria and one to retention\nof urine, treating the subject quite fully, even down to the description\nof preputial calculi; he, however, failed to notice that the irritation\nof preputial constriction or adhesions will produce both conditions,\nand, following many of the authors of the time, as has been done since,\nhe adopted the urino-digestion theory of acid and irritating urine, due\nto faulty digestion, of Prout and Magendie, who looked to regulating the\ndigestion of the child, or the mother who nursed it, as the only method\nof cure; the lithic-acid diathesis being, in their opinion, the main\nthing to be guarded from.\n\nOther works that mention these conditions are equally on the wide sea of\nspeculation, as they all, more or less, look upon the treatment that\nthey advise as indefinite and unsatisfactory, showing an equal want of\nsound anchorage-grounds for their etiological reasonings. Dillnberger,\nof Vienna, in his hand-book of children's diseases, mentions enuresis,\nbut has nothing better to offer for its relief than that advised by\nBednar, who followed a systematically-timed period of awakening,\ngradually lengthened out, from the time of putting the child to bed. In\naddition, he advises internal medication, and, like Ultzmann, he\nrecognizes the possibility of a local cause in little girls, in whom he\nadvises the local application of nitrate of silver. Edward Ellis\nmentions dysuria, and a long prepuce is noticed among its numerous\ncauses. The works that give the subject the most intelligent treatment\n(the word \"intelligent\" is here used advisedly, and is in reference to\nthe results obtained) are those of West, of London, and Henoch, of\nBerlin. West, in his \"Diseases of Children,\" says: \"In the child,\nhowever, we sometimes find the symptoms produced by difficulty in making\nwater owing to the length of the prepuce and the extreme narrowness of\nits orifice, which may even be scarcely large enough to admit the head\nof a pin. This congenital phimosis is, I may add, not an infrequent\noccasion of incontinence of urine in children, and is also an exciting\ncause of the habit of masturbation, owing to the discomfort and\nirritation which it constantly keeps up. In every case, therefore, where\nany difficulty attends the passing or the retention of the urine, or\nwhere the practice of masturbation is suspected, the penis ought to be\nexamined, and circumcision performed if the preputial opening is too\nsmall. This little operation, too, ought never to be delayed, since, if\nput off, adhesions are very likely to form between the glans and the\nforeskin, which render the necessary surgical proceeding less easy and\nmore severe.\"\n\nIn the \"Lectures on Diseases of Children,\" Henoch, of Berlin, says: \"I\nneed scarcely add that an examination of the external genitals should\nnever be omitted in any case of dysuria during childhood. You will not\ninfrequently discover a phimosis which interferes more or less with the\ndischarge of urine and retains portions of the latter behind the\nforeskin, where it may decompose and give rise to an inflammatory\ncondition of the prepuce, with painful dysuria.... This is also true of\nthe occasional adhesion of the labia minora in little girls, like the\nsimilar adhesion of the foreskin in boys. It is almost constant in the\nfirst period of life, but sometimes persists to the end of the first\nyear; can usually be torn by the handle of the scalpel, and rarely\nrequires an incision. In a few cases this adhesion appeared to me to be\nthe cause of the dysuria, which disappeared after the separation of the\nlabia from one another.\"\n\nHenoch, however, does not seem to have grasped the full relation that\nthe natural phimosis of young children bears to dysuria, as he here\nfollows the prevailing opinion, that where by dint, push, hauling, and\nhard work the prepuce can be pushed back phimosis does not exist, as\nwell as the general apathy to the fact that a prepuce can exert a very\ninjurious influence by its pressure, even when not adherent and very\nretractable; such a prepuce is often attended by balanitis and\nposthitis, with an accompanying difficult, frequent, and painful\nurination. In a case which will be related farther on, in the discussion\nof the systemic effects of a long, contracted prepuce, as it induces\ndiseased action by continuity of tissues, there is an account of a death\nof a two-year-old child which we can assume to have had its original\nstarting-point in a condition of phimosis. Henoch, however, rather\nattributes the death in that case to what may well be considered the\nresult of a cause, leaving the original cause more to appear as a final\naccessory condition.\n\nMy reasons for this view of the subject are simply owing to the fact\nthat I do not believe that a child can long be afflicted with the\n_ischuria phimosica_ of Sauvages without having the urinary organs\nbeyond more or less seriously affected from the mere retention alone,\nirrespective of any reflex irritation from the pressure on the glans or\nof any from the irritation of the peripheral nerves; the dilatation of\nthe adjacent cavities or channels and the deposit of calcareous matter\nbeing facilitated by the retention of urine and its naturally altered\ncondition owing to that retention. So that dysuria in young children,\nbeginning in a slightly phimosed condition, or in the irritability of\nthe glans and meatus, due to its preputial covering, it is safe to\nassume, may produce a train of symptoms ending in permanently-injured\nhealth, or even death. The irritating urine of a slight access of fever\nmay, by its passage over the irritable mucous lining of the prepuce, be\nthe initial starting-point of a serious or fatally-ending disease. In\nall of these, it must be admitted, the presence of the prepuce is either\nactively or passively the cause of the most serious disease processes\nthat may follow.\n\nUltzmann, of Vienna, in his work on the \"Neuroses of the Genito-Urinary\nOrgans,\" gives the subject of enuresis considerable attention. It is not\na work on diseases of children, but it, nevertheless, goes into the\nsubject as if it were, and furnishes the profession with considerable\ninformation. He defines enuresis to be the passage of urine of a normal\nquality in a child who, with the exception of this involuntary\nurination, is healthy. In the first periods of life, a slight vesical or\nintestinal expulsive effort is sufficient to overcome the guarding\nsphincter muscles at their outlet; the child first obtains a voluntary\ncontrol of the rectal sphincter; and, generally, with the second year it\ngains control of the vesical. Those who pass their second year without\nobtaining this control, but in whom the organs and urine are normal, may\nbe said to be afflicted with enuresis. He divides enuresis into three\nvarieties; that involuntary urination which takes place at night during\nsleep he terms the _nocturnal_; that which takes place while climbing,\nlaughing, coughing, or in the course of any violent muscular exercise is\nthe _diurnal_; and that wherein the involuntary evacuation takes place\nday and night alike he terms as the _continued_. This last is again\nsubdivided into the continuous and periodical. As a cause, he cites\nanaemia, scrofula, rachitis; but adds that physical debility is not\nnecessary for its presence, as well-developed, vigorous, puffy children\nare as liable to be affected as thin and scrawny ones; while not all\nscrofulous or rachitic children are so affected, only a small portion\nbeing enuretic. Sex has no influence on the liability that tends to\nbeing attacked, the proportion between the sexes being about equal. As\nto age, he finds the greatest proportion to be between three and ten\nyears, but he has often treated those of either sex even at the age of\nfourteen and up to seventeen years. It is absolutely necessary to\nexamine the external genitals and the urine of those affected by this\ndisease, as phlegmasiae of the vagina, of the vestibule or urethra in\ngirls, or the practice of onanism, or lithiasis, cystitis, or pyelitis\nmay be the cause of the disease. Girls are apt to be found affected with\npolypoid excrescences at the meatus, which when removed will cause the\nenuresis to disappear.\n\nFrom the above it will be observed that Ultzmann has paid much attention\nto these neuroses; but it will also be remarked that neither the\nbalanitis, collection of infantile smegma, preputial adhesions nor\nirritations are taken into any account as possible factors of either\ndysuria or enuresis; he has followed more or less an electrical form of\ntreatment for genito-urinary neuroses, the rectal rheophore being one of\nhis favorite modes of treating enuresis; in his etiological views of\nthese disturbances he has adhered more or less to the views of\nTrousseau, Bretonneau, and Dessault, who looked upon a debilitated or\nanomalous condition of the vesical neck as the cause of the majority of\nneuroses in that region.\n\nIt may be asked why these celebrated and observing physicians have\nneglected the preputial condition, if, as it is claimed, it is, in\nitself, so important and sure a factor of the derangements at the\nvesical neck? To answer this, or to explain any marked discrepancy that\nmay occur in medicine between minds equally as acute and observing, it\nis but necessary to observe that there is, in medicine, to a certain\nextent, a like rule of inheritance, education, with fashion or custom of\nhabit of thought and practice, as we find in religion. Canon Kingsley\nand Froude are equally as acute and discerning as the late Cardinal\nNewman, but that did not necessitate their following that prelate into\nthe foremost ranks of the Catholic Church; and Pere Hyacynthe was\nequally as intelligent as Cardinal Newman, but that did not prevent him\nfrom leaving the fold into which the Cardinal had entered from out of\nthe Reformed Church. Some are born Catholics or Protestants, and are so\nwith vehemence; others are born in these religions, but are only\nlukewarm in their doctrinal observance; while others reason and jump the\ntraces in either direction. The followers of the destructive theories of\nBronssais could not see the errors of their ways, and neither could they\nbe made to see the merits of a less interfering form of medical\npractice. Trousseau was himself at one time tainted with Bronssaisism,\nbut, like Paul of Tarsus, he was made to see the error of his way, as he\nrelates, through a case of gout that he nearly laid out in trying to lay\nout the disease antiphlogistically.\n\nI do not assume that preputial irritation is at the bottom of _all_\ncases of dysuria or enuresis, any more than it would be rational to deny\nthat cases of circumcision performed in some cases of diabetic enuresis\nhave proved fatal as a result of the operative interference; but it is\nsafe to assume that, in the great number of cases in whom some\nirritating conditions were found and removed, the enuresis or dysuria\nwas due to such preputial irritation. It is also logical to assume, with\nWest and Henoch, that the organ should in all cases be examined, and its\ncondition rendered as harmless as possible. That the condition of\npreputial irritation has not been fully recognized by all parties as a\ncause of enuresis does not do away with the fact that it does exist, any\nmore than the refusal of the prelates and doctors of Salamanca to listen\nto Columbus did away with the fact of the existence of the American\ncontinents.\n\nA. L. Ranney, in his \"Lectures on Nervous Diseases,\" pages 174, 175,\nspeaks of enuresis in children as being a reflex cachexia, \"excessive\nstimulation of the centripetal nerves connected with the so-called\n'vesical centres' of the spinal cord,\"--a condition which may be\nproduced by either worms in the intestines or by preputial irritation.\nRanney advises a careful exploration of the urethra and rectum in these\ncases, and the elimination of all local causes of the conditions.\n\nProbably the most remarkable case of the immediate continuous effects\nresulting from phimosis is the one recorded by Vidal, in the fifth\nvolume of the third edition of his \"Surgery.\" This was a young man with\na congenital phimosis, having but a very small aperture; on an operation\nto relieve the phimosis there was a gush of water, but this only fell at\nthe feet of the patient, without being ejected at any distance; the\nurethra was found to have undergone precisely the same dilatation back\nof this preputial orifice that it usually undergoes back of a stricture;\nthe whole urethra from the meatus backward was found to have exceeded\nthe calibre of that of the vesical neck; the bladder was greatly\ndilated.\n\n\n\n\nCHAPTER XXV.\n\nGENERAL SYSTEMIC DISEASES INDUCED BY THE PREPUCE.\n\n\nAside from all the local affections or reflex neuroses, either mental or\nphysical, that a prepuce may induce, there are an innumerable train of\ndiseases that may originate in this one cause that at first sight would\nseem to have no connecting-link with any preputial condition.\n\nIt has already been suggested that the prepuce does not at all ages bear\nthe same analogous relation to man. In childhood, especially during our\nearliest years, it is out of all proportion in size when compared to the\nrest of the organ, or to any use it may have placed to its credit. Man\ndoes not, then, certainly need that refinement of nervous sensitiveness\nin the corona that is useful in after life in inducing the flow or\nejaculation of the seminal fluid; neither is there at that age much of a\ncorona to protect. In middle life, or what might be called the\nprocreative period of man, when the corona would seem to require all its\nexcitability or sensitiveness, seems to be the very season in life when\nthe glans is most apt to remain uncovered; so that nature and this\nhypothetical idea of the use of the prepuce are evidently at variance.\nSo we go through childhood with this long funnel-shaped appendage into\nmanhood, when the increasing size of the body of the penis restores a\nsort of equilibrium between the size and bulk of the organ and its\nintegumentary covering. At this period, as we have seen, although it\ndoes not, from the equilibrium restored, and the more or less use to\nwhich it is subjected, induce any great immediate or uncomplicated\ntroubles, it nevertheless endangers the existence of the penis through\nthe accidental course of some putrid or continued fever, or it subjects\nman to the manifold dangers of venereal or tubercular infections.\n\nIn advanced age, owing to the diminution in size of the organ, the\nprepuce resumes the proportionate bulky dimensions of childhood, and as\nthe organ recedes and becomes more and more diminutive, the prepuce\nagain, like in childhood, begins to tend to phimosis; the urine of the\naged is also more irritating and prone to decomposition or putrefaction,\nand the constant state of moisture that the preputial canal of the aged\nis necessarily kept in, either by frequent urination or the incomplete\nemptying of the urethra that is peculiar to old age, and which results\nin more or less dribbling, is a powerful factor in inducing the many\nattacks of posthitis and balanitis, as well as those attacks of\nexcoriation and eczema which are so annoying to the aged. I have often\nseen such cases happening to men past fifty, who, being widowers, and\nnever having had anything of the kind, as well as being in the most\ncomplete ignorance of the nature of the disease, have, from delicacy and\nfear that the disease might induce some suspicions as to their conduct\nin the minds of those whose good opinions they value above all else,\ngone on suffering untold miseries, especially if the urine were in the\nleast diabetic.\n\nOne such case that fell under my observation not only produced such\nmisery as to entail a loss of rest and of appetite, but even induced\nsuch a disturbance of assimilation and nutrition that the resulting\nhypochondriacal condition that developed from these enervating causes\nran the patient into a low condition, ending in complete prostration of\nall vital powers and death, without the intervention of any other\ndisease. The subject was a timid, retiring man of about fifty-five\nyears, and this was the first and only time that the prepuce had ever\ncaused him any annoyance,--a circumstance which greatly preyed upon his\nmind, as he could not disconnect it with the idea that it must be\nsuspected as venereal, although he had always led a most continent life\nsince the death of his wife. This is, of course, an extreme case; but as\nit is a result beginning in a certain condition, be it an extreme,\nerratic, or infrequent occurrence, it is, nevertheless, an example of\nwhat may happen in advanced life, even where the prepuce has never\nbefore been a source of the least disturbance or annoyance. Persons who,\nwith the increase of years, are also liable to an increase of adipose\ntissue, are more subject to this dwindling down of the penis and\nconsequent elongation of the prepuce, with all the attendant annoyances,\nthan thin or spare people.\n\nIn this irritation that the prepuce is liable to cause, we have not only\nto encounter the dangers that its thickenings or indurations may bring\non in their train, in the shape of cancer, gangrene, or hypertrophies,\nbut other and no less serious results are liable to follow a herpetic\nattack, or in consequence of an attack of balanitis or posthitis. The\ndysuria attending any of these conditions may be the initial move for\nsuch a serious complication that life may be brought to a sudden end,\neven in infancy, to say nothing of the ease with which life is taken off\nin after years and in old age; with debilitated and imperfect kidney\naction, it takes very little to hustle us off from life's foot-bridge.\n\nA case as occurring in Henoch's clinic, already mentioned or referred to\nin a previous chapter, shows what a simple phimosis is capable of\ninducing. In the history of the case the phimosis and the resulting\nretention in the preputial cavity no doubt were the causes of the\ncalculus found there; and the succeeding calculi and abnormal condition\nof the urinary organs, we can safely assume, were a subsequent creation\nto that in the prepuce. The case is taken from Henoch's \"Lectures on\nDiseases of Children,\" Wood Library edition, page 256, and is as\nfollows:--\n\n\"A. L., aged two, admitted November 28, 1877. Quite well nourished, but\npale. Complete retention of urine for two days; slight redness and\nmarked oedema of penis, scrotum, and perineum. The foreskin cannot be\nretracted, on account of phimosis. Abdomen distended, hard, and\nsensitive, the dilated bladder extending a few fingers' breadth above\nthe symphysis. In order to introduce the catheter, it was first\nnecessary to operate upon the phimosis, during which a calculus, which\ncompletely occluded the meatus, was removed. The catheter, when\nintroduced into the bladder, removed a quantity of cloudy urine. The\noedema, rapidly disappeared under applications of lead-wash, but on\nNovember 29th vomiting and diarrhoea occurred during the night, with\nrapid collapse; December 1st, death. Autopsy: In the bladder, a\nsulphur-yellow stone, as large as a hen's egg, completely filling the\norgan; similar calculi, from the size of a pea to that of a bean, in the\npelvis of the left kidney; right kidney normal.\"\n\nIn the above case, the oedema of the penis, scrotum, and perineum was as\nmuch a result of the distension of the bladder by the retained urine\ninterfering with the return circulation from the oedematous parts as the\ndifferent appearances of diseased conditions were a result of the\nprimary phimosis; yet this case, if seen during its early infancy, when\nprobably the contraction of the preputial orifice was as yet not so\nwell marked, would have been pronounced one in which it would be\nneedless and barbarous to perform circumcision upon. We would most\nassuredly have to wander aimlessly and unprofitably in the region of\nspeculation to build up the etiology of the above-related case and reach\nthe culmination there found, unless we accept the one that it was all,\nfrom first to last, the result of the phimosis.\n\nJonah, pitched overboard at sea to appease the tempest and swallowed by\nthe whale, became convinced finally that he had better return to Nineveh\nto preach reform; while Pharaoh would not let the children of Israel\ndepart even after Moses had so frightened him--as it is related in the\nrabbinical traditions compiled by the Rev. T. Baring-Gould, M.A.--that\nthe royal bowels were completely relaxed at the sight of the snakes\nturned loose about the royal throne,--a circumstance which nearly lost\nhim his claim to divinity, which was based on the fact that his bowels\nmoved only once a week, as in this case they not only moved out of time\nand in the most unkingly manner, so that the noble king hid underneath\nthe throne, but before even Pharaoh could disengage himself from the\nroyal robes, which event could hardly have raised him in the estimation\nof the gentlemen eunuchs of the bed-chamber. Those who unwound the mummy\nof Pharaoh tell us that he had the appearance of a self-willed,\ndespotic, but intelligent, old gentleman; but the above rabbinical\nrelation, from Baring-Gould's \"Legends of the Patriarchs and Prophets,\"\nseems to have had no convincing effect on Pharaoh; so we must not be\nsurprised if even a case like the one from Henoch's clinic would, with\nmany, carry no conviction.