History of circumcision, from the earliest times to the present. Moral and physical reasons for its performance

Front matter

A.

Columbia ^mberj6:tt|>

George W.TobiaSjM.D.

Preface

In ancient Egypt the performance of circumcision was at one time limited to the priesthood, "who, in addition to the cleanliness that this operation imparted to that class, added the shaving of the whole bodj" as a means of farther purification. The nobilit}', royalty, and the higher warrior class seem to have adopted circumcision as well, either as a hygienic precaution or as an aristocratic prerogative and insignia. Among the Greeks we find a like practice, and we are told that in the times of Pythagoras the Greek philosophers were also circumcised, although we find no mention that the operation went beyond the intellectual class. In the United States, France, and in England, there is a class which also observe circumcision as a hygienic precaution, where, from my personal observation, I have found that circumcision is thoroughly practiced in every male member of many of the families of the class, — this being the phj^sician class. In general conversation with phj^sicians on this subject, it has really been surprising to see the large number who have had themselves circumcised, either through the advice of some college professor while attending lectures or as a result of their

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iv Preface.

own subsequent convictions when engaged in actual practice and daily coming in contact both with the benefits that are to be derived in the way of a better physical, mental, and moral health, as well as with the many dangers and disadvantages that follow the uncircumcised, — the latter being probably the most frequent incentive and determinator, — as in many of these latter examples the operation of circumcision, with its pains, annoyances, and possible and probable dangers, sink into the most trifling insignificance in comparison to some of the results that are daily observed as the tribute that is paid b}'^ the unlucky and unhappy wearer of a prepuce for the privilege of possessing such an appendage.

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

Tor the benefit of these, who may congratulate themselves upon the dangers and annoyances that they

Preface. v

» and their families have escaped, and for the benefit of

those who would run into these dangers but for timely

warning, this book has been especiallj^ written. To my

professional brothers the book will prove a source of

instruction and recreation, for, while it contains a lot

of pathology regarding the moral and physical reasons

why circumcision should be performed, which might

be as undigestible as a mess of Boston brown bread

and beans on a French stomach, I have endeavored to

make that part of the book readable and interesting.

The operative chapter will be particularly useful and

interesting to phj'sicians, as I have there given a careful

and impartial review of all the operative procedures, —

from the most simple to the most elaborate, — besides

paying more than particular attention to the subject of

after-dressings. The part that relates to the natural

history of man will interest all manner of people. I

regret that the tabular statistics are not to be had, but

in this regard we must use our best judgment from the

material we have on hand ; at any rate, I have tried to

furnish a suflScieney of facts, so that, unless the reader

is too overexacting, he will not find much diflSculty in

arriving at a conclusion on the subject.

P. C. Remondino, M.D.

San Diego, California, 1891.

Surgical Operations Performed on the Prepuce, 302

JSToTES to Text, 323

Works and Authorities Quoted, . . . 336 Index, 389

Introduction

This book is the amplification of a paper, tlie subject of whicli was, " A Plea for Circumcision ; or, tlie Dangers tliat Arise from tlie Prepuce," which was read at the meeting of the Southern California Medical Society, at Pasadena, in December, 1889. The material gathered for that paper was more than could be used in the ordinary limits of a society paper; it was gathered and ready for use, and this suggested its arrangement into book form. The subject of the paper was itself suggested by a long and personal observation of the changes made in man by circumcision. From the individual observation of cases, it was but natural to wish to enlarge the scope of our observation and comparison ; tliis naturally led to a stud}' of the phj'sical characteristics of tiie only race that could practically be used for the purpose. This race is tlie Jewish race. On carefully studying into the subject, I plainly saw that much of tlieir longevity could consistently be ascribed to their more practical humanitarianism, in caring for their poor, their sick, as well as in their generous provision for their unfortunate aged people. The social fabric of the Jewish fixmily is also more calculated to promote lonolife, as, strangely as it may seem, family veneration and family love and attachment are far more strono- and practical among this people than among Christians, this sentiment not being even as strong in the Christian races as it is in tlie Chinese or Japanese. It certainly forms as much of a part of the teachings of Christianity as it does of Judaism, Buddhism, or Confucianism, only

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Christians, as a mass, have practically forgotten it. The occupation followed by the Jews also in a certain degree favors longevity, and the influence on heredity induced by all these combined conditions goes for something. But it is not alone in the matter of simple longevitj' — although that implies considerable — that the Jewish race is found to be better situated. Actual observations show them to be exempt from many diseases which affect other races ; so that it is not onlj- that they recover more promptly, but that they are not, as a class, subjected to the loss of time b}^ illness, or to the consequent sufferings due to illness or disease, in anything like or like ratio with other people.

