SURGICAL OPERATIONS PERFORMED ON THE PREPUCE.
In operative interference there is one point which should not be lost
sight of, this being that the length and bulk of the prepuce in a great
measure depends on the constriction at its orifice; if the orifice is
small, the prepuce tight and inelastic, every erection, by putting the
penis-integument on the stretch, adds to its bulk,--nature naturally
trying to make up the deficiency,--the two points of resistance being
where the glans pushes it ahead, having the constricting orifice for a
hold or purchase, and the skin at the pubes, which is called upon to
furnish the extra tissue for the time being needed during erection,
which should be supplied by the prepuce--this being the only office
which I have been able to assign to this otherwise useless but very
mischievous appendage. In cases where preputial irritation produces more
or less priapism, the continued stretching of this integument causes a
marked increase in its growth, which is mostly added forward. It was on
this principle or its recognition, that Celsus devised his operations,
and on which the persecuted Jews undertook to recover their glans by
manufacturing a prepuce; and, although the trial was not reported as
being very successful, I do not doubt but that, if the skin could have
been drawn sufficiently over so as to constrict it anteriorly so as to
give the glans a purchase, as in the case of phimosis with an inelastic
prepuce, the operation could be more of a success; all that is required
is the continued extension and the prepuce might be made to rival in
length the labia majorae of the females of some African tribes, or the
pendulous buttocks of the Hottentot Venus.
I have employed the knowledge of this elasticity and source of supply of
the penis-integument, on more than one occasion, in recovering the
denuded organ with skin. A number of cases are on record where, owing to
the want of that artistic and mechanical knowledge without which no
surgeon is perfect, the operator has drawn forward the skin too tight in
circumcising, after which, owing to the natural elasticity of the skin,
the integument has retracted, leaving the penis like a skinned eel or
sausage. This accident is even liable to occur where the skin has not
been tightly drawn, but where subsequent erections have torn through the
sutures, and where the natural retraction of the skin has laid the organ
bare for some distance. I have seen a number so recorded, but do not
remember seeing any remedy suggested, it seemingly being accepted that
the recovery must take place by gradual granulation,--a necessarily very
slow process, owing to the constant interference by--the always present
in such cases--unavoidable erections.
Several years ago I advised circumcision to a gentleman owing to a
contracted condition of the muscles of one hip and thigh, which was
threatening to render him a deformed cripple; he had a congenital
phimosis and a very irritable glans penis. The operation was performed
in a proper manner by a surgical friend, but this friend, unfortunately,
was a great believer in antiseptic and wet dressings. A few days after
the operation he called upon me to ask me to go and see the patient, as
they were both in a pickle, the patient being exceedingly angry, being
in constant misery, and the penis so denuded by the giving way of the
sutures--owing to the erections--that it looked to the patient as if he
never could have a whole penis again, and the doctor saw no way out of
the difficulty; the penis was, in reality, a dilapidated and
sorrowful-looking appendage, and anything else but a thing of beauty or
pride; it was raw, angry-looking, and bleeding at every move; the first
wink of sleep was followed by an attempt at erection that raised the
patient as effectually as an Indian would in scalping him; so that,
taken altogether, the penis, anxious countenance, and the flexed
position of the whole body to relieve the tension on the organ, the man
looked about as battered, cast down, and sorrowful as Don Quixote did in
the garret of the old Spanish inn, with his plastered ribs and
demolished lantern-jaw.
Luckily, the patient was seen before the retracted portion of the penile
integument had had a chance to condense and indurate. The bed was
slopping wet with the drenchings of carbolized water that the penis had
undergone, the man's clothing was necessarily damp, and the whole
bedding and clothes were steamy,--all of which greatly added to his
discomfort and tendency to erections. The man was washed, placed in a
new, clean, and dry bed, and his clothing changed. The organ was then
forced backward until the preputial frill or edge was approximated to
the cut end of the penis-skin, where it was made fast by an
uninterrupted suture around the whole of the circumference. A short
catheter, about three inches in length,--the catheter being as full size
as the urethra would comfortably hold, and of the best and thickest of
the red, stiff variety,--was introduced into the urethra. This protruded
about half an inch beyond the meatus. A stiff, square piece of
card-board was pierced and slipped over this, and then adhesive rubber
straps were brought from the integument to this little platform, the
first being from the median line of the scrotum, lifting the sac forward
and upward. The pubes were shaved and the next four straps started from
the root of the penis, each strap being split at the glans-end so as to
encircle the protruding end of the catheter. By these means the skin was
brought back and firmly supported over the penis, toward the glans; and,
in case of any erection, the act would only assist in drawing the
covering farther over the penis as the pasteboard platform and adhesive
straps formed the distal end of an artificial phimosis. The catheter
allowed of free urination, and the scrotum was further held up in
position by a flat suspensory bandage passed underneath the scrotum and
fastened over the abdomen near each hip. The penis wound was then
dressed with a very little benzoated oxide-of-zinc ointment passed
between the adhesive straps; a bridge-support placed over the hips to
support the bed-clothes, and all was finished, and full doses of bromide
of sodium and chloral were ordered at bed-time. When the dressings were
removed, five days afterward, all was healed, the sutures removed, and
the suspensory alone replaced. The patient had not been troubled with
any more erections or annoyances of any kind. These are the points which
often do more or less mischief: wet dressings are uncomfortable and
favor erections, while the effect of the weight and action of the
scrotum in drawing backward on the integument should not be overlooked;
in addition, it should not be overlooked that we have it in our power to
produce, so to speak, an artificial phimotic action, which has the same
traction on the penis-integument that the natural phimosis induces.
The foregoing method, to be used in these cases, has proved very
serviceable in my hands, and it is here given that it may assist others;
as there is no need of waiting for granulations or of allowing the
patient to undergo so much misery, which, besides the local injury,
cannot help but affect the general health very injuriously. The penis
can stand any amount of forcing backward; it stands this in cancer or
hypertrophy of the prepuce, or in the inflammatory thickenings that
precede gangrene of the prepuce, in any extended degree; becoming, for
the time being, more or less atrophied. As has been shown by Lisfranc,
the penis can be made nearly to disappear into the pubes; so that we are
not as helpless in these cases as our text-books would have us believe.
In infants, and in young children below the age of ten or twelve, the
Jewish operation, as modified and done in accordance with the dictates
of modern surgery, will be found the most expedient. By this method we
avoid the need of any anaesthetic agents, which are more or less
dangerous with children, as well as the need of sutures, which are
painful of adjustment and very annoying to remove in those little
fellows who dread new harm; there is also much less risk of
haemmorrhages, as the frenal artery is not wounded. In children of a year
or over, a very good result will be found often to follow Cloquet's
operation, care being taken to carry the slitting well back, as well as
care in taking it on one side of the frenum, so as to avoid any wound of
that artery, the subsequent dressing being a small Maltese-cross
bandage, pierced so as to admit the glans to pass through; the prepuce
is retracted and the tails folded over each other and held there by a
small strip of rubber adhesive plaster; a little vaselin prevents the
soiling by urine underneath. This last operation is short and very
easy, is not painful, nor does it require much manipulation; it is only
one quick cut on the grooved director and it is over; by the retraction
of the prepuce, the longitudinal cut becomes a transverse one, making
the prepuce wider and shorter at once; the glans soon develops and
remains uncovered. As there is a very small wound to heal over, the
repair is very prompt.
In adults with a very narrow, thin, not overlong prepuce, a very good
result often follows a combination of the dorsal slit with the inferior
slit alongside of the frenum of Cloquet. The narrower and tighter the
prepuce, the better the result, as the cuts are at once converted from
longitudinal into transverse wounds, and the organ at once assumes the
shape and condition of a circumcised organ, without having suffered any
loss of substance; three stitches or sutures in each cut (silver or
catgut) adjust the cut edges; a small roller of lint and adhesive
plaster, placed so as to shoulder up against the corona, completes the
dressing. Where this operation is practicable, by the thinness and
narrowness of the prepuce, it has many advantages. I have repeatedly
performed it on lawyers, book-keepers, clerks, and even laboring men,
who have gone from the office to the courts, counting-rooms, or stores
without the least resulting inconvenience or loss of time. In laborers
it is better to perform the operation on a Saturday evening, which gives
them a rest of thirty-six hours before going to their labor again. The
operation is comparatively painless and almost bloodless, as there need
not be more than half a teaspoonful of blood lost during the operation;
there is no danger of any subsequent haemorrhage, and, with proper
precautions against the occurrence of erections, from seventy-two to
ninety-six hours is sufficient for a complete union; the sutures are
then removed and a simple lint and adhesive-plaster dressing worn for a
few days more. In many, no more dressings are required. In many cases,
with a properly adjusted dressing, that comes forward underneath so as
to include the frenum, the simple dorsal slit is sufficient; but if any
of the prepuce depasses the dressing underneath, it will puff and become
oedematous and require frequent puncturing. To avoid it, it is better to
make the Cloquet slit at once. This operation is of no value, and
perfectly impracticable in a thick, pendulous prepuce. Absorption will
often remove considerable preputial tissue, but where there is too much
its very bulk interferes with its removal by any natural means.
Dilatation is recommended by a number of surgeons, but, I must admit, in
my hands it has always proved a failure; it may be, that if the
subsequent history of the cases reported as so operated upon had been
carefully traced, the reports would not have been so good. Nelaton,
whose dilating instrument is generally recommended, seems, himself, to
prefer some of the circumcising methods, as in the volume on "Diseases
of the Genito-Urinary Organs," in his "Surgery," being the sixth volume
of the revised edition of 1884, by Despres, Gillettte, and Horteloup,
the subject of dilatation is dismissed in two short lines. St. Germain,
of Paris, uses, as has been before observed, a two-bladed forceps, used
after the manner of Nelaton, and reports good results. Dr. J. Lewis
Smith agrees in his statements with Dr. St. Germain. Dr. Holgate, of New
York, reports a like experience. In my own practice the prepuce has
often been made _temporarily_ lax and retractable, but with the usual
results of the return of the contraction, with a possible thickening of
the inner fold, as a result of the interference; so that only in case of
any immediate demand, where the tight prepuce is producing irritation,
either through pressure or adhesions, or retained sebaceous matter, do I
ever resort to dilatation; always, however, even then, not as a final
operation, but merely as preparatory procedure toward a future operation
of a more efficient order.
In cases of timid adults, who refuse all kinds of operative
interference, good results may be obtained by the use of a mild
lead-wash or cold tea-baths and the introduction of flat layers of dry
lint interposed between the prepuce and the glans; this has a very good
effect in keeping the parts apart and dry, and may in time produce a
certain amount of dilatation; but even when this is done, unless it will
render the foreskin sufficiently loose to allow of its being kept
finally back of the corona, it is, after all, but a temporary makeshift.
The corona should be exposed and kept clear of the preputial covering;
anything short of this will not give all the good results to be desired.
I have more than once performed a secondary operation on Jews, who had
been imperfectly circumcised by not having the prepuce removed
sufficiently, and in whom the subsequent contraction of the preputial
orifice had re-covered part of the glans, and only lately visited a
four-year-old boy, circumcised when eight days old, in whom the prepuce
covered half of the glans, the corona acting as a tractive point from
which the penile integument was being drawn forward. In this case the
simple pierced-lint Maltese cross was used, with an adhesive band to
hold the tails down behind and around the penis just back of the corona.
These means, although not circumcision either in a surgical or in the
Hebraic religious sense, are, nevertheless, sufficient in a medical
sense for all desired purposes; provided, however, that there is no
resulting constriction, or a mild condition of paraphimosis, back of
the corona, and that the whole of the glans is sufficiently uncovered,
and that no abnormal dog-ears are left to garnish each side of the penis
like an Elizabethan frill or collar; although Agnew holds that, in
slitting, the practice adopted by many of rounding off the corners is
mostly superfluous, as nature will do so itself in time.
The ordinary way of performing the operation by modern surgeons is by
what is known as the Bumstead circumcision. It was not an invention of
Bumstead, but was adopted by him in preference to all others. The
requisites are a sharp-pointed bistoury, blunt-pointed scissors, and a
pair of Henry's phimosis forceps, with fine needles and fine oculists'
suture silk. The penis is allowed to hang naturally and the position of
the corona glandis marked on the outer skin with a pen and ink, which is
to serve as a guide for the incision. The prepuce is now drawn forward
until this line is brought in front of the glans and grasped between the
blades of the forceps. The prepuce is now transfixed, and, with a
downward cut, that portion is severed; the knife's edge is now turned
upward and the excision finished. The forceps are now removed and the
integument allowed to retract; with the scissors the inner mucous fold
is now split along the dorsum and trimmed off so as to leave about half
an inch in front of the corona. The parts are then brought together with
the continuous suture and dressed according to the fancy of the surgeon.