\n\nIn the second volume of Otis on \"Genito-Urinary Diseases,\" of the\nBirmingham edition, at page 380, there is an interesting account of a\nphysician who, in youth, was troubled with an annoying prepuce, which,\nfrom frequent attacks of balanitis, had finally become more or less\nadherent to the glans penis; up to the age of nineteen he had been\nunable to completely uncover the glans. By six months of hard and\npersistent labor he had finally broken up these adhesions. At the age of\ntwenty-two he married, and he then ruptured the frenum, which bled\nprofusely and left him sore for some days. Then for twenty-seven years\nhe had no further trouble, but at the end of that time he began to\nexperience what he believed were attacks of dumb ague, and the scrotum\nbegan to swell and felt sore on firm pressure. Heavy, aching pains then\nfollowed. This condition of things lasted for over five years, varied by\nthe appearance of carbuncles on the nose and elsewhere, to relieve the\nmonotony of the thing. From this time on, abscesses began to form in the\nscrotum and into the integument of the penis, burrowing forward into the\nprepuce, which was much swollen and painful. A gangrenous opening\neffected itself in the dorsal surface, which relieved him somewhat. The\npatient was finally examined by Dr. Otis, who found a badly strictured\nurethra, the strictures beginning at the meatus, and at intervals\nextended down as far as two and three-fourths inches. The case had no\nvenereal history, the patient never having had any disease or anything\nof the kind. The strictures were plainly the result of the\nbalano-posthitic attacks as much as they were the cause of the\ndegeneration of the mucous membrane in the lower urethra, that allowed\nof the infiltration of urine into the tissues, which caused all the\nsystemic disturbances, abscesses, misery, and agony of the patient,\ndepriving him of comfort, sleep, or ability for labor, and which sent\nhim here and there in search of health and relief.\n\nIt would seem really as if a prepuce was a dangerous appendage at any\ntime, and life-insurance companies should class the wearer of a prepuce\nunder the head of hazardous risks, for a circumcised laborer in a\npowder-mill or a circumcised brakeman or locomotive engineer runs\nactually less risk than an uncircumcised tailor or watchmaker. They\nrecognize the danger that lurks in a stricture, but what a prepuce can\nand does do, they entirely ignore. I have not had any opportunities for\ncomparison, but it would be interesting to know, from the statistics of\nsome of these companies, how much more the Hebrew is, as a\npremium-payer, of value to the company than his uncircumcised brother.\nWere they to offer some inducement, in the shape of lower rates, to the\ncircumcised, as they should do, they would not only benefit the\ncompanies by insuring a longer number of years, on which the insured\nwould pay premiums, but they would be instrumental in decreasing the\ndeath-rate and extending longevity.\n\nI have seen so many cases of stricture whose origin could be traced to\nbalanitis that it can almost with confidence be assumed that, wherever\nthere is a long prepuce with a red and inflamed meatus in a child, that\nunfortunate child will be a victim of fossal strictures when arrived to\nmanhood, and that, moreover, he will be a surer victim to the reflex\nneuroses which so often accompany strictures, and which have been so\nably described by Otis, than the victim of uncomplicated strictures\nacquired in the worship of Venus. There is no end to the misery that\nthese poor fellows have to suffer, besides the habitual hypochondriacal\ncondition into which the accompanying physical depression, throws them;\nit unfits them for business, any undertaking, or even for social\nenjoyment or entertainment; they keep themselves and their families in\ncontinued hot water. These subjects are, also, more prone to gouty and\nrheumatic affections, asthma, and other neuroses.\n\nAmong the many cases of nervous disorders simulating other diseases that\nI have seen relieved were two Jewish lads with an imperfection of the\nmeatus. They were two brothers, and from the history of the cases, and\nthat given me by the mother of the lads in regard to the father, the\nmalformation must have been hereditary and congenital. It consisted of a\npartial occlusion of the meatus by a false membrane, which divided the\nmeatus in two, horizontally, but which was closed at the posterior end\nof the lower passage, which readily admitted a probe from the front as\nfar as the occlusion, about a third of an inch to the rear. The\nrestoration, or rather the making the anterior urethra and meatus to\ntheir normal condition, relieved both boys of asthma, under which they\nhad labored for years.\n\nThe many cases simulating the general disturbances that accompany many\nkidney disorders, that are simply the result, in their primary causes,\nof preputial irritation and the disturbances to the kidney function due\nto the same cause, have long induced me to look upon the prepuce as a\ngreat and avoidable factor to some of the many forms of kidney diseases,\nprostatic enlargements, vesical diseases, and many other diseases of the\nurinary organs, which we know full well can result from strictures, as\nthe latter need not always act in a purely mechanical mode to do its\nfull extent of mischief.\n\nOne result of these preputial irritations not generally or particularly\nmentioned in any of our text-books--a condition far-reaching as regards\nits own results, and more annoying and serious than it appears at first\nsight--usually begins with a reflex irritability of the anal sphincter\nmuscle, or a rectal irritation of the same order, which in time produces\nsuch organic change that an hypertrophied and irritable, indurated,\nunyielding muscle is the result. Agnew, of Philadelphia, describes the\ncondition, but does not mention this frequent cause under the name of\nsphincterismus; once this is established, the train of resulting\npathological or diseased conditions that may follow are without\nend.[108] This is no fancy sketch, nor will the student of the pedigree\nand origin of diseases feel that the case is exaggerated or imaginative.\nThese are some of those cases that are always ailing, never well and\nreally never sick, but who are, nevertheless, gradually breaking down\nand finally die of what is termed \"a complication of diseases,\" before\nliving out half their term of life.\n\nHow this happens is simple enough--the straining required to produce an\nevacuation is out of all proportion with the character of the discharge;\nsuch patients often complain of being constipated when the evacuations\nare semi-fluid; this straining is followed by a dilatation and\nconsequent loss of power of the rectum, which becomes pouched and its\nmucous membrane thickened; the whole intestinal tract sympathizes and\ndigestion is interfered with, and the forcible expulsive efforts affect\nall the abdominal and thoracic organs in a more or less degree, laying\nthe foundation for serious organic diseases. Now, this condition, which\nmay be said to be no more than one of obstinate constipation, is a far\nmore reaching condition and a far more injurious state than can be\nimagined at a first glance. Constipation is not, as a rule, always\naccompanied by the indigestion, either stomachic or intestinal, that\ngoes with this condition; the contents of the intestines in simple\nconstipation may simply lack fluidity without undergoing putrefactive\nfermentation, but in this condition the undigested and retained\nintestinal contents do undergo that change, resulting in the generation\nof material whose re-absorption produces a toxic condition of the blood,\nfrom whence begins a series of serious organic changes in the blood, and\nfrom this in the organs.\n\nTo the practical physician these changes are evident and their cause\njust as plain, and it is just here where the laity lack the proper\neducation, and where they should understand that the intelligent\nphysician generalizes the disease and only individualizes the patient;\nand it is this ignorance on the part of the laity that gives to\nempiricism and quackery that advantage over them, as they look upon all\ndisease as a distinct individual ailment, that should have an equally\ndistinct and individual therapeutic agent to cope singly with. The laity\nknow very little of these things, and in their happy ignorance care\nstill less for the finer definitions of or of the clinical importance of\ntoxaemia, or the processes of abnormal conditions that lead up to such a\nstate, or the results that may follow when that condition is once\nreached. To them, dyspepsia is an indigestion ascribable to the stomach,\nand a sick-headache is ascribed to something wrong about the stomach or\nliver.\n\nThe laity have never been called upon to answer the questioning of the\nlate Prof. Robley Dunglison: \"What do you mean, sir, by biliousness? Do\nyou mean, sir, that the liver does not secrete or manufacture a\nsufficiency of bile, or not enough? Do you mean that the bile-material\nis left in the blood, or too much poured in? Do you mean that there is\nan excess in the alimentary canal, and a deficiency elsewhere? Please,\nsir, explain what you really mean by the term 'bilious!'\" The Professor\nhad a way about him that at least made one stop and seriously inquire,\nbefore adopting any random notion in regard to medicine. It is to be\nregretted that, in the humdrum tread-mill work of many physicians, they\neven have to drop into the commonplace way of treating dyspepsias and\nsuch ailments without any further inquiry. A farmer knows better than to\ndrive a dishing wheel, or with merely having a nail clinched in the\nloose shoe of a valuable horse; but he is fully satisfied to do so in a\nmetaphorical sense, as regards his own constitution, and the mere hint\nfrom his physician that he had better lay up for repairs, or that there\nis something wrong about him that will require investigation, and that\nthere is an ulterior cause to his feeling tired, headachy, or dyspeptic,\nor an allusion that there is something systemic, as a cause, to his\nmomentary attacks of disordered vision or amaurosis, will generally make\nhim look on the doctor with mistrust.\n\nThe merchant, banker, and mechanic are not up to Professor von Jaksch's\nideas of toxaemia,--that toxaemia may be exogenous or endogenous, or that\nthe latter is further subdivided into three more varieties,--and, what\nis worse, he cares still less. The above three classes of humanity, when\nsick, simply would want to know if Professor von Jaksch was good on\ndyspepsia, the measles, or typhoid fever. They care very little that he\ndivides endogenous or auto-toxaemia into that produced by the normal\nproducts of tissue-interchange, abnormally retained in the body, giving\nrise to uraemia, toxaemia from acute intestinal obstruction, etc., the\nabove being the first division. The second depends on the outcome of\npathological processes, which change the normal course of assimilation\nof food and tissue-interchange; so that, instead of non-toxic, toxic\nmatter is formed. The second group he names noso-toxicoses, which he\nsubdivides into two principal divisions:--\n\n(_a_) The carbohydrates, fats, or albuminous matter, which may be\ndecomposed abnormally and give rise to toxic products, _e.g._, diabetic\nintoxication, coma carcinomatosum.\n\n(_b_) A _contagium vivum_ enters the body through the skin, or the\nrespiratory or digestive tract, and develops toxic agents in the tissues\non which it feeds, as in infectious diseases.\n\nIn the third group the toxic substance results from pathological\nnon-toxic products, which again produce a toxic agent, only under\ncertain conditions. This group he calls auto-toxicoses, and includes in\nit poisonous substances, resulting from decomposition of the urine in\nthe bladder, under certain pathological conditions, and giving rise to\nthe condition called ammoniaemia. (_Medical News_ of January 7, 1891;\nfrom _Wiener klinische Wochenschrift_ of December 25, 1890.)\n\nAs observed above, unfortunately the patients know nothing, nor can they\nbe made to understand these conditions, that are only reached through\nlabyrinthic pathological processes, and, what is still worse, this way\nof looking at disease is incompatible with the idea of specific-disease\ntreatment, which to them looks more practicable and quick, and which is\nalso more to their liking. They cannot see any sense in such reasoning,\nwhich to them is something eminently impracticable; neither can they see\na reasonable being in the doctor who practices on such, as they call\nthem, _theories_.\n\nThe practical physician, however, sees in Professor von Jaksch's\nsummary the turning-point of many a poor fellow's career,--from one of\ncomparative health into one of organic disintegration, decay, and\ndissolution,--all the required processes starting visibly from the very\nsmallest of beginnings; any obstruction in the urinary tract or\nintestinal canal being sufficient to start any of the conditions which\nend in toxaemia; and, from a careful observation running over several\nyears, I do not think that I am assuming too much in saying that a\nbalanitis is often the tiny match that lights the train that later\nexplodes in an apoplectic attack or sudden heart-failure due to toxaemia;\nthe organic and vascular systems being gradually undermined until,\nunannounced and unawares, the ground gives way and the final catastrophe\noccurs,--unfortunately, an occurrence or ending looked upon as\nunavoidable by the friends of the victim. They cannot see any danger;\nthe idea that diseases have the road paved, not only for an easy\nentrance but an easy conquest, by the action of these toxic agents on\nthe tissues, is something that they cannot grasp. These blood changes or\nblood conditions are things too intricate, and the physician who\nunderstands them is, to them, a visionary and unpractical man. These\nconditions are, however, neither new nor unknown, and there is really no\nexcuse for the ignorance exhibited in these matters by the general\npublic, as it is through the blood that this mischief takes place. They\ncan reason in their impotent way, that they should drench themselves\nwith \"blood tonics\" and all manner of nauseous compounds to \"purify\"\ntheir blood, but the simple, scientific truth is something beyond their\nunderstanding, as well as something that they steel themselves against.\n\nSir Lionel Beale, in observing the immense importance he attaches to\nblood composition and blood change in diseases of various organs, truly\nremarks that \"blood change is the starting-point, and may be looked upon\nas the cause, of what follows,\" the other factor being the \"'tendency'\nor inherent weakness or developmental defect of the organ which is the\nsubject of attack;\" to which he adds that he feels convinced that, if\nonly the blood could be kept right, thousands of serious cases of\nillness would not occur; while the persistence of a healthy state of the\nblood is the explanation of the fact that many get through a long life\nwithout a single attack of illness, although they may have several weak\norgans; and that an altered state of the blood, a departure from the\nnormal physiological condition, often explains the first step in many\nforms of acute or chronic disease. Sir Lionel has been a pioneer in the\nfield of thought that looks for the cause of the disease, which, however\nremote it may be, should not be overlooked as a really primary\naffection. His extensive labor in the microscopic field has fully\nconvinced him that many of the pathological changes in the different\norgans are due to what might be called some intercellular substance that\nis deposited from the blood. (Beale: \"Urinary and Renal Disorders.\")\n\nToxic elements in the blood affect the kidneys in a greater or less\ndegree, and there produce changes at first unnoticed,--at least, as long\nas the kidney can perform its function,--but the day arrives when, as\ndescribed by Fothergill, blood depuration is imperfect, and we get many\ndiseases which are distinctly uraemic in character, and ending in any of\nthe so-called kidney diseases, Bright's disease being one of the most\ncommon. As observed by Fothergill, however, the kidney is not the\nstarting-point, the new departure only taking place when the structural\nchange on the kidney has reached that point that it is no longer equal\nto its function--the \"renal inadequacy\" of Sir Andrew Clarke. (J. Milner\nFothergill, in the _Satellite_, February, 1889.)\n\nDuring the Bradshawe lecture, Dr. William Carter made the following\nremarks: \"According to Bonchard, one-fifth of the total toxicity of\nnormal urines is due to the poisonous products re-absorbed into the\nblood from the intestines, and resulting from putrefactive changes which\nthe residue of the food undergoes there.\" In the course of the lecture,\nDr. Carter fully explains that one of the benefits derived from milk\ndiet in Bright's disease is the small residuum deficient in toxic\nproperties, and lays great stress on the employment of intestinal\ndisinfectants or antiseptics that exercise their influence throughout\nthe whole tract, suggesting naphthalin as peculiarly efficacious,\nthereby cutting off one source of blood contamination at its source.\nAlthough these are recent developments in medicine, Bonchard mentions\nthat in the practice of M. Tapret cases treated on this principle did\nwell. (Braithwaite's _Retrospect_, January, 1889.)\n\nPersons laboring under this toxic condition of the blood, with a\nconsequent deterioration in the texture and the physiological function\nof the vital organs, are of that class that easily succumb to injuries\nor serious sickness, and of that class to whom a surgical operation of\neven medium magnitude is equal to a death-warrant.\n\nThe above conditions are an almost constant attendant on that condition\nof the sphincter described by Agnew as sphincterismus, which also is\nproductive of haemorrhoids and fissure, and often of fistula. That\nsphincterismus is caused in many cases by preputial irritation is as\nevident as that the same affection, or haemorrhoids or any other rectal\nor anal affection, will, in its turn, produce vesical and urethral\nreflex actions, and primarily functional and secondarily organic changes\nin those parts. Besides, the great number of cases wherein the gradual\nand progressive march of each pathological event could be traced with\naccuracy has convinced me of the true cause of the difficulty being the\nresult of reflex irritation.\n\nDelafield, in his \"Studies in Pathological Anatomy,\" gives, as the first\nform of pneumonia, that from heart disease; in the days of Broussais\nthis would have sounded absurd, but, to-day, some forms of heart disease\nare known to be the regular sequences of some particular form of kidney\ndisease, just as some form of pneumonia attends an affected heart and\nthat some forms of pneumonia degenerate into phthisis. When the blood\nchange is an established fact, it is only a question as to which is the\nweak organ, and the organism of the individual will decide whether it\nwill be a simple sick-headache or the beginning of a pneumonia ending in\nphthisis.\n\nI have purposely dwelt on this part of this subject, owing to the recent\norigin and publication of many of the views connected with it; also on\naccount of the greater ease of making the subject plain by fully\ndiscussing each step of the process; and if the views of Sir Lionel will\nbe recalled, that a toxic element in the blood is the starting-point,\nand that an irritable or weakened organ invites destruction,--the\ninduction of serious and fatal kidney disorder by the transmitted\nirritability and consequent injury to the kidney produced by preputial\nirritation in the first instance, and the supplemental blood-poisoning\nby intestinal absorption of septic matter, which soon brings about Sir\nAndrew Clarke's \"inadequacy of kidney,\"--all will be readily understood.\nWhen this point is reached, a too hearty meal, exposure to variable\nweather, or a little extra care or anxiety, are sufficient, as\ndetermining causes, to bring life into danger.\n\nAs pointed out, many cases of Bright's disease or other renal difficulty\nhave their origin in this distant but visible source, and, although\nmalarial poisoning and a great number of other causes will produce the\nsame particular organic changes and diseases, this condition must be\nadmitted as one of the frequent causes. The influence of the\ngenito-urinary tract on the rest of the economy, and the importance of\nthe sympathy it excites, or how quickly, by its being irritated, some\napparently dormant pathological condition will be awakened to life and\nactivity, is not sufficiently appreciated. As observed by Hutchinson, a\npatient who has once been the subject of intermittent fever is more\nprone, on catheterization, to have a urethral chill and fever than one\nwho had never had the fever. (Hutchinson: \"Pedigree of Diseases.