THE PREPUCE, SYPHILIS, AND PHTHISIS.
It is not alone the tight-constricted, glans-deforming,
onanism-producing, cancer-generating prepuce that is the particular
variety of prepuce that is at the bottom of the ills and ailments, local
or constitutional, that may affect man through its presence. The loose,
pendulous prepuce, or even the prepuce in the evolutionary stage of
disappearance, that only loosely covers one-half of the glans, is as
dangerous as his long and constricted counterpart. If we look over the
world's history, since in the latter years of the fifteenth century
syphilis came down like a plague, walking with democratic tread through
all walks and stations in life, laying out alike royalty or the vagrant,
the curled-haired and slashed-doubleted knight, or the tonsured monk, we
must conclude that syphilis has caused more families to become extinct
than any ordinary plague, black death, or cholera epidemic. Without
wishing to enter into a history of syphilis, it is not outside of the
province of this book to allude to its frequency and spread.
Syphilis is not restricted to classes by any means; it is not those of
the lower class alone who are its victims. Dr. Fr. J. Behrend, in his
work, "Die Prostitution in Berlin," observes that abolition of the
brothels in that city in 1845, '46, '47 and '48, trebled the number of
cases of syphilis treated at the Der Charite; in the year 1848 the cases
of syphilis treated at that hospital numbered over 1800. It was also
remarked during this period of legally-enforced virtue, that, as
inconsistently as it might appear, the disease invaded the best of
families. From Dr. Neumann, in his brochure entitled "Die Berliner
Syphilisfrage," published in 1852, we learn that, in the Trades and
Mechanics' Benevolent Union of Berlin, in 1849, 13.51 per cent. of the
sick were so from syphilis.
In the thirteenth volume of the _British and Foreign Medico-Chirurgical
Review_, we find, in a review of the control of prostitution, an
estimate in regard to the syphilization of a nation. The estimates are
made on the most conservative figures, as, in the desire of the reviewer
not to overestimate, he starts by figuring out the actual number of
prostitutes in England, Wales, and Scotland to be only 50,000, when they
were estimated, by those who had carefully studied the subject, as being
more than double that number; the conservative estimate is, however,
suitable for our purpose; so that we cannot be accused of overestimating
the results. The portion of the review to which we wish to call
attention is as follows:--
"Though the result of the evidence contained in the first report of the
commissioners on the constabulary force of England and Wales was that at
that time about 2 per cent. of the prostitutes of London were suffering
under some form of venereal disease, yet we will descend even lower, and
presume that of one hundred healthy prostitutes, taken promiscuously
from England and Scotland, if each submits to one indiscriminate sexual
act in twenty-four hours, not more than one would become infected with
syphilis, an estimate which is without doubt far too low; yet, if
admitted to be correct, the necessary consequence will be, _that of the
fifty thousand prostitutes five hundred are diseased within the
aforesaid twenty-four hours_.
"If we next admit that a fifth of these five hundred diseased women are
admitted to hospital on the day on which the disease appears, it follows
_that there are every day on the streets four hundred diseased women_.
Let it be supposed that the power of these four hundred to infect be
limited to twelve days, and that of every six persons who, at the rate
of one each night, have connection with these women, five become
infected, it will follow _that there will be four thousand men infected
every night, and consequently one million four hundred and sixty
thousand in the year_. Further, as there are every night four hundred
women diseased by these men, one hundred and eighty-two thousand five
hundred _public prostitutes will be syphilized during the year; hence,
one million six hundred and fifty-two thousand five hundred cases of
syphilis in both sexes occur every twelve months_.
"If, then, the entire population had intercourse with prostitutes in an
equal ratio, _the gross population of Great Britain, of all ages and
sexes, would, during eighteen years, have been affected with primary
syphilis_. Be it remembered, we do not assert that more than a million
and a half of _persons_ are attacked every year, but that that number of
_cases_ occurs annually in England, Wales, and Scotland, though the same
individual may be attacked more than once. Although it is evident that
all the estimates used for these calculations are (we know no other word
that expresses it) ridiculously low, yet we find that more than a
million and a half of cases of syphilis occur every year,--an amount
which is probably not half the actual number. How enormous, then, must
be the number of children born with secondary disease! How immense the
mortality among them! How vast an amount of public and private money
expended on the cure of this disease!"
The same reviewer (P. S. Holland), in another article on the "Control of
Prostitution," observes that among the British troops syphilis is one of
the most frequent of diseases, about one hundred and eighty cases
occurring annually among every one thousand soldiers.