Care must be taken _not to bruise_ the parts with the forceps, as, in
such cases, sloughing of the sutured edges will be the result instead of
union. I have seen this accident happen more than once, in one case
being followed by a penitis that seriously complicated matters.
It has been my practice to use fine silver-wire and catgut sutures in
all operations on the prepuce; they excite less suppuration as well as
less irritation. In case of need, the silver can be left in longer, and
they are much easier of removal than the silk; besides, they have the
advantage of not cutting. In the after-treatment the same general plan
can be followed as with any amputated stump, except that it must not be
forgotten that at the end of this organ dwells what has been termed the
_sixth_ sense, and that heat and moisture are very apt to awaken the
dormant energies of the organ, even after it has undergone cruel
mutilation, and even has suffered considerable loss of blood; for that
reason it is best always to avoid wet or sloppy dressing, or too much
ointment, as they are more apt to cause erection than to do any good.
Besides, I find water does here, as elsewhere, interfere with the
deposited plastic matter, properly organizing into cicatricial tissue;
so that I prefer a snug, dry dressing, which is left on for four or five
days without being interfered with, and light covering, plain diet,
quiet, with fifteen grains each of bromide of sodium and chloral hydrate
at bed-time to insure rest and freedom from annoying erections. Where
the organ is large in its flaccid state, it is better to support it on a
small oakum-stuffed pillow, made for the purpose, than to let it hang
downward. Should the stitches give way and the skin tend to retract, the
plan proposed on a previous page can be followed to advantage. In
urinating, care must be taken not to soil the dressings; some patients
are very careless about this if not warned. The penis should hang nearly
perpendicular while in the act, and all dribbling should have ceased and
the meatus and underneath be mopped dry with some soft cotton before
raising the organ; nothing so irritates the parts, retards union, or is
more offensive than a urine-saturated dressing.
Dr. Hue, of Rouen, uses an elastic ligature, which he introduces into
the dorsal aspect of the prepuce by means of a curved needle. This he
ties in front, and in three or four days it cuts its way through.
Although Hue reports a large number so operated upon, the tediousness of
the procedure and the swelling and oedema, as well as the active pain
that must necessarily accompany the operation, will hardly recommend the
ligature in preference to the incision by the knife.
Dr. Bernheim, the surgeon of the Israelitish Consistory of Paris, has
operated on over eleven hundred circumcisions, besides the cases of
phimosis occurring in his general practice. His opinion of the procedure
of M. de Saint-Germain by dilatation is not favorable. He has employed
it in a number of cases of phimosis, at the time unfit for a more
radical operation. He has, however, observed that cicatricial
thickenings and recontractions are very apt to occur, and, as to the
septic accidents mentioned in connection with circumcision, he has noted
that they are as liable to occur in hands that are as careless and
slovenly with what they do with their dilating forceps as they are with
what they do with their bistouries. Dr. Bernheim prefers the
circumcision forceps of Ricord, as modified by M. Mathieu. This
instrument he prefers by reason of its gentler pressure, which, at the
same time, is all-sufficient to properly fix the prepuce. In applying
the forceps, he includes as little as possible of the lower part,
keeping away as much as possible from the frenic artery. The dorsum of
the inner fold he cuts with the scissors. In children under two years of
age, he simply turns this back over the free edge of the integument; in
children over two years of age, he uses serres-fines. In children, he
uses a piece of lint dressing steeped in a watery solution of boracic
acid; in adults, he uses iodoform-gauze dressings. He finds cases unite
in from three to ten days. Dr. Bernheim warns us against using
antiseptics on infants or young children, in connection with the
after-dressing of circumcision. Neither phenic acid, corrosive
sublimate, nor iodoform are well borne by these young subjects, and he
has seen serious results follow upon as light an application as a 1/100
solution of phenic acid. In a number of cases he reports operating with
the galvano-cautery of Chardin, instead of the knife. These operations
were bloodless, and cicatrization was as rapid as when the knife was
used. He has in several cases operated by the dorsal incision, owing to
disease of the prepuce not allowing any other operation.
In France, the Bumstead operation is known under the title of Ricord's
procedure. Lisfranc, Malapert, M. Coster, and Vidal all have operations
which are not as useful as Ricord's, and have not, therefore, come into
general use. M. Sedillot condemns the dorsal incision as leaving two
unsightly-looking flaps. The reverse, or inferior incision of M. Jules
Cloquet is likewise not in favor with either Malgaigne or Ricord. This
inferior incision or section, alongside of the frenum was first advised
by Celsus. M. Cullerier contented himself with slitting the inner
preputial fold, longitudinally, from its junction with the skin backward
to the corona. M. Chauvin, by the aid of a complicated instrument with
barbed points, drew out the mucous fold as far as possible before
excising.
There is something unaccountable in the difference in results that
various operations give in the hands of different surgeons. It must be
that all methods are correct _with properly-chosen cases_ and when
properly _performed_, as well as properly looked after subsequently to
the operation. It must not be expected, however, that, in operations
where the kindly assistance of nature is a thing contemplated in
absorbing superfluous tissue, the case will at once give satisfaction to
all. These cases must have the required time before judgment can be
passed upon the merits of the operation, just as required time in cases
of dilatation or in the method of M. Cullerier will often demonstrate
that the benefits are but transient, and that often even cases that have
been so operated upon will require a complete circumcision, _a la_
Ricord or _a la_ Bumstead, owing to the resulting thickening induration
and overconstriction, when, if left alone, the dorsal slitting or the
inferior incision of Cloquet would have previously given satisfactory
results.
The final cosmetic results in the combined Cloquet and dorsal-slit
operation, for instance, depend on, first, properly choosing the case.
One on whom the operation is unadaptable it is useless to attempt it on,
as a future circumcision or tedious and annoying re-operation of
trimming would be required. The next care is to properly cut through all
constricting bands, which, like fine, tough strings, will be found to
encircle the penis. These must be carefully clipped with a fine pair of
strabismus scissors, as these bands do not give way, either then or
afterward, of their own accord, but form the nucleus for stronger
constricting bands for the future. Then you must be sure to cut far
enough back, either above or below, until you have reached where you
obtain the normal and largest calibre of circumference of the penis. The
adaptation of the edges of the parts and the proper application of a
smooth, equal pressure, by means of the lint strap, is of the next
importance; and then comes the strapping of the whole surface for about
an inch and a half back of the corona, which should and must include all
the tissues of the preputial part of the frenum. A neglect or careless
performance of any of the details, or the carelessness of the patient in
not keeping the dressing clean, necessitating its change before the
fourth day, all tend not only to interrupt the union, but to mar the
future cosmetic results as well. It may be asked why all this care and
trouble, and not circumcise at once? As already observed, this operation
admits of the patient following his business; whereas circumcision, on
the male, will assuredly lay him up for four or five days, and perhaps
ten days,--something that many, be they rich or poor, cannot afford, and
will not submit to.
The cosmetic condition of the penis as a copulating organ is a thing of
some importance, and this should not be overlooked; for, although the
particular dimension, shape, or peculiarity of the penile end never
figures prominently in the complaints of women who apply for
divorce,--the charges being everything else under the sun,--it can
safely be assumed that this organ and its condition is the original,
silent and unseen, as well as unconscious power behind the throne that
is at the bottom of the whole business in more than one case. Like the
fable of the poor lamb that the wolf wished to devour: the real reason
of his wishing to kill him was that he might eat him, the pretext set
forth by the wolf that the lamb had encroached on his pasture, muddied
his brook, or kept him awake by his bleating having been disproven by
the lamb. Besides, it is well not to leave any distinctive or
distinguishing mark, like an individual baronial crest, on the head of
the organ.
To return, however, to the operative procedures, we find that Dr. Vanier
finds that the operation of Cloquet by incision alongside of the frenum
has the advantage of not leaving any deformity--contrary to the opinion
of Ricord and Malgaigne. He, in fact, holds this procedure in such high
esteem that he considers that Cloquet deserves great credit for reviving
this old Celsian operation. H. H. Smith, in his "Operative Surgery,"
coincides with Vanier in his favorable opinion of this method, as he
there says: "Frequent opportunities of testing the advantages of the
plan of Cloquet having satisfied me of its value, I do not hesitate to
recommend it as that best adapted to the adult, because it fully exposes
the glans and leaves little or no lateral deformity, as is frequently
the case with the dorsal incision,"--an opinion that I can fully agree
with, from the results of the same operation in my hands, although I
have used the method even on infants. Vanier does not approve of the
dorsal incision unless it is made V-shaped, as it otherwise leaves the
unsightly lateral flaps, but thinks well of the modification of
Cloquet's practiced by M. Vidal de Cassis, which is performed in the
following manner: The patient stands before the operator, who remains
sitting; the operator seizes the prepuce on its dorsum and draws it
toward him; he then introduces a narrow, sharp-pointed bistoury, with
its point armed with a small waxen bullet, down alongside of the frenum
until he reaches the pouched extremity of the preputial cavity at this
point; the point of the bistoury is now made to transfix the waxen
bullet and out through the skin, which from this point is divided from
behind forward. Vanier very sensibly suggests that the operation that is
effectual, and which can be accomplished in the least number of
movements or _temps_, as being the least likely to cause extensive pain
and agony, should be the one preferred, and that the aim of the surgeon
should be to simplify the operation by reducing the number of necessary
movements. For this reason, where an excision of considerable amount of
tissue is required by the nature of the case, he prefers another
operation, performed by Lallemand,--that of making a dorsal transfixion
and cutting off the two lateral flaps, which can all be done in three
movements.
It makes but little difference as to which operation is performed on the
adult, but that the subsequent dressing will exercise a good or evil
influence, and greatly assist not only in the present comfort or
discomfort of the patient, but in the ultimate result as well. Bearing
these points in view, Charles A. Ballance, of St. Thomas's Hospital, has
adopted the following procedure:--
"When the patient is etherized, the outline of the posterior border of
the glans is marked on the skin with an aniline pencil. The skin of the
prepuce is slit and removed up to the aniline line. The mucous membrane
is next cut away, leaving only a free edge of about one-eighth of an
inch in width. Any bleeding which occurs should be entirely arrested,
and asepsis must be insured by frequent sponging with carbolic or
sublimate solution. Numerous coarse-hair stitches are then inserted, so
as to bring accurately together the fresh-cut edges of the skin and
mucous membrane, and subsequently, after a further sponging and drying,
a piece of gauze two layers of thickness, and wide enough to reach from
the root of the penis nearly to the meatus, is wrapped loosely around
the penis and secured by several applications of the collodion-brush.
The setting of the collodion is hastened by the use of a fan, so that
the air is kept in motion, and the patient should not be allowed to
recover from the anaesthetic until the dressing is quite firm and hard.
This dressing forms a carapace for the penis, protecting it from the
bedclothes and effectually preventing the annoying and distressing
erections. Mr. Ballance reports excellent results from this dressing."
(Braithwaite's _Retrospect_, July, 1888.)
In applying the above dressing, the shrinking incident to the drying of
the collodion must not be overlooked, and the gauze layers must be
loosely applied, as they would otherwise become too tight. The dressing
is a very ingenious and serviceable one.
Mr. A. G. Miller, at a meeting of the Edinburgh Medico-Chirurgical
Society, reported a new method of dressing after circumcision. "It
consisted in first closely suturing the skin and mucous membrane by
numerous catgut sutures, then painting the surface with Friar's balsam
and covering it over with two or three layers of cotton wadding, on
which the balsam is poured. The glans penis was left sufficiently free
to allow of water passing. The band or ring of dressing should be at
least one inch broad. The dressing was not suitable for young infants
who were frequently wetting. In the case of older children, they might
be allowed to go about on the second or third day, when the dressing
would be quite dry, and would not be required to be changed or renewed."
(Braithwaite's _Retrospect_, January, 1888.)