\")\n\nRalfe observes, in his \"Kidney Diseases,\" that long-standing disease of\nthe genito-urinary passages must be reckoned as among the chief\netiological factors of chronic interstitial nephritis (page 227). The\ncondition of the kidneys in cases of strictures of long standing is\nknown not to be a reliable one, and any incentive to dysuria or to\nretention, no matter how slight, is apt to lead, eventually--and that\neven in very young subjects--to that toxic condition mentioned in a\nformer part of this chapter as one of von Jaksch's subdivisions of\ntoxaemia, the ammoniaemia of Frerichs; this condition being the fatal\nending of the case of the two-year-old child mentioned by Henoch, who\ndied after the relief of a retention due to phimosis and calculi\nresulting from the phimotic occlusion. Having seen so many cases wherein\nthe conditions described in this chapter were so apparently--whether\nfrom ammoniaemia due to infection, or toxaemia from the urinary tract, or\nuraemic toxaemia from the intestinal tract--all due to some preputial\ninterference or irritation, I cannot help but feel that in these\nconditions--which, singularly, are not so prevalent with the Hebrews as\nwith Christians--we have one factor in the cause of the shorter and more\nprecarious vitality of the latter.\n\nMorel, in his \"Traite des Degenerescences Phisiques,\" ably discusses the\ndegenerative and morbific influences and results of toxaemia, as well as\nhe clearly defines their sources. The connection between toxaemia and\nmental affections has already been shown, and Prof. Hobart A. Hare, in\nhis instructive and interesting prize essay on \"La Pathogenie et la\nTherapeutique de l'Epilepsie (Bruxelles, 1890)\", mentions that\nconvulsive disorders resulting from the presence of some toxic substance\nare of frequent occurrence. How much this may enter as a partial factor\ninto many of the cases of epilepsy which are classed in the order of\n\"reflex\" may well challenge our consideration. Hare lays great stress on\nthe necessity of circumcision wherever there is an indication of\npreputial local irritation. \"If practicable, circumcision should be\nperformed; it is an operation with but small risk or danger, and easy of\nperformance. In such circumstances it is always permissible to\ncircumcise, were it for no other end than an acknowledged attempt to\nreach a cure.\"\n\n\n\n\nCHAPTER XXVI.\n\nSURGICAL OPERATIONS PERFORMED ON THE PREPUCE.\n\n\nIn operative interference there is one point which should not be lost\nsight of, this being that the length and bulk of the prepuce in a great\nmeasure depends on the constriction at its orifice; if the orifice is\nsmall, the prepuce tight and inelastic, every erection, by putting the\npenis-integument on the stretch, adds to its bulk,--nature naturally\ntrying to make up the deficiency,--the two points of resistance being\nwhere the glans pushes it ahead, having the constricting orifice for a\nhold or purchase, and the skin at the pubes, which is called upon to\nfurnish the extra tissue for the time being needed during erection,\nwhich should be supplied by the prepuce--this being the only office\nwhich I have been able to assign to this otherwise useless but very\nmischievous appendage. In cases where preputial irritation produces more\nor less priapism, the continued stretching of this integument causes a\nmarked increase in its growth, which is mostly added forward. It was on\nthis principle or its recognition, that Celsus devised his operations,\nand on which the persecuted Jews undertook to recover their glans by\nmanufacturing a prepuce; and, although the trial was not reported as\nbeing very successful, I do not doubt but that, if the skin could have\nbeen drawn sufficiently over so as to constrict it anteriorly so as to\ngive the glans a purchase, as in the case of phimosis with an inelastic\nprepuce, the operation could be more of a success; all that is required\nis the continued extension and the prepuce might be made to rival in\nlength the labia majorae of the females of some African tribes, or the\npendulous buttocks of the Hottentot Venus.\n\nI have employed the knowledge of this elasticity and source of supply of\nthe penis-integument, on more than one occasion, in recovering the\ndenuded organ with skin. A number of cases are on record where, owing to\nthe want of that artistic and mechanical knowledge without which no\nsurgeon is perfect, the operator has drawn forward the skin too tight in\ncircumcising, after which, owing to the natural elasticity of the skin,\nthe integument has retracted, leaving the penis like a skinned eel or\nsausage. This accident is even liable to occur where the skin has not\nbeen tightly drawn, but where subsequent erections have torn through the\nsutures, and where the natural retraction of the skin has laid the organ\nbare for some distance. I have seen a number so recorded, but do not\nremember seeing any remedy suggested, it seemingly being accepted that\nthe recovery must take place by gradual granulation,--a necessarily very\nslow process, owing to the constant interference by--the always present\nin such cases--unavoidable erections.\n\nSeveral years ago I advised circumcision to a gentleman owing to a\ncontracted condition of the muscles of one hip and thigh, which was\nthreatening to render him a deformed cripple; he had a congenital\nphimosis and a very irritable glans penis. The operation was performed\nin a proper manner by a surgical friend, but this friend, unfortunately,\nwas a great believer in antiseptic and wet dressings. A few days after\nthe operation he called upon me to ask me to go and see the patient, as\nthey were both in a pickle, the patient being exceedingly angry, being\nin constant misery, and the penis so denuded by the giving way of the\nsutures--owing to the erections--that it looked to the patient as if he\nnever could have a whole penis again, and the doctor saw no way out of\nthe difficulty; the penis was, in reality, a dilapidated and\nsorrowful-looking appendage, and anything else but a thing of beauty or\npride; it was raw, angry-looking, and bleeding at every move; the first\nwink of sleep was followed by an attempt at erection that raised the\npatient as effectually as an Indian would in scalping him; so that,\ntaken altogether, the penis, anxious countenance, and the flexed\nposition of the whole body to relieve the tension on the organ, the man\nlooked about as battered, cast down, and sorrowful as Don Quixote did in\nthe garret of the old Spanish inn, with his plastered ribs and\ndemolished lantern-jaw.\n\nLuckily, the patient was seen before the retracted portion of the penile\nintegument had had a chance to condense and indurate. The bed was\nslopping wet with the drenchings of carbolized water that the penis had\nundergone, the man's clothing was necessarily damp, and the whole\nbedding and clothes were steamy,--all of which greatly added to his\ndiscomfort and tendency to erections. The man was washed, placed in a\nnew, clean, and dry bed, and his clothing changed. The organ was then\nforced backward until the preputial frill or edge was approximated to\nthe cut end of the penis-skin, where it was made fast by an\nuninterrupted suture around the whole of the circumference. A short\ncatheter, about three inches in length,--the catheter being as full size\nas the urethra would comfortably hold, and of the best and thickest of\nthe red, stiff variety,--was introduced into the urethra. This protruded\nabout half an inch beyond the meatus. A stiff, square piece of\ncard-board was pierced and slipped over this, and then adhesive rubber\nstraps were brought from the integument to this little platform, the\nfirst being from the median line of the scrotum, lifting the sac forward\nand upward. The pubes were shaved and the next four straps started from\nthe root of the penis, each strap being split at the glans-end so as to\nencircle the protruding end of the catheter. By these means the skin was\nbrought back and firmly supported over the penis, toward the glans; and,\nin case of any erection, the act would only assist in drawing the\ncovering farther over the penis as the pasteboard platform and adhesive\nstraps formed the distal end of an artificial phimosis. The catheter\nallowed of free urination, and the scrotum was further held up in\nposition by a flat suspensory bandage passed underneath the scrotum and\nfastened over the abdomen near each hip. The penis wound was then\ndressed with a very little benzoated oxide-of-zinc ointment passed\nbetween the adhesive straps; a bridge-support placed over the hips to\nsupport the bed-clothes, and all was finished, and full doses of bromide\nof sodium and chloral were ordered at bed-time. When the dressings were\nremoved, five days afterward, all was healed, the sutures removed, and\nthe suspensory alone replaced. The patient had not been troubled with\nany more erections or annoyances of any kind. These are the points which\noften do more or less mischief: wet dressings are uncomfortable and\nfavor erections, while the effect of the weight and action of the\nscrotum in drawing backward on the integument should not be overlooked;\nin addition, it should not be overlooked that we have it in our power to\nproduce, so to speak, an artificial phimotic action, which has the same\ntraction on the penis-integument that the natural phimosis induces.\n\nThe foregoing method, to be used in these cases, has proved very\nserviceable in my hands, and it is here given that it may assist others;\nas there is no need of waiting for granulations or of allowing the\npatient to undergo so much misery, which, besides the local injury,\ncannot help but affect the general health very injuriously. The penis\ncan stand any amount of forcing backward; it stands this in cancer or\nhypertrophy of the prepuce, or in the inflammatory thickenings that\nprecede gangrene of the prepuce, in any extended degree; becoming, for\nthe time being, more or less atrophied. As has been shown by Lisfranc,\nthe penis can be made nearly to disappear into the pubes; so that we are\nnot as helpless in these cases as our text-books would have us believe.\n\nIn infants, and in young children below the age of ten or twelve, the\nJewish operation, as modified and done in accordance with the dictates\nof modern surgery, will be found the most expedient. By this method we\navoid the need of any anaesthetic agents, which are more or less\ndangerous with children, as well as the need of sutures, which are\npainful of adjustment and very annoying to remove in those little\nfellows who dread new harm; there is also much less risk of\nhaemmorrhages, as the frenal artery is not wounded. In children of a year\nor over, a very good result will be found often to follow Cloquet's\noperation, care being taken to carry the slitting well back, as well as\ncare in taking it on one side of the frenum, so as to avoid any wound of\nthat artery, the subsequent dressing being a small Maltese-cross\nbandage, pierced so as to admit the glans to pass through; the prepuce\nis retracted and the tails folded over each other and held there by a\nsmall strip of rubber adhesive plaster; a little vaselin prevents the\nsoiling by urine underneath. This last operation is short and very\neasy, is not painful, nor does it require much manipulation; it is only\none quick cut on the grooved director and it is over; by the retraction\nof the prepuce, the longitudinal cut becomes a transverse one, making\nthe prepuce wider and shorter at once; the glans soon develops and\nremains uncovered. As there is a very small wound to heal over, the\nrepair is very prompt.\n\nIn adults with a very narrow, thin, not overlong prepuce, a very good\nresult often follows a combination of the dorsal slit with the inferior\nslit alongside of the frenum of Cloquet. The narrower and tighter the\nprepuce, the better the result, as the cuts are at once converted from\nlongitudinal into transverse wounds, and the organ at once assumes the\nshape and condition of a circumcised organ, without having suffered any\nloss of substance; three stitches or sutures in each cut (silver or\ncatgut) adjust the cut edges; a small roller of lint and adhesive\nplaster, placed so as to shoulder up against the corona, completes the\ndressing. Where this operation is practicable, by the thinness and\nnarrowness of the prepuce, it has many advantages. I have repeatedly\nperformed it on lawyers, book-keepers, clerks, and even laboring men,\nwho have gone from the office to the courts, counting-rooms, or stores\nwithout the least resulting inconvenience or loss of time. In laborers\nit is better to perform the operation on a Saturday evening, which gives\nthem a rest of thirty-six hours before going to their labor again. The\noperation is comparatively painless and almost bloodless, as there need\nnot be more than half a teaspoonful of blood lost during the operation;\nthere is no danger of any subsequent haemorrhage, and, with proper\nprecautions against the occurrence of erections, from seventy-two to\nninety-six hours is sufficient for a complete union; the sutures are\nthen removed and a simple lint and adhesive-plaster dressing worn for a\nfew days more. In many, no more dressings are required. In many cases,\nwith a properly adjusted dressing, that comes forward underneath so as\nto include the frenum, the simple dorsal slit is sufficient; but if any\nof the prepuce depasses the dressing underneath, it will puff and become\noedematous and require frequent puncturing. To avoid it, it is better to\nmake the Cloquet slit at once. This operation is of no value, and\nperfectly impracticable in a thick, pendulous prepuce. Absorption will\noften remove considerable preputial tissue, but where there is too much\nits very bulk interferes with its removal by any natural means.\n\nDilatation is recommended by a number of surgeons, but, I must admit, in\nmy hands it has always proved a failure; it may be, that if the\nsubsequent history of the cases reported as so operated upon had been\ncarefully traced, the reports would not have been so good. Nelaton,\nwhose dilating instrument is generally recommended, seems, himself, to\nprefer some of the circumcising methods, as in the volume on \"Diseases\nof the Genito-Urinary Organs,\" in his \"Surgery,\" being the sixth volume\nof the revised edition of 1884, by Despres, Gillettte, and Horteloup,\nthe subject of dilatation is dismissed in two short lines. St. Germain,\nof Paris, uses, as has been before observed, a two-bladed forceps, used\nafter the manner of Nelaton, and reports good results. Dr. J. Lewis\nSmith agrees in his statements with Dr. St. Germain. Dr. Holgate, of New\nYork, reports a like experience. In my own practice the prepuce has\noften been made _temporarily_ lax and retractable, but with the usual\nresults of the return of the contraction, with a possible thickening of\nthe inner fold, as a result of the interference; so that only in case of\nany immediate demand, where the tight prepuce is producing irritation,\neither through pressure or adhesions, or retained sebaceous matter, do I\never resort to dilatation; always, however, even then, not as a final\noperation, but merely as preparatory procedure toward a future operation\nof a more efficient order.\n\nIn cases of timid adults, who refuse all kinds of operative\ninterference, good results may be obtained by the use of a mild\nlead-wash or cold tea-baths and the introduction of flat layers of dry\nlint interposed between the prepuce and the glans; this has a very good\neffect in keeping the parts apart and dry, and may in time produce a\ncertain amount of dilatation; but even when this is done, unless it will\nrender the foreskin sufficiently loose to allow of its being kept\nfinally back of the corona, it is, after all, but a temporary makeshift.\nThe corona should be exposed and kept clear of the preputial covering;\nanything short of this will not give all the good results to be desired.\nI have more than once performed a secondary operation on Jews, who had\nbeen imperfectly circumcised by not having the prepuce removed\nsufficiently, and in whom the subsequent contraction of the preputial\norifice had re-covered part of the glans, and only lately visited a\nfour-year-old boy, circumcised when eight days old, in whom the prepuce\ncovered half of the glans, the corona acting as a tractive point from\nwhich the penile integument was being drawn forward. In this case the\nsimple pierced-lint Maltese cross was used, with an adhesive band to\nhold the tails down behind and around the penis just back of the corona.\n\nThese means, although not circumcision either in a surgical or in the\nHebraic religious sense, are, nevertheless, sufficient in a medical\nsense for all desired purposes; provided, however, that there is no\nresulting constriction, or a mild condition of paraphimosis, back of\nthe corona, and that the whole of the glans is sufficiently uncovered,\nand that no abnormal dog-ears are left to garnish each side of the penis\nlike an Elizabethan frill or collar; although Agnew holds that, in\nslitting, the practice adopted by many of rounding off the corners is\nmostly superfluous, as nature will do so itself in time.\n\nThe ordinary way of performing the operation by modern surgeons is by\nwhat is known as the Bumstead circumcision. It was not an invention of\nBumstead, but was adopted by him in preference to all others. The\nrequisites are a sharp-pointed bistoury, blunt-pointed scissors, and a\npair of Henry's phimosis forceps, with fine needles and fine oculists'\nsuture silk. The penis is allowed to hang naturally and the position of\nthe corona glandis marked on the outer skin with a pen and ink, which is\nto serve as a guide for the incision. The prepuce is now drawn forward\nuntil this line is brought in front of the glans and grasped between the\nblades of the forceps. The prepuce is now transfixed, and, with a\ndownward cut, that portion is severed; the knife's edge is now turned\nupward and the excision finished. The forceps are now removed and the\nintegument allowed to retract; with the scissors the inner mucous fold\nis now split along the dorsum and trimmed off so as to leave about half\nan inch in front of the corona. The parts are then brought together with\nthe continuous suture and dressed according to the fancy of the surgeon.\nCare must be taken _not to bruise_ the parts with the forceps, as, in\nsuch cases, sloughing of the sutured edges will be the result instead of\nunion. I have seen this accident happen more than once, in one case\nbeing followed by a penitis that seriously complicated matters.\n\nIt has been my practice to use fine silver-wire and catgut sutures in\nall operations on the prepuce; they excite less suppuration as well as\nless irritation. In case of need, the silver can be left in longer, and\nthey are much easier of removal than the silk; besides, they have the\nadvantage of not cutting. In the after-treatment the same general plan\ncan be followed as with any amputated stump, except that it must not be\nforgotten that at the end of this organ dwells what has been termed the\n_sixth_ sense, and that heat and moisture are very apt to awaken the\ndormant energies of the organ, even after it has undergone cruel\nmutilation, and even has suffered considerable loss of blood; for that\nreason it is best always to avoid wet or sloppy dressing, or too much\nointment, as they are more apt to cause erection than to do any good.\nBesides, I find water does here, as elsewhere, interfere with the\ndeposited plastic matter, properly organizing into cicatricial tissue;\nso that I prefer a snug, dry dressing, which is left on for four or five\ndays without being interfered with, and light covering, plain diet,\nquiet, with fifteen grains each of bromide of sodium and chloral hydrate\nat bed-time to insure rest and freedom from annoying erections. Where\nthe organ is large in its flaccid state, it is better to support it on a\nsmall oakum-stuffed pillow, made for the purpose, than to let it hang\ndownward. Should the stitches give way and the skin tend to retract, the\nplan proposed on a previous page can be followed to advantage. In\nurinating, care must be taken not to soil the dressings; some patients\nare very careless about this if not warned. The penis should hang nearly\nperpendicular while in the act, and all dribbling should have ceased and\nthe meatus and underneath be mopped dry with some soft cotton before\nraising the organ; nothing so irritates the parts, retards union, or is\nmore offensive than a urine-saturated dressing.\n\nDr. Hue, of Rouen, uses an elastic ligature, which he introduces into\nthe dorsal aspect of the prepuce by means of a curved needle. This he\nties in front, and in three or four days it cuts its way through.\nAlthough Hue reports a large number so operated upon, the tediousness of\nthe procedure and the swelling and oedema, as well as the active pain\nthat must necessarily accompany the operation, will hardly recommend the\nligature in preference to the incision by the knife.\n\nDr. Bernheim, the surgeon of the Israelitish Consistory of Paris, has\noperated on over eleven hundred circumcisions, besides the cases of\nphimosis occurring in his general practice. His opinion of the procedure\nof M. de Saint-Germain by dilatation is not favorable. He has employed\nit in a number of cases of phimosis, at the time unfit for a more\nradical operation. He has, however, observed that cicatricial\nthickenings and recontractions are very apt to occur, and, as to the\nseptic accidents mentioned in connection with circumcision, he has noted\nthat they are as liable to occur in hands that are as careless and\nslovenly with what they do with their dilating forceps as they are with\nwhat they do with their bistouries. Dr. Bernheim prefers the\ncircumcision forceps of Ricord, as modified by M. Mathieu. This\ninstrument he prefers by reason of its gentler pressure, which, at the\nsame time, is all-sufficient to properly fix the prepuce. In applying\nthe forceps, he includes as little as possible of the lower part,\nkeeping away as much as possible from the frenic artery. The dorsum of\nthe inner fold he cuts with the scissors. In children under two years of\nage, he simply turns this back over the free edge of the integument; in\nchildren over two years of age, he uses serres-fines. In children, he\nuses a piece of lint dressing steeped in a watery solution of boracic\nacid; in adults, he uses iodoform-gauze dressings. He finds cases unite\nin from three to ten days. Dr. Bernheim warns us against using\nantiseptics on infants or young children, in connection with the\nafter-dressing of circumcision. Neither phenic acid, corrosive\nsublimate, nor iodoform are well borne by these young subjects, and he\nhas seen serious results follow upon as light an application as a 1/100\nsolution of phenic acid. In a number of cases he reports operating with\nthe galvano-cautery of Chardin, instead of the knife. These operations\nwere bloodless, and cicatrization was as rapid as when the knife was\nused. He has in several cases operated by the dorsal incision, owing to\ndisease of the prepuce not allowing any other operation.