The effect of syphilis in depopulating the islands of the Pacific has
been pointed out in a former chapter; the nature and origin of the
disease that takes them off is unmistakable. Scrofula and rapid phthisis
are taking off the inhabitants at a rate that, in those islands most
affected, the native population will soon become extinct. According to
Lancereaux, in the Marquesas group the women do not live beyond the age
of thirty to thirty-five years, three or four months being the duration
of the disease. Ellis, in his "Polynesian Researches," published in
1836, remarks that at that date the disease, as above described, had but
recently appeared. In the nineteenth volume of the "Archives de Medecine
Navale," Rey mentions that at the Easter Island pulmonary phthisis is
the dominant affection with the adults, and that scrofula is very
prevalent with the children.[75]
The effect of syphilization in inducing a scrofulous taint and the
appearance of a rapidly-marching consumption among savage races has been
well observed among the Indians in the southwestern parts of the United
States, where the appearance of these fatal diseases can easily be
traced to that as a cause. There is something peculiar about the
Anglo-Saxon race that is fatal to the Indian; wherever they come in
contact, the savage race begins physically and morally to crumble; the
habits of the Anglo-Saxon in the matter of intemperance and his lust
soon end the poor Indian; while, on the other hand, the Latin races mix
with them without any physical detriment to the Indian. In what was
formerly the Northwest Territory the French and Indian intermarried, and
syphilis did not begin to tell on the Indian until the Americans settled
the country. From these observations it is very evident that in the
Polynesian Archipelago syphilis must have been the precursor of the
phthisis and scrofula, as we know it to have been that which induced
those diseases among the Indians of the Mississippi or Missouri Valleys,
or of the Colorado and Mojave Deserts, or in the mountains and valleys
of Arizona.
On the other hand, circumcised races, whose women have not carried a
syphilitic taint into the race, are as a class free from any syphilitic
taint. Neither their teeth, physiognomy, skin, nor general condition
denote any syphilitic inheritance. This is true of the Jewish
descendants of Abraham, who have more strictly adhered to the
non-intercourse or marriage with other races, and whose women have
abstained from vice; the Arabian descendants of Ishmael have, in a great
measure, also retained their marked family individuality, except it be a
few tribes, who, by contact with the soldiery of European nations, have
had their women corrupted and syphilis introduced into the tribe through
this channel.
Richardson, in his "Preventive Medicine," observing on the effects of
syphilis in inducing deterioration of the organs of circulation and
their degenerative changes, says that, in his opinion, syphilis is the
progenitor of various diseases, and that those who give this opinion the
greatest range are, unfortunately, nearest the truth. The breathing
organs, he remarks, are distinctly susceptible to injury from this
hereditary cause.
In 1854, at the Metropolitan Free Hospital, situated in the Jews'
quarter in London, Hutchinson observed that the proportion of Jews to
Christians among the out-patients was as one to three; at the same time
the proportion of cases of syphilis in the former to the latter was one
to fifteen. Now, this result was not due to any extra morality on the
part of the Jews, as fully one-half of the gonorrhoea cases occurred
among those of that faith. J. Royes Bell also observes the less
syphilization among circumcised races.[76]
The absence of the prepuce and the non-absorbing character of the skin
of the glans penis, made so by constant exposure, with the necessary and
unavoidably less tendency that these conditions give to favor syphilitic
inoculation, are not evidently without their resulting good effects. Now
and then syphilitic primary sores are found on the glans, or even in the
urethra or on the outside skin of the penis, or outer parts of the
prepuce; but the majority are, as a rule, situated either back of the
corona or on the reflected inner fold of the prepuce immediately
adjoining the corona, or they may be in the loose folds in the
neighborhood of the frenum, the retention of the virus seemingly being
assisted by the topographical condition and relation of the parts, and
its absorption facilitated by the thinness of the mucous membrane, as
well as by the active circulation and moisture and heat of the parts. It
must be evident that but for these favoring conditions the inoculation
or infection would and could not be either as sure or as frequent. Any
protecting mechanical aid that interferes with these favoring conditions
grants an immunity to the individual, even when he is freely exposed;
this protection has often been obtained by applying to the glans and
penis a substantial coat of some tenacious oil like castor-oil, which
was afterward gently washed off, first in a shower of tepid water and
afterward in a tepid bath of warm water and borax.
Horner, formerly of the navy, in his interesting little work on "Naval
Practice,"[77] relates that it was customary, in the older navy of the
United States, to allow public women to come on board at some of the
ports and to go down to the men between decks, the Department of the
Navy being probably actuated by the same humane principle that used to
induce some of the West Indian cannibals to lend their wives to their
prisoners of war who were intended, in the shape of roast or
_fricandeau_, to grace the festive board, as it was deemed inhuman by
these philanthropists to deprive a man of his necessary sexual
intercourse, even if they were soon to roast him and pick his bones.