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

After allowing all that,- which we can, in its fullest limit, to religion, familj^, or social habit, there is still a wide margin to be accounted for. This has naturallj^ let the inquir_y, followed in the course of this book, into a careful review of the Jewish people ; into tlieir religion and its character, its relation to other creeds, and to the world's history; into their many wanderings, and into the dispersion, and we have even been obliged to follow them into the midst of the people among wliom they have become nationed, to try, if possible, to find the cause of this racial difference in health, resistance to disease, decay, and death. It has been necessary, in following out the research, to give a condensed resume of the religious, political, and social condition of the Jewish commonwealth, which, although in a state of dispersion, still exists. I need offer no apology for the extended iiotice this has received in the coui'se of the book. We read with increasing interest either Hallam or May, Buckle or Guizot, through the spasmodic, halting, retrograding, advancing, erratic, aimless, and accidental piiases that England has plowed through, from the days of goutless, simple, and chaste, but barbarian England of the Saxons, to the present civilized, enlightened, gouty, "Darkest England" of General Booth; and, after all is said and done, we are no wiser in anj'^ l)ractical resulting good. We simply know that the English people, so to speak, have, as it were, gone tlirough the figures of some social aspects, as if dancing the '• Lancers," with its forward and back movements, gallop, etc., and have finall}^ sat down, better dressed and better housed, but in an acquired state of moral and plij'sical degeiioration. The Briton of Queen Yictoria is not the Briton of Queen Boadicea, either morallv or physically. On the other hand, the system of sociological tables adopted by Herbert Spencer would have but little to record for some six thousand j-ears — either in religion, morals, or physique — as making any changes in the histor}^ of that simple people which, in the mountainous regions of Ur, in distant Armenia, started on its pilgrimage of life and racial existence; in one branch of the family — that of Ishmael — the changes to be recorded are so invisible that its descendants may really be said to live to-day as they lived then. So that I do not feel that 1 need to apologize for the space I have given to this snbject in the course of the book. The causes that make tliese racial distinctions should be of interest alike to the moralist, theologist, sociologist, and to the physician.

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

For my part, I think that people who can go to the theatre and enjoy " As in a Lookiug-Glass," and witness some of the satyrical or bill3'-goat traits of humanity so graphically exhibited in "La Tosca," with evident satisfaction ; or attend the more robust plays of " Yirginius " or of " Galba, the Gladiator," with all its suggestions of the Caesarian section, and the lust and the fornications of an intensely animal Roman empress, without the destruction of their moral equilibrium or tending to induce in them a disposition to commit a rape on the first met, — I think such people can be safely intrusted to read this book.

And as to the reading public, there are hut few general readers who could honestl}'^ plead an ignorance of the "Decameron," Balzac, La Fontaine, " Heptameron," Grebillon fils^ or of matter-of-fact Monsieur le Docteur Maitre Rabelais, — works which, more or less, carry a moral instruction in every tale, which, like the tales of the " Malice of Women," in the unexpurged edition of the literal translation of the "Arabian Nights," contains much more of practical moral lessons, even if in the flowery and warm, spiced language of the Orient, than an}'^ supposed nastiness, on account of which the}^ are chissed among the prohibited. To these, and the readers of Amelie Rives's books, or other intensel}" realistic literature, I need not imitate the warning of Ansonius, who warned his readers on the threshold of a part of his book to " stop and consider well their strength before proceeding with its lecture." Metaphorical!}^ speaking, the general theatre-going, or modern literaturereading public, can be considered pretty callous and morally' bullet proof. I shall therefore make no apology. Some fault maj', perhaps, be found with some of the occasional st^le of the book, or with some of the subjects used to illustrate a principle. To the extremely wise,, good, and scientific, these illustrations were unnecessary ; this need hardly be mentioned ; and the passages which to some may prove objectionable were not intended for them, either with the expectation of delighting them or with the purpose of shocking them. These passages, they can easily avoid. This book, however, was written that it might be read : not only i-ead by the Solon, Socrates, Plato, or Seueca of the laity or the profession, but even by the billy -goated dispositioned, vulgar plebeian, who could no more be made to read cold, scientific, ungarnished facts than you can, make an unwilling horse drink at the watering-trough. Human weakness and perversity is silly, but it is sillier to ignore thiit it exists. So, for the sake of boring and driving a few solid facts into the otherwise undigesting and unthinking, as well as primarilj^ obdurate understanding of the untutored plebeian, I ask the indulgence of the intelligent and broad-minded as well as the easiU" inducted reader. Cleopatra was smuggled into Caesar's presence in a roll of tapestry ; the Greeks introduced their men into Tro}^ by means of a wooden horse; and the discoverer of the broad Pacific Ocean made his escape from his importunate creditors disguised as a cask of merchandise. So, when we wish to accomplish an object, we must adopt appropriate means, even if they may appareiitl,y seem to have an entirely diametrically opposite object. The Athenian, Themistocles, when wishing to make the battle of Salamis decisive, was inspired with the idea of sending word to the Persian monarch that the Greeks were tr3ing to escape, advisinohim to block the passage ; this saved Greece.