Any constricting or immovable and inelastic dressing is subject to the
same objections as plaster-of-Paris dressings in thigh-fractures,--that
of being dangerous and not expedient, unless the patient is constantly
under your eye.
Dr. Neil Macleod, in the _Edinburgh Medical Journal_ for March, 1883,
advises a procedure that has always looked favorably to me, and which I
once put in practice through the means of the ordinary ptosis
fenestrated forceps, in place of the ordinary circumcision forceps, the
sutures being introduced through the fenestra and the prepuce cut off on
the outer side of the forceps, the thickness of the steel arm on the
outer side of the fenestra allowing of the properly-sized border for the
hold of the sutures. Dr. Macleod places his sutures all in position
before making any incisions,--a procedure which will be found to save
the patient considerable pain; as with many the seizing and holding of
the edges of the skin and mucous membrane and the forcible pressure
exerted by the fingers or forceps while the needle is being forced
through is the most painful part of the operation. In doing this, care
must be taken to allow sufficient length to each thread to make two
sutures, as well as care must be taken to properly pull out the thread
in the centre between the four folds of tissue and to cut it
equidistant, after the ablation of the prepuce, a blunt hook being used
to fish up the threads from the preputial opening.
Erichsen favors the Jewish operation in young children, as being the
easiest and safest of performance. Slitting, or the inferior or superior
incision, he thought, left too much of the prepuce, which, wherever
there is a tendency to phimosis, should be entirely removed, "with a
view of preserving the health and cleanliness of the parts in after
life." In the phimosis that is acquired by old men, he found dilatation
with a two-bladed instrument to be sufficient, provided the indurated
circle was made to yield. For the circumcision of adults he has invented
an adjustable shield, something like the Jewish spatula, with which he
protects the glans.
Gross (the elder) used both slitting on the dorsum and circumcision. He
found neither objection nor deformity in the flaps left by the dorsal
incision, as they were only temporary; in some cases, he simply followed
the practice of Cullerier, of making multiple slits in the constricting
and inelastic mucous membrane.
Agnew believes in circumcision in the treatment of reflex troubles. He
relates a case, in the second volume of his "Surgery," of eczema
extending over the abdomen, of over a year's standing, cured in a child
by circumcision; he operates by incision on the dorsum, in which he
leaves nature to make away with the flaps, or he circumcises by the
Bumstead method.
Van Buren and Keyes recommend both the incision on the dorsum and the
operation of Ricord; where the mucous membrane alone is tight and
constricted, they follow Cullerier's method of either single or multiple
incisions of the inner coat. They lay great stress on the necessity of
keeping the patient quietly in bed to insure rapid and complete union.
My friend, Dr. Robert J. Gregg, of San Diego, has lately operated on a
number of cases, the operation being perfectly painless, the little
patients submitting to it and feeling no more pain than if it were
having its toe-nails trimmed, the local anaesthesia being produced by the
hypodermatic injection of cocaine. This procedure is now used to a
considerable extent throughout the country, and it is a far safer and
more comfortable performance than either etherizing or chloroforming, as
the sudden and spasmodic filling of the lungs of young children--who
will resist and hold their breath for a long time, then suddenly
inhale--with anaesthetic vapor is almost unavoidable, having in two
instances nearly lost two children from such an accident.
Dr. G. W. Overall, in a late _Medical Record_, which is quoted in the
_Journal of the American Medical Association_ of February 21, 1891,
gives the description of a very good and painless method of producing
this local anaesthesia; for it need hardly be said that with a nervous,
irritable child the introduction of the hypodermatic needle is as
formidable an operation as either slitting or the Jewish operation. Dr.
Overall is in the habit of holding a solution within the preputial
cavity and then to introduce the needle in the mucous fold, having
previously applied a light rubber band back of the corona, on the outer
integument, so as to act like a tourniquet and limit the action of the
anaesthetic effect to the prepuce. By this procedure he avoids all pain
and the operation can be performed while the child is even amusing
itself, care being taken that it does not see it. Sutures that require
removal should not be used, according to the Doctor, and the operation
thereby becomes a perfectly painless and unalarming performance to the
patient in all its details.
NOTES TO TEXT.
[1] "Letters of Certain Jews to Monsieur Voltaire, Containing an
Apology for their own People." Pages 451-476. Translated by
Dr. Lefann. Philadelphia, 1848.
[2] "Circoncision chez les Egyptiens." Brochure by F. Chabas. Paris,
1861.
[3] "Atlantis." By Ignatius Donnelly. Page 472.
[4] _Ibid._, page 115.
[5] _Ibid._, page 234.
[6] _Ibid._, page 178.
[7] "Circumcision." A. B. Arnold. _New York Med. Record_, Feb. 13,
1886.
[8] "Atlantis," page 178.
[9] This word is, in the Mandan, _Maho-peneta_; in the Welsh,
_Mawr-penaethir_. "Atlantis," page 115.
[10] "Cyclopedia of Biblical, Theological, and Ecclesiastical
Literature," vol. viii, page 58. Article, Phallus.
[11] "Origine, Signification et Histoire, de la Castration, de
l'eunuchism, et la circoncision." Par. F. Bergmann. Published
in the "Archivio per le Traditione Populaire," 1883.
[12] "Dictionaire des Sciences Medicales." Par une Societe de
medecins et de Chirurgiens. Paris, 1826, 60-volume edition.
[13] Dr. Delange mentions a peculiar social habit or custom among a
tribe of Arabians that in a sociological sense is worth
mentioning. He observes that for these dances females are
preferred, but owing to the peculiar habit about to be related
it is impossible to have any of the village women in Algeria
assist at this part of the festivities; hence the men have to
do the dancing. It appears that the females of one tribe--this
being the tribe of Ouleds-Nails, who live on the southern
borders of Algiers--are in the habit, when young, of
emigrating to the oases of the Sahara, which are occupied by
the French and traveling Arabs, where they give themselves up
to a life of prostitution. After having exercised this life
for some years they return to the tribe with a dowry in money,
besides an ample supply of clothes and jewelry,--the result of
their economy,--which enables them to contract favorable
marriages. This practice is so common in this one particular
tribe, and so much have they monopolized the profession of
courtesan, that the name of the tribe of Ouleds-Nails is in
Arabia synonymous with that of courtesan. These young women
dance every evening in the Arab cafes, and are at times
employed to do the dancing at Arab feasts. For this reason no
self-respecting Arab woman ever allows herself to dance in
public, or why the practice of both sexes dancing together is
not practiced in Algerian villages, as a man would thereby
consider himself disgraced.--Dr. Delange, in _Receuil de
Memoires de Medecine de Chirurgie et de Pharmacie Militaire_,
No. 105, August, 1868.
[14] "Tractatus, Alberti Bobovii, Turcarum Imp. Mohammedis IV olim
Interpretis primarii, De Turcarum Liturgia, peregrinatione
Meccana, Circumcisione, AEgrotorum Visitatione," etc. Oxonii,
1690.
[15] Michel Le Feber. "Le Theatre de la Turquie." Paris, 1681.
[16] "La Circoncision, Sa Signification Social et Religieuse." Par
M. Paul Lafargue, in the _Bulletins de la Societe
d'Anthropologie de Paris_. Tome x, 3d fascicule, Juin a
Octobre, 1887.
[17] "Circumcision." By A. B. Arnold. _New York Med. Record_, Feb.
13, 1886.
[18] Bancroft's "Native Races," vol. ii, page 278.
[19] "Recherches Philosophiques sur les Americains, ou Memoires
Interessants pour servir a l'Histoire de l'Espece Humaine."
Par M. de P. Edition par Dom Pernety. Tome ii. Article,
Circoncision, Berlin, 1774.
[20] "The Family, a Historical and Social Study." By Charles
Franklin Thwing. Boston, 1887.
[21] The "Recherches Philosophiques sur les Americains" and Virey,
in the 24th volume of the "Dictionaire des Sciences
Medicales," are very full on this subject, and for fuller
information the reader is referred to those works.
[22] "Cause Morale de la Circoncision des Israelites, Institution
Preventive de l'Onanisme des Enfants." Par le Docteur Vanier,
du Havre. Paris, 1847.
[23] "Annual Report of the Bureau of Ethnology." By J. W. Powell.
Washington, 1881, 1882.
[24] "Among Cannibals, or Four Years' Travels in Australia." By Carl
Lumholtz. Page 46. Charles Scribner & Son, 1889.
[25] These interesting historical facts in relation to the holy
prepuce were published in the _Journal l'Excommunier_ in
January of 1870, when the writer was in France. They were
contributed by A. S. Morin, of Miron, a learned
historiographer and antiquary. Europe has not recovered from
its love of the supernatural that it had so strongly in the
middle ages. The blood of St. Gennaro still liquefies once a
year, and many churches still claim to possess the identical
winding sheet that served our Lord prior to his resurrection,
as well as more than one church has the holy cloth that St.
Veronica used on the way to Calvary, which has an impression
of the face of the Saviour.
[26] This church has a remarkable history connected with its
foundation. The tradition relates that in the dark ages some
sacrilegious soldier had robbed a church in the neighborhood
of its holy vessels of gold and silver. In the vessel in the
Tabernacle there happened to be a consecrated wafer. The
soldier journeyed on to Turin to dispose of his plunder, when,
on arriving at the spot on which the church now stands, the
wafer is said to have ascended miraculously to some distance
above the soldier's head, while at the same time the mule he
rode, being imbued with more religious piety than his master,
reverently knelt down on his front legs. The holy wafer was
now encircled by a halo of shining light; this, with the
kneeling donkey and the soldier raining blows on the pious
animal, while he himself was unconscious of the presence of
the host above him, attracted the attention of the populace,
who apprehended the soldier, on whom the stolen vessels were
found. The bishop in his pontificial robes, in solemn
procession, received the consecrated wafer, which promptly
descended into pious hands. The donkey was adopted by the
bishop and the soldier was promptly hanged, in accordance with
the general treatment of thieves in those days. The writer has
more than once seen a flagstone inclosed within a railing that
occupies the central spot of the floor or pavement of the
church, it being the identical spot on which the donkey knelt.
[27] Rush's "Medical Inquiries," vol. i, page 217.
[28] Fothergill. "Gout in its Protean Aspects," page 158.
[29] "Philosophy of Magic," from the French of Eusebe Salverte, vol.
ii, page 143.
[30] "Dictionaire des Sciences Medicales." Cullerier. Article,
Phimosis. Vol. xli.
[31] Bergmann has gone into this subject at length, and the writer
has drawn freely from his brochure on "Castration and
Eunuchism," reprinted from the "Archivio per le Traditione
Populaire" of 1883.
[32] "The Hermit." By the Rev. Charles Kingsley. See Introduction.
[33] "Dictionaire des Sciences Medicales," vol. liv, page 570.
[34] _Ibid._, page 567.
[35] _Ibid._, page 570.
[36] "Cyclopedia of Biblical, Theological, and Ecclesiastical
Literature," vol. iii, page 351.
[37] Smollett gives a good account of the Carthagena expedition in
his "Roderick Random," and for a good satisfactory detail of
the blundering Walcheren expedition the reader is referred to
Harriet Martineau's "History of England," vol. i, pages 269,
272, 273, and 354.
[38] Schoopanism, or paederastia, is at times practiced by the
Omahas, and the man or boy who suffers as the passive agent is
called _min-quga_, or hermaphrodite.--"Third Annual Report of
the Bureau of Ethnology." By J. W. Powell. Washington, 1881,
1882.
[39] When the missionaries first arrived in this region they found
men dressed as women and performing women's duties who were
kept for unnatural purposes. From their youth up they were
treated, instructed, and used as females, and were even
frequently publicly married to the chiefs or great
men.--Bancroft's works, vol. i, "Native Races," page 415.
[40] "Recherches Philosophiques sur les Americains," tome ii.
[41] "The History of the Hebrew Commonwealth." From the German of
John Jahn, D.D. Page 25. Oxford, 1840.
[42] "L'Hermaphrodite devant le Code Civil." Par le Docteur Charles
Debierre. Bailliere et Fils. Paris, 1886.
[43] "Recherches Philosophiques sur les Americains," tome ii, page
78.
[44] "L'Hermaphrodite devant le Code Civil." Debierre.
[45] _Occidental Medical Times_, Sacramento, Cal., October, 1890,
page 543.
[46] "Dictionaire des Sciences Medicales," vol. xxxi., page 41.