They may, however, have been selfish in the matter, as by some
authorities it is represented that this was done to improve the flavor
of the prisoner, who was said to offer a more savory dish through this
considerate treatment, the strong flavor that the semen gives to flesh
being well eradicated by free fornication. Whether it was through these
motives of humanitarianism, or the feeling that an American tar was the
equal of the British tar, whose praises and equality Sir Joseph Porter,
K.C.B., writes a song about in "Pinafore," who had as much right to
contract a left-handed marriage as any Prince of Wales or any other
prince or crowned head of Europe, the women were, nevertheless, allowed
to go down between decks in preference to giving the men indiscriminate
liberty on shore, the government further providing for their welfare by
causing the assistant surgeon to examine the women at the gangway or
hatchway, to see that they were not diseased. Horner relates the
ludicrous appearance presented by a near-sighted assistant at one of
the hatchways while making this professional examination, surrounded by
the sailors and marines, who were greatly-interested spectators. Had the
government provided a pot of castor-oil wherein the tar could dip his
penile organ, as bridge piles are dipped into a creasoting mixture,
these humiliations to our professional brother could have been avoided.
In the conclusion to be reached, circumcision is not put forward as the
only exempting element or preventive measure that deserves all the
credit for the immunity that the Jews enjoy from syphilis, or to the
absence of hereditary diseases that are secondary or due to the presence
of that disease in the parents, as considerable credit is to be given to
the well-known chastity of their females. This chastity is, in a great
measure, due to the inseparable conditions of their religion,--moral and
social fabrics which are welded into one. Their charity assumes the most
practical form, so that it is not possible for one of their females to
have to resort to a life of prostitution to save herself or her children
from starvation, as, unfortunately, is too often the case in Christian
communities, where religion is put on and off with Sunday clothes. The
temperance and sobriety, as well as the economy and industry of the
father, are not without a good moral as well as a hereditary effect on
the daughters, who are neither rendered brutal nor demoralized through
the example and instigation of drunken fathers. They have, therefore, a
better average homelife, to which they cling and which protects them.
The aid and benevolent associations of the Jews are among the most
efficacious of charitable institutions, and no class gives more freely
or generously for this purpose. The Home for Aged Hebrews in New York is
an example of the character with which they dispense charity. We need
not, therefore, be surprised to find, in statistics of illegitimacy by
religious denominations taken in Prussia, that the Jewish women are
three times as chaste as the Catholics and more than four times as
chaste as the Evangelists.[78] The Jew has, therefore, two avenues of
infection from syphilis cut off,--the lesser liability due to his
circumcision and the chastity of the women.
Richardson mentions the immunity of the Jewish race from tubercular
disease, and notices the well-known relation existing between a
syphilitic taint and a phthisical tendency. The comparative statistics
offered by the Mohammedans, Jews, and Christians in regard to deaths
from consumption have already been mentioned in a former chapter, they
being as four Christians to one Jew, while the Mohammedan, from his
greater abstemiousness and temperance to assist him, shows a still lower
percentage than the Jew. There can be but little doubt that to this
particular and well-marked less syphilization the Hebrew race owes much
of its exemption from many other diseases and its greater resistance to
ordinary ailments and epidemic diseases.
The relative less frequency of syphilis among all circumcised people is
noticed by Dr. Bernheim, in his brochure "De la Circoncision," he being
the surgeon of the Israelitish Consistory of Paris. His utterances on
this subject are worthy of attention, he having not only paid particular
attention to this, but having had unusual opportunities for the basis of
his opinions. Dr. Bernheim looks upon coition as a frequent source of
tubercular infection, and the sensitive and absorbing covering of the
uncircumcised glans as a ready medium of transmission of the virus from
one system to the other. He calls attention to the frequent granular
condition of the uterine os, in confirmed cases of tuberculosis, as
something that is too much overlooked. This view of the case, from Dr.
Bernheim's stand-point, is worthy of greater consideration than it has
generally received at the hands of the profession.
The great number of examples that have recently come to light in
connection with the direct inoculability of tubercular consumption, both
in the later works on phthisis and in the medical press, are not without
interest or without a lesson. The case recorded within the past year of
a healthy chambermaid, who was immediately inoculated with tubercular
matter with rapidly-following constitutional effects through a scratch
on the hand, received from the sharp edge of a broken china cuspidor
that a consumptive was using, is one of these cases that are to the
point; so it is evident that the uncircumcised need not always wait for
the degeneration of syphilis into syphilitic phthisis or syphilitic
scrofula to become a consumptive, but it is within the greatest range of
possibility and probability that he may become at once a consumptive
through an excoriation or abrasion received during coition with a
tubercular woman. So many tubercular prostitutes ply their trade, or, to
be more definite, so many prostitutes become tubercular, and in its
different stages follow their occupation as the only means of keeping
out of the poor-house, that man runs as much if not more risk, in
consorting with the class, of contracting tuberculosis than that of
contracting syphilis.