\n\nIn France, the Bumstead operation is known under the title of Ricord's\nprocedure. Lisfranc, Malapert, M. Coster, and Vidal all have operations\nwhich are not as useful as Ricord's, and have not, therefore, come into\ngeneral use. M. Sedillot condemns the dorsal incision as leaving two\nunsightly-looking flaps. The reverse, or inferior incision of M. Jules\nCloquet is likewise not in favor with either Malgaigne or Ricord. This\ninferior incision or section, alongside of the frenum was first advised\nby Celsus. M. Cullerier contented himself with slitting the inner\npreputial fold, longitudinally, from its junction with the skin backward\nto the corona. M. Chauvin, by the aid of a complicated instrument with\nbarbed points, drew out the mucous fold as far as possible before\nexcising.\n\nThere is something unaccountable in the difference in results that\nvarious operations give in the hands of different surgeons. It must be\nthat all methods are correct _with properly-chosen cases_ and when\nproperly _performed_, as well as properly looked after subsequently to\nthe operation. It must not be expected, however, that, in operations\nwhere the kindly assistance of nature is a thing contemplated in\nabsorbing superfluous tissue, the case will at once give satisfaction to\nall. These cases must have the required time before judgment can be\npassed upon the merits of the operation, just as required time in cases\nof dilatation or in the method of M. Cullerier will often demonstrate\nthat the benefits are but transient, and that often even cases that have\nbeen so operated upon will require a complete circumcision, _a la_\nRicord or _a la_ Bumstead, owing to the resulting thickening induration\nand overconstriction, when, if left alone, the dorsal slitting or the\ninferior incision of Cloquet would have previously given satisfactory\nresults.\n\nThe final cosmetic results in the combined Cloquet and dorsal-slit\noperation, for instance, depend on, first, properly choosing the case.\nOne on whom the operation is unadaptable it is useless to attempt it on,\nas a future circumcision or tedious and annoying re-operation of\ntrimming would be required. The next care is to properly cut through all\nconstricting bands, which, like fine, tough strings, will be found to\nencircle the penis. These must be carefully clipped with a fine pair of\nstrabismus scissors, as these bands do not give way, either then or\nafterward, of their own accord, but form the nucleus for stronger\nconstricting bands for the future. Then you must be sure to cut far\nenough back, either above or below, until you have reached where you\nobtain the normal and largest calibre of circumference of the penis. The\nadaptation of the edges of the parts and the proper application of a\nsmooth, equal pressure, by means of the lint strap, is of the next\nimportance; and then comes the strapping of the whole surface for about\nan inch and a half back of the corona, which should and must include all\nthe tissues of the preputial part of the frenum. A neglect or careless\nperformance of any of the details, or the carelessness of the patient in\nnot keeping the dressing clean, necessitating its change before the\nfourth day, all tend not only to interrupt the union, but to mar the\nfuture cosmetic results as well. It may be asked why all this care and\ntrouble, and not circumcise at once? As already observed, this operation\nadmits of the patient following his business; whereas circumcision, on\nthe male, will assuredly lay him up for four or five days, and perhaps\nten days,--something that many, be they rich or poor, cannot afford, and\nwill not submit to.\n\nThe cosmetic condition of the penis as a copulating organ is a thing of\nsome importance, and this should not be overlooked; for, although the\nparticular dimension, shape, or peculiarity of the penile end never\nfigures prominently in the complaints of women who apply for\ndivorce,--the charges being everything else under the sun,--it can\nsafely be assumed that this organ and its condition is the original,\nsilent and unseen, as well as unconscious power behind the throne that\nis at the bottom of the whole business in more than one case. Like the\nfable of the poor lamb that the wolf wished to devour: the real reason\nof his wishing to kill him was that he might eat him, the pretext set\nforth by the wolf that the lamb had encroached on his pasture, muddied\nhis brook, or kept him awake by his bleating having been disproven by\nthe lamb. Besides, it is well not to leave any distinctive or\ndistinguishing mark, like an individual baronial crest, on the head of\nthe organ.\n\nTo return, however, to the operative procedures, we find that Dr. Vanier\nfinds that the operation of Cloquet by incision alongside of the frenum\nhas the advantage of not leaving any deformity--contrary to the opinion\nof Ricord and Malgaigne. He, in fact, holds this procedure in such high\nesteem that he considers that Cloquet deserves great credit for reviving\nthis old Celsian operation. H. H. Smith, in his \"Operative Surgery,\"\ncoincides with Vanier in his favorable opinion of this method, as he\nthere says: \"Frequent opportunities of testing the advantages of the\nplan of Cloquet having satisfied me of its value, I do not hesitate to\nrecommend it as that best adapted to the adult, because it fully exposes\nthe glans and leaves little or no lateral deformity, as is frequently\nthe case with the dorsal incision,\"--an opinion that I can fully agree\nwith, from the results of the same operation in my hands, although I\nhave used the method even on infants. Vanier does not approve of the\ndorsal incision unless it is made V-shaped, as it otherwise leaves the\nunsightly lateral flaps, but thinks well of the modification of\nCloquet's practiced by M. Vidal de Cassis, which is performed in the\nfollowing manner: The patient stands before the operator, who remains\nsitting; the operator seizes the prepuce on its dorsum and draws it\ntoward him; he then introduces a narrow, sharp-pointed bistoury, with\nits point armed with a small waxen bullet, down alongside of the frenum\nuntil he reaches the pouched extremity of the preputial cavity at this\npoint; the point of the bistoury is now made to transfix the waxen\nbullet and out through the skin, which from this point is divided from\nbehind forward. Vanier very sensibly suggests that the operation that is\neffectual, and which can be accomplished in the least number of\nmovements or _temps_, as being the least likely to cause extensive pain\nand agony, should be the one preferred, and that the aim of the surgeon\nshould be to simplify the operation by reducing the number of necessary\nmovements. For this reason, where an excision of considerable amount of\ntissue is required by the nature of the case, he prefers another\noperation, performed by Lallemand,--that of making a dorsal transfixion\nand cutting off the two lateral flaps, which can all be done in three\nmovements.\n\nIt makes but little difference as to which operation is performed on the\nadult, but that the subsequent dressing will exercise a good or evil\ninfluence, and greatly assist not only in the present comfort or\ndiscomfort of the patient, but in the ultimate result as well. Bearing\nthese points in view, Charles A. Ballance, of St. Thomas's Hospital, has\nadopted the following procedure:--\n\n\"When the patient is etherized, the outline of the posterior border of\nthe glans is marked on the skin with an aniline pencil. The skin of the\nprepuce is slit and removed up to the aniline line. The mucous membrane\nis next cut away, leaving only a free edge of about one-eighth of an\ninch in width. Any bleeding which occurs should be entirely arrested,\nand asepsis must be insured by frequent sponging with carbolic or\nsublimate solution. Numerous coarse-hair stitches are then inserted, so\nas to bring accurately together the fresh-cut edges of the skin and\nmucous membrane, and subsequently, after a further sponging and drying,\na piece of gauze two layers of thickness, and wide enough to reach from\nthe root of the penis nearly to the meatus, is wrapped loosely around\nthe penis and secured by several applications of the collodion-brush.\nThe setting of the collodion is hastened by the use of a fan, so that\nthe air is kept in motion, and the patient should not be allowed to\nrecover from the anaesthetic until the dressing is quite firm and hard.\nThis dressing forms a carapace for the penis, protecting it from the\nbedclothes and effectually preventing the annoying and distressing\nerections. Mr. Ballance reports excellent results from this dressing.\"\n(Braithwaite's _Retrospect_, July, 1888.)\n\nIn applying the above dressing, the shrinking incident to the drying of\nthe collodion must not be overlooked, and the gauze layers must be\nloosely applied, as they would otherwise become too tight. The dressing\nis a very ingenious and serviceable one.\n\nMr. A. G. Miller, at a meeting of the Edinburgh Medico-Chirurgical\nSociety, reported a new method of dressing after circumcision. \"It\nconsisted in first closely suturing the skin and mucous membrane by\nnumerous catgut sutures, then painting the surface with Friar's balsam\nand covering it over with two or three layers of cotton wadding, on\nwhich the balsam is poured. The glans penis was left sufficiently free\nto allow of water passing. The band or ring of dressing should be at\nleast one inch broad. The dressing was not suitable for young infants\nwho were frequently wetting. In the case of older children, they might\nbe allowed to go about on the second or third day, when the dressing\nwould be quite dry, and would not be required to be changed or renewed.\"\n(Braithwaite's _Retrospect_, January, 1888.)\n\nAny constricting or immovable and inelastic dressing is subject to the\nsame objections as plaster-of-Paris dressings in thigh-fractures,--that\nof being dangerous and not expedient, unless the patient is constantly\nunder your eye.\n\nDr. Neil Macleod, in the _Edinburgh Medical Journal_ for March, 1883,\nadvises a procedure that has always looked favorably to me, and which I\nonce put in practice through the means of the ordinary ptosis\nfenestrated forceps, in place of the ordinary circumcision forceps, the\nsutures being introduced through the fenestra and the prepuce cut off on\nthe outer side of the forceps, the thickness of the steel arm on the\nouter side of the fenestra allowing of the properly-sized border for the\nhold of the sutures. Dr. Macleod places his sutures all in position\nbefore making any incisions,--a procedure which will be found to save\nthe patient considerable pain; as with many the seizing and holding of\nthe edges of the skin and mucous membrane and the forcible pressure\nexerted by the fingers or forceps while the needle is being forced\nthrough is the most painful part of the operation. In doing this, care\nmust be taken to allow sufficient length to each thread to make two\nsutures, as well as care must be taken to properly pull out the thread\nin the centre between the four folds of tissue and to cut it\nequidistant, after the ablation of the prepuce, a blunt hook being used\nto fish up the threads from the preputial opening.\n\nErichsen favors the Jewish operation in young children, as being the\neasiest and safest of performance. Slitting, or the inferior or superior\nincision, he thought, left too much of the prepuce, which, wherever\nthere is a tendency to phimosis, should be entirely removed, \"with a\nview of preserving the health and cleanliness of the parts in after\nlife.\" In the phimosis that is acquired by old men, he found dilatation\nwith a two-bladed instrument to be sufficient, provided the indurated\ncircle was made to yield. For the circumcision of adults he has invented\nan adjustable shield, something like the Jewish spatula, with which he\nprotects the glans.\n\nGross (the elder) used both slitting on the dorsum and circumcision. He\nfound neither objection nor deformity in the flaps left by the dorsal\nincision, as they were only temporary; in some cases, he simply followed\nthe practice of Cullerier, of making multiple slits in the constricting\nand inelastic mucous membrane.\n\nAgnew believes in circumcision in the treatment of reflex troubles. He\nrelates a case, in the second volume of his \"Surgery,\" of eczema\nextending over the abdomen, of over a year's standing, cured in a child\nby circumcision; he operates by incision on the dorsum, in which he\nleaves nature to make away with the flaps, or he circumcises by the\nBumstead method.\n\nVan Buren and Keyes recommend both the incision on the dorsum and the\noperation of Ricord; where the mucous membrane alone is tight and\nconstricted, they follow Cullerier's method of either single or multiple\nincisions of the inner coat. They lay great stress on the necessity of\nkeeping the patient quietly in bed to insure rapid and complete union.\n\nMy friend, Dr. Robert J. Gregg, of San Diego, has lately operated on a\nnumber of cases, the operation being perfectly painless, the little\npatients submitting to it and feeling no more pain than if it were\nhaving its toe-nails trimmed, the local anaesthesia being produced by the\nhypodermatic injection of cocaine. This procedure is now used to a\nconsiderable extent throughout the country, and it is a far safer and\nmore comfortable performance than either etherizing or chloroforming, as\nthe sudden and spasmodic filling of the lungs of young children--who\nwill resist and hold their breath for a long time, then suddenly\ninhale--with anaesthetic vapor is almost unavoidable, having in two\ninstances nearly lost two children from such an accident.\n\nDr. G. W. Overall, in a late _Medical Record_, which is quoted in the\n_Journal of the American Medical Association_ of February 21, 1891,\ngives the description of a very good and painless method of producing\nthis local anaesthesia; for it need hardly be said that with a nervous,\nirritable child the introduction of the hypodermatic needle is as\nformidable an operation as either slitting or the Jewish operation. Dr.\nOverall is in the habit of holding a solution within the preputial\ncavity and then to introduce the needle in the mucous fold, having\npreviously applied a light rubber band back of the corona, on the outer\nintegument, so as to act like a tourniquet and limit the action of the\nanaesthetic effect to the prepuce. By this procedure he avoids all pain\nand the operation can be performed while the child is even amusing\nitself, care being taken that it does not see it. Sutures that require\nremoval should not be used, according to the Doctor, and the operation\nthereby becomes a perfectly painless and unalarming performance to the\npatient in all its details.\n\n\n\n\nNOTES TO TEXT.\n\n\n    [1] \"Letters of Certain Jews to Monsieur Voltaire, Containing an\n          Apology for their own People.\" Pages 451-476. Translated by\n          Dr. Lefann. Philadelphia, 1848.\n\n    [2] \"Circoncision chez les Egyptiens.\" Brochure by F. Chabas. Paris,\n          1861.\n\n    [3] \"Atlantis.\" By Ignatius Donnelly. Page 472.\n\n    [4] _Ibid._, page 115.\n\n    [5] _Ibid._, page 234.\n\n    [6] _Ibid._, page 178.\n\n    [7] \"Circumcision.\" A. B. Arnold. _New York Med. Record_, Feb. 13,\n          1886.\n\n    [8] \"Atlantis,\" page 178.\n\n    [9] This word is, in the Mandan, _Maho-peneta_; in the Welsh,\n          _Mawr-penaethir_. \"Atlantis,\" page 115.\n\n    [10] \"Cyclopedia of Biblical, Theological, and Ecclesiastical\n          Literature,\" vol. viii, page 58. Article, Phallus.\n\n    [11] \"Origine, Signification et Histoire, de la Castration, de\n          l'eunuchism, et la circoncision.\" Par. F. Bergmann. Published\n          in the \"Archivio per le Traditione Populaire,\" 1883.\n\n    [12] \"Dictionaire des Sciences Medicales.\" Par une Societe de\n          medecins et de Chirurgiens. Paris, 1826, 60-volume edition.\n\n    [13] Dr. Delange mentions a peculiar social habit or custom among a\n          tribe of Arabians that in a sociological sense is worth\n          mentioning. He observes that for these dances females are\n          preferred, but owing to the peculiar habit about to be related\n          it is impossible to have any of the village women in Algeria\n          assist at this part of the festivities; hence the men have to\n          do the dancing. It appears that the females of one tribe--this\n          being the tribe of Ouleds-Nails, who live on the southern\n          borders of Algiers--are in the habit, when young, of\n          emigrating to the oases of the Sahara, which are occupied by\n          the French and traveling Arabs, where they give themselves up\n          to a life of prostitution. After having exercised this life\n          for some years they return to the tribe with a dowry in money,\n          besides an ample supply of clothes and jewelry,--the result of\n          their economy,--which enables them to contract favorable\n          marriages. This practice is so common in this one particular\n          tribe, and so much have they monopolized the profession of\n          courtesan, that the name of the tribe of Ouleds-Nails is in\n          Arabia synonymous with that of courtesan. These young women\n          dance every evening in the Arab cafes, and are at times\n          employed to do the dancing at Arab feasts. For this reason no\n          self-respecting Arab woman ever allows herself to dance in\n          public, or why the practice of both sexes dancing together is\n          not practiced in Algerian villages, as a man would thereby\n          consider himself disgraced.--Dr. Delange, in _Receuil de\n          Memoires de Medecine de Chirurgie et de Pharmacie Militaire_,\n          No. 105, August, 1868.\n\n    [14] \"Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim\n          Interpretis primarii, De Turcarum Liturgia, peregrinatione\n          Meccana, Circumcisione, AEgrotorum Visitatione,\" etc. Oxonii,\n          1690.\n\n    [15] Michel Le Feber. \"Le Theatre de la Turquie.\" Paris, 1681.\n\n    [16] \"La Circoncision, Sa Signification Social et Religieuse.\" Par\n          M. Paul Lafargue, in the _Bulletins de la Societe\n          d'Anthropologie de Paris_. Tome x, 3d fascicule, Juin a\n          Octobre, 1887.\n\n    [17] \"Circumcision.\" By A. B. Arnold. _New York Med. Record_, Feb.\n          13, 1886.\n\n    [18] Bancroft's \"Native Races,\" vol. ii, page 278.\n\n    [19] \"Recherches Philosophiques sur les Americains, ou Memoires\n          Interessants pour servir a l'Histoire de l'Espece Humaine.\"\n          Par M. de P. Edition par Dom Pernety. Tome ii. Article,\n          Circoncision, Berlin, 1774.\n\n    [20] \"The Family, a Historical and Social Study.\" By Charles\n          Franklin Thwing. Boston, 1887.\n\n    [21] The \"Recherches Philosophiques sur les Americains\" and Virey,\n          in the 24th volume of the \"Dictionaire des Sciences\n          Medicales,\" are very full on this subject, and for fuller\n          information the reader is referred to those works.\n\n    [22] \"Cause Morale de la Circoncision des Israelites, Institution\n          Preventive de l'Onanisme des Enfants.\" Par le Docteur Vanier,\n          du Havre. Paris, 1847.\n\n    [23] \"Annual Report of the Bureau of Ethnology.\" By J. W. Powell.\n          Washington, 1881, 1882.\n\n    [24] \"Among Cannibals, or Four Years' Travels in Australia.\" By Carl\n          Lumholtz. Page 46. Charles Scribner & Son, 1889.\n\n    [25] These interesting historical facts in relation to the holy\n          prepuce were published in the _Journal l'Excommunier_ in\n          January of 1870, when the writer was in France. They were\n          contributed by A. S. Morin, of Miron, a learned\n          historiographer and antiquary. Europe has not recovered from\n          its love of the supernatural that it had so strongly in the\n          middle ages. The blood of St. Gennaro still liquefies once a\n          year, and many churches still claim to possess the identical\n          winding sheet that served our Lord prior to his resurrection,\n          as well as more than one church has the holy cloth that St.\n          Veronica used on the way to Calvary, which has an impression\n          of the face of the Saviour.