[47] _British and Foreign Medico-Chirurgical Review_, vol. xviii,
1856.
[48] "L'Hermaphrodite devant le Code Civil." Debierre.
[49] Sir Thomas Brown's works, vol. ii, "Religio Medici."
[50] "The Bible and other Ancient Literature in the Nineteenth
Century." L. T. Townsend, D.D. Chautauqua press, 1889. See
pages 32-45.
[51] "The Religions of the Ancient World." George Rawlinson, M.A.
Alden edition of 1885. Page 174.
[52] "The Intellectual Development of Europe." John W. Draper. Vol.
ii, page 113.
[53] _Ibid._ vol. ii, page 122.
[54] In "Clarke's Commentary," vol. i, page 113, the reason of
choosing the eighth day is given. Circumcision was not only a
covenant, but an offering to God; and all born, whether human
or animal, were considered unclean previous to the eighth day.
Neither calf, lamb, or kid was offered to God until it was
eight days old.--Lev., xxii, 27.
[55] A father circumcised his children and the master his slaves. In
case of neglect the operation was performed by the magistrate.
If its neglect was unknown to the magistrate, then it became
the duty of the Hebrew, upon arriving of age, to either do it
himself or have it done.--"Clarke's Commentary," vol. i, page
113.
[56] Bishop Newton points out the remarkable analogy that marks the
Hebrew race as descendants of Isaac and the Arab race as the
descendants of Ishmael, from whom sprung the Saracenic people.
These are the only two races that have gone on in their purity
from their beginning. They intermarry only among themselves
and have, alike, the same customs and habits as their fathers.
The sculptured faces of the Hebrew on the Babylonian monuments
are the same faces that are met in the synagogues of Paris or
New York. So with the descendants of Ishmael, in whom there
flows partly the blood of the dominant element of ancient
Egypt; neither custom, habit, nor physiognomy have changed. In
these two races, as observed by Bishop Newton, we have an
ocular demonstration of the Divine origin of our faith, if
verification of Scripture history is any criterion.--"Clarke's
Commentary," vol. i, page 111; also, Hosmer's "Story of the
Jews," page 5.
[57] "Cause Morale de la Circoncision." Vanier, du Havre. Pages
40-45.
[58] "De la Circoncision." Par le Dr. S. Bernheim. Page 7. Paris,
1889.
[59] "Cyclopedia of Biblical, Theological, and Ecclesiastical
Literature," vol. ii, page 350.
[60] Among the Semitic race, however, it seems possible to bring
forward better evidence than this of an early Stone Age. If we
follow one way of translating we find, in two passages of the
Old Testament, an account of the use of sharp stones or stone
knives for circumcision,--Exodus, iv, 25: "And Zipporah took a
stone"; and Joshua, v, 2: "At that time Jehovah said to
Joshua, Make thee knives of stone." ... The Septuagint
altogether favors the opinion that the knives in question were
of stone, by reading, in the first place, a stone or pebble,
and, in the second, stone knives of sharp-cut stone. These are
mentioned again in the remarkable passage which follows the
account of the death and burial of Joshua (Joshua, xxiv, 29,
30),--"And it came to pass, after these things, that Joshua,
the son of Nun, the servant of Jehovah, died, being a hundred
and ten years old, and they buried him in the border of his
inheritance in Timnath Serah, which is in Mount Ephraim, on
the north side of the hill of Gaash." Here follows, in the
LXX, a passage not in the Hebrew text, which has come down to
us: "And there they laid with him in the tomb, wherein they
buried him there, the stone knives wherewith he circumcised
the children of Israel at the Gilgals, when he led them out of
Egypt, as the Lord commanded. And they are there unto this
day." The rabbinical law, in connection with this subject,
reads as follows: "We may circumcise with anything, even with
a flint, with crystal (glass), or with anything that cuts,
except with the sharp edge of a reed, because enchanters made
use of that, or it may bring on a disease; and it is a
precept of the wise men to circumcise with iron, whether in
the form of a knife or scissors, but it is customary to use a
knife." This mention of the objectionable nature of the reed
as a circumcising medium is attributed to the danger that may
arise from splinters. The Fiji Islanders use both a rattan
knife and a sharp splinter of bamboo in performing
circumcision and in cutting the umbilical cord at child-birth.
Herodotus mentions the use of stone knives by the Egyptian
embalmers. Stone knives were supposed to produce less
inflammation than those of bronze or iron, and it was for this
reason that the Cybelian priests operated upon themselves with
a sherd of Samian ware (Samia testa), as thus avoiding danger.
There seems, on the whole, to be a fair case for believing
that among the Israelites, as in Arabia, Ethiopia, and Egypt,
a ceremonial use of stone instruments long survived the
general adoption of metal, and that such observances are to be
interpreted as relics of an earlier Stone Age.--"Researches
into the Early History of Mankind." By Edward B. Tylor. Pages
217-220. London, 1870.
[61] The cannibals of Australia do not eat white people, as the
flesh of these produces a nausea, which the flesh of the
vegetable-fed blacks does not do. The rice-fed Chinese are
considered a treat, and these are slaughtered in great number,
ten Chinamen having been served up at one dinner.--"Among
Cannibals." By Carl Lumholtz. Page 273.
[62] "Cause Moral de la Circoncision." Par le Dr. Vanier. Page 266.
[63] _Ibid._, page 288.
[64] _Cincinnati Clinic_, vol. ii, page 165.
[65] "The Story of the Jews." Hosmer. Page 263.
[66] "Traite d'Hygiene, publique et privee." Michel Levy. 2d.
edition, vol. ii, page 754.
[67] _Ibid._
[68] "Diseases of Modern Life." B. W. Richardson. Page 19.
[69] "Longevity and other Biostatic Peculiarities of the Jewish
Race." By John Stockton Hough, M.D. _New York Med. Record_,
1873.
[70] "Vital Statistics of the Jews." By Dr. John S. Billings. _North
American Review_, No. 1, vol. 152, page 70, January, 1891.
[71] "On Regimen and Longevity." By John Bell, M.D. Page 13.
[72] _British and Foreign Medico-Chirurgical Review_, vol. xliii,
page 539.
[73] _Ibid._, vol. xlii, page 17.
[74] In "Influence of the Trades on Health," Thakrah mentions the
peculiar exemption enjoyed in this regard by the butcher
class. He quotes Tweedie in saying that he never saw a butcher
admitted to the fever hospital.
[75] Lancereaux. "Distribution de la Phthisie Pulmonaire."
[76] Ashhurst. "Int. Enc. Surgery."
[77] Horner. "Naval Practice."
[78] _Cincinnati Lancet and Observer._, vol. xvi, 1873.
[79] It may well be a question of some interest whether the atrophy
of the testicle in the aged may not at times be partly due to
the compression exercised by the prepuce on the glans through
reflex action, and whether at times the virility that is
departing cannot be restored by circumcision in such cases. I
have seen such results, being guided to the idea by the
Biblical relation in the case of Abraham.
[80] This patient subsequently died of a uraemic complication
following on an attack of fever. The man was in his prime, and
had been of most exemplary habits. The fever that he had was,
I had every reason to believe, directly due to the results of
imperfect blood depuration incident on the irritability of his
kidneys, which, retroactively, again allowed the uraemic
condition to assume that dangerous degree that suddenly and
very unexpectedly to his friends and family ushered the
patient into eternity. This man had only been merely
inconvenienced by his prepuce up to the time that it caused
his death. It is interesting to observe what little trifles
bring about the end of some men. The unlucky habit of putting
the royal countenance on paper brought Louis XVI to a sudden
halt at Varennes, and his head to the scaffold. The lucky
meeting of the _aides_ of Bonaparte and Desaix between Novi
and Marengo gave to France its empire and to Europe the
enlightenment that was diffused by that event. If such trifles
affect individuals and nations, we must not be astonished that
the little useless prepuce should be endowed with the
mischief-working power of the historical old cow and kerosene
lamp that reduced Chicago to ashes.
[81] In the London _Lancet_ for 1885 there is a very interesting
communication at page 46 on this subject. There is no doubt
but that the prepuce offers the best skin-grafting material.
[82] In the seventeenth volume (third series) of "Guy's Hospital
Reports" there is a most interesting report at page 243 of a
case of skin-grafting that was performed by Thomas Bryant. The
case was an extensive ulcer resulting from an injury. Bryant
took some skin-grafts from the man's arm and some from a
colored man in an adjoining bed. The account gives the daily
report as taken from the note-book of Mr. Clarke, and is
accompanied by a colored plate to illustrate the subject; the
proliferation of the black skin is astonishing. In closing the
report Mr. Clarke says: "But in the figures depicted the
amount of increase in the black patches will be well seen. In
ten weeks the four or five pieces of black skin, which
together were not larger than a grain of barley, had grown
twentyfold, and in an another month the black patch was more
than one inch long by half an inch broad, the black centres of
cutification having clearly grown very rapidly by the
proliferation of their own black cells."
[83] _American Journal Med. Sciences_, vol. lx.
[84] "Circumcision." By Dr. A. B. Arnold, of Baltimore.
[85] "De la Circoncision." By Dr. S. Bernheim. Paris.
[86] The reader is referred to a very interesting paper detailing
conditions of adhesions in the _American Journal Med.
Sciences_ for July, 1872. It is taken from the Hungarian of M.
Bokai.
[87] _New York Med. Journal_, vol. xxvi.
[88] _American Journal Med. Sciences_, vol. lx.
[89] Dr. Vanier describes this operation of Celsus mentioned by
Vidal in his work on "Circumcision," at page 294, which
consisted in making, by a circular incision immediately back
of the glans, like in a circular amputation, a complete
detachment of the integument from back of the corona. The
penis was then made to retreat into the sheath thus made and a
short catheter introduced into the urethra, to the end of
which the free end of the new preputial fold was made fast, a
piece of oiled lint being interposed between the raw inner
surface and the glans. Another operation consisted in
forcibly drawing the integument forward and in making a number
of transverse incisions in the integument so as to assist its
extensibility. By these means it was drawn sufficiently
forward so as to fasten it to a canula or catheter made fast
in the urethra. But it can well be imagined that a person must
possess the most exalted idea of the physiological needs of a
prepuce and feel the most sensitive need of such an appendage
to submit to the first of these operations, although it is
more than probable that many Jews submitted to the operation
in the days of Celsus to avoid being exiled or plundered of
all their possessions. The resulting prepuce could not have
been a much more unsightly appendage than that which ornaments
the overburdened virile organ of many Christians, and there is
no doubt but that in many cases they passed muster.
[90] "Circumcision." Dr. A. B. Arnold.
[91] Ashhurst. "Int. Enc. Surgery," vol. vi.
[92] "Pertes Seminales."
[93] "Circoncision." Dr. Vanier, du Havre.
[94] "Dictionaire des Sciences Medicales."
[95] Erichsen's "Surgery," page 1144. Edition of 1869.
[96] _Medical News_ of Philadelphia, page 115. Vol. for 1860.
[97] "Pertes Seminales." In the fourth American edition of the
English translation of McDougall of Lallemand we find that he
fully appreciated the dangers that lurk in a prepuce. At page
216 he says: "Such is the condition which the parts present in
cases of recent balanitis, and these are the inflammations and
ulcerations that cause more or less extensive adhesions of the
prepuce to the glans. Such adhesions are generally cellular,
but sometimes fibrous or even cartilaginous, according to the
severity and frequent repetition of the inflammation. Various
degrees of induration also results according to the intensity,
the duration, and the frequency of the phlogosis. Thus, I have
often found a mucous membrane hardened, thickened, and covered
with numerous papillae, sometimes fibrous or cartilaginous,
with three times its natural thickness. I have also met with
cases in which the prepuce has become cancerous. I have
operated in several cases of cancer of the penis, too, which
certainly arose from no other cause. The patients were
generally peasants between fifty and sixty years of age, who
had never known other than their own wives, but who had
frequently suffered from balanitis attended by abundant
discharge, swelling of the prepuce, and excoriation of its
opening, which was so contracted as to prevent the passage of
the glans. I have seen one case, also, in which balanitis,
irritated by a forced march and the abuse of alcoholic
stimulants, passed into gangrene, by which the greater part of
the glans was destroyed. Such have been the accidents which I
have observed on those whose prepuce was too narrow to permit
the glans being uncovered; accidents which I can only
attribute to the long retention of the sebaceous matter in a
kind of _cul-de-sac_, into which a certain quantity of urine
passes every time the patient makes water."