There is something about syphilis that is not generally noticed; we are
all well acquainted with the dire results that usually follow syphilitic
infection, its course through every stage of suffering and misery, its
transmission and effects in tubercular meningitis or in syphilitic
affections of the mesentery through heredity in children, and of the
many horrible cases of destruction of tissue, in skin, mucous membrane,
cartilage, or bone, with their attending mutilations and disfigurations;
but there is no record of the great number of cases, and very few
physicians of any extended practice but who can recall some such cases,
where, after undoubted syphilitic infection, with the usual course of
primary sores and secondary eruption, the patient has suddenly blossomed
out into a state of robust health that his system was an entire stranger
to before the infection. The writer has, in the course of a long
practice, seen a number of such results follow both the infection
attended with a miliary eruption and that followed by the large
small-pox-appearing eruption, both kinds being preceded by the primary
sore; and these results have been observed in cases of both what are
called the soft and multiple and the hard or Hunterial initial sore.
Some of these cases rapidly gained in flesh, with an evident increase in
the redness of their blood, increasing in vigor and strength with a very
perceptibly less tendency to attacks from accidental or previously
subject-to diseases.
The same result has been observed to follow an attack of small-pox with
some individuals, and the writer well remembers a similar result
following a very extraordinary event. The subject was a man well known
among his old comrades of the First Minnesota Infantry as "Duke," and to
many of the older practitioners of Wabashaw County, of that State, as
"Old Duke." In early life he was sickly and weakly, never having fully
recovered from a malarial fever contracted in the Mexican war. Coming to
Minnesota, he adopted the life of a raftsman, with all the
irregularities that accompanied such a life. On one occasion, after a
protracted spree, feeling the need of stimulation and not having the
wherewith to procure it, he secured a jar in which a snake and several
other reptiles were preserved in spirits, and drank the fluid contents.
He was, some days afterward, taken violently ill with a high fever and
racking pains, ending in an eruption of boils that covered him from head
to foot; he made a slow and tedious recovery; but when recovered he
seemed to have become imbued with a constitution resembling
_lignum-vitae_, for a more stubborn-twisted constitution never existed
than that of "Old Duke." The power of resistance that this man developed
was something wonderful. Dr. C. P. Adams, of Hastings, Minnesota, and
the St. Paul physicians who were connected with the regiment well
remember, though, wiry, precise, and soldierly "Duke," who, even in the
old Army of the Potomac, immersed up to his ears like the rest of the
army in the mud and dirt of the encampment of Falmouth, above
Fredericksburg, came out on general inspection as prim as if he had just
stepped out of a bandbox, for which he received a medal for soldierly
conduct and bearing.
These apparent digressions are not made either to be tedious or to weary
the reader, nor without an object. They are made to show that, whereas
syphilis is looked upon as such a deadly disease, and it may be said to
be the sole cause of fear to the assiduous worshiper at the shrine of
Venus Porcina, there is another still more fatal danger awaiting him,
ambushed in the folds of the vaginal mucous membrane, or coming along
silently out of the cervical canal,--like the legions of Cyrus stealing
along the dry bed of the Euphrates into ancient Babylon, to fall
unawares on the feasting Nebuchadnezzar on that fatal night. So, in like
manner, the virus of tuberculosis, either extruding from a granular os
or from its neighborhood, gradually moves down on the unsuspecting,
uncircumcised, and easily inoculable-surfaced glans penis, to infect the
system with a tubercular poison that has no such exceptions as those
above noted, as at times are the followers of syphilis. It is not alone
the individual himself that may be the sufferer from this poison, but
his progeny for several generations may have to suffer for the infection
thus received, just as much as they would were that infection to have
been syphilitic. As before remarked, this has heretofore not
sufficiently occupied the consideration of the profession, and, as it
cannot certainly be denied that such a source of tubercular infection is
both possible and probable, the subject is entitled to more serious and
deliberate consideration than that which has heretofore been paid to it.
Tuberculosis certainly has these two channels of entrance: either
through direct infection or through an evolutionary process resulting
from syphilis. The appearance and vital statistics offered by the French
War Office in regard to the Algierine provinces, the report of the
United States Census, the opinion of Dr. Billings deduced from the
census reports, the opinions of Hutchinson, Richardson, Bernheim, and
many other observers, as well as the personal but unrecorded
observations of many practitioners, all tend to bear testimony to the
remarkable difference that exists between circumcised and uncircumcised
races in regard to the ravages of consumption. Is circumcision a factor
in this difference, or is it not? If it is, then circumcision should
receive more attention than it has; if it is not, then we should not be
idle in hunting up the cause of difference, for an ounce of prevention
is certainly worth in this regard a whole pound of Koch's lymph as a
curative agent.