\n\n    [26] This church has a remarkable history connected with its\n          foundation. The tradition relates that in the dark ages some\n          sacrilegious soldier had robbed a church in the neighborhood\n          of its holy vessels of gold and silver. In the vessel in the\n          Tabernacle there happened to be a consecrated wafer. The\n          soldier journeyed on to Turin to dispose of his plunder, when,\n          on arriving at the spot on which the church now stands, the\n          wafer is said to have ascended miraculously to some distance\n          above the soldier's head, while at the same time the mule he\n          rode, being imbued with more religious piety than his master,\n          reverently knelt down on his front legs. The holy wafer was\n          now encircled by a halo of shining light; this, with the\n          kneeling donkey and the soldier raining blows on the pious\n          animal, while he himself was unconscious of the presence of\n          the host above him, attracted the attention of the populace,\n          who apprehended the soldier, on whom the stolen vessels were\n          found. The bishop in his pontificial robes, in solemn\n          procession, received the consecrated wafer, which promptly\n          descended into pious hands. The donkey was adopted by the\n          bishop and the soldier was promptly hanged, in accordance with\n          the general treatment of thieves in those days. The writer has\n          more than once seen a flagstone inclosed within a railing that\n          occupies the central spot of the floor or pavement of the\n          church, it being the identical spot on which the donkey knelt.\n\n    [27] Rush's \"Medical Inquiries,\" vol. i, page 217.\n\n    [28] Fothergill. \"Gout in its Protean Aspects,\" page 158.\n\n    [29] \"Philosophy of Magic,\" from the French of Eusebe Salverte, vol.\n          ii, page 143.\n\n    [30] \"Dictionaire des Sciences Medicales.\" Cullerier. Article,\n          Phimosis. Vol. xli.\n\n    [31] Bergmann has gone into this subject at length, and the writer\n          has drawn freely from his brochure on \"Castration and\n          Eunuchism,\" reprinted from the \"Archivio per le Traditione\n          Populaire\" of 1883.\n\n    [32] \"The Hermit.\" By the Rev. Charles Kingsley. See Introduction.\n\n    [33] \"Dictionaire des Sciences Medicales,\" vol. liv, page 570.\n\n    [34] _Ibid._, page 567.\n\n    [35] _Ibid._, page 570.\n\n    [36] \"Cyclopedia of Biblical, Theological, and Ecclesiastical\n          Literature,\" vol. iii, page 351.\n\n    [37] Smollett gives a good account of the Carthagena expedition in\n          his \"Roderick Random,\" and for a good satisfactory detail of\n          the blundering Walcheren expedition the reader is referred to\n          Harriet Martineau's \"History of England,\" vol. i, pages 269,\n          272, 273, and 354.\n\n    [38] Schoopanism, or paederastia, is at times practiced by the\n          Omahas, and the man or boy who suffers as the passive agent is\n          called _min-quga_, or hermaphrodite.--\"Third Annual Report of\n          the Bureau of Ethnology.\" By J. W. Powell. Washington, 1881,\n          1882.\n\n    [39] When the missionaries first arrived in this region they found\n          men dressed as women and performing women's duties who were\n          kept for unnatural purposes. From their youth up they were\n          treated, instructed, and used as females, and were even\n          frequently publicly married to the chiefs or great\n          men.--Bancroft's works, vol. i, \"Native Races,\" page 415.\n\n    [40] \"Recherches Philosophiques sur les Americains,\" tome ii.\n\n    [41] \"The History of the Hebrew Commonwealth.\" From the German of\n          John Jahn, D.D. Page 25. Oxford, 1840.\n\n    [42] \"L'Hermaphrodite devant le Code Civil.\" Par le Docteur Charles\n          Debierre. Bailliere et Fils. Paris, 1886.\n\n    [43] \"Recherches Philosophiques sur les Americains,\" tome ii, page\n          78.\n\n    [44] \"L'Hermaphrodite devant le Code Civil.\" Debierre.\n\n    [45] _Occidental Medical Times_, Sacramento, Cal., October, 1890,\n          page 543.\n\n    [46] \"Dictionaire des Sciences Medicales,\" vol. xxxi., page 41.\n\n    [47] _British and Foreign Medico-Chirurgical Review_, vol. xviii,\n          1856.\n\n    [48] \"L'Hermaphrodite devant le Code Civil.\" Debierre.\n\n    [49] Sir Thomas Brown's works, vol. ii, \"Religio Medici.\"\n\n    [50] \"The Bible and other Ancient Literature in the Nineteenth\n          Century.\" L. T. Townsend, D.D. Chautauqua press, 1889. See\n          pages 32-45.\n\n    [51] \"The Religions of the Ancient World.\" George Rawlinson, M.A.\n          Alden edition of 1885. Page 174.\n\n    [52] \"The Intellectual Development of Europe.\" John W. Draper. Vol.\n          ii, page 113.\n\n    [53] _Ibid._ vol. ii, page 122.\n\n    [54] In \"Clarke's Commentary,\" vol. i, page 113, the reason of\n          choosing the eighth day is given. Circumcision was not only a\n          covenant, but an offering to God; and all born, whether human\n          or animal, were considered unclean previous to the eighth day.\n          Neither calf, lamb, or kid was offered to God until it was\n          eight days old.--Lev., xxii, 27.\n\n    [55] A father circumcised his children and the master his slaves. In\n          case of neglect the operation was performed by the magistrate.\n          If its neglect was unknown to the magistrate, then it became\n          the duty of the Hebrew, upon arriving of age, to either do it\n          himself or have it done.--\"Clarke's Commentary,\" vol. i, page\n          113.\n\n    [56] Bishop Newton points out the remarkable analogy that marks the\n          Hebrew race as descendants of Isaac and the Arab race as the\n          descendants of Ishmael, from whom sprung the Saracenic people.\n          These are the only two races that have gone on in their purity\n          from their beginning. They intermarry only among themselves\n          and have, alike, the same customs and habits as their fathers.\n          The sculptured faces of the Hebrew on the Babylonian monuments\n          are the same faces that are met in the synagogues of Paris or\n          New York. So with the descendants of Ishmael, in whom there\n          flows partly the blood of the dominant element of ancient\n          Egypt; neither custom, habit, nor physiognomy have changed. In\n          these two races, as observed by Bishop Newton, we have an\n          ocular demonstration of the Divine origin of our faith, if\n          verification of Scripture history is any criterion.--\"Clarke's\n          Commentary,\" vol. i, page 111; also, Hosmer's \"Story of the\n          Jews,\" page 5.\n\n    [57] \"Cause Morale de la Circoncision.\" Vanier, du Havre. Pages\n          40-45.\n\n    [58] \"De la Circoncision.\" Par le Dr. S. Bernheim. Page 7. Paris,\n          1889.\n\n    [59] \"Cyclopedia of Biblical, Theological, and Ecclesiastical\n          Literature,\" vol. ii, page 350.\n\n    [60] Among the Semitic race, however, it seems possible to bring\n          forward better evidence than this of an early Stone Age. If we\n          follow one way of translating we find, in two passages of the\n          Old Testament, an account of the use of sharp stones or stone\n          knives for circumcision,--Exodus, iv, 25: \"And Zipporah took a\n          stone\"; and Joshua, v, 2: \"At that time Jehovah said to\n          Joshua, Make thee knives of stone.\" ... The Septuagint\n          altogether favors the opinion that the knives in question were\n          of stone, by reading, in the first place, a stone or pebble,\n          and, in the second, stone knives of sharp-cut stone. These are\n          mentioned again in the remarkable passage which follows the\n          account of the death and burial of Joshua (Joshua, xxiv, 29,\n          30),--\"And it came to pass, after these things, that Joshua,\n          the son of Nun, the servant of Jehovah, died, being a hundred\n          and ten years old, and they buried him in the border of his\n          inheritance in Timnath Serah, which is in Mount Ephraim, on\n          the north side of the hill of Gaash.\" Here follows, in the\n          LXX, a passage not in the Hebrew text, which has come down to\n          us: \"And there they laid with him in the tomb, wherein they\n          buried him there, the stone knives wherewith he circumcised\n          the children of Israel at the Gilgals, when he led them out of\n          Egypt, as the Lord commanded. And they are there unto this\n          day.\" The rabbinical law, in connection with this subject,\n          reads as follows: \"We may circumcise with anything, even with\n          a flint, with crystal (glass), or with anything that cuts,\n          except with the sharp edge of a reed, because enchanters made\n          use of that, or it may bring on a disease; and it is a\n          precept of the wise men to circumcise with iron, whether in\n          the form of a knife or scissors, but it is customary to use a\n          knife.\" This mention of the objectionable nature of the reed\n          as a circumcising medium is attributed to the danger that may\n          arise from splinters. The Fiji Islanders use both a rattan\n          knife and a sharp splinter of bamboo in performing\n          circumcision and in cutting the umbilical cord at child-birth.\n          Herodotus mentions the use of stone knives by the Egyptian\n          embalmers. Stone knives were supposed to produce less\n          inflammation than those of bronze or iron, and it was for this\n          reason that the Cybelian priests operated upon themselves with\n          a sherd of Samian ware (Samia testa), as thus avoiding danger.\n          There seems, on the whole, to be a fair case for believing\n          that among the Israelites, as in Arabia, Ethiopia, and Egypt,\n          a ceremonial use of stone instruments long survived the\n          general adoption of metal, and that such observances are to be\n          interpreted as relics of an earlier Stone Age.--\"Researches\n          into the Early History of Mankind.\" By Edward B. Tylor. Pages\n          217-220. London, 1870.\n\n    [61] The cannibals of Australia do not eat white people, as the\n          flesh of these produces a nausea, which the flesh of the\n          vegetable-fed blacks does not do. The rice-fed Chinese are\n          considered a treat, and these are slaughtered in great number,\n          ten Chinamen having been served up at one dinner.--\"Among\n          Cannibals.\" By Carl Lumholtz. Page 273.\n\n    [62] \"Cause Moral de la Circoncision.\" Par le Dr. Vanier. Page 266.\n\n    [63] _Ibid._, page 288.\n\n    [64] _Cincinnati Clinic_, vol. ii, page 165.\n\n    [65] \"The Story of the Jews.\" Hosmer. Page 263.\n\n    [66] \"Traite d'Hygiene, publique et privee.\" Michel Levy. 2d.\n          edition, vol. ii, page 754.\n\n    [67] _Ibid._\n\n    [68] \"Diseases of Modern Life.\" B. W. Richardson. Page 19.\n\n    [69] \"Longevity and other Biostatic Peculiarities of the Jewish\n          Race.\" By John Stockton Hough, M.D. _New York Med. Record_,\n          1873.\n\n    [70] \"Vital Statistics of the Jews.\" By Dr. John S. Billings. _North\n          American Review_, No. 1, vol. 152, page 70, January, 1891.\n\n    [71] \"On Regimen and Longevity.\" By John Bell, M.D. Page 13.\n\n    [72] _British and Foreign Medico-Chirurgical Review_, vol. xliii,\n          page 539.\n\n    [73] _Ibid._, vol. xlii, page 17.\n\n    [74] In \"Influence of the Trades on Health,\" Thakrah mentions the\n          peculiar exemption enjoyed in this regard by the butcher\n          class. He quotes Tweedie in saying that he never saw a butcher\n          admitted to the fever hospital.\n\n    [75] Lancereaux. \"Distribution de la Phthisie Pulmonaire.\"\n\n    [76] Ashhurst. \"Int. Enc. Surgery.\"\n\n    [77] Horner. \"Naval Practice.\"\n\n    [78] _Cincinnati Lancet and Observer._, vol. xvi, 1873.\n\n    [79] It may well be a question of some interest whether the atrophy\n          of the testicle in the aged may not at times be partly due to\n          the compression exercised by the prepuce on the glans through\n          reflex action, and whether at times the virility that is\n          departing cannot be restored by circumcision in such cases. I\n          have seen such results, being guided to the idea by the\n          Biblical relation in the case of Abraham.\n\n    [80] This patient subsequently died of a uraemic complication\n          following on an attack of fever. The man was in his prime, and\n          had been of most exemplary habits. The fever that he had was,\n          I had every reason to believe, directly due to the results of\n          imperfect blood depuration incident on the irritability of his\n          kidneys, which, retroactively, again allowed the uraemic\n          condition to assume that dangerous degree that suddenly and\n          very unexpectedly to his friends and family ushered the\n          patient into eternity. This man had only been merely\n          inconvenienced by his prepuce up to the time that it caused\n          his death. It is interesting to observe what little trifles\n          bring about the end of some men. The unlucky habit of putting\n          the royal countenance on paper brought Louis XVI to a sudden\n          halt at Varennes, and his head to the scaffold. The lucky\n          meeting of the _aides_ of Bonaparte and Desaix between Novi\n          and Marengo gave to France its empire and to Europe the\n          enlightenment that was diffused by that event. If such trifles\n          affect individuals and nations, we must not be astonished that\n          the little useless prepuce should be endowed with the\n          mischief-working power of the historical old cow and kerosene\n          lamp that reduced Chicago to ashes.\n\n    [81] In the London _Lancet_ for 1885 there is a very interesting\n          communication at page 46 on this subject. There is no doubt\n          but that the prepuce offers the best skin-grafting material.\n\n    [82] In the seventeenth volume (third series) of \"Guy's Hospital\n          Reports\" there is a most interesting report at page 243 of a\n          case of skin-grafting that was performed by Thomas Bryant. The\n          case was an extensive ulcer resulting from an injury. Bryant\n          took some skin-grafts from the man's arm and some from a\n          colored man in an adjoining bed. The account gives the daily\n          report as taken from the note-book of Mr. Clarke, and is\n          accompanied by a colored plate to illustrate the subject; the\n          proliferation of the black skin is astonishing. In closing the\n          report Mr. Clarke says: \"But in the figures depicted the\n          amount of increase in the black patches will be well seen. In\n          ten weeks the four or five pieces of black skin, which\n          together were not larger than a grain of barley, had grown\n          twentyfold, and in an another month the black patch was more\n          than one inch long by half an inch broad, the black centres of\n          cutification having clearly grown very rapidly by the\n          proliferation of their own black cells.\"\n\n    [83] _American Journal Med. Sciences_, vol. lx.\n\n    [84] \"Circumcision.\" By Dr. A. B. Arnold, of Baltimore.\n\n    [85] \"De la Circoncision.\" By Dr. S. Bernheim. Paris.\n\n    [86] The reader is referred to a very interesting paper detailing\n          conditions of adhesions in the _American Journal Med.\n          Sciences_ for July, 1872. It is taken from the Hungarian of M.\n          Bokai.\n\n    [87] _New York Med. Journal_, vol. xxvi.\n\n    [88] _American Journal Med. Sciences_, vol. lx.\n\n    [89] Dr. Vanier describes this operation of Celsus mentioned by\n          Vidal in his work on \"Circumcision,\" at page 294, which\n          consisted in making, by a circular incision immediately back\n          of the glans, like in a circular amputation, a complete\n          detachment of the integument from back of the corona. The\n          penis was then made to retreat into the sheath thus made and a\n          short catheter introduced into the urethra, to the end of\n          which the free end of the new preputial fold was made fast, a\n          piece of oiled lint being interposed between the raw inner\n          surface and the glans. Another operation consisted in\n          forcibly drawing the integument forward and in making a number\n          of transverse incisions in the integument so as to assist its\n          extensibility. By these means it was drawn sufficiently\n          forward so as to fasten it to a canula or catheter made fast\n          in the urethra. But it can well be imagined that a person must\n          possess the most exalted idea of the physiological needs of a\n          prepuce and feel the most sensitive need of such an appendage\n          to submit to the first of these operations, although it is\n          more than probable that many Jews submitted to the operation\n          in the days of Celsus to avoid being exiled or plundered of\n          all their possessions. The resulting prepuce could not have\n          been a much more unsightly appendage than that which ornaments\n          the overburdened virile organ of many Christians, and there is\n          no doubt but that in many cases they passed muster.\n\n    [90] \"Circumcision.\" Dr. A. B. Arnold.\n\n    [91] Ashhurst. \"Int. Enc. Surgery,\" vol. vi.\n\n    [92] \"Pertes Seminales.\"\n\n    [93] \"Circoncision.\" Dr. Vanier, du Havre.\n\n    [94] \"Dictionaire des Sciences Medicales.\"\n\n    [95] Erichsen's \"Surgery,\" page 1144. Edition of 1869.\n\n    [96] _Medical News_ of Philadelphia, page 115. Vol. for 1860.\n\n    [97] \"Pertes Seminales.\" In the fourth American edition of the\n          English translation of McDougall of Lallemand we find that he\n          fully appreciated the dangers that lurk in a prepuce. At page\n          216 he says: \"Such is the condition which the parts present in\n          cases of recent balanitis, and these are the inflammations and\n          ulcerations that cause more or less extensive adhesions of the\n          prepuce to the glans. Such adhesions are generally cellular,\n          but sometimes fibrous or even cartilaginous, according to the\n          severity and frequent repetition of the inflammation. Various\n          degrees of induration also results according to the intensity,\n          the duration, and the frequency of the phlogosis. Thus, I have\n          often found a mucous membrane hardened, thickened, and covered\n          with numerous papillae, sometimes fibrous or cartilaginous,\n          with three times its natural thickness. I have also met with\n          cases in which the prepuce has become cancerous. I have\n          operated in several cases of cancer of the penis, too, which\n          certainly arose from no other cause. The patients were\n          generally peasants between fifty and sixty years of age, who\n          had never known other than their own wives, but who had\n          frequently suffered from balanitis attended by abundant\n          discharge, swelling of the prepuce, and excoriation of its\n          opening, which was so contracted as to prevent the passage of\n          the glans. I have seen one case, also, in which balanitis,\n          irritated by a forced march and the abuse of alcoholic\n          stimulants, passed into gangrene, by which the greater part of\n          the glans was destroyed. Such have been the accidents which I\n          have observed on those whose prepuce was too narrow to permit\n          the glans being uncovered; accidents which I can only\n          attribute to the long retention of the sebaceous matter in a\n          kind of _cul-de-sac_, into which a certain quantity of urine\n          passes every time the patient makes water.\"\n\n    [98] Claparede. \"La Circoncision.\"\n\n    [99] Baron Boyer. \"Traite des Maladies Chirurgicales,\" vol. x, page\n          370.\n\n    [100] I have practiced considerably among the Jewish people, but I\n          have never seen their elderly men suffer with prostatic\n          troubles like our own people who are uncircumcised. From\n          having observed the tendency to prostatic complications in\n          young people with troublesome prepuces, and that the great\n          number of the elderly people who are affected with prostatic\n          disease or enlargement are the unlucky possessors of long or\n          large prepuces, I have arrived at the conclusion that the\n          prepuce can be entered as a factor in the etiology of enlarged\n          prostate.\n\n    [101] I have now under my care a poor consumptive who has all the\n          appearance of having always been as virtuous as Joseph, but\n          who, unlike Joseph, has from infancy had as a constant\n          companion a long, miserable, smegmanous, and annoying prepuce.