[98] Claparede. "La Circoncision."
[99] Baron Boyer. "Traite des Maladies Chirurgicales," vol. x, page
370.
[100] I have practiced considerably among the Jewish people, but I
have never seen their elderly men suffer with prostatic
troubles like our own people who are uncircumcised. From
having observed the tendency to prostatic complications in
young people with troublesome prepuces, and that the great
number of the elderly people who are affected with prostatic
disease or enlargement are the unlucky possessors of long or
large prepuces, I have arrived at the conclusion that the
prepuce can be entered as a factor in the etiology of enlarged
prostate.
[101] I have now under my care a poor consumptive who has all the
appearance of having always been as virtuous as Joseph, but
who, unlike Joseph, has from infancy had as a constant
companion a long, miserable, smegmanous, and annoying prepuce.
The young man has an oedema which first affected his feet, but
one day, owing to the irritation of a slight balanitis, the
prepuce swelled at once; it proceeded through the penis
integument to the scrotum; the penis itself retracted, leaving
the integument and scrotum to assume a translucent, puffy,
cork-screw appearance and attitude; from its labyrinthic
passage the urine slowly dribbles during urination in a
scalding stream. In addition to the physical sufferings, he is
tormented by the knowledge that his friends attribute all his
disease and troubles--since the occurence of the penile
oedema--to the fact that his earlier manhood must have been
indiscreet, as well as sinful. The laity cannot connect any
penile, scrotal, or testicular disease with anything except
venereal disease; and if the physician attempts to explain
matters, they simply look upon it as the good-natured and
well-intentioned efforts of the doctor to deceive them and to
cover up the shortcomings of some frail mortal. Many a poor
fellow has to leave this world under a cloud of mistrust and a
bad odor of past deviltry to which he is not entitled, and
suffer all this in addition to all his physical ills, owing to
his having been ornamented through life with an annoying
prepuce,--the luckless heritage of having been born a
Christian. Columbus in chains moralizing on the ingratitude of
this world is nothing to the poor invalid with a swollen
prepuce, innocently acquired, silently "cussing" the ignorance
of his relatives and friends.
[102] This patient, on convalescing, suffered considerable from the
action of numerous small carbuncles, resulting from the
toxaemic condition induced by the partial suppression of urine
that he at times suffered from, and, when nearly well, brought
on a serious relapse by the mail-bag appendage at the penis
working up the organ into a state of erection. While so
situated he had intercourse, and from 99 deg. his temperature
immediately rose to 1041/2 deg., where it remained for several days,
lengthening out his illness by several weeks, into a
long-protracted convalescence. The man is not yet circumcised,
and, from the knowledge that I have of his tendency to uraemia,
I feel that, although in his prime, a fever or an accident may
take him off at any moment.
[103] In looking over the literature of reflex neuroses and more
direct injurious results, I find that George Macilwain, in a
work on "Surgical Observations on the More Important Diseases
of the Mucous Canals of the Body," published in London in
1830, calls special attention to the case of a man aged
thirty-eight, admitted to the Finsbury Dispensary, and who was
in the care of Mr. Hancock. The patient was suffering from
excruciating pain in different joints, the pain being so
great that he was confined to his bed and unable to stand on
his feet. He was unable to rest at nights, and neither
rheumatic nor any other apparently suitable treatment was of
any service. Rigors were soon added to his other troubles, and
during their continuance the pain in his joints was greatly
aggravated. He was referred to Mr. Macilwain for treatment,
who promptly relieved him by the removal of a urethral
stricture, which had quietly been the cause of all the
disturbance. It is particularly interesting that even at that
early day the reflex neuroses and complications that may arise
from the irritability of the genito-urinary organs were so
well understood. How well Dr. Macilwain appreciated the nicety
of these relations can be seen from his remarks in connection
with the above case, in which he says: "It may be observed
that the severity of the symptoms is not always commensurate
either with the duration of the disease or the degree of
stricture, and that, although the progressive development of
them varies considerably in rapidity, in different
individuals, it is, nevertheless, in the latter stages, always
more rapid." Macilwain also graphically describes the
insidious approach of these genito-urinary troubles. In
speaking of stricture he says: "Although minute inquiry
generally informs us that the stricture has been of some
standing, and in some instances has existed for years, yet it
may happen that it is only a few months or a year since the
patient's attention has been directed to the disease. This is
very intelligible; for, in conformity with what we observe in
other parts of the body, the bladder has a power of
accommodating itself to a change of circumstances. Its
strength, for a long time, may increase so correctly in
proportion to the increase of the obstacle which opposes the
ejection of its contents that a very considerable period
elapses before the difficulty in making water becomes
cognizable to the patient, or it occasions an annoyance so
trifling as scarcely to excite his attention. This increase of
strength in the bladder frequently renders the formation of
stricture so insidious that the urethra at the affected part
is very narrow before the individual is aware of the existence
of any contraction whatever; the bladder, however, at length
becomes unable to empty itself, and the abdominal muscles and
diaphragm powerfully act as coadjutors, so that each effort to
make water is accompanied by a straining which is very
distressing, and the complete evacuation of the bladder is
often not accomplished even by these combined forces. The
straining which accompanies stricture, and which seems
necessary to evacuate the bladder, although it be occasionally
exceedingly annoying to the patient at the time, is more
important with reference to the results which are its
consequence. I am firmly of opinion that there are a great
number of patients laboring under hernia which has been
produced by no other cause. I must confess that I had seen a
great number of instances of stricture in ruptured patients
before I drew any inference from the observation of their
co-existence." The foregoing observations of Macilwain, made
in 1830, are here reproduced for their clearness of expression
and explanation, as well as to show what injuries can be
produced on the young child afflicted with phimosis. We are,
as surgeons, familiar with the anatomical and pathological
changes there are undergone by the bladder and its lining
membrane, as well as in the ureters and kidneys, in many
cases of stricture, as well as of the great amount of
prostatic irritability and enlargement that is due to the same
cause. How similarly these results can be and are actually
produced by phimosis is undeniably expressed by the
post-mortem appearances in the poor infant described by
Golding Bird to the London Medical Society, and mentioned in
the London _Lancet_ of May 16, 1846. The bladder and ureter
were like those of a man who had long suffered from stricture.
From the remarks of Dr. J. Lewis Smith, that phimosis may be
productive of inguinal hernia and prolapsus of the rectum, and
the observations of Edmund Owens and Arthur Kemp, both high
authorities on children's diseases, being both connected with
children's hospitals, as well as the remarks of Mr. Bryant in
his "Surgical Diseases of Children," who all concur in looking
upon phimosis as a great factor in hernia, Bryant having
observed thirty-one in fifty consecutive cases of phimosis, we
are certainly warranted in assuming that phimosis is not only
a mere local timely inconvenience that will disappear with the
approach of puberty, but a condition which, in the more easily
affected organism of the child,--lacking, as it does, that
resistance that comes with our prime,--is productive of
serious harm; as even the first few years of life, even a few
months of infant life, with a phimosis, are sufficient to so
change the structures of parts that the poor child will grow
into a man with an impaired kidney or sacculated ureter. The
strain required to induce a prolapsus of the bowel or a
rupture into the inguinal canal is exerted as much on the
bladder, ureter, and kidney as on the other localities.
Physicians who have taken the pains to observe must have
noticed, more than once, how the child afflicted with a
phimosis has not only at times to wait for the stream of urine
to appear, there seemingly being some obstruction to its
starting, but how often such a case is afflicted with a
stammering, halting urination. A child thus started out into
life, with a defective kidney or kidneys, is sadly handicapped
in his usefulness, comfort, or in properly competing in the
race of life. No parent would for a moment think of starting
his son in life by giving him a business that is heavily
mortgaged at the start, but many a parent unconsciously
launches the unsuspecting child into a life of such ill
health--resulting from a simple narrow prepuce--beside which a
heavy mortgage or a heavy yearly tribute would be but a mere
trifle. I have seen such men, who in after life, broken-down
and perfectly physical wrecks, would gladly have given all
their wealth and been willing to have some genii set them down
in the middle of the Sahara, shirtless and pennyless, provided
they had their health. To say nothing of the trifling loss of
the prepuce, these parties would gladly have had a foot or a
leg go with the prepuce if necessary, and have their health.
[104] I have often performed dilatation where, for some reason,
either the timidity of the parents or the health of the child
seemed to contraindicate any more radical procedure. It is
customary to advise mothers or the nurses to retract the skin
daily, but even after a good dilatation I have found as sudden
a recontraction, and even in the majority of cases, where
daily drawing back the skin might have been practicable, the
cries and struggles of the child are a positive prohibition to
these instructions being carried out; it is not once in ten
times that it can be carried out. I have seen two very
annoying cases of paraphimosis resulting from this procedure,
the struggles of the child having prevented the return of the
prepuce to its proper place, and the violent crying and
sobbing of the child having assisted to congest the organ.
[105] It may well be a question, considering the well-established
fact that nervous injuries and affections are easily
transmissible and become hereditary, how much
feeble-mindedness is due to an heredity originally induced in
either parent through reflex neuroses from the genital organs.
The Jews have a very small percentage of feeble-minded; it is
true that they have not any inebriates to assist in their
manufacture, but still the absence of these well-pronounced
cases of reflex neuroses among the race must be largely
ascribed to their practice of circumcision, as that operation
cures the gentiles so afflicted.
[106] I have seen precisely similar conditions resulting from a
sphincterismus being relieved by anal dilatation. I had one
such case who had fallen into the hands of a quack, who made
him believe that he was being affected with incipient
softening of the brain; systematic dilatation or a rupture of
the sphincter _a la_ Van Buren is the appropriate remedy.
[107] In the first volume of the "American and English Encyclopedia
of Law" there is an interesting account of a young child (who
had been bound out by the parish officials) who murdered his
little bed-fellow and, on trial and conviction, was sentenced
to be hanged, but who was reprieved by royal favor on account
of his tender years, the sentence being changed to
imprisonment for life. The little fellow was only eight years
of age. On the trial the boy said he was driven to commit the
crime because the other child soiled the bed. The two children
being both paupers, it may well be imagined that their bedding
was none of the cleanest at the best, or that their bed-room
had the best of ventilation. As at the time the murder was
committed English paupers were not treated in the most humane
manner, it is not surprising that a nervous, sensitive child
would, under such a combination of circumstances, be converted
into an insane murderer.
[108] The study of prematurely acquired impotence in the male is a
most interesting one. I have frequently seen it result from
the presence of anal or rectal irritation, from haemorrhoids. I
have seen cases who could not have erections, and in whom all
sexual desire was extinct at a very early age, who have
informed me that, although unable to have sexual intercourse
because of the total absence of sexual desire, the flaccidity
of the organ, and the want of sound physiological organic
functional activity to suggest the thought, they had,
nevertheless, frequently been the victims of nocturnal
emissions before the total extinction of the function. As a
rule, much of this premature impotence--induced by either
irritation of the genital organs or rectal or anal
troubles--runs its unfortunate possessor through such a course
of physical incidents as described by Hammond, as the wild
Indians of the Southwest induce in the _mujerado_. At first
the sound organ responds in a natural manner to any stimulus
that may affect it, but soon a local satyriacal condition is
set up, which, running a more or less rapid period of intense
activity, soon leaves its victim completely, permanently, and
hopelessly impotent, even as much so as if eunuchized in the
most approved manner. Hammond's description of the manner in
which these unfortunates are manufactured is an interesting
addition to the facts contained in the natural history of man,
and is as follows: "A _mujerado_ is an essential person in the
saturnalia, or orgies, in which these Indians, like the
ancient Greeks, Egyptians, and other nations, indulge. He is
the chief passive agent in the pederastic ceremonies which
form so important a part in the performances. These take place
in the spring of every year, and are conducted with the utmost
secrecy, as regards the non-Indian part of the population. For
the making of a _mujerado_ one of the most virile men is
selected, and the act of masturbation is performed upon him
many times every day; at the same time he is made to ride
almost continuously on horseback. The genital organs are thus
brought, at first, into a state of extreme erethism, so that
the motion of the horse is sufficient to produce a discharge
of seminal fluid, while at the same time the pressure of the
body on the animal's back--for the riding is done without a
saddle--interferes with their proper nutrition. It eventually
happens that, though an orgasm may be caused, emissions can no
longer be effected, even upon the most intense degree of
excitation. Finally, the accomplishment of an orgasm becomes
impossible; in the meantime the penis and testicles begin to
shrink, and in time reach their lowest plane of degradation.