There is a weird and ghostly but interesting tale connected with the Moslem conquest of Spain, of how Roderick, the last of the Gothic kings, when in trouble and worry, repaired to an old castle, in the secret recesses of which was a magic table whereon would pass in grim procession the diflerent events of tlie future of Spain ; as he gazed on the enchanted table he there saw his own ruin and his country's and nation's subjugation. Anatomy is generally called a dry stud}^ but, like the enchanted brazen table in the ancient Gothic castle, it tells a no less weird or interesting tale of the past. Its revelations lighten up a long vista, through the thousands of years through which the human species has evolved from its earliest appearance on earth, gradually working up through the different evolutionary processes to wliat is to-day supposed to be the acme of perfection as seen in the Indo-European and Semitic races of man. Anatomy points to the rudiment — still lingering, now and then still appearing in some one man and without a trace in the next — of that climbing muscle which shows man in the past either nervously escaping up the trunk of a tree in his flight from man^- of the carnivorous animals with whom he was contemporary, or, as the shades of iiiglit were beginning to gather aronnd him, we again see him by the aid of these nmscles leisure!}' climbing up to some hospitable fork in the tree, where the robust habits of the age allowed him to find a comfoi'table resting-place ; protected from the dew of the night by the overhanging branches and frijm the prowling hyena by the height of the tree, he passed the niglit in security.

The now useless ear-muscles, as well as the equally useless series of muscles about the nose, also tell us of a movable, flapping ear capable of being turned in any direction to catch tlie sound of approaching danger, as well as of a movable and dilated nostril that scented danger from afar, — the olfactory sense at one time having a ditferent function and more essential to life than that of merely noting the differential aroma emitted by segars or cups of Mocha or Java, and the ear being then used for some more useful pur[)ose tlian having its tympanum toi'tured b}^ Wagnerian discordant sounds. Our ancestors might not have been a very handsome set, nor, judging from the Neanderthal skull, could they have had a ver^^ winning physiognomy, but they were a ver}' hardy and self-reliant set of men. Nature — always careful that nothing should interfere with the procreative functions — had provided him with a sheath or prepuce, wherein he carried his procreative organ safely out of harm's way, in wild steeple-chases through thorny briars and bramble-brakes, or, when hardl}^ pushed, and not able to climb quickly a tree of his own choice, he was by circumstances forced up the sides of some roughbarked or tliorny tree. This leather}^ pouch also protected him from the many leeches, small aquatic lizards, or other animals that infested the marshes or rivers through which he had at times to wade or swim; oi' served as a protection from the bites of ants or other vermin when, tired, he rested on bis haunches on some mossy bank or sand-hill.

Man has now no use for any of these necessaries of a long-past age, — an age so remote that the speculations of Ernest Renau regarding the differences between the Semitic race of Shem and the idolatrous descendants of Ham, away off in the far mountains and A-alleys of Asia Ij'ing between the Mediterranean Sea and the Euphrates, seem more as if he were discussing an event of 3'esterda3^ than something which is considered contemporary with our earlier histor3% — and we find them disappearing, disuse graduallj^ producing an obliteration of this tissue in some cases, and the modifying influence of evolution producing it in others ; the climbing muscle, probably the oldest remnant and legac}' that has descended from our long-haired and muscular ancestry, is the best example of disappearance caused by disuse, while the efiectual disappearance of the prepuce in man}' cases shows that in that regard there exists a marked difference in the evolutionary marcli among different individuals.

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

We may well exclaim, as we behold this appendage to man, — now of no use in health and of the most doubtful assistance to the verj^ organ it was intended to protect, when that organ, through its iniquitous tastes, has got itself into trouble, and, Job-lilce, is l.ying repentant and sick in its manj^ wrappings of lint, with perhaps its companions in crime imprisoned in a suspensory bandage, — what is this prepuce ? Whence, why, where, and whither ? At times. Nature, as if impatient of the slow march of gradual evolution, and exasperated at this persistent and useless as well as dangerous relic of a far-distant prehistoric age, takes things in her own hands and induces a sloughing to take place, which rids it of its annoj^ance. In the far-off land of Ur, among the mountainous regions of Kurdistan, somethingover six thousand 3'ears ago, the fathers of the Hebrew race, inspired by a wisdom that could be nothing less than of divine origin, forestalled the process of evolution by establishing the rite of circumcision. Whether this has been beneficial or injurious to the race will be, in a measure, the object of the discussion in this book.