\n          The young man has an oedema which first affected his feet, but\n          one day, owing to the irritation of a slight balanitis, the\n          prepuce swelled at once; it proceeded through the penis\n          integument to the scrotum; the penis itself retracted, leaving\n          the integument and scrotum to assume a translucent, puffy,\n          cork-screw appearance and attitude; from its labyrinthic\n          passage the urine slowly dribbles during urination in a\n          scalding stream. In addition to the physical sufferings, he is\n          tormented by the knowledge that his friends attribute all his\n          disease and troubles--since the occurence of the penile\n          oedema--to the fact that his earlier manhood must have been\n          indiscreet, as well as sinful. The laity cannot connect any\n          penile, scrotal, or testicular disease with anything except\n          venereal disease; and if the physician attempts to explain\n          matters, they simply look upon it as the good-natured and\n          well-intentioned efforts of the doctor to deceive them and to\n          cover up the shortcomings of some frail mortal. Many a poor\n          fellow has to leave this world under a cloud of mistrust and a\n          bad odor of past deviltry to which he is not entitled, and\n          suffer all this in addition to all his physical ills, owing to\n          his having been ornamented through life with an annoying\n          prepuce,--the luckless heritage of having been born a\n          Christian. Columbus in chains moralizing on the ingratitude of\n          this world is nothing to the poor invalid with a swollen\n          prepuce, innocently acquired, silently \"cussing\" the ignorance\n          of his relatives and friends.\n\n    [102] This patient, on convalescing, suffered considerable from the\n          action of numerous small carbuncles, resulting from the\n          toxaemic condition induced by the partial suppression of urine\n          that he at times suffered from, and, when nearly well, brought\n          on a serious relapse by the mail-bag appendage at the penis\n          working up the organ into a state of erection. While so\n          situated he had intercourse, and from 99 deg. his temperature\n          immediately rose to 1041/2 deg., where it remained for several days,\n          lengthening out his illness by several weeks, into a\n          long-protracted convalescence. The man is not yet circumcised,\n          and, from the knowledge that I have of his tendency to uraemia,\n          I feel that, although in his prime, a fever or an accident may\n          take him off at any moment.\n\n    [103] In looking over the literature of reflex neuroses and more\n          direct injurious results, I find that George Macilwain, in a\n          work on \"Surgical Observations on the More Important Diseases\n          of the Mucous Canals of the Body,\" published in London in\n          1830, calls special attention to the case of a man aged\n          thirty-eight, admitted to the Finsbury Dispensary, and who was\n          in the care of Mr. Hancock. The patient was suffering from\n          excruciating pain in different joints, the pain being so\n          great that he was confined to his bed and unable to stand on\n          his feet. He was unable to rest at nights, and neither\n          rheumatic nor any other apparently suitable treatment was of\n          any service. Rigors were soon added to his other troubles, and\n          during their continuance the pain in his joints was greatly\n          aggravated. He was referred to Mr. Macilwain for treatment,\n          who promptly relieved him by the removal of a urethral\n          stricture, which had quietly been the cause of all the\n          disturbance. It is particularly interesting that even at that\n          early day the reflex neuroses and complications that may arise\n          from the irritability of the genito-urinary organs were so\n          well understood. How well Dr. Macilwain appreciated the nicety\n          of these relations can be seen from his remarks in connection\n          with the above case, in which he says: \"It may be observed\n          that the severity of the symptoms is not always commensurate\n          either with the duration of the disease or the degree of\n          stricture, and that, although the progressive development of\n          them varies considerably in rapidity, in different\n          individuals, it is, nevertheless, in the latter stages, always\n          more rapid.\" Macilwain also graphically describes the\n          insidious approach of these genito-urinary troubles. In\n          speaking of stricture he says: \"Although minute inquiry\n          generally informs us that the stricture has been of some\n          standing, and in some instances has existed for years, yet it\n          may happen that it is only a few months or a year since the\n          patient's attention has been directed to the disease. This is\n          very intelligible; for, in conformity with what we observe in\n          other parts of the body, the bladder has a power of\n          accommodating itself to a change of circumstances. Its\n          strength, for a long time, may increase so correctly in\n          proportion to the increase of the obstacle which opposes the\n          ejection of its contents that a very considerable period\n          elapses before the difficulty in making water becomes\n          cognizable to the patient, or it occasions an annoyance so\n          trifling as scarcely to excite his attention. This increase of\n          strength in the bladder frequently renders the formation of\n          stricture so insidious that the urethra at the affected part\n          is very narrow before the individual is aware of the existence\n          of any contraction whatever; the bladder, however, at length\n          becomes unable to empty itself, and the abdominal muscles and\n          diaphragm powerfully act as coadjutors, so that each effort to\n          make water is accompanied by a straining which is very\n          distressing, and the complete evacuation of the bladder is\n          often not accomplished even by these combined forces. The\n          straining which accompanies stricture, and which seems\n          necessary to evacuate the bladder, although it be occasionally\n          exceedingly annoying to the patient at the time, is more\n          important with reference to the results which are its\n          consequence. I am firmly of opinion that there are a great\n          number of patients laboring under hernia which has been\n          produced by no other cause. I must confess that I had seen a\n          great number of instances of stricture in ruptured patients\n          before I drew any inference from the observation of their\n          co-existence.\" The foregoing observations of Macilwain, made\n          in 1830, are here reproduced for their clearness of expression\n          and explanation, as well as to show what injuries can be\n          produced on the young child afflicted with phimosis. We are,\n          as surgeons, familiar with the anatomical and pathological\n          changes there are undergone by the bladder and its lining\n          membrane, as well as in the ureters and kidneys, in many\n          cases of stricture, as well as of the great amount of\n          prostatic irritability and enlargement that is due to the same\n          cause. How similarly these results can be and are actually\n          produced by phimosis is undeniably expressed by the\n          post-mortem appearances in the poor infant described by\n          Golding Bird to the London Medical Society, and mentioned in\n          the London _Lancet_ of May 16, 1846. The bladder and ureter\n          were like those of a man who had long suffered from stricture.\n          From the remarks of Dr. J. Lewis Smith, that phimosis may be\n          productive of inguinal hernia and prolapsus of the rectum, and\n          the observations of Edmund Owens and Arthur Kemp, both high\n          authorities on children's diseases, being both connected with\n          children's hospitals, as well as the remarks of Mr. Bryant in\n          his \"Surgical Diseases of Children,\" who all concur in looking\n          upon phimosis as a great factor in hernia, Bryant having\n          observed thirty-one in fifty consecutive cases of phimosis, we\n          are certainly warranted in assuming that phimosis is not only\n          a mere local timely inconvenience that will disappear with the\n          approach of puberty, but a condition which, in the more easily\n          affected organism of the child,--lacking, as it does, that\n          resistance that comes with our prime,--is productive of\n          serious harm; as even the first few years of life, even a few\n          months of infant life, with a phimosis, are sufficient to so\n          change the structures of parts that the poor child will grow\n          into a man with an impaired kidney or sacculated ureter. The\n          strain required to induce a prolapsus of the bowel or a\n          rupture into the inguinal canal is exerted as much on the\n          bladder, ureter, and kidney as on the other localities.\n          Physicians who have taken the pains to observe must have\n          noticed, more than once, how the child afflicted with a\n          phimosis has not only at times to wait for the stream of urine\n          to appear, there seemingly being some obstruction to its\n          starting, but how often such a case is afflicted with a\n          stammering, halting urination. A child thus started out into\n          life, with a defective kidney or kidneys, is sadly handicapped\n          in his usefulness, comfort, or in properly competing in the\n          race of life. No parent would for a moment think of starting\n          his son in life by giving him a business that is heavily\n          mortgaged at the start, but many a parent unconsciously\n          launches the unsuspecting child into a life of such ill\n          health--resulting from a simple narrow prepuce--beside which a\n          heavy mortgage or a heavy yearly tribute would be but a mere\n          trifle. I have seen such men, who in after life, broken-down\n          and perfectly physical wrecks, would gladly have given all\n          their wealth and been willing to have some genii set them down\n          in the middle of the Sahara, shirtless and pennyless, provided\n          they had their health. To say nothing of the trifling loss of\n          the prepuce, these parties would gladly have had a foot or a\n          leg go with the prepuce if necessary, and have their health.\n\n    [104] I have often performed dilatation where, for some reason,\n          either the timidity of the parents or the health of the child\n          seemed to contraindicate any more radical procedure. It is\n          customary to advise mothers or the nurses to retract the skin\n          daily, but even after a good dilatation I have found as sudden\n          a recontraction, and even in the majority of cases, where\n          daily drawing back the skin might have been practicable, the\n          cries and struggles of the child are a positive prohibition to\n          these instructions being carried out; it is not once in ten\n          times that it can be carried out. I have seen two very\n          annoying cases of paraphimosis resulting from this procedure,\n          the struggles of the child having prevented the return of the\n          prepuce to its proper place, and the violent crying and\n          sobbing of the child having assisted to congest the organ.\n\n    [105] It may well be a question, considering the well-established\n          fact that nervous injuries and affections are easily\n          transmissible and become hereditary, how much\n          feeble-mindedness is due to an heredity originally induced in\n          either parent through reflex neuroses from the genital organs.\n          The Jews have a very small percentage of feeble-minded; it is\n          true that they have not any inebriates to assist in their\n          manufacture, but still the absence of these well-pronounced\n          cases of reflex neuroses among the race must be largely\n          ascribed to their practice of circumcision, as that operation\n          cures the gentiles so afflicted.\n\n    [106] I have seen precisely similar conditions resulting from a\n          sphincterismus being relieved by anal dilatation. I had one\n          such case who had fallen into the hands of a quack, who made\n          him believe that he was being affected with incipient\n          softening of the brain; systematic dilatation or a rupture of\n          the sphincter _a la_ Van Buren is the appropriate remedy.\n\n    [107] In the first volume of the \"American and English Encyclopedia\n          of Law\" there is an interesting account of a young child (who\n          had been bound out by the parish officials) who murdered his\n          little bed-fellow and, on trial and conviction, was sentenced\n          to be hanged, but who was reprieved by royal favor on account\n          of his tender years, the sentence being changed to\n          imprisonment for life. The little fellow was only eight years\n          of age. On the trial the boy said he was driven to commit the\n          crime because the other child soiled the bed. The two children\n          being both paupers, it may well be imagined that their bedding\n          was none of the cleanest at the best, or that their bed-room\n          had the best of ventilation. As at the time the murder was\n          committed English paupers were not treated in the most humane\n          manner, it is not surprising that a nervous, sensitive child\n          would, under such a combination of circumstances, be converted\n          into an insane murderer.\n\n    [108] The study of prematurely acquired impotence in the male is a\n          most interesting one. I have frequently seen it result from\n          the presence of anal or rectal irritation, from haemorrhoids. I\n          have seen cases who could not have erections, and in whom all\n          sexual desire was extinct at a very early age, who have\n          informed me that, although unable to have sexual intercourse\n          because of the total absence of sexual desire, the flaccidity\n          of the organ, and the want of sound physiological organic\n          functional activity to suggest the thought, they had,\n          nevertheless, frequently been the victims of nocturnal\n          emissions before the total extinction of the function. As a\n          rule, much of this premature impotence--induced by either\n          irritation of the genital organs or rectal or anal\n          troubles--runs its unfortunate possessor through such a course\n          of physical incidents as described by Hammond, as the wild\n          Indians of the Southwest induce in the _mujerado_. At first\n          the sound organ responds in a natural manner to any stimulus\n          that may affect it, but soon a local satyriacal condition is\n          set up, which, running a more or less rapid period of intense\n          activity, soon leaves its victim completely, permanently, and\n          hopelessly impotent, even as much so as if eunuchized in the\n          most approved manner. Hammond's description of the manner in\n          which these unfortunates are manufactured is an interesting\n          addition to the facts contained in the natural history of man,\n          and is as follows: \"A _mujerado_ is an essential person in the\n          saturnalia, or orgies, in which these Indians, like the\n          ancient Greeks, Egyptians, and other nations, indulge. He is\n          the chief passive agent in the pederastic ceremonies which\n          form so important a part in the performances. These take place\n          in the spring of every year, and are conducted with the utmost\n          secrecy, as regards the non-Indian part of the population. For\n          the making of a _mujerado_ one of the most virile men is\n          selected, and the act of masturbation is performed upon him\n          many times every day; at the same time he is made to ride\n          almost continuously on horseback. The genital organs are thus\n          brought, at first, into a state of extreme erethism, so that\n          the motion of the horse is sufficient to produce a discharge\n          of seminal fluid, while at the same time the pressure of the\n          body on the animal's back--for the riding is done without a\n          saddle--interferes with their proper nutrition. It eventually\n          happens that, though an orgasm may be caused, emissions can no\n          longer be effected, even upon the most intense degree of\n          excitation. Finally, the accomplishment of an orgasm becomes\n          impossible; in the meantime the penis and testicles begin to\n          shrink, and in time reach their lowest plane of degradation.\n          But the most decided changes are at the same time going on,\n          little by little, in the instincts and proclivities of the\n          subject. He loses his taste for those sports and occupations\n          in which he formerly indulged, his courage disappears, and he\n          becomes timid to such an extent that, if he is a man occupying\n          a prominent place in the council of the pueblo, he is at once\n          relieved of all power and responsibility, and his influence is\n          at an end. If he is married his wife and children pass from\n          under his control,--whether, however, through his wish or\n          theirs, or by the orders of the council, I could not\n          ascertain. They certainly become no more to him than other\n          women and children of the pueblo.\" Hammond examined one of\n          these men, who had, as he himself informed him, formerly\n          possessed a large penis and testicles \"grande como\n          huevos,\"--as large as eggs. The penis was in its flaccid state\n          and about an inch and a half in length, with the glans about\n          the size of a thimble, which it very much resembled in shape.\n          The glandular structure of the testicles had disappeared; they\n          were atrophied, little besides connective tissue remaining. He\n          examined another _mujerado_ in the pueblo of Acoma, who had\n          been so made when at about the age of twenty-six. The penis\n          was not more than an inch in length and about the diameter of\n          the little finger, and of the testicles there was apparently\n          nothing left but a little connective tissue. Both of these men\n          had high-pitched voices. The last one examined was then\n          thirty-six years of age. (Hammond: \"Male Impotence.\") The\n          foregoing detailed description shows an extreme degree of\n          results produced by an equally extreme degree of intense and\n          persistent irritation applied to the genital organs, purposely\n          employed to obtain certain results. In the cases cited the\n          irritation or excitation is directly applied, but it is safe\n          to assume that reflex irritability from the anus or rectum,\n          or from that of a stricture or of a prepuce, will in some\n          cases produce a certain degree of excitation in the testicles\n          that may result in their functional or organic derangement, in\n          a degree proportionate to that of the amount of excitation\n          from which they have suffered. That the testicles are very apt\n          to suffer from the existence of a stricture is a well-known\n          fact. I have myself worried over a case of stricture, in whom\n          the attempted passage of a filiform bougie was always\n          immediately followed by a severe attack of epididymitis, and\n          who had always been afflicted with a tenderness and a tendency\n          to inflammation of the testes. I have also noticed a much\n          greater tendency to orchitis in the wearer of an irritating\n          prepuce than where it was absent; so that the presence of a\n          satyriacal tendency, no matter in what proportion of a degree\n          it may be present, can safely be assumed to result in a\n          corresponding degree of apathy, due to an actual physical\n          degeneration of the parts. That these conditions, when present\n          in any degree of permanency or persistence, will in the end\n          induce early impotence, I have no reason to doubt. In this\n          regard we must not overlook the fact that persons with\n          phimosis, stricture, or other genital irritants and\n          impediments, are more liable to be afflicted with haemorrhoids,\n          prolapsus ani, or other anal and rectal irritation, which\n          retroactively assist in bringing about the condition under\n          question. How much this may have to do with certain prolific\n          peculiarities among the Jews may well be questioned; it is a\n          well-known fact that in London the Jewish excess of male\n          births has been as high as eighteen per cent., while among the\n          Christian or Gentile population it is only six and one-half\n          per cent.,--a somewhat analogous condition of proportion being\n          also observable in the United States. Here, it is accounted\n          for, in a measure, by Dr. Billings, in the following words:\n          \"This comparatively large proportion of males among the Jews\n          is probably due to the fact that the death-rate of their\n          infants is less for males, as compared with females, than it\n          is among the average population.