But the most decided changes are at the same time going on,
little by little, in the instincts and proclivities of the
subject. He loses his taste for those sports and occupations
in which he formerly indulged, his courage disappears, and he
becomes timid to such an extent that, if he is a man occupying
a prominent place in the council of the pueblo, he is at once
relieved of all power and responsibility, and his influence is
at an end. If he is married his wife and children pass from
under his control,--whether, however, through his wish or
theirs, or by the orders of the council, I could not
ascertain. They certainly become no more to him than other
women and children of the pueblo." Hammond examined one of
these men, who had, as he himself informed him, formerly
possessed a large penis and testicles "grande como
huevos,"--as large as eggs. The penis was in its flaccid state
and about an inch and a half in length, with the glans about
the size of a thimble, which it very much resembled in shape.
The glandular structure of the testicles had disappeared; they
were atrophied, little besides connective tissue remaining. He
examined another _mujerado_ in the pueblo of Acoma, who had
been so made when at about the age of twenty-six. The penis
was not more than an inch in length and about the diameter of
the little finger, and of the testicles there was apparently
nothing left but a little connective tissue. Both of these men
had high-pitched voices. The last one examined was then
thirty-six years of age. (Hammond: "Male Impotence.") The
foregoing detailed description shows an extreme degree of
results produced by an equally extreme degree of intense and
persistent irritation applied to the genital organs, purposely
employed to obtain certain results. In the cases cited the
irritation or excitation is directly applied, but it is safe
to assume that reflex irritability from the anus or rectum,
or from that of a stricture or of a prepuce, will in some
cases produce a certain degree of excitation in the testicles
that may result in their functional or organic derangement, in
a degree proportionate to that of the amount of excitation
from which they have suffered. That the testicles are very apt
to suffer from the existence of a stricture is a well-known
fact. I have myself worried over a case of stricture, in whom
the attempted passage of a filiform bougie was always
immediately followed by a severe attack of epididymitis, and
who had always been afflicted with a tenderness and a tendency
to inflammation of the testes. I have also noticed a much
greater tendency to orchitis in the wearer of an irritating
prepuce than where it was absent; so that the presence of a
satyriacal tendency, no matter in what proportion of a degree
it may be present, can safely be assumed to result in a
corresponding degree of apathy, due to an actual physical
degeneration of the parts. That these conditions, when present
in any degree of permanency or persistence, will in the end
induce early impotence, I have no reason to doubt. In this
regard we must not overlook the fact that persons with
phimosis, stricture, or other genital irritants and
impediments, are more liable to be afflicted with haemorrhoids,
prolapsus ani, or other anal and rectal irritation, which
retroactively assist in bringing about the condition under
question. How much this may have to do with certain prolific
peculiarities among the Jews may well be questioned; it is a
well-known fact that in London the Jewish excess of male
births has been as high as eighteen per cent., while among the
Christian or Gentile population it is only six and one-half
per cent.,--a somewhat analogous condition of proportion being
also observable in the United States. Here, it is accounted
for, in a measure, by Dr. Billings, in the following words:
"This comparatively large proportion of males among the Jews
is probably due to the fact that the death-rate of their
infants is less for males, as compared with females, than it
is among the average population." Children gotten during the
prime of life of the parents are naturally more virile and
have better stamina than those gotten before full maturity is
reached. If the father is on the verge of impotency just about
the time he is expected to beget his best offspring, that
offspring cannot be expected to present an extra amount of
vitality, virility, or physical stamina; hence, the prepuce
can be brought in as directly tending--in no matter how small
the degree it may be, but nevertheless a factor--to the
physical degeneracy of the race, as well as it demonstrates
the existence of some law for the production of the sexes
which we do not as yet fully comprehend. Aside from the above
considerations, there are those of the actual bar to the
increase of population which the prepuce induces, either by
primarily being the cause of impotence or by direct
interference, as already mentioned, and the impotence that
naturally results from the causes set forth in this note. The
results of a prepuce are certainly such as must act like a
moist, warm, and oily poultice to the irritability induced in
the most confirmed Malthusian when contemplating the--to
him--rapid and unwarranted increase of population.
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Recueil de Memoires de Medecine, de Chirurgie, et de Pharmacie
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Guide du Posthetomiste. Par le Docteur L. Terquem. Paris.
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Le Theatre de la Turquie. Michel Le Feber. Paris, 1681.
Recherches Philosophiques sur les Americains, ou Memoires Interessants
pour servir a l'Histoire de l'Espece Humaine. Par M. de P. Augumentee
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History of the Hebrews' Second Commonwealth. Wise. Cincinnati, 1880.
History of the Hebrew Commonwealth. Jahn. Oxford, 1840.
Jews' Letters to Voltaire. Philadelphia, 1848.
The Jewish Nation. Revised by Kidder. New York, 1850.
The Jews Under Roman Rule. By W. D. Morrison. New York, 1890.
The Story of the Jews. By James K. Hosmer. New York, 1887.
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Early Oriental History. By John Eadie, D.D., LL.D. London, 1852.
The Bible and the Nineteenth Century. By L. T. Townsend, D.D. New York,
1889.
Legends of the Patriarchs and Prophets. By the Rev. S. Baring-Gould. New
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INDEX
Abolishment
of circumcision by Christians, 18;
by the Romans, 66
of eunuchism in Italy, 91, 96
Abraham, 32
Absence of penis, 13
of testicles, 105
Abyssinians, carry off the male members of slain enemies, 30;
circumcised bishop among the, 64
Acosta, Rev. Father, on Mexican circumcision, 47
Adams, Dr. C. Powell, of Hastings, Minn., 198
After-treatment of circumcised Hebrews, 158
Agnew, D. Hayes, on penile cancer, 230;
on eczema as a reflex neurosis from phimosis, 320
Albutt, T. Clifford, on primary cause of disease, 13
American circumcision, 47;
infibulation and muzzling, 48
Amputation of penis, 230, 233, 247
Androgynes, 118
Augleria, Pierre d', on American circumcision, 47
Apis, the white bull, sacred to the Egyptians, 29
Apollo Belvidere, as evidence of exactness of ancient sculpture, 62
Apure Indians and their circumcision, 48
Arabian circumcision, 38;
prostitutes, 323
Arias Montan, on Mexico, 46
Arnold, Dr. A. B., of Baltimore, 25, 219, 220, 223
Asthma as a reflex neurosis from genital irritation, 291
Australian circumcision, 44;
operation on the urethra, 56
Author's modification of circumcision, 307
Aztec circumcision, 46
Ballance, C. W., dressing after circumcision, 317
Bamboo stick worn in vagina as a chastity protector, 52
Baptismal ceremonies of Omaha Indians, 56
Barbarous Arabian marriage custom, 54
mutilations of Guamo and Othomaco Indians, 48
Bas-relief representing Egyptian emasculation, 31
Bassouto circumcision, 42
Battos circumcision, 45
Baumgartner's devout and chaste dervish, 49
Beale, Sir Lionel, on blood changes, 296
Bell, Dr. John, on Jewish hygiene, 181
Dr. J. Royes, 191, 223, 229, 239
Bells, jingling of, under the skirts, denotive of Judean virginity, 52
Belt of brass mail to insure female chastity, 51
Berbers, mutilations of their prisoners, 30
Bergmann, of Strasburg, 20, 27
Bergson, Dr., 160
Bernbeim, Dr., on freedom of Jews from syphilis, 195;
on preputial statistics, 220;
on circumcisial operation, 312
Bernoulli, Prof., of Bale, 168
"Beth Yosef" of Joseph Karo, 153
Biblical vouching for homoeopathy, 113
Billings, Dr. John S., U. S. Army, on Jewish vital statistics, 174;
on cancer amongst Jews, 230
Bird, Dr. Golding, on phimosis, 257
Bishop of Abyssinia accused of heresy on account of circumcision, 64
Blood of prepuce sprinkled on bride's veil, 55;
sprinkled on ears of corn, 56
changes as starting-points of disease, 293, 298
Bobovii, Alberti, on Mohammedan circumcision, 39
Bogera, or African circumcision, 44
Bokai, on preputial statistics, 220
Bornean circumcision, 45
Bowditch, Henry I., on Jewish vital statistics, 176
Boyer, Baron, on cancer of the penis, 232;
on gangrene of the penis, 237
Brett, Dr. F. H., case of hypertrophy of prepuce, 251
Bryant, Thomas, on skin-grafting, 328
Bumstead, on circumcision, 310
Burial of Algerine prepuces in the sands of the deserts, 39
Cahen, Dr., on diminished sensibility of glans after circumcision, 224
Calculus, liability of the Chinese to preputial, 248;
Dr. J. G. Kerr, on preputial, 248;
C. H. Martin, of Mobile, on climatic influence on, 248;
Prof. Enoch, of Berlin, on preputial and vesical calculi, 249;
Claparede's case, 249;
composition of preputial, 249;
Civiale's case, 249;
induced by phimosis, 287
Canary Islands, remains of an antediluvian world, 25
Cancer of the penis, 232;
views of Jonathan Hutchinson as to its origin, 226;
pre-cancerous stage of, 226;
views of Lallemand, 228, 329;
statistics of, 231;
Cullerier on, 231;
fifty cases reported by Dr. Zielewicz, 233;
early mention of, 234;
views of Prof. John C. Warren, 235;
views of Walshe, 235
Canon of St. John Lateran and his profane doubts, 74
Carter, Dr. Wm., on toxic urines, 298
Casalis, M., on Bassouto circumcision, 42
Cases of spontaneous circumcision, 58
Castration, etymology of the term, 80;
as a self-sacrifice to deities, 89
Celsus, on Roman infibulation, 50;
on operations on the prepuce, 302, 313, 328;
originator of Cloquet's operation, 313
Chabas, M., description of Egyptian _bas-relief_, 23
Charlemagne endows an abbey with a holy prepuce, 72
Charles V sacks Rome, and robbery of the holy prepuce, 73
Chastity among Egyptian dervishes, 49;
belt of brass mail of the Ethiopians, 51;
plug of bamboo of Soudan, 51;
rings to insure chastity in the male mentioned by Nelaton, 54;
enforced among the Hindoo bonzes by infibulation, 54;
among the Cybelian priesthood, 89;
Greek monks, ideas of, 89;
comparative, among the different religious creeds of Prussia, 195
Chinese, peculiar liability of, to calculous disease, 248;
considered a delicate diet by Australian cannibals, 327
Chippeway Indians and circumcision, 23
Chivalry of the male Hottentot, 60
Christian abolishment of circumcision, 18;
circumcision in Abyssinia, 63
Circumcised phallus as a religious and civic symbol, 35;
races peculiarly exempt from syphilis, 192
Circumcising knife (see Knife).