One object of this book is to furnish my professional brotliers with some embodied facts that they ma}^ use in convincing the lait}" in man}' cases where they themselves are convinced that circumcision is absolutel}' necessary-; but, -having nothing in their text-hooks to back up their opinion with, their explanations are too apt to pass for their mere unfounded personal view of the matter. If tiie patient, or the parents of the patient, ask the physician for his authority, he is at a loss, as there is nothing that deals with the subject in Viwy extended manner; so that this book has been written in as plain English as the subject-matter could possibly allow, so that non-professionals could easily read and understand it. I have often felt the need of such a work ; people can understand emergency or accident surgerj^, militarj^ surgery, or reparative surgery, but such a thing as surger}' to remed}' a seemingly medical disease, -or what might be called the preventive practice of surgery, is something they cannot understand. First, and not the least, among the incentives to skepticism on this subject is the unwelcome fact of a surgical operation, which, no matter how trivial it may seem to the surgeon, is a matter of considerable magnitude to the patient, his parents, or friends ; there are risks, pain, worry, annoyances, and expenses to be undergone, — considerations which, either singly or unitedly, often lead one to reason against the operation, even when otherwise convinced of its need or utilit3\

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

Then, there is our statistical friend, who cannot discriminate between the exception and the rule b}- any common-sense deductions. He must have all the authentic, carefully-compiled statistics before he can allow himself to form an^^ opinion. As long as there is the smallest fraction of a decimal unaccounted for in a mathematical wa}^, this individual is inconvincible. These men pride themselves upon being methodically^ exact; they express their willingness to be convinced if 30U can present acceptable proofs; but, trying to present simple rational proofs to these individuals is considerably like presenting a meal of boiled pork and cabbage to a confirmed and h^^pochondriacal dyspeptic, — it only increases their mental dyspepsia.

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

The ideas of the etiology and pathological processes through which we journe3', — from a condition of health and good feeling to one of disease, miserable feeling, and death, — as described in, or rather as the}' control the sentiment and polic}' of, this work, are such as have been followed by Hutchinson, Fothergill, Beale, Black, Albutt, and Richardson ; so that if I have totally ignored the old conventional sj^stems, with their hide-bound classification of diseases to control the etiolog}^, I have not done so without some reliable autliority. In studying the etiology of diseases we have, as a rule, been content to accept the disease when fully formed and properly labeled, being apparently satisfied with beginning our investigation not at the - initial point of departure from health, but at some distant point from this, — at the point where this departure has- elaborated itself, on favorable ground, into a tangible general or local disease. As truthfully observed by T. Clifford Albutt : " The philosophic inquirer is not satisfied to know that a person is suflfering, for example, from a cancer. He desires to know why he is so suffering, — that is, what are the processes which necessaril}^ precede or follow it. He wishes to include this phenomena, now isolated, in a series of which it must necessarily be but a member, to trace the period of which it must be but a pliase. He believes that diseased processes have tlieir evolution and the laws of it, as have other natural processes, and he believes that these are fixed and knowable," To do this, the physician must travel beyond the beaten path of etiology as found in our text-books. He must follow Hutchinson in the train of reasoning that elucidates the pre-cancerous stage of cancer, or tread in the path followed by Sir Lionel Beale, in finding that the cause of disease depends on a blood change and the developmental defect, or the tendency or inherent weakness of the affected part or organ ; to fully appreciate the inherent etiological factors that reside in man, and which constitute the tendenc}^ to disease or premature decay and death, we must also be able to follow Canstatt. Day, Rostan, Charcot, Rush, Cheyne, Humphr}^ or Reveille-Parise into tlie study of the different conditions which, though normal, are nevertheless factors of a slow or a long life. We must also be able to appreciate fully the value of that interdependence of each part of our organism, which often, owing to a want of equilibrium of strength and resistance in some part when compared to the rest, causes the whole to give Avaj', just as a fiaw in a levee will cause the whole of the solidl3--constructed mass to give wa}^ or a demoralized regiment may entail the utter route of an army. As described by George Murray Humphry, in his instructive work on " Old Age," at page 11 : —

" The first requisite for longevity must clearly be an inherent or inborn quality of endurance, of steady, persistent nutritive force, which includes reparative force and resistance to disturbing agencies, and a good proportion or balance between the several organs. Each organ must be sound in itself, and its strength must have a due relation to the strength of the other organs. If the heart and the digestive system be disproportionately strong, the}' will overload and oppress the otlier organs, one of which will soon give way; and, as the strength of the human bod}", like that of a chain, is to be measured by its weaker link, one disproportionately feeble organ endangers or destro3^s the whole. The second requisite is freedom from exposure to the various casualties, indiscretions, and other causes of disease to which illness and early death are so much due."