\" Children gotten during the\n          prime of life of the parents are naturally more virile and\n          have better stamina than those gotten before full maturity is\n          reached. If the father is on the verge of impotency just about\n          the time he is expected to beget his best offspring, that\n          offspring cannot be expected to present an extra amount of\n          vitality, virility, or physical stamina; hence, the prepuce\n          can be brought in as directly tending--in no matter how small\n          the degree it may be, but nevertheless a factor--to the\n          physical degeneracy of the race, as well as it demonstrates\n          the existence of some law for the production of the sexes\n          which we do not as yet fully comprehend. Aside from the above\n          considerations, there are those of the actual bar to the\n          increase of population which the prepuce induces, either by\n          primarily being the cause of impotence or by direct\n          interference, as already mentioned, and the impotence that\n          naturally results from the causes set forth in this note. The\n          results of a prepuce are certainly such as must act like a\n          moist, warm, and oily poultice to the irritability induced in\n          the most confirmed Malthusian when contemplating the--to\n          him--rapid and unwarranted increase of population.\n\n\n\n\nWORKS AND AUTHORITIES QUOTED.\n\n\nThese pour le doctorat en Medecine, par J. B. B. Edmond Nogues, sur la\nAnatomie, Physiologie, et Pathologie du Prepuce. Paris, 1850.\n\nThese a la faculte de Medecine de Strasbourg. Par J. B. A. Chauvin.\nConsideration sur le Phimosis et Operation de la Circoncision par un\nprocede nouveau. Strasbourg, 1851.\n\nDe la Circoncision chez les Egyptiens. F. Chabas. Paris, 1861.\n\nCause Morale de la Circoncision des Israelites. Vanier, du Havre. Paris,\n1847.\n\nLa Circoncision, son importance dans la Famille et dans l'Etat. Par le\nDocteur Claparede. Paris, 1861.\n\nDissertation sur la Circoncision, sons les rapports religieux,\nhygieniques, et Pathologiques. Par le Docteur Moyse Cahen. Paris, 1816.\n\nOrigine, Signification, et Histoire, de la Castration, de l'Eunuchisme,\net de la Circoncision. Par le Docteur F. Bergmann de Strasbourg.\nArchivio per le Tradizioni Populari, vol. ii.\n\nDarstellung der Biblichen Krankheiten. Von Dr. J. P. Trusen. Posen,\n1843.\n\nArchives Israelites de France, No. 9, 4em annee, Septembre, 1843.\n\nBulletins de la Societe d'Anthropologie de Paris. Tome x (serie iii), 3d\nfascicule, Juin a Octobre, 1887.\n\nRecueil de Memoires de Medecine, de Chirurgie, et de Pharmacie\nMilitaires. Tome xxi (serie iii), No. 105, August, 1868.\n\nTraite d'Hygiene, publique et privee. Michel Levy. 2d ed. Paris, 1850.\n\nNeuroses des Organes Genito-Urinaires de l'homme. Ultzmann. Paris, 1883.\n\nL'Hermaphrodisme, sa Nature, son Origine, ses Consequences Sociales. Par\nle Docteur Charles Debierre. Paris, 1886.\n\nL'Onanisme. Tissot. Lausanne, 1787.\n\nTraite de la nymphomanie. Dr. Bienville. Amsterdam, 1784.\n\nLa Folie Erotique. Par Prof. B. Balt. Paris, 1888.\n\nDes Pertes Seminales Involontaires. Lallemand. Paris, 1836.\n\nSpermatorrhoea. Lallemand and Wilson. Philadelphia, 1861.\n\nThe Philosophical Dictionary. Voltaire. London, 1765.\n\nOeuvres Completes, avec notes, etc. Montesquieu. Paris, 1838.\n\nDictionaire d'Hygiene, publique et de salubrite. Tardieu. Paris, 1862.\n\nGuide du Posthetomiste. Par le Docteur L. Terquem. Paris.\n\nLa Circoncision et ses suites. Par A.S. Morin. Ext. du Journal\nl'Excommunie, January, 1870.\n\nLa Circoncision. Par le Docteur S. Bernheim.\n\nCircumcision. By Dr. A. B. Arnold, of Baltimore. Reprint from the New\nYork Medical Journal of February 13, 1886.\n\nAmong the Cannibals. By Carl Lumholtz. New York, 1889.\n\nRecueil de Questions proposes par une Societe de savants voyageant an\nArabie, Michealis. Amsterdam, 1774.\n\nTractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim Interpretis\nprimarii, De Turcarum Liturgia, peregrinatione Meccana, Circumcisione,\nAEgrotorum Visitatione, etc. Oxonii, 1690.\n\nLe Theatre de la Turquie. Michel Le Feber. Paris, 1681.\n\nRecherches Philosophiques sur les Americains, ou Memoires Interessants\npour servir a l'Histoire de l'Espece Humaine. Par M. de P. Augumentee\npar Dom Pernety. Berlin, 1774. (Also the first edition of the same work\nprinted at Cleves in 1772.)\n\nHistory of the Hebrews' Second Commonwealth. Wise. Cincinnati, 1880.\n\nHistory of the Hebrew Commonwealth. Jahn. Oxford, 1840.\n\nJews' Letters to Voltaire. Philadelphia, 1848.\n\nThe Jewish Nation. Revised by Kidder. New York, 1850.\n\nThe Jews Under Roman Rule. By W. D. Morrison. New York, 1890.\n\nThe Story of the Jews. By James K. Hosmer. New York, 1887.\n\nThe History of the Jews. By the Rev. H. H. Milman. New York, 1843.\n\nEarly Oriental History. By John Eadie, D.D., LL.D. London, 1852.\n\nThe Bible and the Nineteenth Century. By L. T. Townsend, D.D. New York,\n1889.\n\nLegends of the Patriarchs and Prophets. By the Rev. S. Baring-Gould. New\nYork, 1884.\n\nThe Religions of the Ancient World. By George Rawlinson, M.A. New York,\n1885.\n\nThe Hermits. By the Rev. Charles Kingsley. New York, 1885.\n\nLetters on Demonology and Witchcraft. Letters addressed to J. G.\nLockhart, Esq., by Sir Walter Scott. London, 1831.\n\nThe Philosophy of Magic, Prodigies, and Apparent Miracles. From the\nFrench of Eusebe Salvert. New York, 1855.\n\nAtlantis, the Antediluvian World. Donnelly. New York, 1882.\n\nSir Thomas Browne's Works. London, 1852.\n\nPhysical Education, or the Health Laws of Nature. By Felix Oswald, M.D.\nNew York, 1882.\n\nThe Family: an Historical and Social Study. By Thwing. Boston, 1887.\n\nThe Intellectual Development of Europe. By John W. Draper, M.D. New\nYork, 1876.\n\nHistory of European Morals. By W. E. H. Lecky, M.A. New York, 1884.\n\nLongevity and other Biostatic Peculiarities of the Jewish Race. By John\nStockton Hough. Reprinted from New York Medical Record, 1873.\n\nVital Statistics of the Jews. By Dr. John S. Billings, in North American\nReview for January, 1891.\n\nOn Regimen and Longevity. By John Bell, M.D. New York, 1842.\n\nDiseases of Modern Life. By B. W. Richardson, M.D. New York, 1876.\n\nCyclopedia of Biblical, Theological, and Ecclesiastical Literature. By\nMcClintock and Strong. New York, 1886.\n\nEarly History of Mankind. Tylor. London, 1870.\n\nDictionaire des Sciences Medicales. 60-vol. edition. Paris, 1816.\n\nBritish and Foreign Medico-Chirurgical Review, vols. for 1846, 1854,\n1856, 1858, 1863, 1868, and 1869. London.\n\nBraithwaite's Retrospect of Medicine and Surgery.\n\nThe Chinese. By John Francis Davis, Esq., F.R.S. London, 1851.\n\nMassachusetts State Board of Health Report for 1873.\n\nOn Diseases of Children. Stewart. New York, 1844.\n\nDiseases of Children. West. Philadelphia.\n\nLectures on Diseases of Children. Henoch. New York, 1882.\n\nWomen's and Children's Diseases. Dillnberger. Philadelphia, 1871.\n\nMale Impotence. Hammond. New York, 1883.\n\nGenito-Urinary Diseases. Otis. New York, 1883.\n\nUrinary and Renal Diseases. Roberts. Philadelphia, 1885.\n\nUrinary and Renal Disorders. Beale.\n\nRenal and Urinary Organs. Black. Philadelphia, 1872.\n\nGout in its Protean Aspects. Fothergill. Detroit, 1883.\n\nVenereal Diseases. Bumstead and Taylor. Philadelphia, 1883.\n\nTraite sur les Maladies des Organes Genito-Urinaires. Civiale. Paris,\n1850.\n\nPathologic Chirurgicale, tome vi. Nelaton. Paris, 1884.\n\nPathologie Externe, tome v. Vidal (de Cassis). Paris, 1846.\n\nGuy's Hospital Reports, 3d series, vol. xvii. London, 1872.\n\nTransactions of the Ninth International Medical Congress, vol iii.\nWashington, 1887.\n\nAmerican Journal of Obstetrics for January, 1882.\n\nOn the Reproductive Organs. Acton. Philadelphia, 1883.\n\nOperative Surgery. Smith. Philadelphia, 1852.\n\nOperative Surgery. Stephen Smith. Philadelphia, 1887.\n\nSystem of Surgery. Gross. Philadelphia, 1859.\n\nPrinciples and Practice of Surgery. Agnew. Philadelphia, 1881.\n\nInternational Encyclopedia of Surgery. Ashhurst. Philadelphia, 1886.\n\nScience and Art of Surgery. Erichsen. Philadelphia, 1869.\n\nDiseases of the Kidneys. Ralfe. Philadelphia, 1885.\n\nThe Clinic. Cincinnati, 1872.\n\nAmerican Journal of the Medical Sciences for July, 1872; also vol. lx.\n\nNew York Medical Journal, vols. xvi, xix, xxvi.\n\nOccidental Medical Times. Sacramento, October, 1890.\n\nLondon Lancet, 1875.\n\nDistribution Geographique de la Phthisie Pulmonaire. Lancereaux. Paris,\n1877.\n\nAnnual Report of the Bureau of Ethnology. J. W. Powell. Washington,\n1884.\n\nWestern Journal of Medicine and Surgery. Louisville, 1846.\n\nNative Races of the Pacific Coast. Bancroft. San Francisco, 1875.\n\nEncyclopedia Britannica, 9th edition.\n\nClassical Dictionary. Lempriere. New York, 1847.\n\nCommentary on the Bible. Clark.\n\nSatellite for February, 1889, and January, 1891. Philadelphia.\n\nPedigree of Diseases. Hutchinson.\n\nMedical Inquiries. Rush. Philadelphia.\n\nHalf-Yearly Abstract of the Medical Sciences, vols. xii and lx,\nPhiladelphia.\n\nCincinnati Lancet and Observer, vol. xvi.\n\nStatistics and Climate of Consumption. Millard.\n\nTraite des Maladies Chirurgicales, vol. x. Baron Boyer. Paris, 1825.\n\nDictionary of Medicine. Quain. New York, 1884.\n\n\n\n\nINDEX\n\n\nAbolishment\n  of circumcision by Christians, 18;\n    by the Romans, 66\n  of eunuchism in Italy, 91, 96\n\nAbraham, 32\n\nAbsence of penis, 13\n  of testicles, 105\n\nAbyssinians, carry off the male members of slain enemies, 30;\n  circumcised bishop among the, 64\n\nAcosta, Rev. Father, on Mexican circumcision, 47\n\nAdams, Dr. C. Powell, of Hastings, Minn., 198\n\nAfter-treatment of circumcised Hebrews, 158\n\nAgnew, D. Hayes, on penile cancer, 230;\n  on eczema as a reflex neurosis from phimosis, 320\n\nAlbutt, T. Clifford, on primary cause of disease, 13\n\nAmerican circumcision, 47;\n  infibulation and muzzling, 48\n\nAmputation of penis, 230, 233, 247\n\nAndrogynes, 118\n\nAugleria, Pierre d', on American circumcision, 47\n\nApis, the white bull, sacred to the Egyptians, 29\n\nApollo Belvidere, as evidence of exactness of ancient sculpture, 62\n\nApure Indians and their circumcision, 48\n\nArabian circumcision, 38;\n  prostitutes, 323\n\nArias Montan, on Mexico, 46\n\nArnold, Dr. A. B., of Baltimore, 25, 219, 220, 223\n\nAsthma as a reflex neurosis from genital irritation, 291\n\nAustralian circumcision, 44;\n  operation on the urethra, 56\n\nAuthor's modification of circumcision, 307\n\nAztec circumcision, 46\n\n\nBallance, C. W., dressing after circumcision, 317\n\nBamboo stick worn in vagina as a chastity protector, 52\n\nBaptismal ceremonies of Omaha Indians, 56\n\nBarbarous Arabian marriage custom, 54\n  mutilations of Guamo and Othomaco Indians, 48\n\nBas-relief representing Egyptian emasculation, 31\n\nBassouto circumcision, 42\n\nBattos circumcision, 45\n\nBaumgartner's devout and chaste dervish, 49\n\nBeale, Sir Lionel, on blood changes, 296\n\nBell, Dr. John, on Jewish hygiene, 181\n  Dr. J. Royes, 191, 223, 229, 239\n\nBells, jingling of, under the skirts, denotive of Judean virginity, 52\n\nBelt of brass mail to insure female chastity, 51\n\nBerbers, mutilations of their prisoners, 30\n\nBergmann, of Strasburg, 20, 27\n\nBergson, Dr., 160\n\nBernbeim, Dr., on freedom of Jews from syphilis, 195;\n  on preputial statistics, 220;\n  on circumcisial operation, 312\n\nBernoulli, Prof., of Bale, 168\n\n\"Beth Yosef\" of Joseph Karo, 153\n\nBiblical vouching for homoeopathy, 113\n\nBillings, Dr. John S., U. S. Army, on Jewish vital statistics, 174;\n  on cancer amongst Jews, 230\n\nBird, Dr. Golding, on phimosis, 257\n\nBishop of Abyssinia accused of heresy on account of circumcision, 64\n\nBlood of prepuce sprinkled on bride's veil, 55;\n  sprinkled on ears of corn, 56\n  changes as starting-points of disease, 293, 298\n\nBobovii, Alberti, on Mohammedan circumcision, 39\n\nBogera, or African circumcision, 44\n\nBokai, on preputial statistics, 220\n\nBornean circumcision, 45\n\nBowditch, Henry I., on Jewish vital statistics, 176\n\nBoyer, Baron, on cancer of the penis, 232;\n  on gangrene of the penis, 237\n\nBrett, Dr. F. H., case of hypertrophy of prepuce, 251\n\nBryant, Thomas, on skin-grafting, 328\n\nBumstead, on circumcision, 310\n\nBurial of Algerine prepuces in the sands of the deserts, 39\n\n\nCahen, Dr., on diminished sensibility of glans after circumcision, 224\n\nCalculus, liability of the Chinese to preputial, 248;\n  Dr. J. G. Kerr, on preputial, 248;\n  C. H. Martin, of Mobile, on climatic influence on, 248;\n  Prof. Enoch, of Berlin, on preputial and vesical calculi, 249;\n  Claparede's case, 249;\n  composition of preputial, 249;\n  Civiale's case, 249;\n  induced by phimosis, 287\n\nCanary Islands, remains of an antediluvian world, 25\n\nCancer of the penis, 232;\n  views of Jonathan Hutchinson as to its origin, 226;\n  pre-cancerous stage of, 226;\n  views of Lallemand, 228, 329;\n  statistics of, 231;\n  Cullerier on, 231;\n  fifty cases reported by Dr. Zielewicz, 233;\n  early mention of, 234;\n  views of Prof. John C. Warren, 235;\n  views of Walshe, 235\n\nCanon of St. John Lateran and his profane doubts, 74\n\nCarter, Dr. Wm., on toxic urines, 298\n\nCasalis, M., on Bassouto circumcision, 42\n\nCases of spontaneous circumcision, 58\n\nCastration, etymology of the term, 80;\n  as a self-sacrifice to deities, 89\n\nCelsus, on Roman infibulation, 50;\n  on operations on the prepuce, 302, 313, 328;\n  originator of Cloquet's operation, 313\n\nChabas, M., description of Egyptian _bas-relief_, 23\n\nCharlemagne endows an abbey with a holy prepuce, 72\n\nCharles V sacks Rome, and robbery of the holy prepuce, 73\n\nChastity among Egyptian dervishes, 49;\n  belt of brass mail of the Ethiopians, 51;\n  plug of bamboo of Soudan, 51;\n  rings to insure chastity in the male mentioned by Nelaton, 54;\n  enforced among the Hindoo bonzes by infibulation, 54;\n  among the Cybelian priesthood, 89;\n  Greek monks, ideas of, 89;\n  comparative, among the different religious creeds of Prussia, 195\n\nChinese, peculiar liability of, to calculous disease, 248;\n  considered a delicate diet by Australian cannibals, 327\n\nChippeway Indians and circumcision, 23\n\nChivalry of the male Hottentot, 60\n\nChristian abolishment of circumcision, 18;\n  circumcision in Abyssinia, 63\n\nCircumcised phallus as a religious and civic symbol, 35;\n  races peculiarly exempt from syphilis, 192\n\nCircumcising knife (see Knife).\n\nCircumcision, abolished by Christians, 18;\n  among Chippeway Indians, 23;\n  among the Atlanteans of Plato, 23;\n  among the Phoenicians, 34;\n  among the Egyptians, 34;\n  Arabian, 35, 54;\n  during the reign of Psammetich, 34;\n  civil and religious symbol of ancient Egypt, 35;\n  Aztec, 46;\n  among the Mijes, 46;\n  Mexican, 46;\n  Totonac, 46;\n  among the Orinoco Indians, 47\n  the climatic limits of, as a general rite, 47;\n  in the Island of Cosumel, 47;\n  in Yucatan, 47;\n  in old Florida, 47;\n  Apure Indians, 48;\n  among the Amazons, 56;\n  accidental case of, mentioned by Cullerier, 57;\n  spontaneous, 58;\n  abolished by the Romans, 66;\n  destroying marks of, 68;\n  of Abraham, 143;\n  Hebraic, 143;\n  not practiced in the wilderness, 143;\n  physical conditions that exempt Jewish children from, 144, 145;\n  description of Hebraic, by Montaigne, 146;\n  as a cure for epilepsy, 261;\n  as a preventive of hernia or rupture, 263;\n  as a preventive to prolapsus of the bowel, 263;\n  as a preventive of idiocy, 266;\n  as a cure for dyspepsia, 270, 271\n\nCiviale, on moral effects of penis amputation, 247;\n  case of phimosis and preputial calculi, 249\n\nClaparede, on evils resulting from the prepuce, 229;\n  on preputial calculi, 249\n\nClarke, Sir Andrew, on renal inadequacy, 300\n\nClavigero, on Mexican circumcision, 46\n\nClimatic limits of circumcision, 65\n\nCloquet operation, 306, 316\n\nColchis, colony of, 33\n\nConstantine punished circumcisers with death, 66\n\nConstipation as a divine attribute, 288;\n  as a result of phimosis and its results, 292\n\nConsumption, relation of, to Jewish race, 178, 179\n\nControversy about the holy prepuce, 73\n\nConvent of St. Corneille and the holy knife, 78\n\nConvulsions induced by phimosis, 260, 261\n\nCullerier, accidental circumcision, 57;\n  on penile cancer, 231\n\nCybelian priesthood and castration, 89\n\n\nDakotas, the white bull sacred among the, 26\n\nDavid and the Philistine prepuces, 31\n\nDebreyne, trappist, monk, and physician, 224\n\nDelange, on Arabian circumcision, 37\n\nDelpech, on female circumcision, 36\n\nDemarquay, on penile gangrene, 236\n\nDervishes, holy and chaste, 49\n\nDifference between Turkish and Buddhist heaven, 116\n\nDilatation of prepuce, 308, 312, 332\n\nDonnelly, Hon. Ignatius, on Atlantean circumcision, 23\n\nDressing in cases of retraction of penile skin, 304;\n  C. W. Ballance's, after circumcision, 317;\n  A. G. Miller's, 318\n\nDu Bisson, on Soudanese harems, 52\n\nDyspepsia induced by preputial irritation, 270, 271\n\n\nEbers, Dr., on Karnac _bas-relief_, 23\n\nEczema induced by phimosis, 320\n\nEffect of the holy prepuce on the hands of a lady, 74\n\nEffects of age on the prepuce, 285\n\nEgypt, uncircumcised persons not allowed to study in ancient, 34\n\nEgyptians emasculated their prisoners, 30\n\nEmasculation, its early practices and evolutions, 29;\n  of Uranos, 83\n\nEmperor Adrian forbids circumcision, 66\n\nEndurance and fortitude of Arabs, 55\n\nEnforced continence and its effects on the penis, 61\n\nEnnery, M., Grand Rabbi of Paris, 158\n\nEnoch, Prof., of Berlin, on preputial calculi, 249;\n  on results of phimosis, 266;\n  on enuresis, 277\n\nEnuresis, 275\n\nEpilepsy, induced by the prepuce, 258, 261, 301\n\nEpstein, Dr., of Cincinnati, 156\n\nErichsen, Prof., on cancer of the penis, 228\n\nEthics at the battle of Fontenoy, 76\n\nEthiopian infibulation of infant females, 51\n\nEunuchism, beneficial to guardians of public funds, 84;\n  as excluding from the priesthood, 90;\n  in Italy, 91;\n  in China, 91, 93;\n  in India, 92;\n  in the Soudan, 99;\n  and music, 94;\n  as a punishment, 97;\n  mortality attending its manufacture, 91, 92, 93, 99, 100, 107;\n  does not prevent copulation at all times, 92, 100, 101, 102, 103;\n  manner of procedure among the Pagan priesthood, 106;\n  prices of eunuchs, 99;\n  numbers annually made, 91, 98;\n  fecundating eunuch of Mecca, 100;\n  Velutti, the opera-singer, 102;\n  eunuchs as possessors of harems, 90;\n  eunuch warriors and statesmen, 90\n\nEvidence of circumcision on Egyptian monuments, 23\n\nExtraordinary results of phimosis, 282\n\n\nFemale circumcisers in Arabia, 36\n\nFemales subject to preputial reflex neuroses, 267, 268\n\nFlaccourt, M. Martin, account of the Madecasses, 54\n\nFothergill and the unlicensed practitioner on renal pathology, 77\n\nFrench war-office records, on Jewish vital statistics, 175\n\nFrenum, statistics relating to abnormalities of, 221\n\nFrerichs' ammoniaemia, 300\n\nFresnel, M., on marriage circumcision, 54\n\nFull-moon rites among the Bassouto maidens, 44\n\n\nGalen, on the flaccid virile member, 60, 61\n\nGangrene of the penis, 236\n\nGolden padlocks worn on prepuce for five years, 54\n\nGreek and Roman statuary and the penis, 60\n\nGreek monks' object in infibulations, 54;\n  extreme ideas of chastity, 89\n\nGregg, Dr. Robert J., operative procedure, 320\n\nGriffith, Dr. J. D., cases of reflex irritation, 261\n\nGross, Prof. S. D., on penile cancer, 230;\n  operations, 320\n\nGrotius and the origin of the Peruvians, 46\n\nGuimara, the, 153\n\nGuinzburg, Dr., on Jewish vital statistics, 176\n\nGumilla and his South American voyages, 47\n\n\nHaemostatic powders, 160\n\nHare, Prof. Hobart A., on circumcision, 301\n\nHaskins, Dr. A., on Jewish vital statistics, 176\n\nHeaven, Turkish, 115;\n  Buddhist, 116\n\nHebraic idea of parental origin of constitution of the child, 144\n\nHebrew Consistory of Paris, 157\n\nHebrew words in Central American languages, 24\n\nHebrews, attempts to efface signs of circumcision, 69;\n  secretly circumcise their dead, 68;\n  Hebrew vital statistics, 169 to 179;\n  as proverbial good livers, 171;\n  escape epidemics, 173;\n  peculiarly free from syphilitic taint, 191;\n  their circumcision suitable to young children, 306\n\nHeliogabalus, Emperor, was circumcised, 66\n\nHenry III of France as a Moslem godfather, 64\n\nHenry V of England and the holy prepuce, 71\n\nHeraclius, Emperor, persecuted the Jews, 67\n\nHermaphrodites, earliest mention of, 117;\n  pederasty causes belief in their existence, 118, 119, 120;\n  Debierre on, 123;\n  notable cases of, 124, 125, 127, 128\n\nHernia induced by phimosis, 263\n\nHerodotus, his views adopted by Voltaire, 22;\n  visits Egypt, 34\n\nHerrera, on Mexican circumcision, 47\n\nHey, Dr. William, on preputial cancer, 227\n\nHindoo devotee wears a six-inch ring in prepuce, 54\n\nHitouch, 156\n\nHolgate, Dr., of New York, on preputial adhesions, 220;\n  on preputial dilatation, 308\n\nHoly circumcision, 70, 78\n  prepuces, 70, 72\n  vinegar and its miraculous effects, 79\n\nHomer, Surgeon U. S. Navy, on the worship of Venus Porclna, 193\n\nHorrible marriage performance, 54\n\nHottentot restriction on making twins, 60\n\nHough, Dr., on Jewish longevity, 173\n\nHumphry, Geo. Murray, on \"Old Age,\" 14\n\nHutchinson, Dr. Jonathan, on the pre-cancerous stage of cancer, 226;\n  on urethral child, 300\n\nHypospadias, as a heredity, 129;\n  artificially made, 56;\n  formerly led to belief in hermaphrodism, 129;\n  fecundation in, 129;\n  difficulty in determining sex owing to, 131\n\n\nIdiocy induced by phimosis and preputial adhesions, 265, 269\n\nImpious wretch steals the holy prepuce, 74\n\nImpotence, holy vinegar and shrinal observances in, 71 to 81\n\nIndians and circumcision, 46 to 48\n\nInduration of prepuce, 250\n\nInflbulation practices, 48 to 52\n\nIsis inaugurates Osirian rites, 29\n\nIsserth, Rabbi Israel, 153\n\n\nJansen, Surgeon of the Belgian Armies, on frenum deformities, 221\n\nJews' letters to Voltaire, 22;\n  Jews (see Hebrews).