Circumcision, abolished by Christians, 18;
among Chippeway Indians, 23;
among the Atlanteans of Plato, 23;
among the Phoenicians, 34;
among the Egyptians, 34;
Arabian, 35, 54;
during the reign of Psammetich, 34;
civil and religious symbol of ancient Egypt, 35;
Aztec, 46;
among the Mijes, 46;
Mexican, 46;
Totonac, 46;
among the Orinoco Indians, 47
the climatic limits of, as a general rite, 47;
in the Island of Cosumel, 47;
in Yucatan, 47;
in old Florida, 47;
Apure Indians, 48;
among the Amazons, 56;
accidental case of, mentioned by Cullerier, 57;
spontaneous, 58;
abolished by the Romans, 66;
destroying marks of, 68;
of Abraham, 143;
Hebraic, 143;
not practiced in the wilderness, 143;
physical conditions that exempt Jewish children from, 144, 145;
description of Hebraic, by Montaigne, 146;
as a cure for epilepsy, 261;
as a preventive of hernia or rupture, 263;
as a preventive to prolapsus of the bowel, 263;
as a preventive of idiocy, 266;
as a cure for dyspepsia, 270, 271
Civiale, on moral effects of penis amputation, 247;
case of phimosis and preputial calculi, 249
Claparede, on evils resulting from the prepuce, 229;
on preputial calculi, 249
Clarke, Sir Andrew, on renal inadequacy, 300
Clavigero, on Mexican circumcision, 46
Climatic limits of circumcision, 65
Cloquet operation, 306, 316
Colchis, colony of, 33
Constantine punished circumcisers with death, 66
Constipation as a divine attribute, 288;
as a result of phimosis and its results, 292
Consumption, relation of, to Jewish race, 178, 179
Controversy about the holy prepuce, 73
Convent of St. Corneille and the holy knife, 78
Convulsions induced by phimosis, 260, 261
Cullerier, accidental circumcision, 57;
on penile cancer, 231
Cybelian priesthood and castration, 89
Dakotas, the white bull sacred among the, 26
David and the Philistine prepuces, 31
Debreyne, trappist, monk, and physician, 224
Delange, on Arabian circumcision, 37
Delpech, on female circumcision, 36
Demarquay, on penile gangrene, 236
Dervishes, holy and chaste, 49
Difference between Turkish and Buddhist heaven, 116
Dilatation of prepuce, 308, 312, 332
Donnelly, Hon. Ignatius, on Atlantean circumcision, 23
Dressing in cases of retraction of penile skin, 304;
C. W. Ballance's, after circumcision, 317;
A. G. Miller's, 318
Du Bisson, on Soudanese harems, 52
Dyspepsia induced by preputial irritation, 270, 271
Ebers, Dr., on Karnac _bas-relief_, 23
Eczema induced by phimosis, 320
Effect of the holy prepuce on the hands of a lady, 74
Effects of age on the prepuce, 285
Egypt, uncircumcised persons not allowed to study in ancient, 34
Egyptians emasculated their prisoners, 30
Emasculation, its early practices and evolutions, 29;
of Uranos, 83
Emperor Adrian forbids circumcision, 66
Endurance and fortitude of Arabs, 55
Enforced continence and its effects on the penis, 61
Ennery, M., Grand Rabbi of Paris, 158
Enoch, Prof., of Berlin, on preputial calculi, 249;
on results of phimosis, 266;
on enuresis, 277
Enuresis, 275
Epilepsy, induced by the prepuce, 258, 261, 301
Epstein, Dr., of Cincinnati, 156
Erichsen, Prof., on cancer of the penis, 228
Ethics at the battle of Fontenoy, 76
Ethiopian infibulation of infant females, 51
Eunuchism, beneficial to guardians of public funds, 84;
as excluding from the priesthood, 90;
in Italy, 91;
in China, 91, 93;
in India, 92;
in the Soudan, 99;
and music, 94;
as a punishment, 97;
mortality attending its manufacture, 91, 92, 93, 99, 100, 107;
does not prevent copulation at all times, 92, 100, 101, 102, 103;
manner of procedure among the Pagan priesthood, 106;
prices of eunuchs, 99;
numbers annually made, 91, 98;
fecundating eunuch of Mecca, 100;
Velutti, the opera-singer, 102;
eunuchs as possessors of harems, 90;
eunuch warriors and statesmen, 90
Evidence of circumcision on Egyptian monuments, 23
Extraordinary results of phimosis, 282
Female circumcisers in Arabia, 36
Females subject to preputial reflex neuroses, 267, 268
Flaccourt, M. Martin, account of the Madecasses, 54
Fothergill and the unlicensed practitioner on renal pathology, 77
French war-office records, on Jewish vital statistics, 175
Frenum, statistics relating to abnormalities of, 221
Frerichs' ammoniaemia, 300
Fresnel, M., on marriage circumcision, 54
Full-moon rites among the Bassouto maidens, 44
Galen, on the flaccid virile member, 60, 61
Gangrene of the penis, 236
Golden padlocks worn on prepuce for five years, 54
Greek and Roman statuary and the penis, 60
Greek monks' object in infibulations, 54;
extreme ideas of chastity, 89
Gregg, Dr. Robert J., operative procedure, 320
Griffith, Dr. J. D., cases of reflex irritation, 261
Gross, Prof. S. D., on penile cancer, 230;
operations, 320
Grotius and the origin of the Peruvians, 46
Guimara, the, 153
Guinzburg, Dr., on Jewish vital statistics, 176
Gumilla and his South American voyages, 47
Haemostatic powders, 160
Hare, Prof. Hobart A., on circumcision, 301
Haskins, Dr. A., on Jewish vital statistics, 176
Heaven, Turkish, 115;
Buddhist, 116
Hebraic idea of parental origin of constitution of the child, 144
Hebrew Consistory of Paris, 157
Hebrew words in Central American languages, 24
Hebrews, attempts to efface signs of circumcision, 69;
secretly circumcise their dead, 68;
Hebrew vital statistics, 169 to 179;
as proverbial good livers, 171;
escape epidemics, 173;
peculiarly free from syphilitic taint, 191;
their circumcision suitable to young children, 306
Heliogabalus, Emperor, was circumcised, 66
Henry III of France as a Moslem godfather, 64
Henry V of England and the holy prepuce, 71
Heraclius, Emperor, persecuted the Jews, 67
Hermaphrodites, earliest mention of, 117;
pederasty causes belief in their existence, 118, 119, 120;
Debierre on, 123;
notable cases of, 124, 125, 127, 128
Hernia induced by phimosis, 263
Herodotus, his views adopted by Voltaire, 22;
visits Egypt, 34
Herrera, on Mexican circumcision, 47
Hey, Dr. William, on preputial cancer, 227
Hindoo devotee wears a six-inch ring in prepuce, 54
Hitouch, 156
Holgate, Dr., of New York, on preputial adhesions, 220;
on preputial dilatation, 308
Holy circumcision, 70, 78
prepuces, 70, 72
vinegar and its miraculous effects, 79
Homer, Surgeon U. S. Navy, on the worship of Venus Porclna, 193
Horrible marriage performance, 54
Hottentot restriction on making twins, 60
Hough, Dr., on Jewish longevity, 173
Humphry, Geo. Murray, on "Old Age," 14
Hutchinson, Dr. Jonathan, on the pre-cancerous stage of cancer, 226;
on urethral child, 300
Hypospadias, as a heredity, 129;
artificially made, 56;
formerly led to belief in hermaphrodism, 129;
fecundation in, 129;
difficulty in determining sex owing to, 131
Idiocy induced by phimosis and preputial adhesions, 265, 269
Impious wretch steals the holy prepuce, 74
Impotence, holy vinegar and shrinal observances in, 71 to 81
Indians and circumcision, 46 to 48
Induration of prepuce, 250
Inflbulation practices, 48 to 52
Isis inaugurates Osirian rites, 29
Isserth, Rabbi Israel, 153
Jansen, Surgeon of the Belgian Armies, on frenum deformities, 221
Jews' letters to Voltaire, 22;
Jews (see Hebrews).
Judaism unfavorable to religious insanity, 166
Justinia, Emperor, persecuted the Jews, 67
Karo, Joseph, and the "Beth Yosef," 153
Kemp, Dr. Arthur, on phimosis as a cause of hernia, 264
Kerr, Dr. J. G., on Chinese preputial calculi, 248
Keyes, Dr. E. L., on composition of preputial calculi, 249, 264
King David, the first homoeopathic patient, 113;
secures two hundred Philistine prepuces, 31
Knife, circumcising, used in ancient Egyptian rite, 23;
of shell used by Tonga Islanders, 45;
of stone used by Australians, 45;
of the holy circumcision, 78;
made of rattan among the Fiji Islanders, 327
Lafargue, on Australian circumcision, 44
Lallemand, on masturbation, 223;
on tendency to preputial cancer, 228, 329;
on circumcision, 317
Las Casas, on Aztec circumcision, 46
Leech, Dr. T. F., on preputial irritation, 260
Letenneur, Prof., on the knife of the holy circumcision, 78
Life-insurance and the circumcised, 290
Lisfrane, rules for operations on the penis, 232;
on recession of the body of the penis, 306
Livingstone, on Bassouto circumcision, 44
Longevity of Hebrews, 162, 169, 179
Lonyer-Villermay, M., on female circumcision, 36
Louis XVI as a candidate for the rite, 201
Love, Dr. I. N, on the Mosaic law, 262
Lumholtz, on Australian hypospadias, 56
Macilwain, on reflex neuroses, 330
Magruder, Dr. G. L., on reflex irritation, 261
Maids as heat radiators, 114
Maimonides, Jewish rabbi and physician, 32, 144, 153
Malay circumcision, 45
Malgaigne, operative views, 313, 316
Mapato, or mystery hut, 42
Marriage preceded by circumcision, 54
Martius and Spix, on circumcision on the Amazon, 56
Mastin, Dr. C. H., on calculous disease, 248
Masturbation, 224
Maury, Dr. Frank, on preputial statistics, 219
McLeod, Dr. Neil, circumcision operation, 318
McMahon, Dr. W. R., on reflex epilepsy, 261
Mendelssohn, Rabbi Moses, 164, 168
Mexican circumcision, 46
Mezizah, or act of suction, 150
Milah, 156
Miracles performed by the holy prepuce, 70 to 74
Mishna, the, 153
Mohammed, 65
Mohel, 157, 158
Moses, Dr., of New York, preputial statistics, 220
Moses circumcises his son, 150
Mott, Jr., Dr. A. R., cases of reflex irritation, 258
Music, first schools of, 94
Music at Algerine circumcision, 39;
at Mohammedan, in Asia, 39;
at Turkish feast, 41
Nelaton, case of infibulation, 54;
on penile cancer, 231;
on penile hypertrophy, 252
Nelson, Lord, disregard for red tape, 77
New Caledonian circumcision, 45
Newton, Sir Isaac, and the storm-predicting cow, 77
Nicaraguan baptism of blood, 56
Oath of mohel, 158
Oath, Egyptian manner of making oath, 35
Obod, Battle of, 36
Operations on the prepuce, 302;
Cloquet's, 306;
Bumstead's, 310;
Hue's, 312;
Bernheim's, Sedillat's, 313;
Chauvin's, 313;
Cullerier's, 313;
Vanier's, 316;
Vidal de Cassis', 316;
Lallemand's, 317;
A. G. Miller's, Neil McLeod's, 318;
Erichsen's, 319;
Gross's, 320;
Van Buren and Keyes', 320;
D. Hayes Agnew's, 320;
Overall's procedure, 321
Origin of phallic worship, 29
of human slavery, 29
Orinoco, circumcision on the, 47
Orloth, penis or prepuce? 31
Osiris vanquished by Typhon, 28
Othomacos Indians and their bloody rite, 48
Owen, Dr. Edmund, on phimosis, 263
Packard, Dr., on preputial statistics, 219
Papal indulgences to worshipers of holy prepuce, 72
Paralysis induced by phimosis, 259
Penis, absence of, 132;
diminutive specimens, 213;
amputation of, 230, 233, 234, 247;
cancer of, 232;
gangrene of, 236;
hypertrophy of, 248, 251, 252
Periah, 156
Persecutions on account of circumcision, 66
Phoenician origin of circumcision, 22
Phimosed penis on ancient statues, 60
Phimosis, 218, 221;
as a cause of hernia, 263
Physicians as practical Christians, 141
Pooley, Prof. J. H., case of preputial irritation, 260
Pope, Rabbi Rav, and the _Guimara_, 153
Portuguese sailors as Mohammedan proselytes, 40
Potentia generandi, 103
coeundi, 104
Prepuce, infibulated, 54;
swallowed by mother, 54;
fired off in gun, 54;
holy, 71;
useful for skin grafts, 207;
absence of, 209;
influence on man at different ages, 225;
induration of, 250;
warts of, 250;
reflex neuroses from, 256
Preputial miracles, 72;
statistics, 219;
adhesions, 219, 220;
calculi, 248
Price, Dr. M. F., on reflex neuroses, 265;
on female preputial irritation, 267, 268
Primitive phallic rites, 28
homoeopaths, 113
Procedure in retraction of skin of penis after circumcision, 304
Proselytes, Mohammedan, how circumcised, 40, 41
Public women between decks in U. S. Navy, 193
Puzey, Dr., of Liverpool, on preputial skin grafts, 207
Pythagoras 32;
visits Egypt, 34
Ralfe, on causes of interstitial nephritis, 300
Rameses II, circumcision of his sons, 23
Ranney, Prof. A. L., on enuresis, 282
Reconstruction of a prepuce, 68, 69, 328
Rectum, prolapsus of, induced by phimosis, 263
Reflex neuroses from preputial irritation, 254, 330, 331
Regulations of French Hebrew consistories of 1854, 157
Religion, its connection to insanity, 166
Resectricis nympharum, profession of, 36
Restriction on impregnation, 57;
on twins, 60
Retraction of skin of penis after circumcision, 303
Richardson, Dr. B. W., on relation of race to disease, 169, 170, 171, 177
Ricord's definition of the prepuce, 206;
operations on the prepuce, 313
Roman infibulation, 58
Royal decree of 1845 in France, 157
Roux, on cancer of the prepuce, 227
Rush, Benjamin, and the cancer quack, 77
Saint-Germain, Dr., on preputial abnormalities, 264
Saint Foutin and his shrine, 78
Saint Guerluchon at Bourg-Dieu, 79
Saint Guignole and the miraculous phallus, 80
Saint Coulombs and the miraculous prepuce, 70
Saturnus the first eunuchiser, 83
Sayer, Prof. Lewis A., contributions to medical science, 255
Scythians carry off heads of the slain, 30
Self-circumcision, attempt at, 203
Semiramis first employs eunuchs, 85
Severus Sulpicius, on effects of climate, 50
Sham battles at circumcision feasts, 37, 41, 42, 44
She-circumcisers, 36
Shrine for the recovery of impotent males, 79
Smith, Dr. J. Lewis, on preputial irritation, 263
Solomon, Dr., of Brunswick, on suction, 158
Soudanese chastity protector, 52
Sphincterismus due to phimosis, 292
Spiked chastity belt in Naples museum, 52
Stallard, Dr., on Jewish vital statistics, 173
Sterility cured at sacred shrines, 71 to 81
Stricture of urethra and phimosis, 289, 290
Styptics used by mohels, 158, 159
Syphilis, statistics relating to, 187 to 199
Syphilis and scrofula, 190
Taylor, Dr. C. F., on masturbation, 269
Totonac circumcision, 46
Tonga Islanders' rite, 45
Toxaemia, resulting from phimosis, 293;
of von Jaksch, 294
Tube, penis carried in, 56
Tunca Indian circumcision, 56
Turkish circumcision, 39 to 41
Tylor, on the Stone Age and circumcision, 336
Van Buren and Keyes, on circumcision, 320
Vanier du Havre, Dr., 54, 224;
on operations, 316
Venus, birth of, 84
Vidal de Cassis, on preputial operations, 316
Virey, account of Hindoo bonze, 54
Virgins' chain of bells in ancient Judea, 52
Vital statistics of Jews, 169 to 179
Voltaire, on origins of circumcision, 22
Von Jaksch's definition of Toxaemia, 294
Wadd, Dr., on preputial cancer, 227;
on hypertrophy of penis, 252
Walshe, on preputial cancer, 235
Warren, on preputial cancer, 235
Warts of penis and prepuce, 250
Waterman, Dr., on Jewish vital statistics, 177
Wax images of penis deposited on shrines, 79
Welsh words in Mandan language, 24
Wet dressing objectionable after circumcision, 304, 311
White Bull, sacred among Sioux and Egyptians, 26;
origin of sacredness, 29
Willard, Dr. De Forest, observations on the prepuce, 262
Wine at circumcision feasts, 151
Wirthington, Dr. F. J., on preputial irritation, 259
Wise, Dr. I. M., on St. Paul the apostle, 19
Warman, Prof., of Brooklyn, on circumcision, 26
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Practical and Scientific Physiognomy;
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_FAC-SIMILE PAGE FROM "STANTON'S PHYSIOGNOMY"--Reduced._
HOW TO REDUCE SIZE WITHOUT LOSING STRENGTH. 1109
voice. A thorough-bred person may belong to the artistic, mechanical,
or scientific classes, either appreciatively or executively;
he must exhibit both gentleness and spirit, as occasion requires; he
must be governed by the law of justice; he must make the comfort
of his associates his concern, and do what is _right_ in order to
enhance their happiness.
The facial indications of those who are not thorough-bred,
speaking physiologically, are as follow: A coarse, thick skin; a
"muddy" complexion, or one permanently blotched, pimpled, or
discolored; dull eyes, very small or very large and bulging;
coarse hair, or that which is very light or colorless,--that is to say,
of no _decided_ hue. I regard very light colored, pallid people as
morbid varieties; also those with irregular teeth, a very small or
ill-shapen nose, small nostrils, perpendicular jaws, exposed gums,
open mouth, receding chin, or one that projects greatly forward,
ending in a point; thin, pallid, dry lips; hollow cheeks, flat upper
cheeks. ugly or ill-shapen ears, a voice weak, thin, hoarse, shrill
or nasal; a long, cylindrical neck; a high, narrow forehead.
The undue development of certain organs and systems of the
body induces abnormal conditions, as, for example, an excessive
disposition of fatty tissue. When the appetite is voracious, or the
nutritive system uncommonly active, too much of the carbonaceous
elements of the food are eliminated, or, as it often occurs, too much
carbonaceous food, such as white bread, potatoes, etc., is consumed
for the needs of the body; the consequence is an excess of fat,
which, in many subjects, impedes respiration, prevents activity,
and gives a generally uncomfortable feeling. For this condition a
spare diet is often prescribed, but as this is felt to be a hardship,
and as few who attempt it succeed in continuing it long enough to
produce satisfactory results, it is pronounced a failure.
For this class of people there is a very agreeable and sure
method of reducing the bulk without reducing strength and without
compelling too great a sacrifice of the appetite.
HOW TO REDUCE THE SIZE WITHOUT LOSING STRENGTH.
A diet which will attain this result is easily obtained, and of
it the subject can use a quantity sufficient to allay the craving
for food.
This diet consists of absolutely _raw_ foods, nothing cooked
being allowed. This diet, of course, must consist mainly of fruits,
nuts, grains, milk, and, when flesh-meat is desired, a Hamburg
beefsteak may be partaken of; this steak is raw beef chopped fine
and seasoned with onion, salt, pepper, or other condiments; to
this may be added raw oysters and clams. Every kind of fruit
_FAC-SIMILE PAGE FROM "STANTON'S PHYSIOGNOMY"--Reduced._
SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON. 1143
is a dangerous being); he should develop his friendliness, love of
children, and of the opposite sex; in short, he should be a _lover_
of _humanity_.
THE SYSTEMS AND FACULTIES REQUIRED FOR A SURGEON.
[Illustration: FIG. 300--EDWARD JENNER, M.D. (CELEBRATED ENGLISH
PHYSICIAN, AUTHOR, AND DISCOVERER OF VACCINATION.)
No scientific physiognomist could mistake this face for other than that
of a physician, and an earnest and attentive one as well, as evidenced
by the signs of "natural physician" in the cheek-bones, in the attitude
of the head and neck, and by the thoughtful, observant expression of the
eye. The combination of systems in this subject is such as is most
frequently observed among physicians, viz., the supremacy of the osseous
and brain systems. The muscular, thoracic, and vegetative powers all
assist in this combination by their development. The signs for
Conscience and Firmness are apparent. Love of Home and Patriotism rank
high. Benevolence, Amativeness, Love of Young, Mirth, Approbation,
Self-esteem, Modesty, Friendship, Alimentiveness, Sanativeness,
Pneumativeness, and Color combine to form a lovely domestic and social
nature. The form, size, and peculiarities of the nose claim attention.
It is a nose denoting Constructiveness, Originality, and logical power.
The signs for Hope, Analysis, Mental Imitation, Human Nature, Ideality,
Sublimity, Construction, and Acquisition are strongly delineated.
Self-will is normally developed, while Size, Form, Observation, Weight,
Locality, Calculation, and Memory of various sorts are manifest. The
signs of Language in the eye and mouth denote fluency, while the
practical faculties, being dominant, would give clearness, perspicacity,
and directness to his style of expression, either oral or written. Time,
Order, Reason, and Intuition are well developed. The long-continued
observation and experiments of this noble physician in his endeavor to
protect humanity from the ravages of small-pox by his discovery of
vaccination, met at last with a suitable recognition, for he received by
a vote of Parliament the sum of L30,000, and special honors were awarded
him. It is a singular fact that all of the benefactors of the human
race--those who have benefited it by discoveries of any kind
whatever--have met with the most violent opposition, treachery, and
often disgrace, before they could make the world see the value of their
discoveries. Such was the case with Dr. Jenner, but his firmness and
truth at last gained the victory.]
The best _form_ for a surgeon who attempts the most severe
operations is the round build of body and head, and many of them
are of this shape. The muscular system should be supreme, with
the brain system a close second, the bony and thoracic systems
about equal and next in development.
The muscular tissue is _comparatively unfeeling_--insensitive;
_FAC-SIMILE PAGE FROM "STANTON'S PHYSIOGNOMY"--Reduced._
OTHER CLASSES OF SURGEONS" 1145
in the body. Form and Size are also requisite to aid the memory of
the shape and relative position of each part, and to assist Locality.
Human Nature is essential in order that he may be _en rapport_
with his patients, and also to enable him to _divine_ instinctively all
bodily and mental states. He should be a good physiognomist, and
be well versed in the _pathology_ of physiognomy. He must have
large Observation, in order to take cognizance of the most minute
changes and appearances. Calculation is a useful trait also, as it
is required in many ways in the medication and treatment of the
wounded, as in chemistry and in making surgical implements, etc.
He should have large Friendship; in order to attach his patients to
him and to command their esteem; enough Benevolence to sympathize,
but not enough to weaken the feelings when severity is required.
The faculty of Amativeness is necessary to _comprehend_ the nature of
the opposite sex; Love of Young also, that he may inspire children with
love and confidence.
The sense of Weight should be a strong one, for the muscular
sense is dependent upon its power in order to _gauge_ the amount
of force to be used in handling instruments and in bandaging
wounds, limbs, etc. Executiveness is required to assist authority
and give resistance. Self-will is another ally most necessary, as
well as Analysis, Time, Order, and Reason. A fair share of
musical ability is required to assist the ear in making examinations
of the heart and lungs, and in auscultation for various other purposes.
If to these faculties one adds large Intuition, he has a fine
bodily and mental equipment for the practice of surgery.
OTHER CLASSES OF SURGEONS.
Many army surgeons are characterized by a round and broad
form, with broad, rather low, and round heads; short, round arms,
and round and tapering fingers. This build is the most suitable
for those severe operations which require the greatest exhibition of
force, endurance, and coolness; another class of surgeons--those
who undertake the more delicate and less forceful operations--are
characterized by about an equal development of the brain and
muscular systems. This class of surgeons tend naturally to the
treatment of those finer, less difficult, and more delicate cases of
operative surgery, such, for example, as treatment of the ear, the
eye, etc. This class of surgeons require a fine endowment of the
brain and nervous system. In short, the muscles as well as nerves
of this class must be sensitive to a great degree, and this combination
calls for a fine and high organization.
The surgeon should be something of an actor in order to
know when to be sympathetic and when to be severe. Yet he
+--------------------------------------------------------------+
| Transcriber's Notes and Errata |
| |
| Footnotes 25-30 have been renumbered in sequence. |
| |
| The anchor for footnote 102 was missing. Has been inserted |
| at the appropriate place. |
| |
| 'oe' ligatures have been expanded to separate 'o' and 'e' |
| characters. |
| |
| The following words were found in both hyphenated and |
| unhyphenated forms once each. |
| |
| |bed-clothes |bedclothes | |
| |co-existence |coexistence | |
| |short-comings |shortcomings | |
| |
| The word 'pre-cancerous' occurred four times in the text, |
| while 'precancerous' occurred twice, both in the index. |
| These index entries have been hyphenated. |
| |
| The following typographical errors have been corrected. |
| |
| |Error |Correction | |
| |route |rout | |
| |prepuse |prepuce | |
| |a a |a | |
| |siezes |seizes | |
| |Sterilite |Sterilite | |
| |others |others' | |
| |Tranyslvania |Transylvania | |
| |occasian |occasion | |
| |suprised |surprised | |
| |function |junction | |
| |orginated |originated | |
| |smoulderd |smouldered | |
| |wes |was | |
| |tisses |tissues | |
| |dut |but | |
| |innner |inner | |
| |may |many | |
| |brakemen |brakeman | |
| |thinnes |thinness | |
| |totel |total | |
| |America |American | |
| |
+--------------------------------------------------------------+