\n\nJudaism unfavorable to religious insanity, 166\n\nJustinia, Emperor, persecuted the Jews, 67\n\n\nKaro, Joseph, and the \"Beth Yosef,\" 153\n\nKemp, Dr. Arthur, on phimosis as a cause of hernia, 264\n\nKerr, Dr. J. G., on Chinese preputial calculi, 248\n\nKeyes, Dr. E. L., on composition of preputial calculi, 249, 264\n\nKing David, the first homoeopathic patient, 113;\n  secures two hundred Philistine prepuces, 31\n\nKnife, circumcising, used in ancient Egyptian rite, 23;\n  of shell used by Tonga Islanders, 45;\n  of stone used by Australians, 45;\n  of the holy circumcision, 78;\n  made of rattan among the Fiji Islanders, 327\n\n\nLafargue, on Australian circumcision, 44\n\nLallemand, on masturbation, 223;\n  on tendency to preputial cancer, 228, 329;\n  on circumcision, 317\n\nLas Casas, on Aztec circumcision, 46\n\nLeech, Dr. T. F., on preputial irritation, 260\n\nLetenneur, Prof., on the knife of the holy circumcision, 78\n\nLife-insurance and the circumcised, 290\n\nLisfrane, rules for operations on the penis, 232;\n  on recession of the body of the penis, 306\n\nLivingstone, on Bassouto circumcision, 44\n\nLongevity of Hebrews, 162, 169, 179\n\nLonyer-Villermay, M., on female circumcision, 36\n\nLouis XVI as a candidate for the rite, 201\n\nLove, Dr. I. N, on the Mosaic law, 262\n\nLumholtz, on Australian hypospadias, 56\n\n\nMacilwain, on reflex neuroses, 330\n\nMagruder, Dr. G. L., on reflex irritation, 261\n\nMaids as heat radiators, 114\n\nMaimonides, Jewish rabbi and physician, 32, 144, 153\n\nMalay circumcision, 45\n\nMalgaigne, operative views, 313, 316\n\nMapato, or mystery hut, 42\n\nMarriage preceded by circumcision, 54\n\nMartius and Spix, on circumcision on the Amazon, 56\n\nMastin, Dr. C. H., on calculous disease, 248\n\nMasturbation, 224\n\nMaury, Dr. Frank, on preputial statistics, 219\n\nMcLeod, Dr. Neil, circumcision operation, 318\n\nMcMahon, Dr. W. R., on reflex epilepsy, 261\n\nMendelssohn, Rabbi Moses, 164, 168\n\nMexican circumcision, 46\n\nMezizah, or act of suction, 150\n\nMilah, 156\n\nMiracles performed by the holy prepuce, 70 to 74\n\nMishna, the, 153\n\nMohammed, 65\n\nMohel, 157, 158\n\nMoses, Dr., of New York, preputial statistics, 220\n\nMoses circumcises his son, 150\n\nMott, Jr., Dr. A. R., cases of reflex irritation, 258\n\nMusic, first schools of, 94\n\nMusic at Algerine circumcision, 39;\n  at Mohammedan, in Asia, 39;\n  at Turkish feast, 41\n\n\nNelaton, case of infibulation, 54;\n  on penile cancer, 231;\n  on penile hypertrophy, 252\n\nNelson, Lord, disregard for red tape, 77\n\nNew Caledonian circumcision, 45\n\nNewton, Sir Isaac, and the storm-predicting cow, 77\n\nNicaraguan baptism of blood, 56\n\n\nOath of mohel, 158\n\nOath, Egyptian manner of making oath, 35\n\nObod, Battle of, 36\n\nOperations on the prepuce, 302;\n  Cloquet's, 306;\n  Bumstead's, 310;\n  Hue's, 312;\n  Bernheim's, Sedillat's, 313;\n  Chauvin's, 313;\n  Cullerier's, 313;\n  Vanier's, 316;\n  Vidal de Cassis', 316;\n  Lallemand's, 317;\n  A. G. Miller's, Neil McLeod's, 318;\n  Erichsen's, 319;\n  Gross's, 320;\n  Van Buren and Keyes', 320;\n  D. Hayes Agnew's, 320;\n  Overall's procedure, 321\n\nOrigin of phallic worship, 29\n  of human slavery, 29\n\nOrinoco, circumcision on the, 47\n\nOrloth, penis or prepuce? 31\n\nOsiris vanquished by Typhon, 28\n\nOthomacos Indians and their bloody rite, 48\n\nOwen, Dr. Edmund, on phimosis, 263\n\n\nPackard, Dr., on preputial statistics, 219\n\nPapal indulgences to worshipers of holy prepuce, 72\n\nParalysis induced by phimosis, 259\n\nPenis, absence of, 132;\n  diminutive specimens, 213;\n  amputation of, 230, 233, 234, 247;\n  cancer of, 232;\n  gangrene of, 236;\n  hypertrophy of, 248, 251, 252\n\nPeriah, 156\n\nPersecutions on account of circumcision, 66\n\nPhoenician origin of circumcision, 22\n\nPhimosed penis on ancient statues, 60\n\nPhimosis, 218, 221;\n  as a cause of hernia, 263\n\nPhysicians as practical Christians, 141\n\nPooley, Prof. J. H., case of preputial irritation, 260\n\nPope, Rabbi Rav, and the _Guimara_, 153\n\nPortuguese sailors as Mohammedan proselytes, 40\n\nPotentia generandi, 103\n  coeundi, 104\n\nPrepuce, infibulated, 54;\n  swallowed by mother, 54;\n  fired off in gun, 54;\n  holy, 71;\n  useful for skin grafts, 207;\n  absence of, 209;\n  influence on man at different ages, 225;\n  induration of, 250;\n  warts of, 250;\n  reflex neuroses from, 256\n\nPreputial miracles, 72;\n  statistics, 219;\n  adhesions, 219, 220;\n  calculi, 248\n\nPrice, Dr. M. F., on reflex neuroses, 265;\n  on female preputial irritation, 267, 268\n\nPrimitive phallic rites, 28\n  homoeopaths, 113\n\nProcedure in retraction of skin of penis after circumcision, 304\n\nProselytes, Mohammedan, how circumcised, 40, 41\n\nPublic women between decks in U. S. Navy, 193\n\nPuzey, Dr., of Liverpool, on preputial skin grafts, 207\n\nPythagoras 32;\n  visits Egypt, 34\n\n\nRalfe, on causes of interstitial nephritis, 300\n\nRameses II, circumcision of his sons, 23\n\nRanney, Prof. A. L., on enuresis, 282\n\nReconstruction of a prepuce, 68, 69, 328\n\nRectum, prolapsus of, induced by phimosis, 263\n\nReflex neuroses from preputial irritation, 254, 330, 331\n\nRegulations of French Hebrew consistories of 1854, 157\n\nReligion, its connection to insanity, 166\n\nResectricis nympharum, profession of, 36\n\nRestriction on impregnation, 57;\n  on twins, 60\n\nRetraction of skin of penis after circumcision, 303\n\nRichardson, Dr. B. W., on relation of race to disease, 169, 170, 171, 177\n\nRicord's definition of the prepuce, 206;\n  operations on the prepuce, 313\n\nRoman infibulation, 58\n\nRoyal decree of 1845 in France, 157\n\nRoux, on cancer of the prepuce, 227\n\nRush, Benjamin, and the cancer quack, 77\n\n\nSaint-Germain, Dr., on preputial abnormalities, 264\n\nSaint Foutin and his shrine, 78\n\nSaint Guerluchon at Bourg-Dieu, 79\n\nSaint Guignole and the miraculous phallus, 80\n\nSaint Coulombs and the miraculous prepuce, 70\n\nSaturnus the first eunuchiser, 83\n\nSayer, Prof. Lewis A., contributions to medical science, 255\n\nScythians carry off heads of the slain, 30\n\nSelf-circumcision, attempt at, 203\n\nSemiramis first employs eunuchs, 85\n\nSeverus Sulpicius, on effects of climate, 50\n\nSham battles at circumcision feasts, 37, 41, 42, 44\n\nShe-circumcisers, 36\n\nShrine for the recovery of impotent males, 79\n\nSmith, Dr. J. Lewis, on preputial irritation, 263\n\nSolomon, Dr., of Brunswick, on suction, 158\n\nSoudanese chastity protector, 52\n\nSphincterismus due to phimosis, 292\n\nSpiked chastity belt in Naples museum, 52\n\nStallard, Dr., on Jewish vital statistics, 173\n\nSterility cured at sacred shrines, 71 to 81\n\nStricture of urethra and phimosis, 289, 290\n\nStyptics used by mohels, 158, 159\n\nSyphilis, statistics relating to, 187 to 199\n\nSyphilis and scrofula, 190\n\n\nTaylor, Dr. C. F., on masturbation, 269\n\nTotonac circumcision, 46\n\nTonga Islanders' rite, 45\n\nToxaemia, resulting from phimosis, 293;\n  of von Jaksch, 294\n\nTube, penis carried in, 56\n\nTunca Indian circumcision, 56\n\nTurkish circumcision, 39 to 41\n\nTylor, on the Stone Age and circumcision, 336\n\n\nVan Buren and Keyes, on circumcision, 320\n\nVanier du Havre, Dr., 54, 224;\n  on operations, 316\n\nVenus, birth of, 84\n\nVidal de Cassis, on preputial operations, 316\n\nVirey, account of Hindoo bonze, 54\n\nVirgins' chain of bells in ancient Judea, 52\n\nVital statistics of Jews, 169 to 179\n\nVoltaire, on origins of circumcision, 22\n\nVon Jaksch's definition of Toxaemia, 294\n\n\nWadd, Dr., on preputial cancer, 227;\n  on hypertrophy of penis, 252\n\nWalshe, on preputial cancer, 235\n\nWarren, on preputial cancer, 235\n\nWarts of penis and prepuce, 250\n\nWaterman, Dr., on Jewish vital statistics, 177\n\nWax images of penis deposited on shrines, 79\n\nWelsh words in Mandan language, 24\n\nWet dressing objectionable after circumcision, 304, 311\n\nWhite Bull, sacred among Sioux and Egyptians, 26;\n  origin of sacredness, 29\n\nWillard, Dr. De Forest, observations on the prepuce, 262\n\nWine at circumcision feasts, 151\n\nWirthington, Dr. F. J., on preputial irritation, 259\n\nWise, Dr. I. M., on St. Paul the apostle, 19\n\nWarman, Prof., of Brooklyn, on circumcision, 26\n\n\n\n\nTHE THREE FOLLOWING PAGES ARE REDUCED\nFAC-SIMILES OF PAGES FROM\n\nSTANTON'S\n\nPractical and Scientific Physiognomy;\n\nOR,\n\nHOW TO READ FACES.\n\nBY\n\nMARY OLMSTED STANTON.\n\nThe ablest, most entertaining, trustworthy, and exhaustive treatise of\nthe kind in the English language. Complete in two Royal Octavo volumes\nof OVER 600 PAGES EACH; richly illustrated with 380 CHOICE\nWOOD-ENGRAVINGS, many of them original.\n\nSold by subscription, or sent direct on receipt of\nprice, shipping expenses prepaid.\n\nPrice, in United States, Cloth, $9.00; Sheep, $11.00; Half-Russia,\n$13.00. Canada (duty paid), Cloth, $10.00; Sheep, $12.10; Half-Russia,\n$14.30. Great Britain, Cloth, 56s.; Sheep, 68s.; Half-Russia, 80s.\nFrance, Cloth, 30 fr. 30; Sheep, 36 fr. 40; Half-Russia, 43 fr. 30.\n\nEXAMINE THE FOLLOWING PAGES.\n\nF. A. DAVIS, Publisher,\n\n1231 Filbert Street, Phila., Pa.\n\nBRANCH OFFICES:\n\n_CHICAGO, ILL.--24 Lakeside Building, 214-220 S. Clark St.\nNEW YORK CITY--117 W. 42d Street. ATLANTA, GA.--26 Old Capitol.\nLONDON, ENG.--40 Berners St., Oxford St., W._\n\nORDER FROM NEAREST OFFICE.\n\n\n\n\n_FAC-SIMILE PAGE FROM \"STANTON'S PHYSIOGNOMY\"--Reduced._\n\nHOW TO REDUCE SIZE WITHOUT LOSING STRENGTH.  1109\n\nvoice. A thorough-bred person may belong to the artistic, mechanical,\nor scientific classes, either appreciatively or executively;\nhe must exhibit both gentleness and spirit, as occasion requires; he\nmust be governed by the law of justice; he must make the comfort\nof his associates his concern, and do what is _right_ in order to\nenhance their happiness.\n\nThe facial indications of those who are not thorough-bred,\nspeaking physiologically, are as follow: A coarse, thick skin; a\n\"muddy\" complexion, or one permanently blotched, pimpled, or\ndiscolored; dull eyes, very small or very large and bulging;\ncoarse hair, or that which is very light or colorless,--that is to say,\nof no _decided_ hue. I regard very light colored, pallid people as\nmorbid varieties; also those with irregular teeth, a very small or\nill-shapen nose, small nostrils, perpendicular jaws, exposed gums,\nopen mouth, receding chin, or one that projects greatly forward,\nending in a point; thin, pallid, dry lips; hollow cheeks, flat upper\ncheeks. ugly or ill-shapen ears, a voice weak, thin, hoarse, shrill\nor nasal; a long, cylindrical neck; a high, narrow forehead.\n\nThe undue development of certain organs and systems of the\nbody induces abnormal conditions, as, for example, an excessive\ndisposition of fatty tissue. When the appetite is voracious, or the\nnutritive system uncommonly active, too much of the carbonaceous\nelements of the food are eliminated, or, as it often occurs, too much\ncarbonaceous food, such as white bread, potatoes, etc., is consumed\nfor the needs of the body; the consequence is an excess of fat,\nwhich, in many subjects, impedes respiration, prevents activity,\nand gives a generally uncomfortable feeling. For this condition a\nspare diet is often prescribed, but as this is felt to be a hardship,\nand as few who attempt it succeed in continuing it long enough to\nproduce satisfactory results, it is pronounced a failure.\n\nFor this class of people there is a very agreeable and sure\nmethod of reducing the bulk without reducing strength and without\ncompelling too great a sacrifice of the appetite.\n\n\nHOW TO REDUCE THE SIZE WITHOUT LOSING STRENGTH.\n\nA diet which will attain this result is easily obtained, and of\nit the subject can use a quantity sufficient to allay the craving\nfor food.\n\nThis diet consists of absolutely _raw_ foods, nothing cooked\nbeing allowed. This diet, of course, must consist mainly of fruits,\nnuts, grains, milk, and, when flesh-meat is desired, a Hamburg\nbeefsteak may be partaken of; this steak is raw beef chopped fine\nand seasoned with onion, salt, pepper, or other condiments; to\nthis may be added raw oysters and clams. Every kind of fruit\n\n\n\n\n_FAC-SIMILE PAGE FROM \"STANTON'S PHYSIOGNOMY\"--Reduced._\n\nSYSTEMS AND FACULTIES REQUIRED FOR A SURGEON. 1143\n\nis a dangerous being); he should develop his friendliness, love of\nchildren, and of the opposite sex; in short, he should be a _lover_\nof _humanity_.\n\n\nTHE SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON.\n\n[Illustration: FIG. 300--EDWARD JENNER, M.D. (CELEBRATED ENGLISH\nPHYSICIAN, AUTHOR, AND DISCOVERER OF VACCINATION.)\n\nNo scientific physiognomist could mistake this face for other than that\nof a physician, and an earnest and attentive one as well, as evidenced\nby the signs of \"natural physician\" in the cheek-bones, in the attitude\nof the head and neck, and by the thoughtful, observant expression of the\neye. The combination of systems in this subject is such as is most\nfrequently observed among physicians, viz., the supremacy of the osseous\nand brain systems. The muscular, thoracic, and vegetative powers all\nassist in this combination by their development. The signs for\nConscience and Firmness are apparent. Love of Home and Patriotism rank\nhigh. Benevolence, Amativeness, Love of Young, Mirth, Approbation,\nSelf-esteem, Modesty, Friendship, Alimentiveness, Sanativeness,\nPneumativeness, and Color combine to form a lovely domestic and social\nnature. The form, size, and peculiarities of the nose claim attention.\nIt is a nose denoting Constructiveness, Originality, and logical power.\nThe signs for Hope, Analysis, Mental Imitation, Human Nature, Ideality,\nSublimity, Construction, and Acquisition are strongly delineated.\nSelf-will is normally developed, while Size, Form, Observation, Weight,\nLocality, Calculation, and Memory of various sorts are manifest. The\nsigns of Language in the eye and mouth denote fluency, while the\npractical faculties, being dominant, would give clearness, perspicacity,\nand directness to his style of expression, either oral or written. Time,\nOrder, Reason, and Intuition are well developed. The long-continued\nobservation and experiments of this noble physician in his endeavor to\nprotect humanity from the ravages of small-pox by his discovery of\nvaccination, met at last with a suitable recognition, for he received by\na vote of Parliament the sum of L30,000, and special honors were awarded\nhim. It is a singular fact that all of the benefactors of the human\nrace--those who have benefited it by discoveries of any kind\nwhatever--have met with the most violent opposition, treachery, and\noften disgrace, before they could make the world see the value of their\ndiscoveries. Such was the case with Dr. Jenner, but his firmness and\ntruth at last gained the victory.]\n\nThe best _form_ for a surgeon who attempts the most severe\noperations is the round build of body and head, and many of them\nare of this shape. The muscular system should be supreme, with\nthe brain system a close second, the bony and thoracic systems\nabout equal and next in development.\n\nThe muscular tissue is _comparatively unfeeling_--insensitive;\n\n\n\n\n_FAC-SIMILE PAGE FROM \"STANTON'S PHYSIOGNOMY\"--Reduced._\n\nOTHER CLASSES OF SURGEONS\" 1145\n\nin the body. Form and Size are also requisite to aid the memory of\nthe shape and relative position of each part, and to assist Locality.\nHuman Nature is essential in order that he may be _en rapport_\nwith his patients, and also to enable him to _divine_ instinctively all\nbodily and mental states. He should be a good physiognomist, and\nbe well versed in the _pathology_ of physiognomy. He must have\nlarge Observation, in order to take cognizance of the most minute\nchanges and appearances. Calculation is a useful trait also, as it\nis required in many ways in the medication and treatment of the\nwounded, as in chemistry and in making surgical implements, etc.\nHe should have large Friendship; in order to attach his patients to\nhim and to command their esteem; enough Benevolence to sympathize,\nbut not enough to weaken the feelings when severity is required.\nThe faculty of Amativeness is necessary to _comprehend_ the nature of\nthe opposite sex; Love of Young also, that he may inspire children with\nlove and confidence.\n\nThe sense of Weight should be a strong one, for the muscular\nsense is dependent upon its power in order to _gauge_ the amount\nof force to be used in handling instruments and in bandaging\nwounds, limbs, etc. Executiveness is required to assist authority\nand give resistance. Self-will is another ally most necessary, as\nwell as Analysis, Time, Order, and Reason. A fair share of\nmusical ability is required to assist the ear in making examinations\nof the heart and lungs, and in auscultation for various other purposes.\nIf to these faculties one adds large Intuition, he has a fine\nbodily and mental equipment for the practice of surgery.\n\n\nOTHER CLASSES OF SURGEONS.\n\nMany army surgeons are characterized by a round and broad\nform, with broad, rather low, and round heads; short, round arms,\nand round and tapering fingers. This build is the most suitable\nfor those severe operations which require the greatest exhibition of\nforce, endurance, and coolness; another class of surgeons--those\nwho undertake the more delicate and less forceful operations--are\ncharacterized by about an equal development of the brain and\nmuscular systems. This class of surgeons tend naturally to the\ntreatment of those finer, less difficult, and more delicate cases of\noperative surgery, such, for example, as treatment of the ear, the\neye, etc. This class of surgeons require a fine endowment of the\nbrain and nervous system. In short, the muscles as well as nerves\nof this class must be sensitive to a great degree, and this combination\ncalls for a fine and high organization.\n\nThe surgeon should be something of an actor in order to\nknow when to be sympathetic and when to be severe. Yet he\n\n\n\n\n  +--------------------------------------------------------------+\n  | Transcriber's Notes and Errata                               |\n  |                                                              |\n  | Footnotes 25-30 have been renumbered in sequence.            |\n  |                                                              |\n  | The anchor for footnote 102 was missing. Has been inserted   |\n  | at the appropriate place.                                    |\n  |                                                              |\n  | 'oe' ligatures have been expanded to separate 'o' and 'e'    |\n  | characters.                                                  |\n  |                                                              |\n  | The following words were found in both hyphenated and        |\n  | unhyphenated forms once each.                                |\n  |                                                              |\n  |                |bed-clothes   |bedclothes   |                |\n  |                |co-existence  |coexistence  |                |\n  |                |short-comings |shortcomings |                |\n  |                                                              |\n  | The word 'pre-cancerous' occurred four times in the text,    |\n  | while 'precancerous' occurred twice, both in the index.      |\n  | These index entries have been hyphenated.                    |\n  |                                                              |\n  | The following typographical errors have been corrected.      |\n  |                                                              |\n  |                |Error        |Correction   |                 |\n  |                |route        |rout         |                 |\n  |                |prepuse      |prepuce      |                 |\n  |                |a a          |a            |                 |\n  |                |siezes       |seizes       |                 |\n  |                |Sterilite    |Sterilite    |                 |\n  |                |others       |others'      |                 |\n  |                |Tranyslvania |Transylvania |                 |\n  |                |occasian     |occasion     |                 |\n  |                |suprised     |surprised    |                 |\n  |                |function     |junction     |                 |\n  |                |orginated    |originated   |                 |\n  |                |smoulderd    |smouldered   |                 |\n  |                |wes          |was          |                 |\n  |                |tisses       |tissues      |                 |\n  |                |dut          |but          |                 |\n  |                |innner       |inner        |                 |\n  |                |may          |many         |                 |\n  |                |brakemen     |brakeman     |                 |\n  |                |thinnes      |thinness     |                 |\n  |                |totel        |total        |                 |\n  |                |America      |American     |                 |\n  |                                                              |\n  +--------------------------------------------------------------+","title":"History of circumcision from the earliest times to the present : $b Moral and physical reasons for its performance, with a history of eunuchism, hermaphrodism, etc., and of the different operations practiced upon the prepuce","tradition":"scripture-revelation","translated_text":null,"word_count":108214}